Psychological Symptoms Among Obstetric Fistula Patients Compared to Gynecology Outpatients in Tanzania

Abstract

Background Obstetric fistula is a childbirth injury prevalent in sub-Saharan Africa that causes uncontrollable leaking of urine and/or feces. Research has documented the social and psychological sequelae of obstetric fistula, including mental health dysfunction and social isolation. Purpose This cross-sectional study sought to quantify the psychological symptoms and social support in obstetric fistula patients, compared with a patient population of women without obstetric fistula. Methods Participants were gynecology patients (N = 144) at the Kilimanjaro Christian Medical Center in Moshi, Tanzania, recruited from the Fistula Ward (n = 54) as well as gynecology outpatient clinics (n = 90). Measures included previously validated psychometric questionnaires, administered orally by Tanzanian nurses. Outcome variables were compared between obstetric fistula patients and gynecology outpatients, controlling for background demographic variables and multiple comparisons. Results Compared to gynecology outpatients, obstetric fistula patients reported significantly higher symptoms of depression, posttraumatic stress disorder, somatic complaints, and maladaptive coping. They also reported significantly lower social support. Conclusions Obstetric fistula patients present for repair surgery with more severe psychological distress than gynecology outpatients. In order to address these mental health concerns, clinicians should engage obstetric fistula patients with targeted mental health interventions.

Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting

“…Participants were drawn from a larger study investigating psychosocial sequelae of obstetric fistula [9]. Study inclusion criteria were 18 years of age or older, vesico-vaginal or recto-vaginal fistula from obstetric cause, and admission for surgical repair.…”

“…All study procedures were approved by institutional review boards at both collaborating institutions, and informed consent was obtained prior to data collection. For further information on this study's ethical clearance and consent process, see Wilson et al [9]. …”

“…In 90 % of obstetric fistula cases, stillbirth or early neonatal death occurs [5]. Numerous negative social and mental health consequences of fistula have been previously documented, including social isolation, stigma, divorce, depression, general psychological distress, negative religious coping and low quality of life [6–9]. …”

‘I stayed with my illness’: a grounded theory study of health seeking behaviour and treatment pathways of patients with obstetric fistula in Kenya

“…The symptoms of vaginal fistula include urine incontinence, faecal incontinence, foot drop, infertility, skin ulceration [2, 3] and depression [4, 5]. Often, the illness classic symptoms of faecal and urinary incontinence cause the participants to live socially isolated lives and psychological trauma besides losing their daily source of livelihoods.…”

Development of an intervention to improve mental health for obstetric fistula patients in Tanzania

“…About two thirds of a Tanzanian sample of women with fistulae reported social isolation due to their leaking (Bangser, et al, 2011), and studies in other settings observed fistula associated with divorce (Ahmed & Holtz, 2007), stigma (Yeakey, Chipeta, Taulo, & Tsui, 2009), depression (Balogun, 1994; Weston, et al, 2011), and general mental health dysfunction (Browning, et al, 2007; Goh, et al, 2005). Our own research has identified rates of depression and post-traumatic stress disorder among fistula patients that are significantly higher than women recruited from other gynecological clinics (Wilson, Sikkema, Watt, & Masenga, 2015). …”