Abstract
Background:
The transition to motherhood is often characterized by physical recovery, hormonal fluctuations, sleep deprivation, and the challenges of infant care, all of which can contribute to the vulnerability of mothers to mental health issues. The present study was conducted to estimate the burden of poor mental health status of lactating women in urban slums and rural communities.
Materials and Methods:
A cross-sectional study was conducted on 220 lactating women residing in urban slums and rural areas of Ananthapuramu district. Data was collected by interview method using a pre-designed, semi-structured questionnaire that included Depression, Anxiety, and Stress Scale (DASS-21) for mental health assessment. Multivariate regression analysis was done to determine the predictors for poor mental health status of lactating women.
Results:
The overall prevalence of mental health issues in lactating women from rural and urban slums was 23.6% and 27.3%, respectively. Predictors for poor mental health of lactating women from rural backgrounds were primipara, lower segment cesarean section (LSCS) type of delivery, and class III socioeconomic status (SES) women, and for urban slums were nuclear family, breastfeeding for less than eight times per day, class III SES women, and intended pregnancy.
Conclusions:
Almost one in every fourth of lactating women residing in urban slums and rural areas will suffer from mental health issues. LSCS type of delivery and class IV and V SES have a negative impact on the mental health status of lactating women from rural areas. Nuclear family, breastfeeding less than eight times per day, class IV and V SES, and unintentional pregnancy have negative impacts in urban slums.
Keywords: DASS-21, lactating women, mental health, rural, South India, urban slum
BACKGROUND
The journey of motherhood is a profound and transformative experience, marked by the birth of a new life and the emergence of a nurturing bond between a mother and her child. The mental health of lactating women plays a crucial role in adaptation to their new roles and responsibilities.[1] The transition to motherhood is often characterized by physical recovery, hormonal fluctuations, sleep deprivation, and the challenges of infant care, all of which can contribute to the mental health issues of lactating women. This again can be influenced by the individual conditions of lactating women, such as beliefs, preparedness, and knowledge towards child rearing, social and economic conditions of the family, and prior psychological status of the mother.[2,3,4,5]
As per World Health Organization (WHO), approximately 10% of pregnant women and 13% of lactating women, experience a mental disorder, most commonly depression.[6] This was even higher in low- and middle-income countries, with 15.6% during pregnancy and 19.8% after childbirth.[7] International data obtained from high-, middle-, and low-income countries, suggest that perinatal mental illness was more prevalent in rural women compared to their urban counterparts and the general population.[7,8] As the burden of mental disorders such as depression, anxiety, and stress during the lactating period is increasing in the modern world, adverse outcomes such as lowering breastfeeding self-efficacy and poor mother-infant bond need to be acknowledged.[9,10]
Given the consequences associated with it, addressing the exact burden of mental disorders during the lactating period is vital for safe motherhood and healthy child growth. So, the present study was conducted to estimate the burden of poor mental health status among lactating women of urban slums and rural communities and to determine the influence of sociodemographic factors, breastfeeding practices, and factors of motherhood on poor mental health status of lactating women residing in urban slums and rural areas separately.
MATERIALS AND METHODS
Study design
A community-based cross-sectional study.
Study setting
The study was conducted in four urban slums (Aravind Nagar, Obuldev Nagar, Krupananda Nagar, and Vidhyuth Nagar), under UHTC Bukkarayasamudram and four rural areas (Vimala Farook Nagar, Chandrababu Kottalu 1 and 2, and Panthula Colony) under RHTC Atmakur, Department of Community Medicine, Government Medical College, Ananthapuramu, Andhra Pradesh.
Study duration
From August 2022 to February 2023.
Study population
All the lactating women residing in the study setting were eligible to participate in the study.
Inclusion criteria: Participants who are giving exclusive breastfeeding, and residing in the same area at least for a period of 6 months were considered for the study.
Exclusion criteria: Participants who were already on medication for mental illness, not available at their houses even after three consecutive visits, and had not shown willingness to participate were excluded.
Sample size
The sample size was calculated by using the formula given in the WHO manual for sample size determination.[11]
The majority of previous studies focused on depression, anxiety, and stress separately, without evaluating them collectively. Thus, to address this gap, we accounted for a 50% burden of poor mental health status among lactating women in both rural and urban slums. The calculated minimum sample size was 216, considering a relative precision of 14% at a significance level of 5% and incorporating a non-response rate of 10%. After rounding off, a total of 220 lactating women were recruited from urban slums and rural areas.
Sampling technique
Simple random sampling by random number table was used to enroll the eligible lactating women from the study area, after collecting a complete list of lactating women from Anganwadi centers.
Study tool
The lactating women were interviewed using a pre-designed, semi-structured questionnaire, which contains questions about sociodemographic characteristics, perinatal history, and mental health status assessment.
Variables: Sociodemographic characteristics include essential patient information such as age, education, occupation, place of residence, religion, type of family, and socioeconomic status (SES). Perinatal history consists of parity, mode of delivery, gender of child, and frequency of breastfeeding. To evaluate the mental health status of lactating women, the short form of Depression, Anxiety, and Stress Scale (DASS-21) was used.[12] The reliability of this DASS-21 scale in the current study setting was 0.81. The questionnaire consists of 21 items, that can assess Depression, Anxiety, and Stress separately with seven items each. These seven items of each scale are graded on a Likert scale from 0 to 3 (0: “Did not apply to me at all,” 1: “Applied to me to some degree or some of the time,” 2: “Applied to me to a considerable degree or a good part of the time,” and 3: “Applied to me very much or most of the time”). The total score for each subscale can be obtained by summing up related seven items and multiplying by two. The lactating women with scores of 10 and above in the Depression subscale, 8 and above in the Anxiety subscale, and 15 and above in the Stress subscale were labeled as having Depression, Anxiety, and Stress, respectively.
Data collection
Urban slums and rural areas were chosen based on their distances from the urban health training center (UHTC) and rural health training center (RHTC). The first area was the farthest, the second was the closest, and the remaining two were in between. The list of the lactating women residing in these areas was collected from respective Anganwadi centers. After considering inclusion and exclusion criteria, the eligible lactating women were entered into a random number table for the random selection. The selected participants were approached at their houses by the principal investigator with the assistance of Anganwadi workers and Accredited Social Health Activist (ASHA). The principal investigator introduced themselves and explained the purpose of the visit to both lactating women and their family members and obtained consent. The lactating women who agreed to participate in the study were interviewed using a questionnaire, which was translated into their local language (Telugu or Urdu) for better understanding. The same procedure was continued for all the lactating women residing in both urban slums and rural areas until the estimated sample size was reached. Finally, the overall mental health status of lactating women was assessed by considering the presence of either depression, anxiety, or stress. The mental health status of lactating women was categorized as poor if either depression, anxiety, or stress was present and categorized as good if none of them were present. The entire plan of the study and the flow of the participants were presented as a flow diagram in Figure 1.
Figure 1.
Study plan and Flow of the Study Participants
Human subject protection
We obtained ethical clearance before starting the study from the Institutional Ethical Committee (IEC), Government Medical College, Ananthapuramu (Ref. No.: 2-5-22; dated 04/05/2022). Informed consent from all the study participants was also obtained in the local language, both for participation and publication of the findings.
Statistical analysis
Data collected from the participants were entered into Microsoft Excel version 2405 (Microsoft office suite 2021, Microsoft Corporation, Redmond, Washington, USA). Categorical variables were presented in proportions and associations were tested using Chi-square statistics with or without Yate’s correction. We conducted univariate analysis followed by multivariate regression analysis to determine the predictors for poor mental health status among lactating women of urban slums and rural areas. Predictor variables with P value <0.2 in univariate analysis were included for multivariate regression analysis. Risk for poor mental health status was presented with adjusted odds ratio (aOR) with an appropriate 95% confidence interval (CI). For all the comparisons, a probability value of less than 0.05 was considered statistically significant.
RESULTS
Table 1 presents a comparison of the sociodemographic characteristics of lactating women in urban slums and rural areas. Most factors were similar between the two groups, except for religion (where the proportion of Hindus was higher in urban slums and Muslims were more common in rural areas), type of family (where the proportion of joint and three-generation families was higher in rural areas), and SES (where the proportion of class IV and V was higher in rural areas).
Table 1.
Sociodemographic characteristics of Lactating Women of Rural and Urban slums
| Variable | Overall patients (n=220) | Rural (n=110) | Urban (n=110) | χ2 (df) | P |
|---|---|---|---|---|---|
| Age | |||||
| 24 years and below | 136 (61.8%) | 72 (65.5%) | 64 (58.2%) | 1.232 (1) | 0.267; NS |
| Above 24 years | 84 (38.2%) | 38 (34.5%) | 46 (41.8%) | ||
| Education | |||||
| Degree and above | 60 (27.3%) | 28 (25.5%) | 32 (29.1%) | 0.367 (1) | 0.545; NS |
| No degree | 160 (72.7%) | 82 (74.5%) | 78 (70.9%) | ||
| Employment | |||||
| In paid employment | 22 (10%) | 12 (10.9%) | 10 (9.1%) | 0.202 (1) | 0.653; NS |
| Not in paid employment | 198 (90%) | 98 (89.1%) | 100 (90.9%) | ||
| Religion | |||||
| Hindu | 160 (72.7%) | 70 (63.6%) | 90 (81.8%) | 11.59 (2) | 0.003; S |
| Muslim | 44 (20%) | 32 (29.1%) | 12 (10.9%) | ||
| Christian | 16 (7.3%) | 8 (7.3%) | 8 (7.3%) | ||
| Type of family | |||||
| Nuclear | 74 (33.6%) | 22 (20%) | 52 (47.3%) | 18.326 (1) | <0.001; S |
| Three-generation and Joint | 146 (66.4%) | 88 (80%) | 58 (52.7%) | ||
| Socioeconomic status | |||||
| Class I and II | 39 (17.7%) | 13 (11.8%) | 26 (23.6%) | 11.478 (2) | 0.003; S |
| Class III | 94 (42.7%) | 42 (38.2%) | 52 (47.3%) | ||
| Class IV and V | 87 (39.6%) | 55 (50%) | 32 (29.1%) | ||
| Parity | |||||
| One | 104 (47.3%) | 50 (45.5%) | 54 (49.1%) | 0.292 (1) | 0.589; NS |
| Two or more | 116 (52.7%) | 60 (54.5%) | 56 (50.9%) | ||
| Mode of delivery | |||||
| LSCS | 57 (25.9%) | 24 (21.8%) | 33 (30%) | 1.918 (1) | 0.166; NS |
| NVD | 163 (74.1%) | 86 (78.2%) | 77 (70%) | ||
| Gender of child | |||||
| Male child | 99 (45%) | 51 (46.4%) | 48 (43.6%) | 0.165 (1) | 0.685; NS |
| Female child | 121 (55%) | 59 (53.6%) | 62 (56.4%) | ||
| Intended pregnancy | |||||
| Yes | 185 (84.1%) | 90 (81.8%) | 95 (86.4%) | 0.849 (1) | 0.357; NS |
| No | 35 (15.9%) | 20 (18.2%) | 15 (13.6%) | ||
| Frequency of breastfeeding | |||||
| Less than eight times a day | 22 (10%) | 12 (10.9%) | 10 (9.1%) | 0.202 (1) | 0.653; NS |
| Eight times and above a day | 198 (90%) | 98 (89.1%) | 100 (90.9%) | ||
df=Degree of freedom; S=Significant; NS=Not Significant
The overall prevalence of mental health issues in rural lactating women was 23.6% [26 out of 110], in which depression [n = 14; 12.7%] was the commonest mental health issue, followed by anxiety [n = 13; 11.8%], and stress [n = 8; 7.3%]. In urban slums, the overall prevalence of mental health issues was 27.3% [30 out of 110], in which anxiety [n = 19; 17.3%] was the commonest mental health issue, followed by depression [n = 18; 16.4%], and stress [n = 14; 12.7%]. The burden of depression, anxiety, stress individually, and mental health status as a whole among lactating women was reported to be almost similar in rural and urban slums [Table 2].
Table 2.
Burden of Mental health issues of Lactating Women of Rural and Urban slums
| Variable | Overall patients (n=220) | Rural (n=110) | Urban (n=110) | Odds ratio (95% CI) | P |
|---|---|---|---|---|---|
| Mental health issues | |||||
| Depression | 32 (14.5%) | 14 (12.7%) | 18 (16.4%) | 0.75 (0.35–1.58) | 0.445; NS |
| Anxiety | 32 (14.5%) | 13 (11.8%) | 19 (17.3%) | 0.64 (0.30–1.37) | 0.254; NS |
| Stress | 22 (10%) | 8 (7.3%) | 14 (12.7%) | 0.54 (0.22–1.34) | 0.183; NS |
| Overall mental health status | |||||
| Poor mental health | 56 (25.5%) | 26 (23.6%) | 30 (27.3%) | 0.83 (0.45–1.52) | 0.536; NS |
| Good mental health | 164 (74.5%) | 84 (76.4%) | 80 (72.7%) | ||
CI=Confidence Intervals; NS=Not Significant
In rural lactating women as per univariate analysis, predictors such as Muslim by religion [OR 5.27, 95% CI 1.96–14.2], primipara [OR 2.92, 95% CI 1.17–7.32], lower segment cesarean section (LSCS) type of delivery [OR 5.14, 95% CI 1.92–13.8], and breastfeeding for less than eight times per day [OR 5.82, 95% CI 1.66–20.4], have significantly higher risk for poor mental health. On the contrary, class III SES women [OR 0.23, 95% CI 0.06–0.91] and women intended for pregnancy [OR 0.22, 95% CI 0.08–0.61] have a lower risk for poor mental health. With multivariate regression analysis, predictors such as primipara [aOR 6.16, 95% CI 1.55–24.5], and LSCS type of delivery [aOR 8.63, 95% CI 2.01–37.0] were found to have higher risk and class III SES women [aOR 0.13, 95% CI 0.02–0.90] have lower risk for poor mental health [Table 3].
Table 3.
Predictors of poor mental health status in rural lactating women
| Variable | No. of participants (n=110) | Mental health status |
Unadjusted OR (95% CI) | Adjusted OR (95% CI) | |
|---|---|---|---|---|---|
| Poor (n=26) | Good (n=84) | ||||
| Age | |||||
| 24 years and below | 72 | 18 (25%) | 54 (75%) | 1.25 (0.49–3.22) | - |
| Above 24 years | 38 | 8 (21.1%) | 30 (78.9%) | ||
| Education | |||||
| Degree and above | 28 | 4 (14.3%) | 24 (85.7%) | 0.46 (0.14–1.46) | 0.22 (0.04–1.33) |
| No degree | 82 | 22 (26.8%) | 60 (73.2%) | ||
| Employment | |||||
| In paid employment | 12 | 4 (33.3%) | 8 (66.7%) | 1.73 (0.48–6.28) | - |
| Not in paid employment | 98 | 22 (22.4%) | 76 (77.6%) | ||
| Religion | |||||
| Hindu | 70 | 9 (12.9%) | 61 (87.1%) | Reference category | |
| Muslim | 32 | 14 (43.8%) | 18 (56.2%) | 5.27* (1.96–14.2) | 2.82 (0.78–10.2) |
| Christian | 8 | 3 (37.5%) | 5 (62.5%) | 4.07 (0.83–20.0) | 4.20 (0.49–36.3) |
| Type of family | |||||
| Nuclear | 22 | 8 (36.4%) | 14 (63.6%) | 2.22 (0.81–6.11) | 1.16 (0.24–5.70) |
| Three-generation and Joint | 88 | 18 (20.5%) | 70 (79.5%) | ||
| Socioeconomic status | |||||
| Class I and II | 13 | 6 (46.2%) | 7 (53.8%) | Reference category | |
| Class III | 42 | 7 (16.7%) | 35 (83.3%) | 0.23* (0.06–0.91) | 0.13* (0.02–0.90) |
| Class IV and V | 55 | 13 (23.6%) | 42 (76.4%) | 0.36 (0.10–1.27) | 0.16 (0.02–1.21) |
| Parity | |||||
| One | 50 | 17 (34%) | 33 (66%) | 2.92* (1.17–7.32) | 6.16* (1.55–24.5) |
| Two or more | 60 | 9 (15%) | 51 (85%) | ||
| Mode of delivery | |||||
| LSCS | 24 | 12 (50%) | 12 (50%) | 5.14* (1.92–13.8) | 8.63* (2.01–37.0) |
| NVD | 86 | 14 (16.3%) | 72 (83.7%) | ||
| Gender of child | |||||
| Male child | 51 | 15 (29.4%) | 36 (70.6%) | 0.55 (0.23–1.34) | 0.71 (0.21–2.35) |
| Female child | 59 | 11 (18.6%) | 48 (81.4%) | ||
| Intended pregnancy | |||||
| Yes | 90 | 16 (17.8%) | 74 (82.2%) | 0.22* (0.08–0.61) | 0.26 (0.06–1.17) |
| No | 20 | 10 (50%) | 10 (50%) | ||
| Frequency of breastfeeding | |||||
| Less than eight times a day | 12 | 7 (58.3%) | 5 (41.7%) | 5.82* (1.66–20.4) | 4.20 (0.71–24.7) |
| Eight times and above a day | 98 | 19 (19.4%) | 79 (80.6%) | ||
*Statistically significant; OR=Odds ratio; CI=Confidence Interval
In lactating women of urban slums as per univariate analysis, predictors such as primipara [OR 4.13, 95% CI 1.64–10.4], nuclear family [OR 3.00, 95% CI 1.24–7.24], and LSCS type of delivery [OR 3.44, 95% CI 1.42–8.37] have significantly higher risk for poor mental health. On the contrary, women intended for pregnancy [OR 0.13, 95% CI 0.04–0.43] have lower risk for poor mental health. With multivariate regression analysis, predictors such as nuclear family [aOR 4.15, 95% CI 1.38–12.5], and breastfeeding for less than eight times per day [aOR 5.27, 95% CI 1.03–27.0] were found to have higher risk and class III SES women [aOR 0.15, 95% CI 0.04–0.96] and intended pregnancy [aOR 0.20, 95% CI 0.04–0.96] have lower risk for poor mental health [Table 4].
Table 4.
Predictors of Mental Health Status in Urban Lactating Women
| Variable | No. of participants (n=110) | Mental health status |
Unadjusted Odds ratio (95% CI) | Adjusted OR (95% CI) | |
|---|---|---|---|---|---|
| Poor (n=30) | Good (n=80) | ||||
| Age | |||||
| 24 years and below | 64 | 22 (34.4%) | 42 (65.6%) | 2.49 (0.99–6.25) | 1.35 (0.36–5.03) |
| Above 24 years | 46 | 8 (17.4%) | 38 (82.6%) | ||
| Education | |||||
| Degree and above | 32 | 11 (34.4%) | 21 (65.6%) | 1.63 (0.67–3.97) | - |
| No degree | 78 | 19 (24.4%) | 59 (75.6%) | ||
| Employment | |||||
| In paid employment | 10 | 5 (50%) | 5 (50%) | 3.00 (0.80–11.2) | 2.93 (0.58–14.9) |
| Not in paid employment | 100 | 25 (25%) | 75 (75%) | ||
| Religion | |||||
| Hindu | 90 | 26 (28.9%) | 64 (71.1%) | Reference Category | |
| Muslim | 12 | 2 (16.7%) | 10 (83.3%) | 0.49 (0.10–2.40) | - |
| Christian | 8 | 2 (25%) | 6 (75%) | 0.82 (0.16–4.33) | - |
| Type of family | |||||
| Nuclear | 52 | 20 (38.5%) | 32 (61.5%) | 3.00* (1.24–7.24) | 4.15* (1.38–12.5) |
| Three-generation and Joint | 58 | 10 (17.2%) | 48 (82.8%) | ||
| Socioeconomic status | |||||
| Class I and II | 26 | 9 (34.6%) | 17 (65.4%) | Reference Category | |
| Class III | 52 | 9 (17.3%) | 43 (82.7%) | 0.39 (0.13–1.17) | 0.15* (0.04–0.96) |
| Class IV and V | 32 | 12 (37.5%) | 20 (62.5%) | 1.13 (0.39–3.34) | - |
| Parity | |||||
| One | 54 | 22 (40.7%) | 32 (59.3%) | 4.13* (1.64–10.4) | 1.45 (0.40–5.34) |
| Two or more | 56 | 8 (14.2%) | 48 (85.7%) | ||
| Mode of delivery | |||||
| LSCS | 33 | 15 (45.5%) | 18 (54.5%) | 3.44* (1.42–8.37) | 2.10 (0.66–6.73) |
| NVD | 77 | 15 (19.5%) | 62 (80.5%) | ||
| Gender of child | |||||
| Male child | 48 | 11 (22.9%) | 37 (77.1%) | 1.47 (0.63–3.52) | - |
| Female child | 62 | 19 (30.6%) | 43 (69.4%) | ||
| Intended pregnancy | |||||
| Yes | 95 | 20 (21.1%) | 75 (78.9%) | 0.13* (0.04–0.43) | 0.20* (0.04–0.96) |
| No | 15 | 10 (66.7%) | 5 (33.3%) | ||
| Frequency of breastfeeding | |||||
| Less than eight times a day | 10 | 5 (50%) | 5 (50%) | 3.00 (0.80–11.2) | 5.27* (1.03–27.0) |
| Eight times and above a day | 100 | 25 (25%) | 75 (75%) | ||
*Statistically significant; OR=Odds ratio; CI=Confidence Interval
DISCUSSION
This study was an attempt to understand the influence of sociodemographic and obstetric factors on mental health status of lactating women residing in rural and urban slums separately. The reported burden of overall poor mental health status of lactating women living in the rural and urban slums was 23.6% and 27.3%, respectively. However, an international study done at Qaliubeya Governorate, Egypt, reported a considerable burden of overall mental health issues in lactating women, with a burden of 32.9% in rural areas, and 42.9% in urban slums.[13] Another study done in urban slums of Dhaka, Bangladesh, also reported a considerable burden of overall mental health issues (46.2%). It suggests that the burden of overall mental health status of lactating women in developing countries was huge and varies from country to country, with a burden of 31.2% in Vietnam, 39.4% in Ethiopia, and 30% in Peru.[14,15]
The reported proportion of depression, anxiety, and stress in rural lactating women was 12.7%, 11.8%, and 7.3%, respectively, and in urban slums was 16.4%, 17.3%, and 12.7%, respectively. The burden of depression in the current study area was less compared to rural Karnataka, India, and urban slums of Dhaka, Bangladesh, where the reported prevalence of post-natal depression was 31.4% and 39.4%, respectively.[16,17] Another study from Qaliubeya Governorate, Egypt, also reported a high prevalence of depression and anxiety in both rural areas and urban slums, with a burden of 23.7% depression and 29.5% anxiety in rural areas and 31.9% depression and 41.9% anxiety in urban slums.[13] But another study from rural Karnataka, India, reported a similar prevalence of post-partum depression (12.5%) and anxiety (11.3%).[18] The variation in burden observed can be attributed to the utilization of various study tools, as well as differences in sociocultural norms, and levels of poverty.
The current study reported that primipara, LSCS type of delivery, and class III SES were significant predictors of the mental health status of lactating women from a rural community. But in urban communities, nuclear family, breastfeeding less than eight times per day, class III SES, and intended to be pregnant were significant predictors of the mental health status of lactating women. Among the aforementioned predictors, the recognized modifiable factors associated with good mental health status among lactating women were class III SES in rural areas and breastfeeding more than eight times daily, having class III SES, and intending to become pregnant in urban slums. It is vital to delve deeper into these modifiable factors as they can aid new mothers in preparing for the mental health challenges they may face after childbirth.
Class III SES was a common modifiable predictor with a lower risk for poor mental health status of lactating women from both urban slums and rural areas. This finding was supported by US- and Egypt-based studies, where lactating women from both rural and urban localities reported to health facilities studied.[13,19] This could be due to the cumulative impact of socioeconomic disadvantage with decreased financial resources, resulting in neglected access to mental health services and reduced interest in disclosing mental health symptoms to healthcare professionals.[20,21]
Moreover, the poor mental health status of lactating women from the rural community was influenced by primiparity and LSCS type of delivery. Primipara women have poorer mental health status than multipara because multipara will acquire high levels of maturity and life experience that enable them to cope with the emotions associated with motherhood more than primipara.[22] Poor mental health status in LSCS delivery will be caused by disruption of the normal labor physiology with a dysregulated hormonal environment of deficiency in oxytocin and cortisol.[23,24]
The current study showed that intended pregnancy was a positive modifiable factor in determining mental health, especially for lactating women in urban slums. Similar findings were reported in a study conducted in the urban slums of Dhaka, Bangladesh.[17] A patient-centered approach, guiding women to make independent decisions for conceiving, and access to different contraceptives, may help women to control unintended pregnancies.[25]
Strengths and limitations
The main strength of the study was assessing overall mental health status by considering depression, anxiety, and stress together. The assessment was made separately for rural and urban slums, which are expected to have different demographic characteristics.
Though the study was well planned, a few limitations need to be addressed. First, the cross-sectional nature of the study makes it unable to conclude the directionality or causality of the relationship between factors and the mental health status of lactating women. Second, the mental health status was assessed based on the self-reporting of symptoms from the participants rather than a professional diagnosis. Due to the stigma of reporting symptoms of mental illness, the burden of depression, anxiety, and stress might be underestimated in these areas.
CONCLUSIONS AND RECOMMENDATIONS
Almost one in every fourth of lactating women residing in either urban slums or rural areas will suffer from mental health issues in the form of depression, anxiety, and stress. Primiparity, LSCS type of delivery, and class IV and V SES have negative impacts on the mental health status of lactating women from rural areas. Nuclear family, breastfeeding less than eight times per day, class IV and V SES, and unintentional pregnancy have negative impacts on the mental health status of lactating women from urban slums. By considering the burden and the influencing risk factors, it is recommended that lactating women be screened for mental health status during post-natal visits and appropriate management needs to start immediately. It is again instructed to educate about the contextually relevant risk factors of poor mental health and coping strategies as a part of the training component.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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