Researcher’s Introduction

Name of the Researcher : Shakeel Ahmed Jan

Last degree and University: BS HONs KIU Gilgit
Area of Specialization: Psychology
Strength of the Researcher:
Publication (if any): NA
IS No: NA
Supervisor:

02/01/22

1
 Vulnerability to Peripartum
depression and anxiety among
expecting mothers in Ghizer
Gilgit Baltistan
Introduction
 Peripartum depression and peripartum anxiety are psychological disorders that
exist among expecting mothers.
 District Ghizer is rural area of Pakistan in which there is hard climatic
conditions especially in winters faced by expecting mothers make them
vulnerable to this disorder.
 One other reason responsible during period of pregnancy is unavailability of
proper care facilitation to mothers due to longer distances to hospital facilities
(Calık & Aktas, 2015).
 Social support plays a vital role during pregnancy. Support provided by care
givers like, spouse, in-laws, and peers can positively affect the mental health
of expecting mothers.
 A woman receiving higher level of socially support from husband and other
members of family have lower risk of mental stress situation (Gul, Riaz,
Batool, Yasmin, & Riaz, 2018).
 Peripartum depression
4

 Peripartum depression is a mental state during pregnancy.

 The World Health Organization (WHO) listed depression as
the number one cause of disability globally in 2015.
 The medical review of an article shows that 7% to 20% of
pregnant women worldwide suffer from depression (Timothy,
2016).
 Perinatal mothers experience extreme emotional sadness,
anxiety, and it is difficult for them to carry out daily tasks,
including taking care of themselves and others (Kessler,
2003).
Peripartum anxiety
 Spielberger (2010) defines anxiety as autonomic
nervous system activation and subjective feelings of
apprehension and fear.
 Perinatal anxiety disorder refers to anxiety disorders
that occur during pregnancy, including generalized
anxiety disorder, panic disorder, phobia, obsessive-
compulsive disorder and post-traumatic stress
disorder
 Problem statement
6

 Peripartum depression and anxiety are mental

disorder exist in expecting mothers. Expecting
mothers during pregnancy suffer from depression and
anxiety depending upon many factors among them
one is social support provided to them by their
family, significant others, and friends. This study was
conducted to explore the relationship between
perceived social support and peripartum depression
and anxiety in expecting mothers.
Objectives
 To find the vulnerability of peripartum depression
and anxiety among expecting mothers in Ghizer.
 To evaluate the relationship between social support
and level of depression among expecting mothers in
Ghizer.
 To measure the relationship between social support
and anxiety level among expecting mothers in
Ghizer.
Gap Analysis
 Peripartum depression and anxiety are significant
mental health issues that has not been acknowledged
in Pakistan yet.
 Despite the high prevalence of peripartum depression
and peripartum anxiety linked to the context of
Gilgit-Baltistan, we cannot deny that such questions
are not recognised and studied to this very day.
 Most studies focuses postpartum depression and
anxiety not peripartum.
 Gap Analysis
9

 This study focused only on peripartum depression and anxiety

during three trimesters and its relationship with perceived
social support.
 Literature review
 Depression in expecting mothers and after birth affects
approximately 15% of pregnant mothers and 13% of new
mothers within the first 6 months of childbirth (Dietz, 2015)
 According to studies accompanied in city sides of Pakistan
showed that 18% of the pregnant mothers were worried and
unhappy at the time of gestation period.
 In comparison among Canada and Pakistani females showed
that 31.2% of prenatal depression reported in original Canadian
females whereas District Ghizer, Gilgit-Baltistan, Pakistan
reports showed 48.4% out of 128 pregnant females suffered
from prenatal depression.
Continue
 Prevalence of anxiety disorder during pregnancy, in developed
and developing countries are 10% and 25%, respectively
(Glover , 2014).
 In Pakistan, similar outcomes have been described according
literature. Anxiety complaints at the time of pregnancy and after
birth are extensive amongst females, but because of some
cultural aspects, people are unaware.
 According to study conducted in Hyderabad, Pakistan
described that the occurrence of anxiety during pregnancy was
of 18%. It also highlighted 42% of females have suffer from
physical and sexual misapplication have a frequency of 42%
(Karmaliani et al., 2009).
 Theoretical model
12
 Research Design
13

 Unit of Analysis in the current study were

expecting mothers from tehsil Gupis Ghizer
 Descriptive statistics (frequencies, Mean, Standard
deviation), and inferential statistics (Correlation,
Independent t test, one way ANOVA) were used to
test the hypotheses.
 The statistical Package of Social Sciences (SPSS
20) was used for analysis.
Research design
 A Quantitative research design was used in conducting this
research which was cross-sectional in nature.
 Population sample consisted of 100 expecting mothers belonging
to first trimester (N=32), second trimester (N=34) and third
trimester (N=34), working (N=55), non-working (N=45), having
nuclear family (N=52) and joint family (48), with different
monthly income (low=08, middle=52, high=40) from Gupis,
Ghizer, Gilgit Baltistan.
 Data was collected through non-random purposive sampling
technique as the study was on specific group (expecting mothers)
only.
 Research Design - Instrument
15

 The following scales were used for data collection

 Patient Health Questionnaire (PHQ-9) Scale
 Developed by Drs. Development Spitzer (R.L. Spitzer)
Williams, K. Kroenke and colleagues (1990s).
 This 9 itemed Likert type scale has four choices ranging from
0 to 4 rating (never, sometimes, often and always) respectively.
 The Urdu type of this scale was used which has 0.91
Cronbach‘s alpha and 0.77 split-half reliability translated by
(Ahmad et al., 2018).

02/01/22
Instrument
 Generalized Anxiety Disorder (GAD-7) Scale
 The Generalized Anxiety Disorder Scale 7 (GAD-7) is a
seven-item self-rating scale developed by (Spitzer, 2006).
 This 7 itemed Likert type scale has four options ranging from
0 to 4 rating never, specially, often and always respectively.
 The Urdu version of this scale was used which has 0.92
Cronbach‘s alpha and 0.82 split-half reliability translated by
(Ahmad et al., 2017)
17

 Multi-Dimensional Scale for Perceived Social Support

questionnaire (MSPSS)
 This scale was developed by Zimet, Dahlem, Zimet and Farley to
assess subjective perceived from three sources (family, friends and
significant others).
 The Urdu version of this scale was used which has 0.92
Cronbach‘s alpha and all the three sub-scales were extremely inter-
correlated with correspondences alternating from (r=0.65 to
r=0.78) translated by (Akhtar, 2010)
 Data Analysis and Results
18

 Descriptive of study variables (N=100)

Variables M SD Min Max Range Skewness kurtosis

PHQ_9 9.41 5.15 1 27 26 .84 .93

GAD-7 7.48 4.68 .00 21 21 .74 .43

MSPSS 63.00 14.67 18 84 66 -.93 .55

SOS 20.87 5.80 6 28 22 -.75 -.44

FRSSS 20.32 5.67 4 28 24 -.73 -.12

FSS 21.81 5.73 4 28 24 -.97 .26

 Frequency of depression in first trimester of pregnancy
as measured by PHQ-9 (n=32)
19

S. no Range f (%) Interpretation

1. 0-4 4(12.5) Minimal or none

2. 5-9 14(43.75) Mild

3. 10-14 9(28.12) Moderate

4. 15-19 4(12.5) Moderately severe

5. 20-27 1(3.12) Severe

 Frequency of depression in second trimester of
pregnancy as measured by PHQ-9 (n=34)
20

S. no range f (%) Interpretation

1. 0-4 8(23.5) Minimal or none

2. 5-9 8(23.5) Mild

3. 10-14 14(41.17) Moderate

4. 15-19 2 (5.88) Moderately severe

5. 20-27 2(5.88) Severe

 Frequency of depression in third trimester of pregnancy
as measured by PHQ-9 (n=34)
21

S. no (third) range f (%) Interpretation

1. 0-4 9(26.47) Minimal or none

2. 5-9 12(35.29) Mild

3. 10-14 8 (23.5) Moderate

4. 15-19 4 (11.76) Moderately severe

5. 20-27 1(2.94) Severe

 Frequency of anxiety in 1st trimester as measured by
GAD-7 (n=32)
22

(1st trimester) Range f (%) Interpretation

1. 0-4 13(40.64) Minimal or none

2. 5-9 10(31.25) Mild

3. 10-14 8(25) Moderate

4. 15 and above 1(3.12) Severe

 Frequency of anxiety in second trimester as measured
by GAD-7 (n=34)
23

(2nd trimester) Range f (%) Interpretation

1. 0-4 11(32.35) Minimal or none

2. 5-9 12(35.29) Mild

3. 10-14 8(23.5) Moderate

4. 15 and above 3(8.82) Severe

 Frequency of anxiety in third trimester as measured by
GAD-7 (n=34)
24

(3rd Trimester) range f (%) Interpretation

1. 0-4 10(29.41) Minimal or none

2. 5-9 10(29.41) Mild

3. 10-14 11(32.35) Moderate

4. 15 and above 3(8.82) Severe

 Demographic studies
25

  Working Non-working

    95% CI  
Variable (n= 56) (n= 44)

  M SD M SD T p LL UL Cohen’s d

PHQ 8.64 4.88 10.38 5.36 -1.677 0.09 -3.809 0.322 0.33

GAD 6.67 4.32 8.5 4.96 -1.925 0.05 -3.702 0.059 0.39

MSPSS 64.73 14.89 60.79 14.25 1.344 0.18 -1.878 9.752 0.27
 Mean, standard deviation, and independent sample t-test of
routine check-up on depression, anxiety and social support
measures (N=100)
26

  Routine checkup Routine checkup        

Variable Yes (n= 57) No (n= 43) 95% CI

  M SD M SD t p LL UL Cohen’s d

PHQ -1.463 .147 0.29

8.75 5.001 10.27 5.274 -3.595 .546

GAD -3.083 .003 0.62

6.26 4.328 9.09 4.699 -4.654 -1.005

MSPSS 5.715 .000 1.20

69.73 8.433 54.06 16.417 10.180 21.153
 One-way ANOVA analysis of monthly income on
measures
27

High  

  Low Middle
(n=40)

Variables (n=08) (n=52)

p
 
  M SD M SD M SD F

 
PHQ 11.25 8.64 9.11 4.42 9.42 5.24 .59 .556

 
GAD 11.37 5.39 7.61 4.36 6.52 4.63 3.82 .025

 
MSPSS 49.12 21.02 61.21 14.91 68.10 10.30 7.17 .001
 Correlation between depression and multidimensional scale for
perceived social support and its sub-scales for 1st , trimester as
measured by PHQ-9 and MSPSS (n=100)
28

S. no Scales M SD 1 2 3 4 5

1. PHQ-9 10.03 4.84

2. MSPSS 7.06 4.19 -.32

3. SOS 64.96 11.81 -.31 .81**

4. FrSS 20.96 5.90 -.03 .67** .32

5. FSS 21.37 4.90 -.36* .73** .41* .24

 Correlation between depression and multidimensional scale for
perceived social support and its sub-scales for 3rd trimester as
measured by PHQ-9 and MSPSS (n=100)
29

S. no Scales M SD 1 2 3 4 5

1. PHQ-9 8.85 5.43

2. MSPSS 62.00 15.44 -.34*

3. SOS 21.35 5.46 -.26 .86**

4. FrSS 19.67 5.79 -.34* .87** .57**

5. FSS 20.97 6.03 -.31 .93** .75** .74**

 Correlation between depression and multidimensional scale for
perceived social support and its sub-scales for third trimester as
measured by GAD and MSPSS (n=34)
30

S. no Scales M SD 1 2 3 4 5

1. GAD-7 7.70 4.92

2. MSPSS 62.00 15.44 -.46**      

3. SOS 21.35 5.46 -.32 .86**    

4. FrSS 19.67 5.79 -.44** .87** .57**  

5. FSS 20.97 6.03 -.47** .93** .75** .74**

 Findings and Discussion
31

 The current findings showed that significant negative correlation

between measured depression and subscales of MSPSS.
 This indicated that during first trimester of pregnancy the
increase in family support decreases depression (-.36 ⃰).
 Previous studies have shown that women who report moderate
and high social support from family during pregnancy are
significantly less likely to report depressive symptoms (Dibaba,
Fantahun, and Hindin, 2013).
32

 The present findings shows that an increase in social support

especially support from friends (-.34 ⃰) decreases the
depression in women with third trimester of pregnancy .
 These findings are similar to previous study which suggests
that close female friends and relatives may be important
sources of influence during pregnancy for women.
 They are described as the most valued advice-givers because
they had first-hand experience with pregnancy (Dunn et al.,
1998)
33

 The present study shows that during third trimester of pregnancy

the increase in family support decreases anxiety (-.47⃰⃰). Likewise
more support from friend also decreases the level of anxiety
(-.44*).
 In parallel to current findings a previous study reported that
pregnant mothers who have been well buttressed by their family
would be less frequently effected by anxiety and depression
(Mirabzadeh, 2013).
 Furthermore, les social support from community has shown to be
associate with presence of psychological problems (Morikawa,
2015).
34

 Mean values reflect that anxiety is relatively higher in non-

working women compared to working ones.
 Similar to what is shown in the literature, the risk of anxiety
in pregnancy was higher among pregnant women who did not
perform paid work activities (Gourounti , Anagnostopoulos ,
& Lykeridou , 2013)
35

 Mean, standard deviation, and independent sample t-test of

routine check-up on depression, anxiety and social support
reflect that women do not visiting for routine check-ups show
relatively higher anxiety.
 In parallel to current study, a previous study revealed that
anxiety during pregnancy has been associated with poor
attendance at antenatal clinics, substance abuse, and low birth
weight, all of which can lead to neonatal morbidity and
mortality (Field, Diego , & Hernandez-Reif , 2006)
36

 Analysis of monthly income showed expecting mothers who had low

monthly income (M= 11.37, SD= 5.39) reported high anxiety as
compared to those who had high monthly income (M= 6.52, SD= 4.63)
 Similarly expecting mother having low monthly income (M= 49.12, SD=
21.02) had reported low perceived social support as compared to those
who had high monthly income
(M=68.10, SD= 10.30).
 This is in parallel with previous studies showing that the monthly family
income of pregnant mothers is an important variable that occupies a large
share of prenatal depression and anxiety(Assefa , 2015).
 Implications of the Study
37

 This study can contribute in enriching the existing literature

on peripartum depression and anxiety in the context of
Gilgit Baltistan, Pakistan
 It can help the researchers to have a good understanding of
prevalence of psychological issues among expecting
mothers
 It can provide a basic source of information to the health
professional about mental health issues of expecting
mothers.
 Limitations of the study
38

 Due to lack of resources and time this research data was

collected from only few areas of the region so the findings
cannot be much generalized.
 Cultural barriers might have influenced the present study in
reporting social support.
 Many societal and cultural expectations are being
associated with becoming a mother that might have
compelled mothers to under report depression as well as
anxiety
 Recommendations
39

 It is suggested that social support should be given to the

expecting women to avoid the increased level of depression.
 It is also recommended to provide social support from family,
friends and others to reduce anxiety level in pregnant women.
 It is suggested that proper checkup should be maintained in
order to decrease anxiety and depression in pregnant women
during first, second and third trimester of pregnancy.
 References
40

 Abdollahpour , S., Ramezani , S., & Khosravi , A. (2015). Perceived social

support among family in pregnant women. International Journal of
Pediatrics, 879–888.
 Adhikari, H. (2012). Anxiety and Depression: Comparative Study between
Working and NonWorking Mothers. Global Journal of Human Social
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 Ahmad, S., Hussain, S., Shah, F. S., & Akhtar, F. (2017). Urdu translation
and validation of GAD- 7: A screening and rating tool for anxiety
symptoms in primary health care. Journal of Pakistan Medical
Association, 60(10), 1536-1540.
 Ahmed , S., Hussain, S., Akhtar, F., & Shah, F. S. (2018). Urdu translation
and validation of PHQ- 9, a reliable identification, severity and treatment
outcome tool for depression. JPMA. The Journal of the Pakistan Medical
Association, 68(8), 1166-1170
41

 Collins , C. H., Zimmerman , C., & Howard , L. M. (2011). Refugee,

asylum seeker, immigrant women and postnatal depression: Rates and risk
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 Copertaro, A., Bracci, M., Manzella, N., Barbaresi, M., Copertaro, B., &
Santarelli, L. (2014). Low perceived social support is associated with
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 Da Costa, D., Larouche, J., Dritsa, M., & Brender, W. (2009). Psychosocial
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