Factors associated with a positive Tilburg Pregnancy Distress Scale among hospitalized Ghanaian obstetric patients

Abstract

Background: Psychological distress during the antenatal and postpartum period can negatively impact the quality of life and health of the pregnant person and fetus(es). But there is a discrepancy between Ghanaian community prevalence and engagement with mental health services leading to underdiagnosis and missed therapeutic opportunities. Therefore, it is important to identify factors that contribute to the gap of underdiagnosis and treatment, and screening for pregnancy distress is the first step in bridging this gap.

Objective: To identify factors associated with increased prenatal and postpartum pregnancy distress via the administration of the Tilburg Pregnancy Distress Scale (TPDS).

Study design: We performed a cross-sectional study of obstetric patients who were admitted at the largest referral teaching hospital in urban Ghana between November 20, 2023, and December 22, 2023. Patients were eligible to participate if they were admitted to the 275-bed maternity block for an antepartum or postpartum indication, alert and oriented, and able to speak one of the following languages: English, Twi, or Ga. Patients below the age of 18 years, or critically ill or unstable were excluded. Participants were asked about their socioeconomics, medical history, current pregnancy and/or delivery outcomes, and satisfaction with care. All patients then completed the validated TPDS, a multiple-choice questionnaire to determine the level of pregnancy or postpartum-related distress.

Results: Among hospitalized obstetric patients in Ghana, less than 1% reported a diagnosed depression, anxiety, or mental health disorder. However, over 37% of our participants, both antepartum and postpartum, screened positive for pregnancy distress using the TPDS. Among antepartum participants, young age, low household income, and low parity were significantly associated with a positive pregnancy distress screen. Among postpartum participants, no factors were significantly associated with a positive screen in the final, controlled, model.

Conclusion: Our study is the first to identify factors associated with Ghanaian patients' pregnancy distress, which can contribute to pregnancy, maternal, and child health consequences. Over one-third of obstetric patients screened positive on the TPDS with prevalence rates comparable across antepartum and postpartum patients. Our study identified antepartum patient factors of young age, low income, and low parity for increased positive screening on the TPDS. Identifying Ghanaian pregnant patients with these factors may help to target those at the greatest need for increased screening and monitoring, which is aligned with the Sustainable Development Goals.

Keywords: child health; depression with peripartum onset; low- and middle-income countries; maternal health; mental health; neonatal health; public health.