ORIGINAL ARTICLE

COMPARISON OF THE MENTAL HEALTH POST ABORTION AND POST PARTUM (NORMAL VAGINAL DELIVERY AND CESARIAN SECTION)
Najmeh Tehranian, Azadeh Manoochehri, Fatemeh Shobeiri, Anooshirvan Kazemnejad, Farkhondeh Aminshokravi, Maryam Vafaee, Khadigeh Mirzaii
Department of Obstetrics & Gynecology, Department of Biostatistics, Department of Health Educatione and Department of Psychiatry Tarbiat Modarres University, Tehran, Iran; Hamadan Medical Sciences University, Hamadan, Iran and Shahrood Medical Sciences University, Shahrood, Iran

ABSTRACT
Objectives: to assess and compare mental health after spontaneous abortion, normal vaginal delivery (NVD) and cesarian section (C/S). Materials and Method: This prospective analytical descriptive study was carried out in universityaffiliated teaching hospitals in Tehran city, Iran.. The specific questionnaire (PANAS & SCL-90) was applied in this study. The sample population of this study included 48 women during their post abortion period as well as 48 women after NVD and 48 women after C/S. The subjects' mental changes and disorders have been measured. It has been followed by interview and completing the questionnaires at first 24 hours and the weeks of 6th and 12th. Results: The negative emotional change in the first 24 hours showed no significant differences between abortion and delivery (P=0/002) but on the week 6th and 12th after abortion and delivery the ANOVA test showed significant differences between (NVD & C/S) and abortion (P=0/00). The frequency of mental disorders in the first 24th in the case and control groups were 33.3% and 10.3% respectively and the difference was statistically significant (P=0/00). The severity of emotional changes after spontaneous abortion was more than NVD and in the C/S was more than the rate in NVD. Conclusion: The statistics reveals that abortion and delivery threaten women's psychological well-being and through the time the intensity of negative mental changes and disorders in all three mentioned groups was decreasing. Keywords: Abortion, Mental Health, Post Partum, Normal Vaginal Delivery, Cesarian Section.

INTRODUCTION
Abortion means end of conception before week 20th from the first day of the last menstruation. This can occur spontaneously as a miscarriage, or may be artificially induced through chemical, surgical or other means. Worldwide approximately 46 Million abortions occur per year and approximately 126,000 abortions occur per day while most abortions occur in developing countries35 million annually, compared with seven million in developed countries 1-4 . After abortion the women might get stressful disorder with refusal defense mechanism5 negative emotional changes like nervous disorder and bipolar depression fallowing abortion is more than post delivery 6 . Also the chance of getting

emotional disorders after induced abortion is more than live birth and stillborn7. The purpose of this study was to assess and compare mental health after spontaneous abortion, normal vaginal delivery (NVD) and cesarian section (C/S). This is an applicable study and hopping to establish suitable preventive and remediable strategies for this problem.

MATERIALS AND METHODS

This was a prospective analytical descriptive study that examined the emotional effects of spontaneous abortion on the mental health of women on the first 24 hours and the 6th week and 12th week after the abortion and compared with the mental changes of the women

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COMPARISON OF THE MENTAL HEALTH POST ABORTION AND POST PARTUM (NORMAL VAGINAL DELIVERY AND CESARIAN SECTION)

CHARACTERISTICS OF THE STUDY GROUPS (%)

Variable
Age(year) Range:20-25 Education: High school Diploma Job (House worker) Para(1) No.Ab 0 1 Gravida(1) No. of Marriage 1 Familial marriage No Yes Duration of marriage(<5year) Mental status (Good) Social status (Good) Economic status Good Fair Satisfaction of marriage (Satisfactory) Satisfaction of husband family (Satisfactory)

Sp. Ab* n=48

37.5

C/S** n=48
54.1

NVD*** n=48
66.6

Statistical significance(P)
0.45

56.2 43.8 77.1 52.0 4.2 95.8 50% 93.7 58.3 41/7 50 85.4 70.8

56.2 43.8 81.3 64.5 89.5 10.5 52.0 91.7 56.3 43.7 56.2 93.8 81.3

52.1 47.9 95.8 77.1 8 3.3 16.7 54.1 100 52.1 47.9 68.7 87.5 81.3

0.16 0.12 S S 0.92 0.14 0.17 0.32 0.27 0.55

52.1 47.9 70.8 72.9

54.2 45.8 89.6 79.2

50 50 81.3 75

0.21 0.30 0.76

*Spontaneous Abortion

**Cesarian section

***Normal vaginal delivery Table 1 delivery by applying convenience interview about demographic information, careful behavioral observation during the interview, the specific standard questionnaire PANAS and SCL-90. economical, maternal, cultural and psychological factors.

after NVD and C/S. This study was carried out in university-affiliated teaching hospitals in Tehran city, Iran. Target population was included 48 women with spontaneous abortion (case group) and in the control group 96 women who had got delivery (48 NVD and 48 C/S). This sample size estimated on the basis of conducted research about the ratio of some of the mental indicators such as nervous disease and depression after abortion and delivery 40% and 10% consequently. Written informed consent to participate in the study was obtained from each subject. They were examined at the first 24 hours, the 6th week and 12th week after abortion and

RESULTS
Three groups were matched with personal factors (age, job, education, social, in this study the confined aged were (20-35) in the case and (20-39) in the control groups. There was no significant relationship in age frequency (P=0.45). The most of the women (52.7%) in both groups were in aged group of (20-25 years).

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COMPARISON OF THE MENTAL HEALTH POST ABORTION AND POST PARTUM (NORMAL VAGINAL DELIVERY AND CESARIAN SECTION)

COMPARISON OF THE NEGATIVE EMOTIONAL CHANGES BY THE PANAS QUESTIONNAIRE DURING THE FIRST 24TH HOURS AFTER SPONTANEOUS ABORTION, NORMAL DELIVERY AND CESARIAN
Statistical Data PANAS
Arousal Sorry Panic Guiltiness Shame nervous Worry Distressed Fear Opposition

P value
0.00 0.00 0/36 0.00 0.00 0.00 0/97 0/40 0.00 0.00

NVD mean Std.

1/09 1/16 0/66 0/96 0/81 1/25 1/18 1/04 1/10 1/07 2/04 0/81 0/16 0/47 0/37 1/72 1/16 1/08 0/97 0/89

C/S Std.
0/94 0/95 1/06 1/20 0/70 0/70 1/03 1/01 1/06 01/18

mean
2/31 1/77 0/60 0/79 0/27 2/41 1/22 1/33 1/91 1/00

Abortion mean Std.

0/73 1/00 1/09 1/03 0/75 0/78 0/59 0/63 0/74 0/92 2/91 1/95 0/77 1/70 1/22 2/75 1/22 1/25 1/52 2/22

Decision making in concept of significance

Sig Sig Not. Sig Sig Sig Sig N.Sig Not. Sig Sig Sig

Table 2 Considering educational level in the both groups, clarified that almost half of the individuals (43.8%) did not completed high school and there was no significant relationship between these two groups (P=0.16). In consider the job most of the women (84.7%) had no job, and had 1 child (64.5%) and (95.1%) were in the first marriage and about half of them (47.2%) were unfamiliar. The duration of marriage in most of them (58.3%) was less than five years. Most of the women emotional and social were in good status and in points of cultural and economical were from mid class [Table- 1]. As shown in [Table-2], considering the negative mental changes in the first 24 hours including; arousal, to be sorry, guiltiness, shame, to be nervous, fear and opposition that on all mentioned points using ANOVA test showed significant differences between abortion and delivery (P=0.002). According to [Table-3], in the week 6th after abortion and delivery the negative emotional changes including arousal, to be sorry, to be nervous, guiltiness, shame, to be nervous, fear , opposition and to be worry applying ANOVA test showed significant differences between delivery and abortion (P= 0.00). As shown in [Table- 4], the negative emotional changes on the week 12th about worry, distress, frightened and opposition by using ANOVA test showed significant differences between abortion and delivery (P= 0.00) .

THE COMPARISON OF THE NEGATIVE EMOTIONAL CHANGES BY THE PANAS QUESTIONNAIRE DURING THE WEEK 6TH AFTER SPONTANEOUS ABORTION, NORMAL VAGINAL DELIVERY AND CESARIAN
Statistical Data PANAS
Arousal Sorry Panic Guiltiness Shame nervous Worry Distressed Fear Opposition

P value
0.00 0.00 0/36 0.00 0.00 0.00 0/05 0/09 0.00 0.00

NVD mean Std.

1/03 0/87 0/66 0/69 0/54 1/10 1/02 0/91 0/77 0/82 1/31 0/45 0/16 0/25 0/14 1/12 0/75 0/62 0/45 0/43

C/S Std.
0/98 0/82 0/72 0/82 0/42 0/83 1/03 1/03 0/89 0/89

mean
1/62 1 0/33 0/50 0/10 1/64 0/85 0/83 1/29 0/56

Abortion mean Std.

0/66 0/77 0/59 0/89 0/68 0/66 0/67 0/68 0/76 0/83 2/02 1/20 0/33 0/95 0/45 1/83 0/41 0/43 0/60 1/35

Decision making in concept of significance

Sig Sig Sig Not sig Sig Sig Sig Not sig Sig Sig

Table 3

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COMPARISON OF THE MENTAL HEALTH POST ABORTION AND POST PARTUM (NORMAL VAGINAL DELIVERY AND CESARIAN SECTION)

THE COMPARISON OF THE MEAN AND STANDARD DEVIATION OF THE NEGATIVE EMOTIONAL CHANGES BY THE PANAS QUESTIONNAIRE DURING THE WEEK 12TH AFTER SPONTANEOUS ABORTION, NORMAL VAGINAL DELIVERY AND CAESARIAN
Statistical Data PANAS
Arousal Sorry Panic Guiltiness Shame nervous Worry Distressed Fear Opposition

P value
0/09 0/13 0/56 0/20 1 0/24 0/03 0/04 0.00 0/01

NVD mean Std.

0/89 0/66 0/58 0/55 0/34 0/94 0/82 0/91 0/65 0/74 0/79 0/25 0/14 0/16 0/08 0/79 0/52 0/41 0/20 0/31

C/S Std.
0/80 0/71 0/55 0/58 0/40 0/77 0/89 0/82 0/69 0/70

mean
1/10 0/5 0/22 0/29 0/08 1/04 0/47 0/5 0/64 0/37

Abortion mean Std.

0/61 0/61 0/33 0/56 0/34 0/58 0/50 0/48 0/51 0/67 1/08 0/47 0/12 0/37 0/08 1 0/14 ? 0/16 0/72

Decision making in concept of significance

N.Sig N.Sig N.Sig N.Sig N.Sig N.Sig Sig Sig Sig Sig

Table 4

DISCUSSION
Emotional health means health of think and the spirit 8 . Technological and industrial development increased the power and the wealth but deprived the wellbeing and calmness and replaced nervous and psychosomatic diseases, as the statistics stating the increase of psychosomatic diseases. One of the high risk groups are the pregnant women and the women after given birth and abortion9. The objective of this study was to investigate the changes of positive and negative emotional after abortion and delivery. The result, out of the applying PANAS, indicated, negative emotional changes including arousal, to be sorry, fear, guiltiness, shame ,opposition and to be nervous on the first 24 hours and there are significant differences in all mentioned points after th abortion and delivery (P=0.002). In the week 6 , arousal, to be sorry, fear, guiltiness, shame, to be worry, opposition and to be nervous after abortion was more than delivery (P=0.00). In the week 12th distressed, fear, opposition and to be worry after abortion was more than delivery also the differences between negative emotional changes after abortion and delivery was significant (P=0.00). In this research, passing the time the rate of negative emotional changes decreased and the finding showed that delivery and with a higher degree abortion threatened the heath of women. Some researches like this study emphasized the findings. For instance in an investigation conducted by Coleman in the America on 2002, the ratio of negative changes

after abortion was more than delivery10. Coleman also showed that the women who got abortion (%63) had more emotional complication than the delivery group but with time passing from the abortion and delivery the rate of emotional complication decreased10. Also, in a study by Anglehard on the year 2004, clarified syndrome symptoms after abortion continued till 4 months after that11. In a study conducted by Gooyan in Africa, % 44 of women 8 weeks after abortion had nervous disease. 1 2 In Iran also the rate of depression after abortion estimated %3313 and in another investigation the rate of depression in Iran estimated %3914. In summary, negative mental changes in the first 24 hours including; arousal, to be sorry, guiltiness, shame, nervous, fear and opposition, they were significantly different in two groups (abortion and delivery). In the week 6th after abortion and delivery the negative emotional changes including arousal, sorry, nervous, guiltiness, shame, fear, opposition and worry showed significant differences between delivery and abortion (P= 0.00). The negative emotional changes on the week 12th about worry, distress, frightened and opposition were significantly different in two groups i.e. abortion and delivery (P= 0.00). The results out of the present study showed that delivery and some more abortion threatens the emotional health of women.

REFERENCES
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10. Coleman PK, Reardon DC, Rue VM, Cougle J. State funded abortions versus deliveries: a comparison of outpatient mental health claims over 4years. Am J Orthopsychiatry 2002;72(1):141-56. 11. Engelhard IM, van den Hout MA, Arntz A. Post traumatic stress disorder after pregnancy loss. Gen Hosp Psychiatry 2001; 23: 62-66. 12. Goyaun N. Abortion Complication in Abidjan (Ivory Coast). Contraception 1999; 60: 107109. 13. E s k a n d a r i e F. T h e s i t u a t i o n o f s o c i a l psychiatry of women with habitual abortion Midwifery Master Thesis, Medical Sciences of Iran University 2002: 93. 14. Abadian SM. The prevalence of depression after delivery. Midwifery Master Thesis, Medical Sciences of Iran University 1998.

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Address for Correspondence: Fatemeh Shobeiri Department of Obstetrics, School of Nursing & Obstetrics, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail: fshobeiri@yahoo.com

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