GHQ-12 score as a determinant for Postpartum depression: evidence from a tertiary care centre in Bhubaneswar, India

Abstract

Background Odisha, a state in Eastern India, has made laudable progress in delivering MCH care through robust comprehensive obstetric care, and reduction of maternal deaths by 60–70% as per NFHS-5. However, the mental health component is under-represented in India, even in urban areas. Postpartum depression (PPD) in women can be scored by the validated tool Edinburgh postnatal depression scale (EPDS) and overall mental state at any time of adulthood is evaluated using General Health Questionnaire (GHQ)-12 scores. Objectives To assess the association of GHQ-12 score with EPDS score among the postpartum women soon after delivery and to determine variations in associations between the two scores at 2 points of assessment. Methods Women who gave birth, within 24–48 hours were selected as per convenient sampling, after taking consent. Questionnaire was used that elicited information on socio-demographic details. GHQ-12 scores were used as independent variable and a proxy measure of cumulative distress and familial stress. Validated tool EPDS was used on the subjects and scores calculated for PPD. Same tools were repeated on 2nd visit timed within 6–8 weeks of delivery. Scores were checked for correlation using Pearson’s r. Results Total 176 women participated and completed 2nd assessment. Prevalence of PPD was 10.8% as per EPDS. PPD burden increased in 2nd visit but the mean scores decreased. Similarly, psychological stress indicated by GHQ-12 scores increased in 2nd visit, although the mean scores decreased by 6–8 weeks postpartum. Both the time, GHQ 12 and EPDS scores show strong positive correlation (r = 0.69), that increased in 2nd visit (r = 0.74). Conclusion This indicates that robust healthcare services alone doesn’t address the holistic health of reproductive women. Psychological stress is a determinant of postpartum depression. PPD in this case among women increases within 6–8 weeks of delivery and hence a continuum of care is warranted to address PPD, which calls for screening of women for PPD and subsequently counselling them.