title: Difficult delivery and some selected factors as predictors of early postpartum psychological symptoms among Nigerian women.
abstract: OBJECTIVE
  The objectives of this study were to compare depressive and anxiety symptoms between Nigerian women with a difficult delivery (cesarean or instrumental) and those with an unassisted vaginal delivery during the puerperium and to highlight other factors of predictive value for symptoms.
  
  
  METHODS
  Women (n=83) who had a difficult delivery (index group) were compared with matched control subjects (n=83) who had an unassisted vaginal delivery. They were all evaluated using the State-Trait Anxiety Inventory (state form) and Zung's Self-Rating Depression Scale. Information was also collected on their sociodemographic characteristics, obstetric factors, and general health problems.
  
  
  RESULTS
  After delivery, 19 subjects from the index group (22.9%) obtained scores higher than the threshold for significant depressive symptoms, as compared with 13 subjects from the control group (15.7%). Six weeks later, the rates were 10 (12.0%) and 8 (9.6%), respectively. The mean anxiety and depressive symptom scores for the difficulty delivery group were significantly higher at birth. Although both groups improved over time, the differences were still significant after 6 weeks. Using stepwise regression analysis, we observed cesarean delivery and polygamy to predict depressive symptoms after birth but not after 6 weeks. Previous induced abortions were also observed to predict anxiety and depressive symptoms throughout. Depressive symptoms at 6 weeks were predicted by depressive symptoms at birth and by anxiety symptoms at 6 weeks. The same pattern was observed for anxiety symptoms.
  
  
  CONCLUSIONS
  Although difficult delivery was associated with higher levels of symptoms, it was not predictive of postpartum depressive and anxiety symptoms at 6 weeks. Also, of other possible risk factors studied, only illegal abortions were observed to be important in the study population during the puerperium.
authors.affiliation: Department of Mental Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. fofatoye@yahoo.com
authors.forename: F O
authors.initials: FO
authors.lastname: Fatoye
authors.forename: B Y
authors.initials: BY
authors.lastname: Oladimeji
authors.forename: A B
authors.initials: AB
authors.lastname: Adeyemi
mesh_terms: D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D002585:Cesarean Section / Q000523:psychology* / Q000706:statistics & numerical data*; D003863:Depression / Q000175:diagnosis / Q000208:ethnology* / Q000209:etiology*; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000208:ethnology* / Q000523:psychology*; D009549:Nigeria; D049590:Postpartum Period / Q000208:ethnology* / Q000523:psychology*; D011247:Pregnancy; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013997:Time Factors