Pain and associated factors in depressed and non depressed puerperal women

Angelo, Rita di Cássia de Oliveira; Sabino, Lorena Ferreira; Schwingel, Paulo Adriano; Lima, Antonio Plauto Oliveira; Zambaldi, Carla Fonseca; Cantilino, Amaury; Sougey, Everton Botelho

doi:10.5935/1806-0013.20140022

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ORIGINAL ARTICLES • Rev. dor 15 (2) • Apr-Jun 2014 • https://doi.org/10.5935/1806-0013.20140022 copy

Pain and associated factors in depressed and non depressed puerperal women^* * Received from Federal University of Pernambuco, Post-Graduation Program in Neuropsychiatry and Behavioral Sciences, Recife, PE, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND AND OBJECTIVES:

Physical pain during puerperium is in general caused by musculoskeletal changes inherent to gestation; however, its clinical progression may be changed by mood disorders. This study aimed at evaluating the association between pain and postpartum depression.

METHODS:

Participated in the study 80 women at 2 to 30 weeks postpartum. Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale. Pain intensity was evaluated with the analog visual scale, while the Nordic Musculoskeletal Questionnaire was used for pain location.

RESULTS:

Univariate analysis has shown that postpartum depression was associated to more severe pain (p<0.001), to constant mood changes (p=0.001), to early sexual initiation (p<0.05) and to a larger number of people living together (p<0.05). Chest was the most common painful site referred by depressed puerperal women (p=0.01). Logistic regression analysis has shown that moderate to severe pain was a strong predictor of postpartum depression (OR=4.6; confidence interval 95%: 1.5-13.9).

CONCLUSION:

Moderate to severe pain increases the probability of puerperal women developing postpartum depressive symptoms.

Musculoskeletal pain; Pain measurement; Postpartum depression

Variables		DP (n=26) (%)	NDP (n=54) (%)	p value^* * p<0.05 statistically significant
Age (years) (Mean ± SD)		25.3±4.6	27.3±6.3	0.167^c c Student's t test for independent samples.
	Marital status
	Married	6 (23.1)	15 (27.8)	0.766^a a Pearson Chi-square
	Consensual union	18 (69.2)	33 (61.1)
	Single	2 (7.7)	6 (11.1)
Marital relationship
	Good	22 (84.6)	47 (87.0)	0.453^a a Pearson Chi-square
	Bad	2 (7.7)	2 (3.7)
	No answer	2 (7.7)	5 (9.3)
Education level (years)
	0 to 8	9 (34.6)	19 (35.2)	0.260^a a Pearson Chi-square
	9 to 11	17 (65.4)	30 (55.6)
	12 to 17	0 (0.0)	5 (9.3)
	Family income (Mean ±SD)	1060.9±985.3	1085.8±898.0	0.911^c c Student's t test for independent samples.
Number of people living together
	1 to 3	14 (51.9)	38 (70.4)	0.070^a a Pearson Chi-square
	4 to 6	10 (37.0)	16 (29.6)
	>6	2 (7.4)	0 (0.0)
Working during current gestation
	Yes	14 (53.8)	24 (44.4)	0.430^a a Pearson Chi-square
	No	12 (46.2)	30 (55.6)	0.430^a a Pearson Chi-square
Position during work
	Sitting down	3 (21.4)	5 (20.8)	0.873^a a Pearson Chi-square
	Standing up	10 (71.4)	16 (66.7)
	Walking	1 (7.1)	3 (12.5)
Domestic tasks
	Yes	26 (100.0)	51 (94.4)	0.221^b b Fisher Exact test
	No	0 (0.0)	3 (5.6)	0.221^b b Fisher Exact test
Changing diapers
	Yes	26 (100.0)	52 (96.3)	1.000^b b Fisher Exact test
	No	0 (0.0)	2 (3.7)	1.000^b b Fisher Exact test
Height of diapers changing place
	High	5 (19.2)	15 (28.8)	0.359^b b Fisher Exact test
	Low	21 (80.8)	37 (71.2)	0.359^b b Fisher Exact test
How the baby is carried
	In stroller	1 (3.8)	5 (9.3)	0.658^b b Fisher Exact test
	On lap	25 (96.2)	49 (90.7)	0.658^b b Fisher Exact test
Pain (intensity)
	Moderate/severe	18 (69.2)	15 (27.2)	<0.00l^a b Fisher Exact test
	Absent/mild	8 (30.8)	39 (72.2)	<0.00l^a b Fisher Exact test
Mood changes
	Yes	25 (96.2)	34 (63.0)	0.001^b b Fisher Exact test
	No	1 (3.8)	20 (37.0)	0.001^b b Fisher Exact test
	Smoking
	Yes	1 (3.8)	0 (0.0)	0.325^b b Fisher Exact test
	No	25 (96.2)	54 (100.0)	0.325^b b Fisher Exact test
Alcoholism
	Yes	15 (57.7)	17 (31.5)	0.025^a a Pearson Chi-square
	No	11 (42.3)	37 (68.5)	0.025^a a Pearson Chi-square
Sexual initiation (years)
	≤ 18	23 (88.5)	34 (63.0)	0.020^b b Fisher Exact test
	>18	3 (11.5)	20 (37.0)	0.020^b b Fisher Exact test
Use of contraceptive
	Yes	16 (61.5)	36 (66.7)	0.652^a a Pearson Chi-square
	No	10 (38.5)	18 (33.3)	0.652^a a Pearson Chi-square
Number of children
	1	5 (19.2)	20 (37.0)	0.252^a a Pearson Chi-square
	2 to 3	17 (65.4)	21 (48.2)	0.252^a a Pearson Chi-square
	>3	4 (15.4)	8 (14.8)
Obstetric complications (pregnancy or delivery)
	Yes	4 (15.4)	14 (25 9)	0.395^b b Fisher Exact test
	No	22 (84.6)	40 (74.1)	0.395^b b Fisher Exact test
Miscarriage
	Yes	9 (34.6)	16 (29.6)	0.652^a a Pearson Chi-square
	No	17 (65.4)	38 (70.4)	0.652^a a Pearson Chi-square
Type of delivery
	Vaginal	20 (76.9)	36 (66.7)	0.348^a a Pearson Chi-square
	Cesarian	6 (23.1)	18 (33.3)	0.348^a a Pearson Chi-square
Current pregnancy planning
	Yes	11 (42.3)	22 (40.7)	0.894^a a Pearson Chi-square
	No	15 (57.7)	32 (59.3)	0.894^a a Pearson Chi-square
Postpartum period (days)
	≤ 30	13 (50.0)	34 (63.0)
	31 to 59	3 (11.5)	2 (3.7)	0.259^a a Pearson Chi-square
	60 to 89	1 (3.8)	6 (11.1)
	90 to 119	2 (7.7)	5 (9.3)
	≥ 120	7 (26.9)	7 (13.0)
Breastfeeding
	Yes	25 (96.2)	51 (94.4)	1.000^b b Fisher Exact test
	No	1 (3.8)	3 (5.6)	1.000^b b Fisher Exact test
Baby gender
	Female	9 (34.6)	31 (57.4)	0.056^a a Pearson Chi-square
	Male	17 (65.4)	23 (42.6)	0.056^a a Pearson Chi-square
Companion support to take care of the baby
	Yes	20 (76.9)	35 (64.8)	0.274^a a Pearson Chi-square
	No	6 (23.1)	19 (35.2)	0.274^a a Pearson Chi-square

Variables		Moderate/ severe pain(n=33) n (%)	Mild/absent pain(n=47) n (%)	p value^* * p<0.05 statistically significant
Age (years) (Mean ± SD)		25.2 ± 5.0	27.6 ± 6.2	0.066^c c Student's t test for independent samples.
Marital status
	Married	10 (30.3)	11 (23.4)
	Consensual union	22 (66.7)	29 (61.7)	0.206^a a Pearson Chi-square
	Single	1 (3.0)	7 (14.9)
Marital relationship
	Good	30 (90.9)	39 (83.0)
	Bad	3 (9.1)	1 (2.1)	0.031^a
	No answer	0 (0.0)	7 (14.9)
Education level (years)
	0 to 8	13 (39.4)	15 (31.9)
	9 to 11	19 (57.6)	28 (59.6)	0.534^a a Pearson Chi-square
	12 to17	1 (3.0)	4 (8.5)
Family income (Mean±SD)		994.9±1097.0	1137.0 ± 779.8	0.503^c c Student's t test for independent samples.
Number of people living together
	1 to 3	16 (48.5)	36 (76.6)
	4 to 6	15 (45.5)	11 (23.4)	0.017^a a Pearson Chi-square
	>6	2 (6.1)	0 (0.0)
Working during current gestation
	Yes	18 (54.5)	20 (42.6)	0.290^a a Pearson Chi-square
	No	15 (45.5)	27 (57.4)	0.290^a a Pearson Chi-square
Position during work
	Sitting down	5 (27.8)	3 (15.0)
	Standing up	11 (61.1)	15 (75.0)	0.603^a a Pearson Chi-square
	Walking	2 (11.1)	2 (10.0)
Domestic tasks
	Yes	33 (100.0)	44 (93.6)	0.264^b b Fisher Exact test
	No	0 (0.0)	3 (6.4)	0.264^b b Fisher Exact test
Changing diapers
	Yes	33 (100.0)	45 (95.7)	0.509^b b Fisher Exact test
	No	0 (0.0)	2 (4.3)	0.509^b b Fisher Exact test
Height of changing diapers place
	High	7 (21.2)	13 (28.9)	0.443^a a Pearson Chi-square
	Low	26 (78.8)	32 (71.1)	0.443^a a Pearson Chi-square
How the baby is carried
	In stroller	1 (3.0)	5 (10.6)	0.392^b b Fisher Exact test
	On lap	32 (97.0)	42 (89.4)	0.392^b b Fisher Exact test
PPD
	Yes	18 (54.5)	8 (17.0)	<0.001^a a Pearson Chi-square
	No	15 (45.5)	39 (83.0)	<0.001^a a Pearson Chi-square
Mood changes
	Yes	27 (81.8)	32 (68.1)	0.169^a a Pearson Chi-square
	No	6 (18.2)	15 (31.9)	0.169^a a Pearson Chi-square
Smoking
	Yes	0 (0.0)	1 (2.1)	1.000^b b Fisher Exact test
	No	33 (100.0)	46 (97.9)	1.000^b b Fisher Exact test
Alcoholism
	Yes	16 (48.5)	16 (34.0)	0.194^a a Pearson Chi-square
	No	17 (51.5)	31 (66.0)	0.194^a a Pearson Chi-square
Sexual intiaition (years)
	≤ 18	26 (78.8)	31 (66.0)	0.212^a a Pearson Chi-square
	>18	7 (21.2)	16 (34.0)	0.212^a a Pearson Chi-square
Use of contraceptive
	Yes	20 (60.6)	32 (68.1)	0.490^a a Pearson Chi-square
	No	13 (39.4)	15 (31.9)	0.490^a a Pearson Chi-square
Number of children
	1	7 (21.2)	18 (38.3)
	2 to 3	19 (57.6)	24 (51.1)	0.182^a a Pearson Chi-square
	>3	7 (21.2)	5 (10.6)
Obstetric complications (pregnancy or delivery)
	Yes	6 (18.2)	12 (25.5)	0.438^a a Pearson Chi-square
	No	27 (81.8)	35 (74.5)	0.438^a a Pearson Chi-square
Miscarriage
	Yes	9 (27.3)	16 (34.0 )	0.520^a a Pearson Chi-square
	No	24 (72.7)	31 (66.0)	0.520^a a Pearson Chi-square
Type of delivery
	Vaginal	24 (72.7)	32 (68.1)	0.656
	Cesarian	9 (27.3)	15 (31.9)	0.656
Current pregnancy planning
	Yes	14 (42.4)	19 (40.4)	0.858^a a Pearson Chi-square
	No	19 (57.6)	28 (59.6)	0.858^a a Pearson Chi-square
Postpartum period (days)
	< 30	19 (57.6)	28 (59.6)
	31 to 59	3 (9.1)	2 (4.3)
	60 to 89	3 (9.1)	4 (8.5)	0.511^a a Pearson Chi-square
	90 to 119	1 (3.0)	6 (12.8)
	> 120	7 (21.2)	7 (14.9)
Breastfeeeding
	Yes	32 (97.0)	44 (93.6)	0.639^b b Fisher Exact test
	No	1 (3.0)	3 (6.4)	0.639^b b Fisher Exact test
Babies' gender
	Female	14 (42.4)	26 (55.3)	0.256^a a Pearson Chi-square
	Male	19 (57.6)	21 (44.7)	0.256^a a Pearson Chi-square
Companion support to take care of the baby
	Yes	21 (63.3)	34 (72.3)	0.408^a a Pearson Chi-square
	No	12 (36.4)	13 (27.7)	0.408^a a Pearson Chi-square

Pain site	DP (n=26)n (%)	NDP (n=54)N (%)	p value^* * p<0.05 statistically significant
Neck	7 (26.9)	6 (11.1)	0.073^a a Pearson Chi-square
Shoulder	3 (11.5)	5 (9.3)	0.710^b b Fisher Exact test.
Arm	2 (7.7)	5 (9.3)	1.000^b b Fisher Exact test.
Elbow	0 (0.0)	0 (0.0)	-
Forearm	1 (3.8)	0 (0.0)	0.325^b b Fisher Exact test.
Wrist, hand and fingers	2 (7.7)	1 (1.9)	0.245^b b Fisher Exact test.
Thoracic	13 (50.0)	12 (22.2)	0.012^a a Pearson Chi-square
Lumbar	9 (34.6)	17 (31.5)	0.779^a a Pearson Chi-square
Hips/LLLL	6 (23.1)	12 (22.2)	0.932^a a Pearson Chi-square

Variabless		p value	OR (CI95%)
Pain intensity
	Mild/absent pain	0.004	5.62 (2.10-16.29)
	Moderate/severe pain	0.004	5.62 (2.10-16.29)
Constant mood changes
	No	0.017	15.65 (1.85-116.97)
	Yes	0.017	15.65 (1.85-116.97)
Sexual initiation (years)
	≤18	0.187	0.37 (0.08-1.63)
	>18	0.187	0.37 (0.08-1.63)
Alcholism
	No	0.117	2.58 (0.79-8.45)
	Yes	0.117	2.58 (0.79-8.45)
Babies' gender
	Female	0.284	1.90 (0.59-6.09)
	Male	0.284	1.90 (0.59-6.09)

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[1] Correspondence to: Rita di Cássia de Oliveira Angelo, Rua Marcos Passos, 465 - Vila Eduardo, 56328-030, Petrolina, PE, Brasil. E-mail: ritangel@gmail.com

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Pain and associated factors in depressed and non depressed puerperal women* * Received from Federal University of Pernambuco, Post-Graduation Program in Neuropsychiatry and Behavioral Sciences, Recife, PE, Brazil.

BACKGROUND AND OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION:

Pain and associated factors in depressed and non depressed puerperal women^* * Received from Federal University of Pernambuco, Post-Graduation Program in Neuropsychiatry and Behavioral Sciences, Recife, PE, Brazil.