This study showed a high prevalence of 37.8% which is comparable to some other Nigerian studies done in similar hospital setting20,23. In Nigeria varying rates from 10–44% has been reported from different regions of the country21,24−26. This wide range prevalence is also reflected in Africa as well as other continents27. However, majority of developing countries have estimated prevalence rates higher than that those found in high-income countries27,28,29. This variability from country to country could be due to study design (diagnostic tool, cut off scores, period of assessment), cross cultural differences, socio-economic terrain, and perception of PPD/ mental health. This further indicates that a woman’s susceptibility to postpartum depression is not based on geographical location but on social, economic, psychological and biological factors that thrive in enabling environments.
With three quarter of the women reporting moderate to high physical activity (PA), prevalence of physical activity was quite high (72.1%). Although there was no exact study measuring PA in postpartum women in Nigeria, however two Nigerian studies report 79% and 52.2% postnatal exercises engagement30,31 with activity participation differing from this study. Other foreign studies have shown lower physical activity levels16,32. Though High PA in this study could be due to the economic terrain which necessitates a woman getting back to work shortly after whilst joggling home care, the high levels of PA could be because a one-year range was used. Physical activity was found to be lesser in the immediate postpartum period and increased constantly throughout the postpartum period. This may also have influenced the high rate reported. The increasing levels of PA down the postpartum period may reflect the reduction in help and support earlier received and more women being comfortable participating in PA. This was similarly reported by Borodulin et al. (2009)33. Women think it unsafe to participate in physical activity earlier than three months postpartum31.
There was no statistically significant association between postpartum depression and physical activity (PA) levels in this study. This was similarly reported by Daley et al. (2008) and Saligheh, et al. (2014)7,34. The latter was a cross sectional study assessing physical activity and postpartum depression amongst women from post puerperal to the first-year post delivery, similar with this present study. Other studies however report exercise to be effective in preventing and treating mild to moderate depression18.19,35−38. These studies were either experimental or a review of literature. Although there was no significant association, high PA increased the chances of developing PPD symptoms as compared to lower PA. This finding is buttressed by Demissie et al. (2011) who reported women who had high levels of PA had twice the risk of developing elevated depressive symptoms17. High PA in this study involved vigorous exercises which were household activities and walking than activities performed for leisure. It has been reported that leisure/outdoor physical activity reduces PPD as compared to activities due to childcare or household work17,39
Age of child which is illustrative of the postpartum period was significantly associated with postpartum depression. Mothers with younger babies were less likely to have postpartum depression compared with older babies. This finding is similar with those of Saligheh et al. (2014) and Shorey et al. (2018)34,40. Shorey et al. (2018) who reviewed the literature using healthy women noted a general increasing prevalence with age of child. Age of child, which is a proxy for postpartum period, was associated with an increase in prevalence of postpartum depression as the period progresses. Bugdayci, et al. (2004) reports PPD prevalence increased from 29% (0-2-month) to 36% (7-12months) and higher above 13 months41. This increase in PPD may account for higher outcomes of PPD in later postpartum periods than earlier ones2,42. With the significant waning of physical, financial and emotional support from friends and family coupled with the mother’s full participation in home activities, childcare, employment and/or business, one might see how this could account for increased PPD.
Most studies have found positive association between relationship satisfaction and PPD, this study wasn’t any different. Whilst marital satisfaction has been suggested as a mild predictor of PPD, its effect is majorly based on the perceived level of support; physical, financial and emotional the woman receives in the relationship3,43,44. This same perceived satisfaction can be connected to the effect family setting has on PPD. In this study family setting was independently associated with postpartum depression with polygamy conferring a three-fold increase in postpartum depression than women in monogamous marriage. This finding is similarly reported in other studies done in traditional societies44,45. In contrast, Ghosh & Goswami (2011) and Rahman et al. (2003) found women coming from nuclear family suffer more from PPD46,47. The quality of the relationship with the husband and type of support received could determine the impact of family setting on postpartum symptoms.
Gender of the child showed a positive risk factor for postpartum depression. This is similar to other studies done both in Nigeria11 and other traditional societies43,48 where the husband’s or even the wife’s disappointment with the gender of the baby is significantly associated with developing postpartum depression, specifically if the baby is a girl. This is especially seen if the woman already had a female child. This preference most Africans have for male children as heirs and progenitor of family puts pressure on the woman. Comparably, in some western studies similar relationship did not exist between the gender of the child and postpartum depression29,49.