Impact of HIV/AIDS on Postnatal Depression among Postnatal mothers at the University Teaching Hospital,Lusaka, Zambia
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Postnatal depression (PND), a major depressive episode during the puerperium that affects 10% to 22% of adult women before the infant’s first birthday. Being HIV positive has been known to be associated with increased risk of mental disease. Its influence on postnatal depression has not been explored. This study examines the association between HIV status and postnatal depression extending upon previous studies by including the role of known determinants for postnatal depression such as mode of baby feeding, maternal age, place of residence and parity. The objective of the research was to study the contribution of HIV/AIDS to the problem of postnatal depression among women delivering at University Teaching Hospital (UTH), Lusaka.This was a cross sectional analytic study conducted among 229 postnatal mothers at UTH and included 46 (20.1%) that were HIV positive. Respondents were interviewed using a structured and standardized questionnaire to obtain information on potential demographic and medical risk factors for PND, after which an Edinburgh Postnatal Depression Scale (EPDS) was administered. Results of the 183 postnatal women that were HIV negative were compared with the 46 that were positive. The relationship between the outcome variable (EPDS scores) and the predictor variable (HIV status), and other risk factors, was explored using multiple linear regression. A p-value of 0.05 was considered significant when interpreting the test results at 95% level of confidence.Apart from the type of infant feeding offered by the 229 mothers, there were no significant differences in studied characteristics between HIV positive and negative women. Using different cut-offs of EPDS scores (8, 10 or 13) the odds of an HIV positive woman having PND was 1.38, 1.15, and 1.70, respectively. However, all the 95% confidence intervals crossed unity and corresponding p values were greater than 0.05. The mean EPDS score for all 229 women was 9.6 (SD 5.4). Using different cut-offs of the mean scores; 146 women had mean EPDS scores greater than 7 (63.8%; 95% CI 56.2-70.0%), and 64 had mean EPDS scores greater than 12 (27.9%; 95% CI 22.2- 34.2%). The mean EPDS score of HIV positive women was 10.6 vs. 9.4 for negative women (p=0.1615). There was a statistical difference in mean scores for different categories of the following: parity, days spent in hospital after delivery and type of infant feeding. In a multiple linear regression model, those risk factors, together with other potential risk factors for PND, like place of residence (as a proxy of socio-economic circumstances), parity, gestational age at delivery, and mode of delivery, were added to explore the relationship between mean EPDS score and HIV status. In the model, the EPDS score was independently significantly associated with parity 4 or 5, and mixed infant feeding, though not with HIV status of mother. Conclusion: As illustrated by the use of the Edinburgh Postnatal Depression Scale, postnatal depression was not an insignificant condition in the selected hospital population of postnatal mothers at UTH. However, HIV/AIDS was not statistically significantly and independently associated with postnatal depression amongst the mothers, though the use of mixed feeding and higher parity were. It is imperative for health practitioners to consider the possibility of PND, particularly for those with risk factors, including adverse socio-economic conditions and poor obstetric and neonatal outcomes, so as to counsel and refer for further care as necessary.