Persistent depression after obstetric fistula repair.

Area of Science:

• Obstetrics and Gynecology
• Mental Health Research
• Surgical Patient Outcomes

Background:

• Obstetric fistula significantly impacts women's physical and mental well-being.
• Depression is a common comorbidity in women undergoing surgical repair for obstetric fistula.
• Understanding depression trajectories is vital for improving patient care.

Purpose of the Study:

• To quantify depression levels using the Patient Health Questionnaire 9 (PHQ-9) over time.
• To identify demographic and clinical factors linked to persistent depression in women with obstetric fistula.
• To assess the impact of surgical repair and follow-up on depressive symptoms.

Main Methods:

• Analysis of a database of women undergoing obstetric fistula repair.
• Utilized the Patient Health Questionnaire 9 (PHQ-9) for depression assessment.
• Examined associations between depression and variables including age, parity, fistula duration, and postoperative continence.

Main Results:

• Prevalence of depression (PHQ-9 score ≥5) was 45.8% (365/797) preoperatively.
• Preoperative depression was associated with younger age (18-34 years), nulliparity, and shorter fistula duration (≤5 years).
• Postoperative depression correlated with persistent incontinence, but decreased over time in women attending follow-up.

Conclusions:

• Depression rates diminished among women with obstetric fistula who attended follow-up appointments.
• This reduction may be attributed to selection bias or improved coping mechanisms.
• Emphasizes the necessity of continuous patient follow-up, especially for those with incontinence or who miss appointments.