Determination of the Prevalence of Postpartum

Depression and Risk Factors Among Postpartum

Patients at a Tertiary Government Urban Hospital
Using the Edinburgh Postnatal Depression Scale-
Filipino Translation (EPDS-F): A Cross-Sectional
Study
Maria Carmina Lorenzana Santiago  (  mindy.santiago@gmail.com )
Philippine General Hospital https://orcid.org/0000-0003-2624-9114
Maria Antonia Esteban Habana 
University of the Philippines-Philippine General Hospital

Research article

Keywords: Edinburgh Postnatal Depression Scale, Edinburgh Postnatal Depression Scale-Filipino

Translation, postnatal depression, postpartum depression, Psychiatric Status Rating Scales

Posted Date: June 15th, 2020

DOI: https://doi.org/10.21203/rs.3.rs-34244/v1

License:   This work is licensed under a Creative Commons Attribution 4.0 International License.  
Read Full License
 1

Determination of the Prevalence of Postpartum Depression and Risk

Factors Among Postpartum Patients at a Tertiary Government Urban

Hospital Using the Edinburgh Postnatal Depression Scale-Filipino

Translation (EPDS-F):

A Cross-Sectional Study

Maria Carmina L. Santiago, M.D. (corresponding author)

Department of Obstetrics and Gynecology, University of the Philippines-

Philippine General Hospital

Email: mindy.santiago@gmail.com

Maria Antonia E. Habana, M.D. M.Sc.

Department of Obstetrics and Gynecology, University of the Philippines-

Philippine General Hospital

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ABSTRACT

Background

Postpartum depression (PPD) occurs in 10-15% of deliveries worldwide.

Unfortunately there is a dearth of local studies on its exact prevalence.

Method

This cross-sectional study aimed to determine the prevalence of and risk factors

for PPD among postpartum patients at a tertiary government hospital using the

Edinburgh Postnatal Depression Scale-Filipino Translation (EPDS-F), a 10-

point questionnaire translated into Filipino and previously validated. Four

hundred patients within 8 weeks postpartum were recruited and their EPDS-F

scores and sociodemographic, medical and personal history, and delivery and

perinatal outcome data were obtained.

Results

The overall prevalence of PPD was 14.5%, which is within the known worldwide

prevalence. Among those that had family incomes below PhP10,000, the

proportion that had high EPDS-F scores was 68.8%, while those that had low

EPDS-F scores was 48.8% (significant at p=0.001). Among those that finished

below tertiary education, the proportion that had high EPDS-F scores was 81%,

while those that had low EPDS-F scores was 59.9% (significant at p=0.002).

Among those who delivered vaginally, 62.1% had high EPDS-F scores vs

44.2% low EPDS-F (p=0.03). Of those that had epidural anesthesia (106 or

26.5%), 44.8% had high EPDS scores and 26.0% had low EPDS-F scores

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(p=0.04). Regression analysis showed that having an abdominal delivery is

correlated with a lower EPDS-F score by 0.87% by logistic regression and 0.46

% by probit regression. Having a higher educational attainment and monthly

income are associated with a lower EPDS-F score by regression analysis.

Conclusions

The prevalence may be skewed because a tertiary government institution

caters to delicate pregnancies and those in low socioeconomic brackets. It may

be worthwhile to compare responses from a public versus a private institution,

also urban versus rural areas. It would be interesting also to evaluate the mode

of delivery variable and how exactly it correlates with the development of

postpartum depression.

KEYWORDS: Edinburgh Postnatal Depression Scale, Edinburgh Postnatal

Depression Scale-Filipino Translation, postnatal depression, postpartum

depression, Psychiatric Status Rating Scales

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BACKGROUND

Postpartum depression (PPD) occurs in 10-15% of all deliveries worldwide1.

Unfortunately there is a dearth of local studies on the exact prevalence of this

disorder. It is estimated that there were 126,826 cases of PPD in the Philippines

in 20042. However very little research has been done on the development and

prevention of this disorder, despite the fact that depression that has onset in

the postpartum period has been shown to lead to persistence of depression

after one year and even behavioral problems in the child 3.

Among patients with PPD, approximately 50 percent experience symptoms

before or during pregnancy4. In a prospective study of 546 pregnant and

postpartum women and diagnosed with postnatal depression, 20 percent had

symptom onset prepregnancy, 38 percent antepartum, and 42 percent

postpartum5. And in those whose symptoms begin after delivery, majority seem

to have onset within the first few months postpartum6. A retrospective study of

women with postpartum onset of major depression (n = 116) found that onset

occurred as follows7.

•Postpartum month 1 – 54 percent

•Postpartum month 2 to 4 – 40 percent

•Postpartum month 5 to 12 – 6 percent

The Edinburgh Postnatal Depression Scale (EPDS) is a ten-item questionnaire

used to identify women who have postpartum depression. It was designed by

Cox et al in 19878; each item is assigned a score 0 to 3 and the test yields a

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score of 0 to 30. The items ask about symptoms that the patient felt in the last

week and the patient rates her mood, feelings of anxiety, guilt, anhedonia, self-

harm, and suicidal ideation. Women with a score of 10-12 are said to be at risk

for PPD.

The EPDS may be used within eight weeks postpartum. This tool was

translated into the Filipino and validated in a 2005 study9 (Edinburgh Postnatal

Depression Scale-Filipino Translation or EPDS-F). It is proposed that this tool

be used to determine the prevalence of postpartum depression in Filipinos and

at the same time, determine the risk factors for this.

Critical review of past researches concerning research questions

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition10 defines

postpartum depression as a major depressive episode with an onset in

pregnancy or within four weeks of delivery. In the Philippines, there were an

estimated 126,826 cases of postpartum depression in 2004, but a dearth of

local studies on the disorder2. The late Senator Miriam Defensor-Santiago

authored the Postpartum Depression Research Act in 2007, for the 13th

Congress2. This act aimed to provide research on understanding the causes of,

and to find a cure for, postpartum depression and psychosis. If approved,

resources would be allocated for activities that include basic research

concerning the etiology and causes of the conditions, epidemiological studies

to address the frequency and natural history of the conditions, development of

improved diagnostic techniques, clinical research for the development and

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evaluation of new treatments, and information and education programs for

health care professionals and the public. However, this bill is still currently

pending in the senate.

A study conducted by De Chavez11 at a tertiary hospital in Dasmariñas, Cavite,

Philippines aimed to determine the prevalence of postpartum depression

among postpartum patients. The authors determined the proportion of mothers

experiencing postpartum depression on the basis of the following socio-

demographic factors: age, marital status, employment status, manner of

delivery, parity, age of gestation upon delivery, gender of the newborn and

breastfeeding status. They used the Edinburgh Postnatal Depression Scale

(EPDS) and found that of 115 patients, 89 had an EPDS score below 10 points

corresponding to 77.39% of the total population studied, while 26 participants

had a score of at least 10 points corresponding to 22.61%. There were 9

respondents who scored at least 1 point in question number 10 pertaining to

7.83% of the population. The prevalence of postpartum depression among

them was 22.61%.

The development of postpartum depression is multifactorial. A meta-analysis

by Beck12 of 84 studies published in the decade of the 1990s was conducted to

determine the magnitude of the relationships between postpartum depression

and various risk factors. Thirteen significant predictors of postpartum

depression were revealed: Prenatal depression, self-esteem, childcare stress,

prenatal anxiety, life stress, social support, marital relationship, history of

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previous depression, infant temperament, maternity blues, marital status,

socioeconomic status, and unplanned/unwanted pregnancy. Ten of these 13

risk factors had moderate effect sizes while three predictors had small effect

sizes.

A study by Miller13 demonstrated that the following risk factors are strong

predictors of postpartum depression: depression or anxiety during pregnancy,

stressful recent life events, poor social support and a previous history of

depression. Moderate predictors of postpartum depression are childcare stress,

low self-esteem, maternal neuroticism and difficult infant temperament. Small

predictors include obstetric and pregnancy complications, negative cognitive

attributions, single marital status, poor relationship with partner, and lower

socioeconomic status including income. No relationship was found for ethnicity,

maternal age, level of education, parity, or gender of child.

The lack of research on this disorder is alarming, because of the burden of the

disease not only on the mother but on the child as well. Studies show that 25

% of women with postpartum depression will be depressed 1 year later. And as

the duration of depression increases, so too do the number of sequelae and

their severity. Also, maternal depression during the first weeks and months after

delivery can lead to insecure attachment and later behavioral problems in the

child3.

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Philipps14 conducted a 4.5-year prospective study of postpartum depression in

70 women. He found that women who had experienced a postpartum

depression were predicted to be at increased risk for subsequent depression

and poor adjustment of their child. Postpartum depression was directly related

to subsequent depression but not child problems. Later depression was related

to child problems at 4½ yrs. It was concluded that postpartum depression may

increase risk for later maternal depression and in turn increases risk for child

behavior problems. Intervening with women who have experienced a

postpartum depression may reduce likelihood of future depressions and child

behavior problems.

Early recognition is one of the most difficult challenges with postpartum

depression because of how covertly it is suffered. Dennis15 conducted a

systematic review on help-seeking behavior among women diagnosed with

postpartum depression. Forty articles were reviewed, and it was found that a

common help-seeking barrier was women’s inability to disclose their feelings,

which was often reinforced by family members and health professionals’

reluctance to respond to the mothers’ emotional and practical needs. The lack

of knowledge about postpartum depression or the acceptance of myths was a

significant help-seeking barrier and rendered mothers unable to recognize the

symptoms of depression.

According to the American College of Obstetricians and Gynecologists, there is

currently insufficient evidence to make a recommendation for routine

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depression screening, either during or after pregnancy16. At Parkland Hospital,

all women are asked about depression and domestic violence at their first

prenatal visit. They are also screened again during their first postpartum visit

using the Edinburgh Postnatal Depression Scale (EPDS). In an analysis17 of

more than 17,000 of these questionnaires, 6% had scores that indicated either

minor or major depressive symptoms. Twelve of these 1106 women also had

thoughts of self-harm.

The Edinburgh Postnatal Depression Scale (EPDS), a 10-item questionnaire

that was developed in Scottish health centers in Edinburgh and Livingston to

identify women who have PPD8. Items of the scale correspond to various

clinical depression symptoms, such as guilt feeling, sleep disturbance, low

energy, anhedonia, and suicidal ideation. The EPDS may be used within 8

weeks postpartum and it also can be applied for depression screening during

pregnancy.

The EPDS was validated among 191 women 1-6 weeks postpartum at the

Philippine General Hospital9. They answered the Edinburgh Postnatal

Depression Scale-Filipino Translation (EPDS-F) and underwent DSM-IV based

psychiatric interview. They found that sensitivity was 71.4 %, specificity was

84.2 %, positive predictive value was 26.3 % and negative predictive value was

97.4 %. Their results confirm the validity of EPDS-F among postpartum

Filipinas. This tool can therefore be used to determine the prevalence of the

disease as well as the risk factors for its development.

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Significance of the study

Currently there are only a few available local studies on postpartum depression.

It is fortunate that we have available the Edinburgh Postnatal Depression Scale

that has been translated into Filipino and validated in a 2005 study 13. This study

also recommended that future research would have a larger sample size in

order to obtain a more accurate estimate of prevalence of PPD in the country.

Participation in the study may diagnose existing postpartum depression or

identify patients at risk for its development. The results may be used for further

research on postpartum depression and will thus also be beneficial for future

generations of postpartum women. Also, answering the questionnaire will serve

as screening for postpartum depression and should postpartum depression be

detected, it can be managed immediately with referral to a psychiatrist.

OBJECTIVES

General objective: To determine the prevalence of and risk factors for the

development of postpartum depression among postpartum patients at a tertiary

government hospital using the Edinburgh Postnatal Depression Scale-Filipino

Translation (EPDS-F).

Specific objectives:

1. To describe the socio-demographic profile of the patients diagnosed with

postpartum depression.

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2. To determine the prevalence of postpartum depression among postpartum

patients at a tertiary government hospital.

3. To determine the risk factors for developing postpartum depression.

METHODS

Study design

A cross-sectional study was conducted among postpartum patients at a tertiary

government hospital using the Edinburgh Postnatal Depression Scale-Filipino

Translation (EPDS-F).

Selection of subjects and sample size calculation

Based on the Annual Perinatology and Neonatology Statistics done at this

tertiary government hospital, there were 5126 deliveries in the year 2016. This

number was used as the population size. The worldwide estimated prevalence

of depression among recently delivered women at 10-15%, and the prevalence

found by Torres study 7.3%, though with a small sample size of 191. The

prevalence was thus set at 50% and the confidence level at 95%, the computed

sample size was 357. Ten percent was added to account for incomplete

information and losses; hence the sample size was set at 400.

Inclusion criteria: Patients at least 18 years of age who have delivered a fetus

of more than 20 weeks age of gestation, weighing more than 500 grams, within

the last 8 weeks, whether vaginal or abdominal delivery, term or preterm, alive

or dead.

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Exclusion criteria:

• Cases of abortion, ectopic pregnancy, hydatidiform mole.

• Those who have previously been diagnosed with a depressive disorder.

• Those who cannot speak Filipino.

Data collection

In 2016, the tertiary government hospital had a total of 5126 deliveries. It is thus

an ideal setting for research on postpartum women. It was decided that the data

gathering be done on postpartum patients on follow up at the outpatient

department instead of immediately postpartum to allow for adequate time for

the patient to settle at home after the delivery. Also, postpartum depression

typically manifests within the first 1-3 weeks postpartum, and the first

postpartum visit is usually scheduled within the first 1-2 weeks after delivery.

The study was conducted at a tertiary government hospital of Obstetrics and

Gynecology Outpatient Department (OPD) where postpartum patients come for

their follow up. An average of 5 to 10 postpartum patients are seen at the OPD

per day. A research assistant conducted the data collection over 5 months from

April to October 2018. Four hundred participants were recruited and answered

the self-administered questionnaire while waiting for their turn for checkup.

The Edinburgh Postnatal Depression Scale (APPENDIX A) was previously

translated into the Filipino and validated. The Edinburgh Postnatal Depression

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Scale-Filipino Translation (APPENDIX B) were answered by postpartum

patients on follow up at the outpatient clinic. Each item of the EPDS is assigned

a score 0 to 3 give a total score between 0 to 30. Women with a score of 10 are

classified as at risk for development of PPD. For sociodemographic data, there

was a separate sociodemographic data sheet in Filipino (APPENDIX C, English

translation also provided, APPENDIX D, and other pertinent information (data

on the delivery, course of hospital stay, among others) were retrieved from the

patient’s charts (APPENDIX E), permission for which was included in the

informed consent) (APPENDIX F in Filipino, APPENDIX G in English).

Data processing and analysis

Analysis of the data from the actual survey included computation of

prevalence and descriptive statistics to calculate the risk factors based on

patient demographics and profile. Chi-square test was used to determine the

association.

Once the data was extracted by the investigator from the charts of the

patients, all the information was manually entered into an electronic

spreadsheet for data processing and analysis. The socio-demographic and

clinical variables were presented in frequencies and percentages for

categorical variables such as sex, marital status, mode of delivery and reasons

for removal; or mean, standard deviation or range for continuous variables such

as age, gravidity and parity.

For the general objective, the prevalence of PPD were presented as

frequency and percentage, the denominator being the total number of subjects

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included in the study. A 95% confidence interval of the prevalence rate was

computed.

For the first specific objective, independent t-test was used to compare

variables such as age, number of pregnancies and children between those who

were noted by the scale to have PPD and otherwise. Chi-square test of

association was used to determine differences across categorical variables

such as marital status, employment status, presence of co-morbidities, and use

of contraception in terms of PPD status from the EPDS-F.

For the second specific objective, z-test of proportions was done to

compare the prevalence and established risk factors in Filipinos to the general

population of postpartum women if there are available data for the comparison.

Regression analysis was performed for all the variables, specifically

multivariate regression estimated through ordinary least squares (OLS).

Analysis was performed using the software Stata 13. The level of

significance for all sets of analysis was put at 0.05 using two-tailed

comparisons.

RESULTS

Of the 400 participants, 58 had EPDS-F scores 10 and higher, classifying them

as at risk for developing postpartum depression. All 58 were referred to

Psychiatry for further evaluation and management.

The overall prevalence of PPD was thus computed to be at 14.5%. This is within

the known worldwide prevalence of 10-15%1 but higher than in the local study

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done by Torres13 in 2005 (7.3% in 191 women). The mean EPDS-F score of

the depressed group was 13.1, as opposed to 3.0 in the non-depressed group.

Tables 1, 2, and 3 show the breakdown and percentages of the socio-

demographic variables, medical and personal history variables, and delivery-

related and perinatal outcome variables, respectively.

Socio-Demographic Variables (Table 1)

High EPDS score Low EPDS Score

Characteristics p-value
N=58 (%) N=342 (%)
Age in years 28.3 ± 5.4 28.8 ± 6.4
Obstetric score
Multigravid 43.0 (74.1) 231.0 (67.5) 0.70
Primigravid 15.0 (25.9) 111.0 (32.5) 0.20
Marital status
Single 33.0 (56.8) 191.0 (55.8) 0.46
Married 19.0 (32.7) 129.0 (37.7) 0.66
Live in partner 6.0 (10.3) 21.0 (6.1) 0.36
Highest level of education
Elementary 5.0 (8.6) 14.0 (4.1) 0.35
Secondary 42.0 (72.4) 191.0 (55.8) 0.02*
**Elementary and secondary **47.0 (81.0) **205.0 (59.9) **0.002*
Tertiary 11.0 (18.9) 137.0 (40.1) 0.92
Employment status
Employed 13.0 (22.4) 91.0 (26.6) 0.63
Unemployed 45.0 (77.6) 251.0 (73.3) 0.28
Monthly family income
< 5,000 18.0 (31.0) 54.0 (15.8) 0.08*
5,000-10,000 22.0 (37.8) 110.0 (32.2) 0.30
**<10,000 **40.0 (68.8) **164.0 (48.0) **0.001*
10,000-15,000 12.0 (20.7) 109.0 (31.8) 0.79
15,000-20,000 4.0 (6.9) 38.0 (11.1) 0.60
≥ 20,000 2.0 (3.4) 31.0 (9.1) 0.61

The mean age of all 400 respondents was 28.7 (SD ± 6.2) . Mean age for the

high EPDS-F score group was 28.3 (SD ± 5.4) and 28.8 (SD ± 6.4) for the low

EPDS-F score with no significant difference between groups. The majority or

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68.5% of participants were multigravids (high EPDS-F 74% vs low EPDS-F

67.5%. Majority or 56% are single (high EPDS 56.8 % vs low EPDS 55.8 %),

and unemployed (high EPDS-F 77.5% vs low EPDS-F 73.3%). The majority of

those with high EPDS-F scores had a monthly family income below PhP10,000

or USD198 (high EPDS-F 69% vs low EPDS-F 48%). For education, 58% of

respondents completed secondary education (high EPDS-F 72.4% vs low

EPDS-F 55.8%). Of those who completed college, 18.9% had high EPDS-F

scores vs 40% with low EPDS-F scores.

Of these, the only variables which reached statistical significance (p <0.05)

were the monthly family income below PhP10,000 and completed secondary

education. So these were further analyzed to include those with family income

less than PhP5,000 or USD99, and those who completed only elementary

education. Among those that had family monthly incomes below PhP10,000,

the proportion that had high EPDS-F scores was 68.8%, while those that had

low EPDS-F scores was 48.8%. This was significantly different at p=0.001.

Similarly, among those that finished below tertiary education or only elementary

or secondary, the proportion that had high EPDS-F scores was 81%, while

those that had low EPDS scores was 59.9%. This was significantly at p=0.002.

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Medical and Personal History Variables (Table 2)

High EPDS score Low EPDS Score

Characteristics
N=58 (%) N=342 (%) p-value
Personal history of
psychiatric condition
Yes 0.0 1.0 -
No - -
Family history of psychiatric
condition
Yes 5.0 (8.6) 28.0 (8.2) 0.49
No 53 (91.4) 314 (91.8) 0.54
Presence of medical
comorbidities
None 42 (72.4) 259.0 (75.5) 0.68
Hypertension 5.0 (8.6) 23.0 (6.7) 0.44
Diabetes mellitus 5.0 (8.6) 8.0 (2.3) 0.30
Heart disease 2.0 (3.4) 4.0 (1.2) 0.42
Thyroid disease 1.0 (1.7) 21.0 (6.1) 0.57
Bronchial asthma 1.0 (1.7) 16.0 (4.7) 0.55
Others 2.0 (3.4) 11.0 (3.2) 0.49
Currently smoking
Yes 0.0 (0.0) 3.0 (0.9) -
No 58.0 (100.0) 339.0 (99.1) 0.24
Currently with alcohol intake
Yes 4.0 (6.9) 19.0 (5.5) 0.46
No 54.0 (93.1) 323.0 (94.4) 0.65
History of physical abuse
Yes 0.0 (0.0) 7.0 (2.0) -
No 58.0 (100.0) 335.0 (98.0) 0.14
History of sexual abuse
Yes 1.0 (1.7) 4.0 (1.2) 0.48
No 57.0 (98.3) 338.0 (98.8) 0.64
Status of child
Alive 58.0 (100.0) 340.0 (99.4) 0.28
Died 0.0 (0.0) 2.0 (0.6) -
Child with congenital illness
Yes 5.0 (8.6) 16.0 (4.7) 0.37
No 53.0 (91.4) 326.0 (95.9) 0.92

Only 1 of the 400 respondents reported a personal history of mental illness, and

she had a low EPDS-F score. Thirty-three participants reported having mental

illness in the family (high EPDS-F 8.6% vs low EPDS-F 8.2). Seven

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respondents had a history of physical abuse, and all of them had low EPDS-F

scores. Five had a history of sexual abuse of which one had a high EPDS-F

score (1.7% vs Low EPDS-F 1.2%). Three respondents admitted to smoking,

all had a low EPDS-F score while 23 were alcohol consumers (high EPDS-F-F

6.9% vs low EPDS 5.5%. Ninety-nine patients or 24.8 percent had medical

comorbidities—28 hypertensive (high EPDS-F 8.6% vs low EPDS-F 6.7%), 13

diabetics (high EPDS-F 8.6% vs low EPDS-F 2.3%), 6 with heart disease (high

EPDS-F 3.4% vs low EPDS-F 1.2%), 22 with thyroid disease (high EPDS-F

1.7% vs low EPDS-F 6.1%), 17 with bronchial asthma (high EPDS-F 1.7% vs

low EPDS-F 4.7%), and 13 with other illnesses (high EPDS-F 3.4% vs low

EPDS-F 3.2%). None of these were significantly different. Among those with

children with congenital illness, majority had high EPDS-F scores (8.6%) as

opposed to low EPDS-F scores (4.7%). All were live births. None of the medical

and personal history variables were significantly different between the high and

low EPDS score groups.

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Delivery-related and Perinatal Outcome Variables (Table 3)

High EPDS
Low EPDS Score
Characteristics score p-value
N=342 (%)
N=58 (%)
Planned pregnancy?
Yes 22.0 (37.9) 137.0 (40.1) 0.58
No 36.0 (62.1) 205.0 (59.9) 0.40
Mode of delivery
Vaginal 36.0 (62.1) 151 (44.2) 0.03*
Abdominal 22.0 (37.9) 191 (55.8) 0.94
Induction of labor
Yes 24.0 (66.7) 89.0 (58.9) 0.25
No 12.0 (33.3) 62.0 (41.1) 0.69
Use of epidural?
Yes 26.0 (72.2) 80.0 (53.0) 0.04*
No 10.0 (27.8) 71.0 (47.0) 0.87
Hours of labor
< 8 hours 22.0 (61.1) 79.0 (52.3) 0.23
≥ 8 hours 1.0 (0.7) 1.0 (0.7) 0.50
Obstetric complications
Yes 4.0 (11.1) 19.0 (12.6) 0.53
No 32.0 (88.9) 132.0 (87.4) 0.41
Child with congenital illness
Yes 5.0 (8.6) 16.0 (4.7) 0.37
No 53.0 (91.4) 326 (95.9) 0.92
Breastfeeding
Yes 55.0 (94.8) 323.0 (94.4) 0.45
No 3.0 (5.2) 19.0 (5.6) 0.51

A total of 159 or 39.8% had unplanned pregnancies. Thirty-eight percent had

high EPDS-F scores vs 40% with low EPDS-F scores. Majority were

breastfeeding (94.8% high EPDS vs 94.4% low EPDS-F). One hundred eighty-

seven (46.8%) delivered vaginally (high EPDS-F 62.1% vs low EPDS-F

44.2%). Those who underwent vaginal delivery were further analyzed

according to whether or not they underwent labor induction, whether or not

epidural anesthesia was given, and the duration of their labor (less than or more

than 8 hours. Of those that had labor induction, 24 (41.4%) were in the high

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 20

EPDS-F score group vs 89 (26%) in the low EPDS-F score group. Majority had

labor lasting less than 8 hours (61.1% high EPDS-F vs 52.3% low EPDS-F). Of

those that had epidural anesthesia (106 or 26.5%), 44.8% had high EPDS-F

scores and 26.0% had low EPDS-F scores. Twenty-three patients (5.8%)

developed obstetric complications. Four had wound dehiscence while 20 had

surgical site infections. Among these, 4 were had high EPDS-F scores (6.9%)

and 19 (5.6%) had low EPDS-F scores. Only 2 reported that their children had

expired, both of whom had low EPDS scores. Among those with children with

congenital illness, more mothers had high EPDS scores (8.6 % vs 4.7% low

EPDS scores).

Among these, only the mode of delivery and use of epidural anesthesia were

statistically significant. Among those who underwent vaginal delivery, 62.1%

had high EPDS scores vs 44.2% low EPDS-F (p=0.03). Of those that had

epidural anesthesia (106 or 26.5%), 44.8% had high EPDS scores and 26.0%

had low EPDS scores (p=0.04).

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Regression Analysis (Table 4)

Ordinary Logistic Probit
Method
Least Squares Regression Regression
Dependent Variable EPDS PPD PPD
Independent Variables
C 10.17 1.16 0.56
[7.04]** [1.08] [0.95]

Age -0.06 -0.02 -0.01

[-1.59] [-0.83] [-0.62]

Child with Congenital Illness 2.17 0.80 0.44

[1.81] [1.41] [1.37]
Medical Comorbidities -0.04 -0.03
[-0.43] [-0.53]

Obstetric Complications 1.73 0.74 0.40

[1.47] [1.20] [1.20]

Mode of Delivery -1.60 -0.87 -0.46

[-3.42]** [-2.76]** [-2.72]**

Education -1.23 -0.69 -0.4

[-3.39]** [-2.39]* [-2.54]*

Employment -0.40 -0.26 -0.13

[-0.72] [-0.69] [-0.65]

History of Family Mental

0.51 0.26 0.14
Illness
[0.67] [0.49] [0.49]

Family Income -0.41 -0.44 -0.23

[-2.10]* [-2.84]** [-2.84]**

OB Score 0.48 0.22

[1.25] [1.07]
Planned Pregnancy 0.43 0.04 -0.01
[0.87] [0.14] [-0.05]
Observations: 400 400 400
R-squared: 0.09 0.09 0.09
t-Statistic in brackets. Significance at 1 percent (***), 5 percent (**), and 10
percent (*) levels.

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Regression analysis was performed for all the variables. Using the multivariate

regression estimated through ordinary least squares (OLS), the mode of

delivery, level of education, and monthly family income were found to be

significant in determining the EPDS-F score. Women who underwent

abdominal delivery had a lower EPDS-F score on average by 1.60 points.

Meanwhile, women who have finished elementary, high school, and college

education have EPDS-F scores lower by 1.23 points, 2.46 points, and 3.69

points, respectively, compared to women who have no educational attainment.

In addition, having a higher level of family income was found to be associated

with a lower EPDS-F score.

The same results were found to be robust using the logistic and probit

regression approaches. Having an abdominal delivery is correlated with a lower

EPDS-F score by 0.87% using the logistic regression and 0.46% using the

probit regression. Similar to the results from the OLS approach, having a higher

level of educational attainment and monthly family income are associated with

a lower EPDS-F score.

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DISCUSSION

The characteristics that were noted to be significant in the development of

postpartum depression as determined by the Edinburgh Postnatal Depression

Scale-Filipino Translation (EPDS-F) are low educational attainment (below

tertiary education, p <0.01) and lower family income (below PhP10,000 below

family income, p <0.01). Both are consistent with the Torres study9.Low family

income was also a significant risk factor in an Indian study 18. Interestingly,

abdominal delivery was found to be correlated to a high EPDS-F score (p

<0.05). Previous studies showed no effect of route of delivery on the

development of PPD. A meta-analysis in 201719 showed that caesarean section

increases the risk for PPD. It is important to note that the rate of abdominal

delivery for this study is quite high at 53.3% (the ideal rate according to the

World Health Organization is only 10-15%20). This could be attributed to the fact

that this study was conducted in a tertiary hospital that caters to more

complicated pregnancies, many of which require delivery by caesarean section.

In 2016, 43% of deliveries at this hospital were by caesarean section.

Among all of the above characteristics, based on the computed p-values and

regression analysis, it appears that the ones that proved significant for having

a high EPDS-F score are the following: having low educational attainment

(below tertiary), having lower family income (less than PhP10,000), vaginal

delivery, and use of epidural anesthesia. The finding that those with high EPDS-

F scores are most likely to have had epidural anesthesia is contradictory to the

finding that those with high EPDS scores are most likely to have undergone

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abdominal rather than vaginal delivery, if decreased pain is the supposed

rationale. Perhaps there are other factors associated with vaginal delivery that

increases the EPDS-F score.

Comparing with the findings of the Torres study9, the only common risk factors

for developing postpartum depression are having low educational attainment

and low family income. This can be explained by the growing inflation and the

increased poverty rates. Additional factors that are frequently associated with

postpartum depression include, stressful life events (e.g., marital conflict or

emigration) during pregnancy or after delivery, as well as poor social and

financial support in the puerperium21.

LIMITATIONS

As this is a cross-sectional design, the data is reflective of the prevalence and

risk factors of postpartum depression only at the point in time they were

obtained. It is recommended that further studies using a cohort design to

determine lifetime prevalence of postpartum depression be conducted.

Causality cannot be established as well.

CONCLUSIONS

The Edinburgh Postnatal Depression Scale Filipino Translation (EPDS-F) is a

useful screening tool for postpartum patients. It is an ideal tool because it

consists of only ten items and is self-administered.

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The prevalence of postpartum depression in this study was found to be 14.5%.

The variables that were found to be significant in those who had high EPDS-F

scores were monthly family income below PhP10,000, educational attainment

below tertiary, and vaginal delivery.

The higher prevalence noted in this study may be due to risk factors present in

the population—such as low socioeconomic status and low educational

attainment. It may be worthwhile to compare responses from a public versus a

private institution, as well as urban versus rural, non-hospital based areas. It

would be interesting also to further evaluate the mode of delivery variable and

how exactly it correlates with the development of PPD.

Obstetricians, midwives, and all those who care for pregnant women will do well

to remember that the duty to each patient does not end with a safe delivery. It

is imperative to ensure her complete physical and mental well-being even in the

puerperium and beyond. Screening during a critical period of vulnerability such

as in the puerperium will allow early detection, prevention and treatment.

ABBREVIATIONS

PPD – Postpartum depression

EPDS – Edinburgh Postnatal Depression Scale

EPDS-F – Edinburgh Postnatal Depression Scale-Filipino Translation

OPD – outpatient department

OLS – ordinary least squares

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DECLARATIONS

Ethics approval and consent to participate

This study was conducted through survey. All patient information was kept

confidential. No data or test result were used for any other purpose other than

what it was intended. The study protocol was submitted for ethics review by the

University of the Philippines Manila Research Ethics Board (UPMREB), which

has the following reference numbers:

UPMREB IRB Registration #: IRB00002908

IORG #: IORG0002365 - Expiry: 02/15/2021

FWA #: 00018728 - Expiry: 04/12/2022

Data collection only ensued upon approval. This study was funded by the

primary investigator only. Written consent was obtained from the participants

and they were also given copies of the informed consent form. No conflict of

interest was identified among the investigators, the patients and the institution.

It is important to note that answering items on the EPDS-F might cause

participants to think about feelings of depression, worthlessness, and self-

harm. Participants who were classified as at risk for developing PPD based on

their EPDS-F score were referred to Psychiatry for further evaluation and

management.

Consent for publication

Not applicable

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Availability of data and materials

All data generated or analyzed during this study are included in this published

article.

Competing interests

The authors declare that they have no competing interests.

Funding

This study received no funding. All expenses were shouldered by the primary

author.

Authors' contributions

MS was responsible for the conception of the study; the acquisition, analysis,

and interpretation of data, as well as drafting and revision of the work.

MH was likewise responsible for the conception of the study; the acquisition,

analysis, and interpretation of data, as well as drafting and revision of the

work.

All authors have read and approved the manuscript.

Acknowledgements

Mr. Jan Christopher G. Ocampo

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REFERENCES

1. Thurgood S, Avery D, William L. Postpartum depression. American Journal

of Clinical Medicine. 2009; 6(2).

2. Kupfer DJ, Regier DA (eds). Diagnostic and Statistical Manual of Mental

Disorders, 5th ed. American Psychiatric Association, 2013.

3. De Chavez M, Capco-Dichoso M, Prevalence of postpartum depression

among mothers who delivered in a tertiary hospital. Philippine Journal of

Obstetrics and Gynecology 2014; 38 (3): 15-21.

4. Defensor-Santiago M. Postpartum depression research act of 2007. Senate

Bill No. 2655. 13th Congress.

5. Beck CT. 2001. Predictors of Postpartum Depression: An Update. Nursing

Research 50(5): 275-285.

6. Miller LJ. Postpartum Depression. Journal of the American Medical

Association. 2002; 287(6):762-765.

7. Cunningham FG, Gant NF, Leveno KJ, Gilstrap III LC, Hauth JC and

Wenstrom KD (eds): Williams Obstetrics, 24th ed. USA: McGraw-Hill, 2014.

8. Philipps LH, O’Hara MW. Prospective study of postpartum depression: 4½-

year follow-up of women and children. Journal of Abnormal Psychology

1991; 100(2): 151-155.

9. Dennis CL, Hodnett ED. Psychosocial and psychological interventions for

treating postpartum depression. Cochrane Database of Systematic Reviews

2007; Issue 4. Art. No.: CD006116.

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 29

10. Screening for perinatal depression. Committee Opinion No. 630. American

College of Obstetricians and Gynecologists. Obstet Gynecol

2015;125:1268–71.

11. Nelson DB, Freeman MP, Johnson NL, et al: A prospective study of post-

partum depression in 17648 parturients. J Matern Fetal Neonatal Med 2013;

26(12):1156.

12. Cox JL et al. Development of a 10-item Edinburgh Postnatal Depression

Scale. British Journal of Psychiatry 1987 (150); 6 (3): 82-87.

13. Torres RF, et al. Validation of the Edinburgh Postnatal Depression Scale

(EPDS) among Filipino women. Philippine Journal of Obstetrics and

Gynecology 2009; 29 (1): 21-27.

14. Goker A, et al. Postpartum depression: Is mode of delivery a risk factor?

ISRN Obstetrics and Gynecology 2012, article ID 61675.

15. Hui Xu, Yu Ding, Yue Ma, Xueling Xin, Dongfeng Zhang. Cesarean section

and risk of postpartum depression: A meta-analysis. Journal of

Psychosomatic Research, 2017.

16. WHO Statement on Caesarean Section Rates. Department of

Reproductive Health and Research, World Health Organization, 2015.

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ADDITIONAL FILES

APPENDIX A: EDINBURGH POSTNATAL DEPRESSION SCALE (EPDS)

CODE _______

As you have recently had a baby, we would like to know how you are feeling.
Please SHADE the answer which comes closest to how you have felt IN THE
PAST 7 DAYS, not just how you feel today.
Here is an example, already completed.
I have felt happy:
 Yes, all the time
Yes, most of the time
 No, not very often
 No, not at all
This would mean: “I have felt happy most of the time” during the past week.
Please complete the other questions in the same way.

In the past 7 days:

1. I have been able to laugh and see the funny side of things
 As much as I always could
 Not quite so much now
 Definitely not so much now
 Not at all
2. I have looked forward with enjoyment to things
 As much as I ever did
 Rather less than I used to
 Definitely less than I used to
 Hardly at all
3. I have blamed myself unnecessarily when things went wrong
 Yes, most of the time
 Yes, some of the time
 Not very often
 No, never
4. I have been anxious or worried for no good reason
 No, not at all
 Hardly ever
 Yes, sometimes
 Yes, very often
5. I have felt scared or panicky for no very good reason
 Yes, quite a lot
 Yes, sometimes
 No, not much
 No, not at all
6. Things have been getting on top of me
 Yes, most of the times I haven’t been able to cope at all

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 Yes, sometimes I haven’t been coping as well as usual

 No, most of the time I have coped quite well
 No, I have been coping as well as ever
7. I have been so unhappy that I have had difficulty sleeping
 Yes, most of the time
 Yes, some of the time
 Not very often
 No, not at all
8. I have felt sad or miserable
 Yes, most of the time
 Yes, some of the time
 Not very often
 No, not at all
9. I have been so unhappy that I have been crying
 Yes, most of the time
 Yes, some of the time
 Only occasionally
 No, never
10. The thought of harming myself has occurred to me
 Yes, quite often
 Sometimes
 Hardly every
 Never

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APPENDIX B: EDINBURGH POSTNATAL DEPRESSION SCALE-FILIPINO

TRANSLATION (EPDS-F)

CODE _______
Kumusta na ang iyong pakiramdam?

Sa dahilang ikaw ay nanganak kamakailan lamang, nais naming malaman kung

ano ang iyong pakiramdam sa ngayon. Mangyari lamang na guhitan ang sagot
na pinakamalapit sa iyong naramdaman sa nakaraang 7 araw, hindi lamang
ang iyong nararamdaman sa ngayon.

Narito ang isang halimbawa, na nasagutan na:

 Ako ay nakaramdam ng kaligayahan:

 Oo, kadalasan
 Oo, minsan
 Hindi, hindi gaano
 Hindi, hindi ni minsan

Nangangahulugan ito na: ‘Minsan ako ay nakaramdam ng kaligayan sa

nakaraang linggo.’ Mangyari lamang na kumpletohin ang iba pang mga
katanungan sa parehong paraan.

SA NAKARAANG 7 ARAW:

1. Nagawa kong tumawa at nakita ko ang nakakatuwang bahagi ng mga

bagay:
 Kasing dalas ng palagi kong ginagawa
 Hindi na gaano kadalas sa ngayon
 Talagang hindi na gaano kadalas sa ngayon
 Hindi ni minsan

2. Umaasa ako na masisiyahan sa mga bagay:

 Kasing dalas ng dati kong ginagawa
 Hindi na gaano kadalas katulad ng dati kong ginagawa
 Talagang di na gaano kadalas katulad ng dati kong ginagawa
 Bibihirang mangyari

3. Sinisi ko ang aking sarili kapag may mga maling bagay na nangyari:
 Oo, kadalasan
 Oo, minsan
 Hindi gaanong madalas
 Hindi, hindi kailanman

4. Nag-alala ako o nabalisa nang walang magandang kadahilanan:

 Hindi, hindi ni minsan
 Bibihirang mangyari

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 Oo, kung minsan

 Oo, napakadalas
5. Nakaramdam ako ng takot o biglang pagkatakot nang walang
magandang dahilan:
 Oo, napakadalas
 Oo, paminsan-minsan
 Hindi, hindi gaanong madalas
 Hindi, hindi ni minsan

6. Nahihirapan akong makayanan ang mga bagay:

 Oo, kadalasan ay hindi ko nakakayanan ang mga bagay
 Oo, paminsan-minsan ay hindi ko nakakayanan ang mga bagay
nang kasing husay ng dati
 Hindi, kadalasan ay nakayanan ko nang mahusay ang mga
bagay
 Hindi, nakakayanan ko ang mga bagay katulad ng palagian

7. Naging sobrang malungkutin ako kaya nahirapan ako sa pagtulog:

 Oo, kadalasan
 Oo, napakadalas
 Hindi gaanong madalas
 Hindi, hindi kailanman

8. Nakaramdam ako ng lungkot at pagiging kahabag-habag:

 Oo, kadalasan
 Oo, napakadalas
 Hindi gaanong madalas
 Hindi, kailanma’y hindi

9. Naging malungkutin ako na naging dahilan ng aking pag-iyak:

 Oo, kadalasan
 Oo, napakadalas
 Paminsan-minsan lamang
 Hindi, kailanma’y hindi

10. Ang pag-iisip na saktan ang aking sarili ay nangyari sa akin:

 Oo, napakadalas
 Paminsan-minsan
 Bibihirang mangyari
 Hindi kailanman

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APPENDIX C: SOCIODEMOGRAPHIC DATA SHEET (FILIPINO)

CODE: __________

1. Edad:
2. Estado:
 Di-kasal
 Kasal
 Hiwalay
 May kinakasama sa bahay
 Biyuda
3. Natapos na pag-aaral
 Elementary
 High school
 College
4. Nagtatrabaho
 Oo (Trabaho: __________)
 Hindi
5. Suweldo ng pamily kada buwan (Pesos)
 < 5,000
 5,000-10,000
 10,000-15,000
 15,000-20,000
 ≥ 20,000
6. Nagkaroon ng sakit sa pag-iisip?
 Oo
 Hindi
7. May kamag-anak na nagkaroon ng sakit sa pag-iisip?
 Oo
 Hindi
8. Kasalukuyang naninigarilyo?
 Oo
 Hindi
9. Kasalukuyang umiinom ng alak?
 Oo
 Hindi
10. Nakaranas ng pisikal na pang-aabuso?
 Oo
 Hindi
11. Nakaranas ng sekswal na pang-aabuso?
 Oo
 Hindi
12. Estado ng anak?
 Buhay
 Namatay
13. Pinlano ang pagbubuntis?
 Oo

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 Hindi
14. Kasalukuyang nagpapasuso sa anak?
 Oo
 Hindi

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APPENDIX D: SOCIODEMOGRAPHIC DATA SHEET - English

15. Age:
16. Marital status
 Single
 Married
 Separated
 Common-law partner
 Widowed
17. Educational attainment
 Elementary school
 High school
 College
18. Employment status
 Employed
 Unemployed
19. Monthly family income (in Pesos)
 < 5,000
 5,000-10,000
 10,000-15,000
 15,000-20,000
 ≥ 20,000
20. Previously diagnosed with psychiatric condition?
 Yes
 No
21. Family history of psychiatric illness?
 Yes
 No
22. Currently smoking?
 Yes
 No
23. Currently with alcohol intake?
 Yes
 No
24. History of physical abuse
 Yes
 No
25. History of sexual abuse?
 Yes
 No
26. Status of child?
 Alive
 Died
27. Planned pregnancy?
 Yes
 No
28. Currently breastfeeding?

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 Yes
 No

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APPENDIX E: DATA OBTAINED FROM CHARTS

1. OB score:
2. With medical comorbidities?
 Hypertension
 Diabetes mellitus
 Heart disease
 Thyroid disease
 Others: __________
3. Mode of delivery
 Vaginal
 Abdominal
If vaginal delivery:
a. Induction of labor?
 Yes
 No
b. Epidural anesthesia given?
 Yes
 No
b. Hours of labor
 < 8 hours
 ≥ 8 hours
4. Any obstetric complication?
 Yes (Specify: _____________)
 No
5. Child with congenital illness?
 Yes
 No

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APPENDIX F: INFORMED CONSENT (FILIPINO)

University of the Philippines

College of Medicine & Philippine General Hospital
Department of Obstetrics and Gynecology
Taft Avenue, Manila
Tel. No. 524-5741/5218450 loc. 2357/ Telefax 632-5241098
Email address: pghobgyn2002@yahoo.com

Kaalamang pahintulot para sa mga bagong panganak sa Outpatient

Department ng Philippine General Hospital Department of Obstetrics and
Gynecology, na inaanyaya naming maging kalahok sa pananaliksik sa
postpartum depression o PPD.

Ang pamagat ng pananaliksik na ito ay: Determination of the Prevalence

of Postpartum Depression and Risk Factors Among Postpartum Patients
at a Tertiary Government Urban Hospital Using the Edinburgh Postnatal
Depression Scale

➢ Pangunahing Imbestigador: Maria Carmina L. Santiago, M.D.

➢ Tagapatnubay na Imbestigador: Ma. Antoinette Habana, M.D.
➢ Department of Obstetrics and Gynecology, Philippine General
Hospital

Ang Kaalamang Pahintulot na ito ay may dalawang bahagi:

➢ Impormasyon Tungkol sa Pananaliksik
➢ Patunay ng Pahintulot

Kayo po ay bibigyan ng kopya ng buong kaalamang pahintulot.

Unang Bahagi: Impormasyon Tungkol sa Pananaliksik

Panimula
Ako po si Dr. Maria Carmina Santiago, residente po ng Department of
Obstetrics and Gynecology ng Philippine General Hospital. Ako po ay
kasalukuyang may isinasagawang pananaliksik tungkol sa depresyon sa mga
bagong kapapanganak o POSTPARTUM DEPRESSION. Bibigyan ko po kayo
ng impormasyon tungkol sa pananaliksik na ito at iniimbita ko po kayo maging
kalahok. Kung mayroong pong hindi malinaw sa pananaliksik or kung nais
ninyo nang karagdagang impormasyon, huwag po kayo mag-alinlangang
magtanong.

Layunin ng pananaliksik
Ang depresyon sa mga bagong panganak o POSTPARTUM DEPRESSION
(PPD) ay nararanasan ng 10-15% ng lahat ng bagong panganak na
kababaihan. Ang PPD kapag hindi naagapan ay maaring magdulot ng patuloy

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na depression sa ina o kaya problema sa kilos ng kanyang anak. Sa Pilipinas,

kaunti pa lamang ang nagagawang pananaliksik tungkol sa kondisyong ito.

Uri ng pananaliksik
Ang Edinburgh Postnatal Depression Scale (EPDS) ay isang palatanungan na
ginagamit upang malaman kung ang isang bagong panganak ay mayroong
depresyon. Maari po lamang na sagutan niyo ito pati na rin ang data sheet
tungkol sa inyong mga personal na detalye.

Pagpili ng mga kalahok

Kayo po ay inaanyayahang makilahok sa pag-aaral na ito kasama ng 400 na
mga bagong panganak na babae.

Boluntaryong pakikilahok
Ang pagsali sa pananaliksik na ito ay hindi sapilitan. Kayo ay maaari tumanggi
sa pagsali kung nais ninyo. Wala po magiging implikasyong ang pagtanggi niyo
sa pakikilahok sa pag-aaral na ito. Makakatanggap pa rin kayo ng lahat ng
serbisyo ng pasyente ng ospital na ito kahit piliin niyong hindi maging kalahok.

Paglalarawan ng proseso
Kayo po ay bibigyan ng dalawang palatanungan:
1. Edinburgh Postnatal Depression Scale (Filipino)
2. Sociodemographic data sheet
Maari po lamang na sagutin ninyo ito habang naghihintay na kayo ay tawagin
sa Outpatient Department.
Maari din po na kumuha ng karagdagang impormasyon mula sa inyong tsart.

Mga posibleng panganib

Ang partisipasyon sa pag-aaral ay maaring magdulot ng mga di kanais-nais na
damdamin dahil sa mga sensitibong tanong sa EPDS. Kung sakaling
makaranas kayo ng mga ito, maaari po kayong komonsulta sa doktor ng pag-
iisip o psychiatrist. Lahat po nang gastusin sa pagpapakonsulta at gamutan ay
sasagutin ng Pangunahing Imbestigador.

Mga benepisyo
Ang pakikilahok ninyo sa pag-aaral na ito ay ang magiging
napakahalagang kontribusyon sa pananaliksik sa PPD at makakatulong
sa lahat ng kababaihang nakararanas at makakaranas pa nito. Bukod
doon, ang pagsagot sa EPDS ay magsisilbing pagsuri kung mayroong
PPD. At kung natuklasan na mayroong PPD, maagapan kaagad sa
pamamagitan ng pagkonsulta sa espesyalista.

Kompensasyon
Walang dagdag na gastusin ang inaasahan sa inyo sa pagiging kalahok ninyo
sa pag-aaral na ito. Wala rin kayong matatanggap na kabayaran o
kompensasyon.

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Kompidensyalidad
Ang lahat ng impormasyong makokolekta sa pananaliksik na ito ay magiging
lihim o kompidensyal. Tanging ang mga imbestigador lamang ang
makakahawak ng impormasyong ito. Ang impormasyon tungkol sa inyo ay
itatago sa isang numero at hindi gamit ang inyong pangalan.

Pagbabahagi ng resulta
Maari po kayong makahingi ng kopya ng resulta ng pananaliksik na ito bago pa
man mailabas sa publiko. Posible pong mailabas sa mga opisyal na pahayagan
ang mga resulta ng pananaliksik na ito. Ang kompidensiyal na impormasyon ay
hindi po ilalabas.

Karapatang tumanggi o bawiin ang pahintulot

Ang pakikilahok ninyo sa pananaliksik na ito ay boluntaryo at hindi sapilitan.
Maari ninyong bawiin ang inyong pagsali sa kahit anong punto ng pananaliksik.
Hindi po maapektuhan ang mga serbisyong matatanggap ninyo bilang
pasyente ng institusyong ito.

Pakikipag-ugnayan
Kung kayo ay mayroong mga katanungan maaari po kayo magtanong
ngayon o sa susunod kahit pagkatapos ninyo sagutin ang palatanungan.
Kung may mga katanungan kayo sa susunod, maaari po kayo
makipagugnayan sa mga sumusunod:

Pangunahing Imbestigador:
Dr. Maria Carmina L. Santiago
09189054618
mindy.santiago@gmail.com

Tagapatnubay na Imbestigador:
Dr. Maria Antonia E. Habana
09178965778
aehabana@yahoo.com

Ang pag-aaral na ito ay inaprubahan ng University of the Philippines

Manila Research Ethics Board (UPMREB) Panel, na ang tungkulin ay
tumangkilik sa mga karapatan ng mga kalahok sa pananaliksik. Kung
mayroon kayong mga katanungan tungkol sa UPMREB Panel, paki-
kontak si:

Dr. Doris R. Benavides

UPMREB Panel 3 Chair
Address: National Institutes of Health
547 Pedro Gil St
Ermita 1000 Manila
Email: upmreb@post.upm.edu.ph
Tel: +63 2 526 4346

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Mobile: 0917-621-3630

Ikalawang bahagi: Patunay ng Pahintulot

Nabasa ko ang impormasyon sa ibabaw o naibasa siya sa akin.

Nakapagtanong na ako at nasagot nang sapat ang aking mga katanungan.
Pumapayag akong maging kalahok sa pananaliksik na ito.

Buong pangalan ng kalahok__________________

Lagda ng kalahok ___________________

Petsa ___________________________
Araw/buwan/taon
Kapag hindi nakakabasa o nakakasulat ang kalahok:

Ako ay naging saksi ng tamang pagbasa ng kaalamang pahintulot sa

posibleng kalahok. Nabigyan siya ng pagkakataong magtanong.
Pinapatunayan ko na kusang nagbigay siya ng kanyang pagsang-ayon sa
pakikilahok.

Pangalan ng saksi __________________ AT Bakas-daliri ng hinlalaki ng

kalahok
Lagda ng saksi ______________________
Petsa ________________________
Araw/buwan/taon

Pahayag ng Imbestigador/tagakuha ng pahintulot

Naibasa ko nang tama ang mga impormasyon sa posibleng kalahok at, sa

lubos ng aking kakayanan, sinigurado na naintindihan ng kalahok na:
1. Sasagutan niya ang Edinburgh Postnatal Depression Scale (Filipino)
2. Sasagutan niya ang sociodemographic questionnaire
3. Maaring kumuha ng karagdagang impormasyon mula sa kanyang tsart

Pinapatunayan kong nabigyan ng sapat na pagkakataong magtanong

tungkol sa pananaliksik, at lahat ng kanyang katanungan ay nasagot sa
lubos ng aking kakayanan. Pinapatunayan ko na mwalang sapilitang
naganap upang makuha ang pahintulot ng kalahok. Ang kalahok ang
kusang nagbigay ng kanyang pahintulot.

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Ang kalahok ay nabigyan ng kopya ng kaalamang pahintulot na ito.

Pangalan ng Imbestigador/tagakuha ng pahintulot

________________________
Lagda ng Imbestigador/tagakuha ng
pahintulot________________________
Petsa ________________________
Araw/buwan/taon

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APPENDIX G: INFORMED CONSENT (ENGLISH)

University of the Philippines

College of Medicine & Philippine General Hospital
Department of Obstetrics and Gynecology
Taft Avenue, Manila
Tel. No. 524-5741/5218450 loc. 2357/ Telefax 632-5241098
Email address: pghobgyn2002@yahoo.com
PHIC – Accredited Health Care Provider

Informed Consent form for postpartum women on follow up at the Outpatient

Department of the Philippine General Hospital Department of Obstetrics and
Gynecology, whom we are inviting to participate in research on postpartum
depression. The title of this research project is Determination of the Prevalence
of Postpartum Depression and Risk Factors Among Postpartum Patients at a
Tertiary Government Urban Hospital Using the Edinburgh Postnatal
Depression Scale]

➢ Principal Investigator: Maria Carmina L. Santiago, M.D.

➢ Supervising investigators: Ma. Antoinette Habana, M.D.
➢ Department of Obstetrics and Gynecology

This Informed Consent Form has two parts:

➢ Information Sheet (to share information about the research with you)
➢ Certificate of Consent (for signatures if you agree to take part)

You will be given a copy of the full Informed Consent Form.

PART I: Information Sheet

Introduction

I am Dr. Maria Carmina Santiago, a resident of the Department of Obstetrics and

Gynecology of the Philippine General Hospital. I am currently conducting research on
postpartum depression (PPD). I will give you information on this research and invite
you to participate. You do not have to decide today whether or not you will participate
in the research. Before you decide, you can talk to anyone you feel comfortable with
about the research.
There may be some words that you do not understand. Please ask me to stop as we
go through the information and I will take time to explain. If you have questions later,
you can ask them of me.

Purpose of the research

Postpartum depression occurs in 10-15% of all deliveries. However very little research
has been done on the development and prevention of this disorder in the Philippines.
It is the goal of this research to establish the prevalence of PPD among Filipina women
and evaluate the possible risk factors for its development.

Type of Research Intervention

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The Edinburgh Postnatal Depression Scale (EPDS) is a 10-item questionnaire used to

identify women who have postpartum depression. It consists of a ten-item self-report
scale. You will be asked to answer this questionnaire along with a personal data sheet.

Participant selection
We are inviting you, along with 400 other postpartum women, to participate in this
research on postpartum depression.

➢ Voluntary Participation
Your participation in this research is entirely voluntary. It is your choice whether to
participate or not. Whether you choose to participate or not, all the services you receive
at this institution will continue and nothing will change. You may change your mind
later and stop participating even if you agreed earlier.

B. Description of the Process

You will be given two forms to fill up:
1. The Edinburgh Postnatal Depression Scale (translated in Filipino)
2. Sociodemographic data sheet.
You can accomplish these two sheets while waiting for your turn at the Outpatient
Department.
We are also requesting your permission to access additional data in your hospital
chart.

Risks
Your participation in this research may evoke negative emotions due to the sensitive
nature of the questions in the EDPS. If you do develop any of these, please let us
know right away and we can arrange for proper counseling with a psychiatrist. Rest
assured that any and all expenses incurred for consultation and/or treatment will be
shouldered by the Primary Investigator.

Benefits
You participation in this research will benefit those currently suffering from postpartum
depression as well as future generations of women who are at risk for developing PPD.

Reimbursement
You will not be asked to spend for anything for this study. Likewise, you will also not
receive any compensation for your participation.

Confidentiality
The information that we collect from this research project will be kept confidential.
Information about you that will be collected during the research will be put away and
no one but the researchers will be able to see it. Any information about you will have
a number on it instead of your name. Only the researchers will know what your number
is and we will lock that information up with a lock and key. It will not be shared with or
given to anyone except the UPMREB.

Sharing the Results

The knowledge that we get from doing this research may be available to you if you are
interested. Confidential information will not be shared. It is hoped that the results be
published in order that other interested people may learn from our research.

Right to Refuse or Withdraw

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You do not have to take part in this research if you do not wish to do so and refusing
to participate will not affect your treatment at this institution in any way. You will still
have all the benefits that you would otherwise have at this institution. You may stop
participating in the research at any time that you wish without losing any of your rights
as a patient here. Your treatment at this institution will not be affected in any way.

Who to Contact
If you have any questions you may ask them now or later, even after the study has
started. If you wish to ask questions later, you may contact the Primary Investigator:
Dr. Maria Carmina L. Santiago
09189054618
mindy.santiago@gmail.com

This proposal has been reviewed and approved by the University of the
Philippines Manila Research Ethics Board (UPMREB) Panel, a committee whose
task is to make sure that research participants are protected from harm. If you
wish to find more about the UPMREB Panel, you may call the UPMREB at 554-
8400 local 2065, Monday thru Thursday, 8:00AM-4:00PM, located at the 2nd Floor
Main Administrative Building, Philippine General Hospital, Taft, Manila.
PART II: Certificate of Consent
I have read the foregoing information, or it has been read to me. I have had the
opportunity to ask questions about it and any questions that I have asked have
been answered to my satisfaction. I consent voluntarily to participate as a
participant in this research.

Print Name of Participant__________________

Signature of Participant ___________________
Date ___________________________
Day/month/year

If cannot read and/or write

I have witnessed the accurate reading of the consent form to the potential
participant, and the individual has had the opportunity to ask questions. I
confirm that the individual has given consent freely.

Print name of witness_____________________ AND Thumb print of

participant
Signature of witness ______________________
Date ________________________
Day/month/year

Statement by the researcher/person taking consent

I have accurately read out the information sheet to the potential participant, and
to the best of my ability made sure that the participant understands that the
following will be done:
1. Accomplishment of the Edinburgh Postnatal Depression Scale (Filipino)

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2. Accomplishment of the sociodemographic questionnaire

3. Data from the participant’s hospital chart can be accessed

I confirm that the participant was given an opportunity to ask questions about
the study, and all the questions asked by the participant have been answered
correctly and to the best of my ability. I confirm that the individual has not been
coerced into giving consent, and the consent has been given freely and
voluntarily.

A copy of this ICF has been provided to the participant.

Print Name of Researcher/person taking the

consent________________________
Signature of Researcher /person taking the consent________________________
Date ___________________________
Day/month/year

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Supplementary Files
This is a list of supplementary les associated with this preprint. Click to download.

EdinburghPostnatalDepressionScaleEnglish.pdf
Strobechecklistforcrosssectionalstudies.pdf