ASSESSMENT OF MENTAL HEALTH CHALLENGES AMONG FIRST-TIME MOTHERS: A CASE STUDY OF UNIVERSITY COLLEGE HOSPITAL (UCH), IBADAN

ABSTRACT

Background: The transition to first-time motherhood represents one of the most psychologically complex periods in a woman's life, characterised by hormonal upheaval, role redefinition, sleep deprivation, and heightened vulnerability to perinatal mental health disorders. Postpartum depression (PPD), anxiety, post-traumatic stress disorder (PTSD) secondary to childbirth, and puerperal psychosis constitute the major perinatal mental health conditions, collectively affecting an estimated 10–20% of women in high-income countries and up to 35% in low- and middle-income countries. This study assessed the prevalence and determinants of mental health challenges among first-time mothers receiving postnatal care at the University College Hospital (UCH), Ibadan, Oyo State, Nigeria.

Methodology: A cross-sectional descriptive study was conducted among 310 primipara mothers attending the six-week postnatal clinic at UCH Ibadan between March and August 2024. Participants were recruited using systematic random sampling. The Edinburgh Postnatal Depression Scale (EPDS; 10 items, cut-off score ≥10 for probable depression) and the Generalised Anxiety Disorder 7-item Scale (GAD-7; cut-off ≥10 for moderate-to-severe anxiety) were used alongside a researcher-developed sociodemographic and obstetric questionnaire. Data were analysed using SPSS version 27; bivariate chi-square and multivariate logistic regression analyses identified independent predictors of perinatal mental health challenges at p ≤ 0.05.

Findings: The prevalence of probable postpartum depression (EPDS ≥10) was 34.5%, while probable generalised anxiety was detected in 28.7% of participants. PTSD symptoms related to childbirth were reported by 17.2% of respondents. Key risk factors independently associated with postpartum depression included lack of partner/family social support (AOR = 4.11; 95% CI: 2.23–7.58), emergency caesarean section (AOR = 2.84; 95% CI: 1.53–5.28), history of prior mental health disorder (AOR = 3.62; 95% CI: 1.87–7.01), infant feeding difficulties (AOR = 2.37; 95% CI: 1.22–4.60), and unplanned pregnancy (AOR = 2.09; 95% CI: 1.11–3.93). Alarmingly, 81.3% of women with probable PPD had not received any mental health screening during their antenatal or postnatal contacts at UCH.

Conclusions: Mental health challenges are highly prevalent and grossly under-detected among first-time mothers at UCH Ibadan. The study underscores the critical need for universal perinatal mental health screening, integration of mental health services into routine obstetric and postnatal care, and the strengthening of psychosocial support systems for primiparae in Nigerian tertiary hospitals.

Keywords: Postpartum depression, perinatal mental health, first-time mothers, Edinburgh Postnatal Depression Scale, anxiety, UCH Ibadan, Nigeria.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Perinatal mental health disorders those occurring during pregnancy and in the first year after childbirth constitute the most common complication of childbearing globally, yet they remain among the most systematically neglected in health systems across sub-Saharan Africa. The World Health Organization estimates that 10–15% of women in high-income countries and 15.6–19.8% in low- and middle-income countries will experience a diagnosable perinatal mental health condition, with postpartum depression (PPD) being the most prevalent (WHO, 2023). In Nigeria, reported prevalences of PPD range from 17% to 42% across different studies, reflecting heterogeneous populations, varying screening instruments, and inconsistent healthcare-system screening practices (Fatoye et al., 2022; Adewuya et al., 2023).

First-time mothers primiparae are a particularly vulnerable subgroup. The absence of prior experience with labour, infant care, breastfeeding, and the profound identity shift that accompanies motherhood collectively amplify psychological stress and reduce adaptive coping capacity. Qualitative studies from Nigeria have documented themes of isolation, loss of self-identity, fear of inadequacy, relationship strain, and economic anxiety as dominant experiential features of first-time motherhood (Oluwole et al., 2022; Ekezie et al., 2023). When these subjective stressors are compounded by obstetric trauma including emergency operative delivery, perineal injury, or neonatal illness the risk of clinically significant mental health sequelae increases substantially.

The University College Hospital, Ibadan, is the oldest and one of the largest tertiary teaching hospitals in Nigeria, serving a population of several millions in Oyo State and the broader South-West region. The UCH obstetric unit delivers over 5,000 babies annually, and its postnatal clinic is the primary point of postpartum care for women discharged from the maternity ward. Despite this substantial patient volume, routine universal perinatal mental health screening is not currently institutionalised at UCH, and mental health services within the obstetric unit remain fragmented and largely reactive rather than proactive (Adewuya et al., 2023).

The consequences of undetected and untreated perinatal mental health disorders extend beyond the mother, adversely affecting mother-infant attachment, infant cognitive and emotional development, breastfeeding duration, and the broader family unit. Longitudinal evidence from low- and middle-income countries confirms that children of mothers with untreated PPD are at significantly increased risk of stunting, cognitive delays, behavioural problems, and reduced school performance (Surkan et al., 2022; Nguyen et al., 2024). These cascading intergenerational consequences underscore the public-health imperative of identifying and responding to perinatal mental health challenges among first-time mothers in Nigerian tertiary hospitals.

1.2 Statement of the Problem

Despite the high prevalence of perinatal mental health disorders documented in Nigerian studies, systematic mental health screening, diagnosis, and referral pathways remain absent from standard obstetric and postnatal care protocols at most Nigerian tertiary hospitals, including UCH Ibadan. First-time mothers, who face unique psychological vulnerabilities associated with the novelty of motherhood, represent a high-risk group that warrants targeted assessment. The absence of facility-specific prevalence data and risk-factor profiles for mental health challenges among primiparae at UCH means that clinicians lack the evidence base to advocate for and implement evidence-based screening and intervention programmes. This study addressed this critical gap by providing the first comprehensive mental health assessment of first-time mothers at UCH Ibadan.

1.3 Objectives of the Study

The broad objective was to assess the mental health challenges among first-time mothers at UCH Ibadan. Specifically, the study aimed to:

i. Determine the prevalence of postpartum depression (probable PPD, EPDS ≥10) among first-time mothers at UCH Ibadan.

ii. Assess the prevalence of generalised anxiety disorder (GAD-7 ≥10) among first-time mothers at UCH Ibadan.

iii. Determine the prevalence of childbirth-related PTSD symptoms among first-time mothers at UCH Ibadan.

iv. Identify the sociodemographic, obstetric, and psychosocial factors independently associated with mental health challenges among the study participants.

v. Assess the utilisation of mental health services, including screening and referral, by first-time mothers during their antenatal and postnatal care at UCH.

1.4 Research Questions

i. What is the prevalence of probable postpartum depression among first-time mothers attending the postnatal clinic at UCH Ibadan?

ii. What is the prevalence of probable generalised anxiety disorder among first-time mothers at UCH Ibadan?

iii. What is the prevalence of childbirth-related post-traumatic stress disorder symptoms among first-time mothers at UCH Ibadan?

iv. What sociodemographic, obstetric, and psychosocial factors are significantly associated with mental health challenges among first-time mothers at UCH Ibadan?

v. What proportion of first-time mothers with probable mental health disorders were screened or referred for mental health care during their perinatal contacts at UCH?

1.5 Hypotheses

H01: There is no statistically significant association between the mode of delivery (vaginal vs. caesarean section) and the prevalence of postpartum depression among first-time mothers at UCH Ibadan.

H02: There is no statistically significant association between the level of social support and the prevalence of generalised anxiety disorder among first-time mothers at UCH Ibadan.

H03: There is no statistically significant association between obstetric complications during labour and the prevalence of childbirth-related PTSD symptoms among first-time mothers at UCH Ibadan.

1.6 Significance of the Study

The findings of this study carry significant implications for midwifery practice, obstetric nursing, hospital policy, and maternal mental health advocacy in Nigeria. For midwives and nurses providing postnatal care at UCH, the study validates the use of the EPDS and GAD-7 as feasible, psychometrically sound screening tools in the Nigerian tertiary-hospital context, and provides normative prevalence data to justify their integration into routine postnatal assessments. For UCH hospital management and the Department of Obstetrics and Gynaecology, the evidence supports the establishment of a perinatal mental health unit or liaison psychiatry service embedded within the obstetric directorate. For the Federal Ministry of Health and the Nigerian Association of Midwives, the study contributes evidence for the revision of the national antenatal and postnatal care guidelines to include mandatory mental health screening components. Internationally, the study adds to the growing body of evidence on perinatal mental health in sub-Saharan Africa, informing WHO and UNFPA regional mental health strategies.

1.7 Scope of the Study

This study was conducted at the postnatal clinic of the University College Hospital, Ibadan, Oyo State, Nigeria, between March and August 2024. Participants comprised primiparae women who had experienced their first delivery attending the six-week postnatal visit at UCH. Women who had experienced a stillbirth or neonatal death, those with pre-existing severe psychiatric disorders currently under inpatient management, and those unable to communicate in English or Yoruba were excluded. The assessment covered postpartum depression, generalised anxiety, and childbirth-related PTSD symptoms; other perinatal mental health conditions such as puerperal psychosis and bipolar disorder were not within the study's primary scope.

1.8 Definition of Terms

Postpartum Depression (PPD): A non-psychotic depressive episode of moderate-to-severe intensity occurring within the first year after childbirth, characterised by persistent sadness, anhedonia, fatigue, cognitive impairment, and impaired bonding with the infant, in the absence of puerperal psychosis (Fatoye et al., 2022).

Edinburgh Postnatal Depression Scale (EPDS): A 10-item self-report screening questionnaire specifically designed and validated for the identification of probable postpartum depression in postnatal women; a score of ≥10 indicates probable depression and ≥13 indicates probable major depressive episode (Adewuya et al., 2023).

Generalised Anxiety Disorder (GAD): A chronic psychiatric disorder characterised by persistent, excessive, and difficult-to-control worry about multiple domains of life, accompanied by physical symptoms including tension, fatigue, and sleep disturbance (WHO ICD-11, 2022).

Post-Traumatic Stress Disorder (PTSD): A trauma- and stressor-related disorder arising after exposure to a traumatic event in this context, a distressing or life-threatening childbirth experience characterised by intrusive re-experiencing, avoidance, negative cognitions, and hyperarousal persisting for more than one month (Nguyen et al., 2024).

Primipara (First-Time Mother): A woman who has given birth to a viable infant for the first time; in this study, operationally defined as a woman attending her first six-week postnatal visit following her inaugural delivery (Oluwole et al., 2022).

Perinatal Mental Health: The spectrum of mental health conditions including depression, anxiety, PTSD, puerperal psychosis, and tokophobia that occur during pregnancy and in the first year after childbirth, affecting the mother's psychological wellbeing and her relationship with her infant (WHO, 2023).

Social Support: The perceived or actual availability of emotional, informational, instrumental, and appraisal assistance from a partner, family members, friends, and/or healthcare providers, which buffers the psychological impact of stressors associated with new motherhood (Surkan et al., 2022).

Puerperal Psychosis: A rare, severe psychiatric emergency occurring within two weeks of childbirth, characterised by abrupt onset of psychotic symptoms including delusions, hallucinations, disorganised thought, and markedly disturbed behaviour, requiring immediate psychiatric hospitalisation (WHO, 2023).

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