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November 1999, Volume 49, Issue 11

Original Article

Anxiety, Depression and Stress among the Husbands of Obstetric Cases at Karachi

M. Iqbal Afridi  ( Department of Neuropsychiatry, Jinnah Postgraduate Medical Centre, Karachi. )
Ahmed Mashhood  ( Psychiatric Clinic, Neuro-Spinal and Medical lnstitute, Karachi. )


Objective: To determine the level of Anxiety, Depression and Stress among the Husbands of Obstetric Cases.
Subjects and Methods: This hospital-based prospective study was conducted at Karachi, during the year 1998. A semi-structured proforma along with Hospital Anxiety Depression Scale (HAD) and Life Events Scale were administered to the consenting spouses of obstetric cases.
Results: Only 23% of lower socio-economic group husbands accompanied their wives to the hospital compared to 70% of the higher socio-economic group. Out of the 56% of husbands of 82 consecutive obstetric cases interviewed, 13% of those whose wives were NVD showed anxiety and depression as compared to 25% of those with Cesarean Section (C/S). Life Events Scale showed 50% of lower socio-economic group having stress compared to only 10% in higher socio-economic group.
Conclusion: Contrary to the West, where majority of the Obstetric cases are accompanied by their spouses, in our study only 23% of the cases had their husbands present within the obstetric facility. There is a need of such a study, based on a larger sample in order to address this critical period/issue, considering the concept of ‘paternity leaves’. Surprisingly, majority of husbands did not have Anxiety or Depression during the Obstetric period (a critical period needing appropriate attention) of their wives (JPMA 49:265, 1999).


No one is immune to psychiatric illness, especially anxiety and depression-which are the most common conditions1-4. The person is more vulnerable to such ailments, when he is facing stress5. This is also true for the obstetric period. Various researchers have established such an association6. This period is critical in terms of emotional and psychological changes for every related individual. Concern about the frequency of psychological distress among women has been expressed by the researchers including gynaecologists and psychiatrists7. Additionally, during this period the pregnant lady along with her expected baby, receives at least some amount of family support and due attention. However, the husband who has significant participation in the child bearing processes is not only ignored8 in terms of support but is rather expected to bear additional responsibilities such as coping with increased financial demands and caring more for his wife as well as to be prepared to welcome the newly expected family member9.
Keeping in mind all this and because, in our society, the husbands are mostly the primary or the only earning members of the whole family, the present study was designed to assess the level of Anxiety, Depression and Stress among them10. This may help to chalk out some therapeutic measures, in order to prevent the vicious cycle of stress which the whole family enters.

Subjects and Methods

This prospective study was conducted at the Gynaecology & Obstetric ward of Jinnah Postgraduate Medical Centre (JPMC) and Al-Maimoona Hospital, the former being a government and the latter a private obstetric facility, during the year 1998. The planning was based according to the Gantt Chart directions which include literature review, designing of semi-structured Proforma covering the socio-demographic information, induction of all consecutive consenting Husbands of obstetric cases in this study with assurance for maintenance of confidentiality and application of the designed proforma along-with Urdu version of Hospital Anxiety Depression (HAD) Scale3 and culturally relevant Indian version of Life Events Chart! Scale11.
Those cases, whose Husbands were not present at the time of our first visit, were invited the next day or the day after the next day on the time convenient to them. Those who were illiterate or were having inadequate command of the language were assisted.


Eighty-two consecutive obstetric cases were approached. Forty six (56%) husbands could be interviewed despite repeated requests. Only 23% husbands accompanied their wives to the Government Obstetric facility while 70% husbands accompanied their wives to the Private Obstetric facility (Table 1).

Their mean & median age was about 30 years. Further details regarding socio-demographic profile are shown in (Table 2).

Only 13.3% of the husbands whose wives were Normal Vaginal Delivery (NVD) cases had anxiety and depression on Hospital Anxiety Depression scale (H.A.D.). Comparative levels, however, were observed in 25% of the Husbands of cases for Cesarean Section (C/S), on the same H.A.D. scale (Table 3).

Life Events Scale showed 50% of Government Obstetric facility (lower socio-economic group) husbands suffering from stress as opposed to only 10% of husbands of cases of Private Obstetric facility (higher socio-economic group) (Table 4).


Contrary to the West, where majority of Obstetric cases are accompanied by their spouses, in our study only 23% of the cases had their husbands present at the time of presentation to the Govt. Obstetric facility (lower socio­economic group), as opposed to 70% in the Private Obstetric facility (higher socio-economic group) (Table 1). Majority of the cases reported the unavailability of their husbands due to their job. This shows that males are the main earners and supporters of a traditional Pakistani family. Moreover, they are usually so much overburdened by their work (especially the lower-middle and lower economic classes) that they cannot play their role adequately, even in such critical and important moments of their lives.
Combined socio-demographic profile (Table 2) shows that all the husbands of the Private Obstetric facility cases were literate, as compared to only half of the husbands in the Govt. Obstetric facility. This finding is consistent with the already existing general impression that usually lower socio-economic group people attend the govt. health facilities while the higher socio-economic group can well afford the private health facilities. All this becomes more obvious when we look at the median of monthly incomes of the two groups (Table 2). This clearly reflects the economic disparity as well as the deteriorating conditions and plight of the majority of our population.
Anxiety and Depression rates were lower than expected (13.3% and 20% for Government and private obstetric facilities respectively). These findings are comparable to studies regarding psychiatric morbidity in general population7,12,13. However, this rate was approximately double when the wives were planned for Cesarean Section rather than NVD. This finding was present regardless of the socio-econornic status of the family ( Table 3). However, Stress was found to be very high in the lower socio-economic group (50%), when financial problems etc. within the past six months, were assessed (Table 4). Keeping in mind our socio-cultural difference’4 , these findings reflect the need to sensitize people regarding the importance of husband support and involvement at least during labor.
It is recommended that, in future, such studies should take into account other variables such as whether the couple were cousins etc., which may be additional factors playing their due role in increasing family support, especially from the in-laws, hence decreasing Anxiety and Depression.
For definite conclusion, the sample of subjects should be increased. Consideration of other variables from the socio-demographic profile (Table 2), e.g., number of family members (especially dependent ones), length of gestational period etc. should be taken into account.


The authors wish to thank Dr. Shakila Abdullah, Dr. Talat Zafar and the nursing staff at Al- Maimoona Hospital for their cooperation. Special thanks to Mr. Akhter Ahmed, M.R.S.S., JPMC, for his statistical help.


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