C842 Clinical Psychology

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C842 Clinical Psychology

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C842 Clinical Psychology

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Course Code: C842
University: University Of Plymouth

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Country: United Kingdom

Question:
Prevalence of depression in third trimester of pregnancy in a tertiary care unit.
Answer:

Introduction
Prevalence of depression in third trimester of pregnancy carries a greater importance to the health of public. It is a kind of a clinical depression which tends to cause bad effects on the women while they are pregnant. It has also been estimated that the Antenatal depression affects 7% to 20% of pregnant women. If mother takes stress, it would affect the development of fetus. Antenatal depression brings worry and stress at a severe level (2). The symptoms of depression include how a mother feels about going through changes of life. It incorporates the lifestyle of mother and even how her partner would feel about the baby. Mood swings, pain, changes of memory, irritation are expected in third trimester of the pregnancy (2; 9).
 Depression takes place one in every ten women. It has also become quite prevalent as more medical studies are being conducted. The depression was once considered as a normal stress linked with pregnancy and was discarded on ground of common weakness. The followings are can be taken into account such as the status of relationship, economic background for the reasons of depression (7). Depression can also happen out of physical and hormonal changes linked with pregnancy (5). The prevailing depression and anxiety among pregnant women in Pakistan is 18%. It has caused out of unemployment of the husband, family culture and also sexual or the physical abuses which are linked with anxiety or depression.
A cross sectional study was conducted by the help of EDPS in Lahore at Tertiary care. Out of 510 antenatal patients, 128 people are not suffering from depression. The score of EPDS is less than 10. To identify depression, the score has to be greater or equal to ten (8). The fear of giving birth to child and getting separated from husband are being identified under the risk factors. The Domestic violence, lack of support and the incidents of miscarriage are however not found under important factors (3).
Objectives
The aim of study is to indicate the depression in trimester pregnancy at a tertiary health care unit.  Objective is to point out the risk factors for treatment and intervention. For this, the women between ages of 15 and 40 years old are taken into consideration. The sample comprises of 150 women.
Operational definition  
A person would be taken into consideration who has managed to score 8 or > 8 on the Hospital anxiety and the Depression scale (HADS). If a woman is suffering from depression for more than four and a half months, necessary steps are needed to rectify her problems accordingly.
Pregnant women in a tertiary hospital
Women, who are visiting the tertiary care hospital unit at third trimester of pregnancy, get panicked and tensed during the tenure. It can be identified that some women are negatively reacting to the childbirth out of the fear of taking mothering responsibilities (3). In the Edinburgh postnatal depression scale score, the score having ten or more than ten are being indicated on ground that patient is suffering from depression during pregnancy (1).
Hypothesis:
H 1- There is prevalence of depression in third trimester of pregnancy in a tertiary care unit
H 2- There is no prevalence of depression in third trimester of pregnancy in a tertiary care unit
Sample size is being carried out to make sure about the number of respondents are to be acted as representation of entire population of city of Multan. A method based on population by the usage of the effect of double design is to be used. 150 respondents are in the target list.
(n= 150) which is based on the confidence interval of 95%, d= 8% margin of the error and p= 58% 9 
n= z 2 pq/d 2
Where as;
z= 1.96
P= 58% 9
q = 100-p=100-56=44
d=8% (n= 147, but 150 patients will be taken into account).
Gender is women
Pregnant woman of age 15 years and above
Able to communicate in Urdu language
Women if or if not having a past history are suffering from depression
Sample selection (non- inclusion)
Immigrants who are not willing to become respondent to the research work
 Patients who were drug addicted
 Patients who voluntarily do not want to participate in the research.
Data collection
Consecutive 150 patients who are fulfilling the criteria would be enrolled. Consent has to be taken from each patient, describing them the objectives and procedures of study. The respondents are to be informed that there would be no risk while the study would be conducted. The patients are needed to be assessed by a single psychiatrist on the basis of scale of HADS. Accordingly the patients would be divided having depression or not having depression.  Outcome would be noted down in the proforma which is designed for the purpose to study along with the demography (4)   
Data analysis  
Including HADS, a questionnaire framework has to be utilized in order to achieve basic information about the following respondents, which would include the parameters of social- demographic and also other relevant information. A private area has to be set up where all respondents are needed to be viewed. In order to avoid biasness, members of the family of respondents are not allowed to take part in interview or disrupt interview.  Responses would be recorded and further analyzed with the usage of IBM Package of Statistical Social sciences (SPSS) (6). To describe the characteristics of demography, descriptive analysis method has to be used. The test of Chi Square would be used in order to identify the association between the study variables. However, regression of logistics is to be used to determine the predictors of depression while carrying out the study (4).
References
Cosco TD, Doyle F, Ward M, McGee H. Latent structure of the Hospital Anxiety And Depression Scale: a 10-year systematic review. Journal of psychosomatic research. 2012 Mar 31;72(3):180-4.
Ibanez G, Charles MA, Forhan A, Magnin G, Thiebaugeorges O, Kaminski M, Saurel-Cubizolles MJ, EDEN Mother–Child Cohort Study Group. Depression and anxiety in women during pregnancy and neonatal outcome: data from the EDEN mother–child cohort. Early human development. 2012 Aug 31;88(8):643-9.
Jeong HG, Lim JS, Lee MS, Kim SH, Jung IK, Joe SH. The association of psychosocial factors and obstetric history with depression in pregnant women: focus on the role of emotional support. General hospital psychiatry. 2013 Aug 31;35(4):354-8.
Matthey S, Fisher J, Rowe H. Using the Edinburgh postnatal depression scale to screen for anxiety disorders: conceptual and methodological considerations. Journal of affective disorders. 2013 Apr 5;146(2):224-30.
Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research. 2015 Sep 1;42(5):533-44.
Schetter CD, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Current opinion in psychiatry. 2012 Mar;25(2):141.
Vigod SN, Wilson CA, Howard LM. Depression in pregnancy. Bmj. 2016 Mar 24;352(8050):492-5.
Wisner KL, Sit DK, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, Perel JM, Jones-Ivy S, Bodnar LM, Singer LT. Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Focus. 2012 Jan;10(1):67-77.
Zahidie A, Jamali T. An overview of the predictors of depression among adult Pakistani women. Journal of the College of Physicians and Surgeons Pakistan. 2013;23(8):574.

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