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Immigrant Asian Indian Women and Postpartum Depression
Abstract
To determine the incidence of postpartum depressive symptomatology in a sample of immigrant Asian Indian women and to establish whether cultural factors such as arranged marriage or gender of the newborn are associated with differences in depression scores.
Quantitative, descriptive study.
Ten private obstetric and pediatric offices in Northern California.
A convenience sample of 58 self-selected immigrant Asian Indian women between 2 weeks and 12 months postpartum.
Depressive symptomatology as measured by the 35-item self-report Postpartum Depression Screening Scale.
There was a minor depressive symptomatology rate of 28% and an additional major depressive symptomatology rate of 24%. No differences in depression scores were found with regard to arranged marriage or the gender of the newborn.
Findings suggest that Asian Indian women living in the United States are just as likely to experience postpartum depressive symptomatology as White women. Therefore, it is critical to identify and refer women at risk for postpartum depression to ensure they do not become part of the 50% who remain undiagnosed. Health care providers need to become cognizant of the potential for postpartum depression and become skilled in the detection of this mood disorder.
... Association of perinatal depression is seen with young maternal age; unmarried status, smoking/drinking habits, substance abuse, hyperemesis gravidarum, preterm birth, high utilization of sick leave during pregnancy, low-and middle-income groups, absence of caretakers, household work, etc. [3][4][5][6][7]. ...
... EPDS score was more than 12 in 28% of patients and was statistically significant, as in Table 7d. Chandran et al. [3] 11 Goyal et al. [4] 52 Upadhyay et al. [5] 22 Saldhana et al. [6] 21.5 Patel et al. [7] 48.5 Zaidi et al. [8] 12.75 Robertson et al. [9] 10-15 Agarwala et al. [10] 21.5 Present study 12-15.7 57.84% delivered vaginally and 42.16% had a cesarean done ( Table 2). The mode of delivery did not have a statistically significant effect on the EPDS score (Table 7e). ...
... Pregnancy and puerperium are stressful enough to provoke mental illness. Postmortem depression major or minor develops in 10% to 20% of parturients, as was seen in our study (12.7% to 15.7%) and corresponding with other studies as well [2][3][4][5]8] Deepika Goyal in a study combined major and minor depressive illnesses to 50% and others too Table 10 [7,9]. ...
Introduction: India is in a state of obstetric transition, where indirect causes of maternal morbidity and mortality are now more common. Depression is one such entity that goes unscreen and untreated, contributing to maternal morbidity. Objective: The study aimed to find the incidence of postpartum depression (PPD) in a tertiary care institute and determine the associated risk factors contributing to PPD. Methods: This was a prospective cross-sectional study conducted in the Department of Obstetrics and Gynecology, Government Medical College and Rajindra Hospital, Patiala, from June 1, 2020 to July 31, 2022. All the patients who were in the postpartum period and gave consent were included in the study. They were subjected to the Edinburgh Postnatal Depression Scale (EPDS) questionnaire, and their responses were recorded. The same patients were subjected to the same EPDS questionnaire at 6 months, and the score was calculated. A score of more than or equal to 12 was considered statistically significant for depression, and patients were referred to a psychiatrist for further evaluation and management. Results: In total, 102 were enrolled in the study. The incidence of PPD in the study participants was 12.75% at the immediate postparity period and 15.69% at 6 months postpartum. Husband’s unemployment (p<0.05), low family income (p<0.05), unplanned pregnancy (p<0.05), development of antenatal complications (p<0.05), lack of regular ANC care (p<0.05), neonatal death (p<0.05), bad relationship with in-laws (p<0.05), and low self-esteem (p<0.05) were the main contributors to the development of PPD in both immediate postpartum period as well as at 6 months postpartum. Only four patients agreed to visit the psychiatrist, the rest refused the evaluation and treatment. Conclusion: In India, despite the National mental health program 1983, maternal mental health is still not a prominent component of the program which needs to be included. Screening tools should be used to identify and treat women.
... Also, pregnancy, newborn and birth-related factors such as prime-parity [26,27], multiple children at home [28], multi-parity [29], unwanted or negative attitude toward pregnancy [20,[30][31][32][33], premarital pregnancy [34,35], depression during pregnancy [29,36], miscarriage [37], and prenatal high anxiety [31] are some of the related factors for the high magnitude of postpartum depression. Moreover, husband and partner-related factors such as intimate partner violence [20,38,39], alcoholism in the husband [40], low husbands educational level [28], psychiatric problems in the husband [41], and husbands unemployment [30,42] were so far identified as associated factors. ...
... The present study was consistent with the results of 27.3% in China [12], 31.4% in Asian [40], and 22.1% in Ethiopia [20]. However, a meta-analysis study in India ...
... Women whose husband was drinking alcohol with in the last month were 2.2 times at higher odds of developing PPD than women whose husband has no history of alcoholism in the past 1 month. A study in India [40] that assessed postpartum depression risk factors by taking a convenience sample of 58 Asian Indian immigrant women between 2 weeks and 12 months postpartum had reached a similar conclusion. Moreover, current substance use increases the probability of developing PPD by 1.8 times. ...
Background: Postpartum depression is a common psychiatric complaint of women following delivery and a multitude of psychosocial, maternal, newborn and husband-related factors were contributing to it. This condition has a detrimental impact on the mother-infant caregiving relationship and hastens the infant's cognitive, emotional and social development. However, a shortage of empirical evidence existed especially in developing countries including Ethiopia. Therefore, we implemented this study to determine the magnitude of postpartum depression and its correlates. Methods: A cross-sectional survey was implemented on 378 postnatal women in the maternal and child health clinic of Dessie health centers within 4 weeks of their delivery. Postpartum depression was assessed using the Edin-burgh Postnatal Depression Scale (EPDS). Intimate partner violence was operationalized as a psychological, physical and sexual abusive action imposed on women by their associates. We estimated the crude and adjusted odds ratio with its 95% CI using binary logistic regression to know the association and statistical significance was declared using a p-value < 0.05. Results: More than one-fourth, 102 (27%) (95% CI 22.5, 31.5) of participants were obtained to have postpartum depression. Being single from socio-demographic variables (AOR = 4.9, 95% CI 1.27, 16.74), dissatisfaction with child gender (AOR = 3.1, 95% CI 1.62, 6.69), unplanned pregnancy (AOR = 2.5, 95% CI 1.76, 7.23) and depression during current pregnancy (AOR = 3.2, 95% CI 2.81, 8.91) from pregnancy and newborn-related variables, intimate partner violence; psychological (AOR = 6.5, 95% CI 1.98, 15.85), sexual and physical violence (AOR = 3.46, 95%CI 2.34, 18.55), current husbands alcoholism (AOR = 2.2, 95% CI 1.48, 5.34) from husband/partner-related variables and current substance use (AOR = 1.8, 95% CI 1.16, 3.75) were found to have a statistically significant association with postpartum depression. Conclusion: More than one-fourth of the interviewed women (27%) were found to have postpartum depression. Being single from socio-demographic variables, dissatisfaction with child gender, unplanned pregnancy, and depression during current pregnancy from pregnancy and newborn-related variables, intimate partner violence, and current husband's alcoholism from husband/partner-related variables and current substance use were the related factors. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'
... Also, pregnancy, newborn and birth-related factors such as prime-parity [26,27], multiple children at home [28], multi-parity [29], unwanted or negative attitude toward pregnancy [20,[30][31][32][33], premarital pregnancy [34,35], depression during pregnancy [29,36], miscarriage [37], and prenatal high anxiety [31] are some of the related factors for the high magnitude of postpartum depression. Moreover, husband and partner-related factors such as intimate partner violence [20,38,39], alcoholism in the husband [40], low husbands educational level [28], psychiatric problems in the husband [41], and husbands unemployment [30,42] were so far identified as associated factors. ...
... The present study was consistent with the results of 27.3% in China [12], 31.4% in Asian [40], and 22.1% in Ethiopia [20]. However, a meta-analysis study in India which incorporated 38 studies obtained a pooled estimate of PPD to be 22% [8] and also another meta-analytic study that incorporated 53 studies obtained a pooled magnitude of PPD to be 19% [6]; both of which were lesser as compared to the current result. ...
... Women whose husband was drinking alcohol with in the last month were 2.2 times at higher odds of developing PPD than women whose husband has no history of alcoholism in the past 1 month. A study in India [40] that assessed postpartum depression risk factors by taking a convenience sample of 58 Asian Indian immigrant women between 2 weeks and 12 months postpartum had reached a similar conclusion. Moreover, current substance use increases the probability of developing PPD by 1.8 times. ...
Abstract Background Postpartum depression is a common psychiatric complaint of women following delivery and a multitude of psychosocial, maternal, newborn and husband-related factors were contributing to it. This condition has a detrimental impact on the mother–infant caregiving relationship and hastens the infant’s cognitive, emotional and social development. However, a shortage of empirical evidence existed especially in developing countries including Ethiopia. Therefore, we implemented this study to determine the magnitude of postpartum depression and its correlates. Methods A cross-sectional survey was implemented on 378 postnatal women in the maternal and child health clinic of Dessie health centers within 4 weeks of their delivery. Postpartum depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Intimate partner violence was operationalized as a psychological, physical and sexual abusive action imposed on women by their associates. We estimated the crude and adjusted odds ratio with its 95% CI using binary logistic regression to know the association and statistical significance was declared using a p-value
... A flow diagram of the study selection process is shown in Fig. 1 All of the studies were conducted in high-income countries. The countries with the highest numbers of studies were Canada, 15 studies (Ballantyne et al. 2013;Dennis et al. 2004;Gagnon et al. 2013;Ganann et al. 2012;Lanes et al. 2011;McDonald et al. 2013;Mechakra-Tahiri et al. 2007;Minde et al. 2001;Miszkurka et al. 2010;Peer et al. 2013;Stewart et al. 2008Stewart et al. , 2012Sword et al. 2006;Van Lieshout et al. 2011;Zelkowitz et al. 2008); the USA, 14 studies (Balbierz et al. 2014;Connelly et al. 2013;Davila et al. 2009;Diaz et al. 2007;Elo and Culhane 2010;Fleuriet and Sunil 2014;Fortner et al. 2011;Goyal et al. 2006;Harrison and Sidebottom 2009;Heilemann et al. 2004;Huang et al. 2007;Luecken et al. 2013;Valentine et al. 2011;Yeung and Schwartz 1986); Australia, 7 studies (Bandyopadhyay et al. 2010;Eastwood et al. 2011;Milgrom et al. 2008;Shafiei et al. 2015;Small et al. 2003;Tran et al. 2002;Yelland et al. 2010); and Taiwan, China, 6 studies (Chen et al. 2013;Chen et al. 2012;Chien et al. 2012;Huang and Mathers 2008;Hung et al. 2012;Tsao et al. 2014). ...
... Thirty-one studies were cross-sectional surveys (Abbott and Williams 2006;Balestrieri et al. 2012;Ballantyne et al. 2013;Chen et al. 2012;Chien et al. 2012;Choi et al. 2012;Davila et al. 2009;Dennis et al. 2004;Eastwood et al. 2011;Elo and Culhane 2010;Fisch et al. 1997;Fleuriet and Sunil 2014;Ganann et al. 2012;Glasser et al. 2000;Goyal et al. 2006;Harrison and Sidebottom 2009;Heilemann et al. 2004;Huang and Mathers 2008;Hung et al. 2012;Lanes et al. 2011;Mechakra-Tahiri et al. 2007;Minde et al. 2001;Miszkurka et al. 2010;Peer et al. 2013;Ratcliff et al. 2015;Shafiei et al. 2015;Small et al. 2003;Stewart et al. 2008;Sword et al. 2006;Yelland et al. 2010;Yeung and Schwartz 1986), 20 were prospective cohorts (Bandyopadhyay et al. 2010;Bjerke et al. 2008;Chen et al. 2013;Diaz et al. 2007;Escribà-Agüir et al. 2013;Fortner et al. 2011;Gagnon et al. 2013;Huang et al. 2007;Jayaweera and Quigley 2010;Luecken et al. 2013;McDonald et al. 2013;Milgrom et al. 2008;Rudman et al. 2008;Stewart et al. 2012;Tran et al. 2002;Tsao et al. 2014;Valentine et al. 2011;Van Lieshout et al. 2011;Yoshida et al. 1997;Zelkowitz et al. 2008) and two were randomized controlled trials (Balbierz et al. 2014;Connelly et al. 2013). ...
... Fifty studies looked at depression alone (Abbott and Williams 2006;Balbierz et al. 2014;Balestrieri et al. 2012;Ballantyne et al. 2013;Bandyopadhyay et al. 2010;Bjerke et al. 2008;Chen et al. 2012Chen et al. , 2013Chien et al. 2012;Choi et al. 2012;Connelly et al. 2013;Davila et al. 2009;Dennis et al. 2004;Diaz et al. 2007;Eastwood et al. 2011;Elo and Culhane 2010;Escribà-Agüir et al. 2013;Fisch et al. 1997;Fleuriet and Sunil 2014;Fortner et al. 2011;Ganann et al. 2012;Glasser et al. 2000;Goyal et al. 2006;Harrison and Sidebottom 2009;Heilemann et al. 2004;Huang and Mathers 2008;Huang et al. 2007;Hung et al. 2012;Jayaweera and Quigley 2010;Lanes et al. 2011;Luecken et al. 2013;McDonald et al. 2013;Mechakra-Tahiri et al. 2007;Milgrom et al. 2008;Minde et al. 2001;Miszkurka et al. 2010;Peer et al. 2013;Ratcliff et al. 2015;Rudman et al. 2008;Shafiei et al. 2015;Small et al. 2003;Stewart et al. 2008Stewart et al. , 2012Sword et al. 2006;Tran et al. 2002;Tsao et al. 2014;Valentine et al. 2011;Van Lieshout et al. 2011;Yoshida et al. 1997;Zelkowitz et al. 2008), one study depression and anxiety (Yelland et al. 2010), one study depression and posttraumatic stress disorder (PTSD) (Gagnon et al. 2013) and one study looked at any DSM-III diagnosis (Yeung and Schwartz 1986). ...
This study was conducted in order to evaluate the prevalence and risk of mental disorders in the perinatal period among migrant women. Six databases (including MEDLINE) were searched from inception to October 19th, 2015, in addition to citation tracking. Studies were eligible if mental disorders were assessed with validated tools during pregnancy and up to 1 year postpartum among women born outside of the study country. Of 3241 abstracts screened, 53 met the inclusion criteria for the review. Only three studies investigated a mental disorder other than depression. Unadjusted odds ratios were pooled using random effects meta-analysis for elevated depression symptoms during pregnancy (n = 12) and the postpartum (n = 24), stratified by study country due to heterogeneity. Studies from Canada found an increased risk for antenatal (OR = 1.86, 95% CIs 1.32–2.62) and postnatal elevated depression symptoms (OR = 1.98, 95% CIs 1.57–2.49) associated with migrant status. Studies from the USA found a decreased risk of antenatal elevated depression symptoms (OR = 0.71, 95% CIs 0.51–0.99), and studies from the USA and Australia found no association between migrant status and postnatal elevated depression symptoms. Low social support, minority ethnicity, low socioeconomic status, lack of proficiency in host country language and refugee or asylum-seeking status all put migrant populations at increased risk of perinatal mental disorders.
Electronic supplementary material
The online version of this article (doi:10.1007/s00737-017-0723-z) contains supplementary material, which is available to authorized users.
... Two studies to date have evaluated PPD rates among AI women living in the United States (Goyal et al., 2006;Goyal, Wang, Shen, Wong, & Palaniappan, 2012). Goyal et al. (2006) conducted a quantitative, cross-sectional study including a convenience sample of 58 married AI mothers and noted 52% (n = 30) scored above the cutoff for depressive symptoms using the 35-item Postpartum Depression Screening Scale (PDSS) (Beck & Gable, 2001). ...
... Two studies to date have evaluated PPD rates among AI women living in the United States (Goyal et al., 2006;Goyal, Wang, Shen, Wong, & Palaniappan, 2012). Goyal et al. (2006) conducted a quantitative, cross-sectional study including a convenience sample of 58 married AI mothers and noted 52% (n = 30) scored above the cutoff for depressive symptoms using the 35-item Postpartum Depression Screening Scale (PDSS) (Beck & Gable, 2001). Study limitations included the convenience sample design and use of PDSS that has not yet been validated for use in AI women. ...
... Mandated rest consists of rest at home with limited contact with the outside world, except and increased risk of suicide and infanticide (Friedman & Resnick, 2009). Postpartum depression rates of up to 63.3% have been noted among all Asian mothers worldwide (Klainin & Arthur, 2009), 6% to 23% in AI mothers in India (Dubey, Gupta, Bhasin, Muthal, & Arora, 2012), and up to 55% among AI women in the United States (Goyal, Murphy, & Cohen, 2006). Qualitative research data exploring PPD among AI mothers living in the United States are limited. ...
To explore Asian Indian mothers' perspectives of postpartum depression (PPD) and mental health help-seeking behavior.
Qualitative exploratory design.
Using convenience sampling, postpartum mothers were recruited through flyers posted in public places and on social media sites. Postpartum depression risk was assessed with the Edinburgh Postnatal Depression Scale (EPDS) prior to qualitative interviews. Content analysis methods were used to extract themes from participant narratives.
Twelve self-identified, married, Asian Indian mothers, aged between 29 and 40 years, living in Northern California, who gave birth to a healthy infant within the last 12 months, took part in this study. Scores on the EPDS indicated two participants were at an increased risk for developing PPD. Content analysis revealed two emerging themes: (1) Culture-specific postpartum practices and ceremonies and their role in maternal-infant postpartum recovery; and (2) Maternal mental health help-seeking behavior.
Nurses taking care of women during the extended prenatal and postpartum period have the unique opportunity to build rapport with their patients which can offer a window of opportunity to educate and help dispel myths about PPD symptoms and treatment. To promote successful maternal-infant outcomes, PPD education should be initiated at the first prenatal appointment, continue during the pregnancy, and be incorporated into well-baby visits through the first postpartum year. Education should include signs and symptoms of PPD as well as importance of timely mental-health help-seeking.
... The high expectation that the next child be a boy places a pregnant woman who already has a daughter under considerable stress. 26 ...
... 17 Arranged marriage is a common practice, in which the status and reputation of both families play a part. 26,37 Couples are usually expected to start a family immediately, and when a bride becomes pregnant, this is an event celebrated by the couple's extended families and neighbours. 11 Becoming a mother elevates a woman's status within her community and is considered crucial for leading a fulfilling life. ...
... The following discussion is drawn from research studies on Indian women's childbearing experiences in Singapore, 25 Canada, 24 New Zealand 23 and the US, 26 as well as one research article and one literature review from Australia. 4,34 Indian childbearing women who leave their own community imbued with many traditions and resettle abroad face the two-fold challenges of transition to both motherhood and a different childbirth culture. ...
Background
The percentage of overseas-born mothers giving birth in Australia has increased to 31.5% in 2012 and Indian women represent 10% (the highest proportion). It is important for midwives in Australia to be aware of the childbearing traditions of Indian women and how these influence Indian women birthing in Australia.
Aim
To explore childbearing practices in India and Indian women's experience of giving birth abroad; and to discuss the relevant findings for midwives working with Indian women in Australia.
Method
An integrative literature review was employed. 32 items, including 18 original research articles were thematically reviewed to identify commonly occurring themes relating to Indian women's childbearing traditions.
Findings
Five themes relating to traditional childbearing practices of women birthing in India were identified. These themes included diversity and disparity; social context of childbirth and marriage; diet based on Ayurveda; pollution theory and confinement; and finally, rituals and customs.
Conclusion
Indian women giving birth abroad and by implication in Australia experience a transition to motherhood in a new culture. While adjusting to motherhood, they are also negotiating between their old and new cultural identities. To provide culturally safe care, it is essential that midwives reflect on their own culture while exploring what traditions are important for Indian women.
... Decades of interdisciplinary research have produced a significant body of knowledge about PPD such as measurement scales, diagnosis, predictors, characteristics, treatment and consequences of untreated PPD [10,11]. However, the existing research is primarily from high income countries and does not explore lived experiences of women with PPD in sub-Saharan Africa (SSA) and other low-income settings. ...
... The findings of the present study are in tandem with observations of other studies from Africa and other low-income countries [10,41]. In a number of studies, alcoholism and substance abuse has been reported as a key trigger of IPV during the postpartum period [11,41]. ...
Background
Postpartum depression affects a significant proportion of women of childbearing age. The birth of a newborn baby is normally considered a joyful event, inhibiting mothers from expressing their depressive feelings. If the condition is not well understood and managed, mothers with postpartum depression are likely to experience suicidal ideation or even commit suicide. This study explored lived experiences of women who had recovered from a clinical diagnosis of postpartum depression in southwestern Uganda.
Methods
This phenomenological study adopted the explorative approach through in-depth interviews as guided by the biopsychosocial model of depression. It was conducted in Mbarara Regional Referral Hospital, Bwizibwera Health Centre IV and Kinoni Health Centre IV located in Mbarara and Rwampara districts, southwestern Uganda. Data were collected from 30 postpartum mothers who were purposively selected, between 9th December 2019 and 25th September 2020. We analyzed this work using thematic data analysis and this was steered by the Colaizzi’s six-step phenomenological approach of inquiry.
Results
The findings were summarized into five major themes: 1) somatic experiences including insomnia and headache, breast pain, poor breast milk production, weight loss and lack of energy; 2) difficulties in home and family life including overwhelming domestic chores, lack of social support from other family members, fighting at home and financial constraints due to COVID-19 pandemic; 3) negative emotions including anger, self-blame, despondency and feelings of loneliness and regrets of conceiving or marriage; 4) feelings of suicide, homicide and self-harm including suicidal ideation and attempt, homicidal ideations and attempt and feelings of self-harm and 5) coping with postpartum depression including spirituality, termination of or attempt to leave their marital relationships, acceptance, counselling and seeking medical treatment, perseverance.
Conclusion and recommendations
Suicidal and homicidal thoughts are important parts of the postpartum depression experience, and these may put the lives of the mothers, their spouses and their babies at a great risk. Poor relationship quality, intimate partner violence and lack of financial resources contribute significantly to the negative emotional experiences of mothers with PPD.
... PPD involves interplay of multiple factors, the association of which has been evaluated in our study. After gleaning through available literature [2,4,5,[14][15][16][17][18][19] on the factors associated with PPD both from the world and those especially relevant to the Indian subcontinent, a number of categorical variables were studied at 3 days and 6 weeks, which include past history of depression, depressive symptoms during pregnancy, family history of psychiatric disorders, perceived stress during pregnancy, perceived social support, mismatch between preferred gender of baby vs. actual gender, history of domestic violence, availability of husband during delivery, marital disharmony, education status, and type of family. Parturients with postpartum depression at 6 weeks had higher perceived stress during pregnancy which was statistically significant in both the epidural (P = 0.036) and control groups (P = 0.001). ...
... As seen in various studies on the risk factors of PPD in the Indian subcontinent, [2,[14][15][16][17][18][19] birth of a female child tops the chart. It was found that of the 15 parturients with female babies and PPD, 10 (35.7%) belonged to the CSE group versus 5 (14.3%) in the control group (P = 0.047). ...
Background:
Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed.
Materials and methods:
Parturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery (n = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 μg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD.
Results:
Incidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact P = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86-43.55; P = 0.001).
Conclusion:
CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.
... 20,21 Traditionally, Indian societies consider the postnatal depressive or 'low moods' as usual and not a significant psychological problem. 22 Consequently, they are not inclined to seek professional help for their poor postnatal mental health. Mental health is a taboo among Asian-Indian communities, primarily because of their superstitious beliefs surrounding mental illness and the desire to keep such issues within the family. ...
... Previous studies have also found that the incongruity of the Western model of care with complex postnatal care among Indian migrant communities can deprive them of their familiar and supportive cultural practices. 22,46,47 This may influence their mental health and well-being. India is a culturally diverse country with many languages and traditions. ...
Background:
The postpartum period can be challenging for many women. For migrant women, the arrival of a new baby brings unique issues. This study aimed to explore the experiences of motherhood and postpartum support of Indian migrant mothers.
Methods:
A qualitative descriptive naturalist inquiry was adopted, with data collected through face-to-face, semi-structured, in-depth interviews with a purposive sample of 11 English speaking Indian migrant women over 18 years old, (6 weeks to 6 months postpartum) in 2016. The data were thematically analysed.
Findings:
Four themes were found in this study: the role of social support in postpartum care, support from health services, a psycho-emotional journey with socio-cultural expectations and struggling to bridge two cultures. Many of the women felt alone and were distressed with undertaking household duties and caring for older children, as this would not have happened in India. The women expressed needing practical support until they settled back into their normal lives. Women never sought professional advice for their ongoing mental health concerns. Conflicting advice from health professionals left some women confused about their expectations of traditional and modern postnatal care.
Conclusion:
This study gives a unique insight into the experiences of Indian migrant women following birth. There is a need for culturally sensitive and appropriate postnatal services that encourage Indian men to support their partners and help women to find alternative sources of culturally appropriate support. It is vital that mental health support is a key component of any such program of care.
... Mauthner (2010) posits that women's Cultural Lens around Postpartum Depression In Asian context : Literature Review voices are lost in the cabins of health care professionals as their symptoms are largely ignored. Goyal et al. (2006) and Oates et al. (2004) have observed that the symptomatic patterns of postpartum depression are similar at the ethnic level but vary at the cultural and community levels. ...
Postpartum depression is a medical term that refers to a mental illness that begins as a woman embarks on the journey of biological motherhood. Wherein this term has been borrowed from the west, owing to a significant lag in understanding of the cultural making of this condition, there is a need for deconstructing this condition from a cross-cultural lens. This paper would be an attempt to explore how mothers are situated in the postpartum phase across different cultures in the context of rituals and beliefs practiced during the postpartum period. There is a need for stocktaking of the cultural pinnings of the postpartum period and mothering practices in the genesis of postpartum depression. A rich understanding of postpartum depression is incomplete without taking cultural embeddedness into account. The larger objectives of this review paper are: exploring the rituals and beliefs around postpartum period and postpartum depression across Asian cultures; where and how postpartum depression is understood in these cultures; and how the mother is (re)constructed in the context of postpartum rituals. In the paper, prospective directions of research are discussed
... For example, a study conducted on Asian Indians reported that the prevalence of depression was 17.7% (Leung et al., 2012). Another study on immigrant Asian Indian women reported that 28% experienced depression symptology (Goyal et al., 2006). While our study did not analyze major depressive disorder or generalized anxiety disorder, our study findings suggest increased mental health symptoms during Note: Based on 289 adult participants in the study sample. ...
Background
In the United States, the COVID-19 pandemic has caused increased mental health symptoms and mental illness. Specific subgroups such as Asian Indians in the US have also been subject to additional stressors due to unprecedented loss of lives in their home country and increased Asian hate due to the misperception that Asians are to be blamed for the spread of the SARS-CoV-2.
Objective
We examined the various factors including discrimination associated with COVID-19-related mental health symptoms among Asian Indians.
Methods
We administered an online survey between May 2021 and July 2021 using convenient and snowball sampling methods to recruit Asian Indian adults (age > 18 years, N = 289). The survey included questions on mental health and the experience with unfair treatment in day-to-day life. Descriptive analysis and logistic regressions were performed.
Results
Overall, 46.0% reported feeling down, depressed, or lonely and feeling nervous, tense, or worried due to the COVID-19 pandemic; 90.0% had received at least one dose of vaccination and 74.7% reported some form of discrimination. In the fully-adjusted logistic regression, age (AOR = 0.95; 95%CI- 0.92, 0.97;p < 0.01) and general health (AOR=0.84; 95%CI- 0.73, 0.97; p < 0.015) were negatively associated with mental health symptoms. Participants who experienced discrimination were more likely (AOR=1.26; 95%CI- 1.08, 1.46; p < 0.01) to report mental health symptoms.
Conclusion
In this highly vaccinated group of Asian Indians discriminatory behaviors were associated with mental health symptoms suggesting the need for novel institutional level policy responses to reduce anti-Asian racism
... The proportion of mothers reporting high levels of depressive symptoms in this multi-ethnic sample is 39 %. This percentage is consistent with prior research studies that measured levels of depressive symptoms among ethnic/minority Black/African American (50 %) (Atkins, 2015(Atkins, , 2017 and (63 %) (Hatcher et al., 2008), Hispanic/ Latinos (24 %) (De Luca et al., 2018), (19 %) (Brooks et al., 2015), (23 %) (Chaudron et al., 2005), White/Caucasians (25 %) (Conners-Burrow et al., 2016), multi-ethnic, low-income mothers of young children (75 %) (Peden et al., 2004), US, first generation, south east Asian Indian women (48.0 %) (Rehman, 2007), and Asian Indian immigrant postpartum mothers (28 %) (Goyal et al., 2006). Mild levels of depressive symptoms may precede the development of clinically significant major depressive disorder (Ji, 2012). ...
Purpose
To identify mothers' salient normative, behavioral and control beliefs and willingness towards participating in genetic salivary testing for depression.
Design
A qualitative, descriptive design was employed. 41 multi-ethnic mothers completed surveys that underwent directed content analysis according to The Theory of Planned Behavior. Percentages and frequency counts were used to categorize responses and calculate willingness.
Findings
Salient beliefs included: Behavioral: Finding a cure/treatment for depression (29.3 %), Normative: Family would approve (46.3 %), and Church associates would disapprove (19.5 %). Control: Lacking information/explanations (34.1 %) as barriers, convenient locations (24.4 %) as facilitators. Most mothers indicated a willingness to participate (90.2 %).
Conclusions
Interventions should target families, emphasize benefits, explain purposes and procedures, and use community based participatory methods.
... Environmental, physical, biological, and genetic factors can affect the creation and constancy disorder [8,9]. Moreover, the results of different studies showed the stress of infant care [10], marital satisfaction [11], and dissatisfaction with the gender of the baby [12], maternal occupation, low family income, increased duration of labor, undesired gender of the baby by the mother, and breastfeeding less than the infant [13]. We expected an increased risk of PTSD after childbirth. ...
Background: Childbirth is among the most significant and pleasant events in a woman’s life. This event can be a traumatic event and a threat to the mother’s mental health. This study recognizes the relationship between Post-Traumatic Stress Disorder (PTSD) after childbirth and social support and marital satisfaction.
Methods: This Cross-sectional analytical study was performed on a sample of 400 mothers who had delivered at Shohadaye-15-Khordad Hospital in Varamin (in two groups with & without PTSD). The research instruments include the Demographic, Midwifery, Neonatal Factors checklist, Enrich Marital Satisfaction, Weinfeld and Tigman Social Support, and the PTSD Symptoms Scale. We used SPSS to analyze the descriptive and Pearson correlation and logistic regression data. A P0.05). Marital satisfaction significantly affected the probability of PTSD after childbirth (P=0.001). There was a significant correlation between PTSD total score and dimension of avoidance symptoms and infant gender (P=0.038). There was also a significant correlation between gestational age and avoidance symptoms (P=0.001) and type of nutrition feeding and motivational symptoms (P=0.041) of PTSD dimensions.
Conclusion: According to the relationship between marital satisfaction and PTSD, it is recommended to design suitable interventions to improve the marital status and promptly diagnose the susceptible mothers to prevent the spread of this complication.
... Poor social support (37), poverty(38), and childbirth without the presence of relatives (39), history of depression (40), and poor woman autonomy (41) from socio-demographic variables, multi-parity (42), prime-parity (43,44), multiple children at home (45), negative attitude toward to one's pregnancy (22,(46)(47)(48)(49), depression during pregnancy (42,50), premarital pregnancy (51,52), miscarriage (53), and prenatal high anxiety (47) from pregnancy and newborn related factors, alcohol use in the husband (54), intimate partner violence (22,55,56), poor husbands education (45), husbands unemployment (46, 57), and psychiatric problems in the husband (58) among husband related factors were among the associated factors for the development of postpartum depression. In the context of Ethiopia too, poor marital relation (27,29,32,34,35,59), unplanned pregnancy (21,22,24,27,29,32,34), previous history of depression (21,27,28,34), domestic violence (21,22,27,34), poor social support (21,(32)(33)(34)(35), and family history of mental illness (24,28,31) were among the documented factors responsible for the development of postpartum depression (PPD). ...
Background
Maternal mental health in the postpartum period is essential for the optimal development of the newborn and appropriate breastfeeding practices. Despite this, a shortage of concrete evidence exists regarding the magnitude of postpartum depression and associated factors. This meta-analysis study was therefore done to fill such a gap.
Methods
PubMed, Scopus, and EMBASE were investigated with no time limitation. A manual search for a reference list of articles was also done. Relevant data were extracted using Meta XL package and analysis was done Stata-11 meta-prop package. Heterogeneity was checked with Cochran's Q-statistics and the Higgs I² test. Furthermore, sub-group and sensitivity analyses were done. Egger's test and funnel plots tests were engaged to identify publication bias.
Results
A total of 16 studies that assessed 11400 postpartum women in Ethiopia were included. The average estimated prevalence of postpartum depression was 21.9% (95% CI: 18.98, 24.77). The pooled prevalence of postpartum depression was higher in studies that used SRQ-20; 24.6% (95% CI: 18.42, 30.84) than studies that used PHQ-9; 18.9% (95% CI: 11.52, 26.28). Moreover, the pooled estimated prevalence of postpartum depression was slightly higher in the southern part of Ethiopia (22.6%) than Addis Ababa (21.2%). Poor marital relation (pooled aOR = 3.56) (95% CI: 2.50, 4.63), unplanned pregnancy (pooled aOR = 3.48) (95% CI: 2.18, 4.79), previous history of depression (pooled aOR = 4.33) (95% CI: 2.26, 6.59), poor social support (pooled aOR = 4.5) (95% CI: 3.34, 5.56), domestic violence (pooled aOR = 3.77) (95% CI: 2.62, 4.92), family history of mental illness (pooled aOR = 4) (95% CI:1.56, 6.56), use of substance (pooled aOR = 4.67) (95% CI:4.00, 5.34), low income (pooled aOR = 2.87) (95% CI: 1.59, 4.14), stressful life event (pooled aOR = 3.5) (95% CI: 1.39, 5.87) and perinatal complications (pooled aOR = 3.8)( 95% CI: 1.45, 6.15) were among the associated factors for postpartum depression in Ethiopia.
Conclusion
More than one in five women was with postpartum depression and factors such as poor marital relations, history of depression, poor social support, domestic violence, unplanned pregnancy, family history of mental illness were related to it. Therefore, maternal postnatal care services should be geared to incorporate this public essential health concern.
... The participants who had maternity blues tended to have PPD. 5 Another study assessing the incidence of PPD symptomatology in a sample of immigrant Asian Indian women found that there was a minor depressive symptomatology rate of 28% and an additional major depressive symptomatology rate of 24%. 6 Different health care attitudes in different cultures and distance from family leading to homesickness could be the possible reasons. However, no consistent association of PPD has been found with maternal education. ...
Post partum depression (PPD) is an important complication of child-bearing. It requires urgent interventions as it can have long-term adverse consequences if ignored, for both mother and child. If PPD has to be prevented by a public health intervention, the recognition and timely identification of its risk factors is must. We in this review have tried to synthesize the results of Asian studies examining the risk factors of PPD. Some risk factors, which are unique to Asian culture, have also been identified and discussed. We emphasize on early identification of these risk factors as most of these are modifiable and this can have significant implications in prevention of emergence of post partum depression, a serious health issue of Asian women.
... In South Asia, arranged marriages are very common and this type of marriage seems to occur even with South Asians living in the United States. 51,52 There is a possibility that this type of arrangement increases the risk of IPV victimization because younger age when married has been found to be associated with an increased risk for IPV. 53 The lifelong implications of childhood abuse and IPV victimization are critical to understand because cumulative abuse victimization, in which a victim experiences abuse over time and/or multiple types of abuse, is associated with poor health outcomes across the lifespan. ...
Background: Intimate partner violence (IPV) is a common form of interpersonal violence and impacts the health and well-being of victims over their lifetime. Many victims of IPV experience multiple types of victimization throughout their lives, often starting in childhood. The prevalence of IPV victimization of women varies among different race/ethnic groups. The purpose of this project is to examine childhood abuse among Filipina and South Asian women living in the United States who had experienced IPV.
Methods: Data were extracted from Lifecourse Experiences of Intimate Partner Violence and Help-Seeking among Filipina, Indian, and Pakistani Women: Implications for Justice System Responses 2007–2009 (San Francisco, CA) (ICPSR 29682). Data were collected from 143 women (87 Filipina and 56 South Asian (i.e., Indian or Pakistani) aged between 18 and 60 years who had been a victim of IPV and lived in the United States.
Results: Although both Filipina and South Asian women who had experienced IPV reported a high prevalence of childhood abuse, Filipina women reported a higher prevalence than South Asian women. South Asian women were more likely to have first experienced IPV at a younger age and sought some form of IPV services as compared with Filipina women. The factors associated with experiencing all the types of IPV victimization included younger age at the first physical IPV victimization experience and higher educational attainment.
Conclusions: Future research should examine the cumulative victimization of childhood abuse and IPV among Asian populations and its impact on health.
... A similar result was found in Asian Indian women living in the United States showed no significant association between sex of child and PPD. 19 similarly a study conducted in Vietnam also show ed that the sex of new-born did not cause of depression among postpartum mothers. 16 This study showed that pregnancy-related problems/complications were significantly associated with postpartum depression. ...
Introduction: Depression in the postnatal period women is one of the major psychological disorders among reproductive-age women. It is associated with undesirable consequences for mothers as well as their children. Throughout the world, the reported prevalence of postpartum depression ranges from 3.5% to 33%, depending on type, severity and time since delivery. This study assessed the depression in postnatal period women and its associated factors attending a hospital of Pokhara Metropolitan, Nepal. Materials and Methods: A hospital-based cross-sectional study was conducted among postpartum mothers of Pokhara Metropolitan. A quantitative survey method was adapted for collecting the required information. A face-to-face interview was conducted among 172 postpartum women using a structured interview schedule and Edinburg Postpartum Depression Scale (EDPS). We applied descriptive statistics for assessing the demographic, socioeconomic and various pregnancy and delivery-related factors of the postnatal women as number and percentage. We used a chi-square test to find out the association of depression with demographic, socioeconomic and health service-related factors of postnatal women. Results: Overall 12% of women were suffered from the depression in the postnatal period using EPDS at the cutoff value ≥13. The age of the participants ranged from 17 to 38 years and the median age was 24 years. Nearly two-thirds participants (63.4%) were married at an early age (<20 years). All participants included in this study were within seven days of their postpartum period. Amongst various household wealth indexes, pregnancy-related problems/complications were found to be associated with PPD. Conclusion: The study revealed that nearly one-fifth of women were suffering from depression in their postpartum period. For dealing with the problem, there should give importance to women's education, empowerment, and family care and support during pregnancy and the postpartum period.
... In the U.S., the rate of PPD symptoms among immigrant women ranged between 43-60% among Hispanic women [7][8][9][10]. A pilot study conducted in the U.S. with 58 immigrant Asian Indian women found that 28% of them had PPD symptoms [11]. In the Arabic literature, the prevalence of PPD ranged between 10-37% [12]. ...
Acculturation has been related to risk of postpartum depression (PPD) among immigrant women globally. The purpose of this study was to examine the relationship between acculturation and PPD symptoms among U.S. immigrant women of Arabic descent. A cross-sectional study was conducted with 115 postpartum immigrant women of Arabic descent. Women completed questionnaires including measures of acculturation [attraction to Arabic culture (AArC), attraction to American culture (AAmC), marginalization] and PPD symptoms (Edinburgh Postnatal Depression Scale—EPDS) between 1 and 12 months postpartum. Twenty-five percent of women (n = 29) had EPDS scores ≥ 10 that represent PPD symptoms. Women with higher marginalization reported more PPD symptoms (r = .25, p = .008). None of the acculturation factors correlated with PPD symptoms after adjustment for maternal sociodemographic and health characteristics. Higher education (p = .001), lower gestational age at birth (p < .05), and antenatal anxiety (p < .05) were correlated with PPD symptoms in multivariate analyses. Health care providers should identify and assess immigrant women of Arabic descent for antenatal anxiety as this may identify women at risk for development of PPD symptoms. Future studies need to examine acculturation in relation to mental health among immigrant women of Arabic descent.
... Adicionalmente, un estudio determinó la incidencia de depresión posparto, a través de la aplicación de una escala de tamización para esta condición, en una muestra de mujeres indias inmigrantes entre 2 y 12 meses postparto (48). También se revisó un artículo que describió en un puerto de entrada el sistema de detención de inmigrantes con enfermedades mentales. ...
... Because migration often involves the leaving behind of family, friends, acquaintances, neighbors and other people belonging to the same "community," sources of social support are inevitably reduced (Furnham & Shiekh, 1993). All these aspects have been extensively linked to symptoms of anxiety and depression in this ethnic group (Goyal, Murphy, & Cohen, 2006;Nilaweera et al., 2014;Vahabi & Damba, 2015). Specifically, the loss of a social and family extended network and economic difficulties after immigration both contribute to worsening their psychological symptoms (Vahabi & Damba, 2015). ...
This pilot study examined psychological, social and cultural risk factors for child insecure attachment in a sample of South Asian immigrant families experiencing high migration stress in Montreal, Canada. Thirty-three participants were recruited through a local Health and Social Service organization. Maternal anxiety and depression, social support, and national and religious sense of belonging were assessed. Child attachment behaviors were coded from a 15 min free play period. Results indicated that maternal depressive symptoms were related to lower child attachment security scores. Lower support from friends was related to greater child ambivalent attachment behaviors. A higher sense of belonging to the country of origin was related to greater child disorganized attachment behaviors. These findings suggest that migration stresses, which include maternal depression, lack of social support and the sense of belonging, are associated with child attachment, and these variables should be considered in the design of appropriate interventions.
... Adicionalmente, un estudio determinó la incidencia de depresión posparto, a través de la aplicación de una escala de tamización para esta condición, en una muestra de mujeres indias inmigrantes entre 2 y 12 meses postparto (48). También se revisó un artículo que describió en un puerto de entrada el sistema de detención de inmigrantes con enfermedades mentales. ...
Objetivo
Elaborar una propuesta para el fortalecimiento de los sistemas de información de vigilancia epidemiológica y sanitaria para los puntos de entrada y zonas de frontera de Colombia.
Materiales y Métodos
Se desarrolló una revisión sistemática de literatura mediante la metodología Prisma, términos MeSH y DECS. Para ello, se consultaron, las bases de datos PubMed y BVS entre el 2000 y el 2014. Se incluyeron 52 documentos de acuerdo con los criterios de inclusión-exclusión, en los que se discutieron cada una de las categorías propuestas: servicios de salud, salud mental estado de salud y determinantes sociales.
Resultados
El análisis permite determinar que la vigilancia epidemiológica y sanitaria de fronteras y puntos de entradas a nivel mundial, está enfocado principalmente en ejes como salud mental, eventos transmisibles y eventos de condiciones no transmisibles. Adicionalmente, se da importancia a la atención integral en los servicios de salud y al análisis del estado de salud de la población inmigrantes bajo en el enfoque diferencial territorial, étnico y cultural. Sin embargo, hay pocas experiencias con un enfoque intersectorial, así como de determinantes sociales, en los territorios con condiciones de zonas de fronteras y/o puntos de entradas.
Conclusiones
Las diferencias de contexto, sistemas de salud, sistemas de información y prioridades de cada país, hacen que el intercambio y la cooperación entre las fronteras tengan serios retos. Debido a esto, es necesario contar con instrumentos de cooperación entre países limítrofes y análisis e información, con base en el modelo de determinantes sociales de la salud.
... 38,59 Fourteen studies 26,31,32,[35][36][37][38][39][40]48,53,55,59,62 included a non-migrant comparison group and, of these, nine (64%) 26,31,32,36,38,39,53,55,59 reported higher rates of mental illness in the migrant groups. North America (22 studies) 27,30,34,35,[37][38][39]41,42,[46][47][48][49][50][51][52]55,56,59,61,68,69 was the most heavily represented destination region, followed by Europe (six studies) 28,36,40,43,60 and Australasia (six studies). 25,26,53,54,57,58 Thirty-seven studies were conducted in high income countries, four in middle income countries and none in low-income countries. ...
Background:
Migrant women are at risk of perinatal mental disorders due to stressors experienced before, during and after migration.
Objectives:
This systematic review and meta-analysis summarises the prevalence, associated factors and interventions for perinatal mental disorders in migrant women from low- and middle-income countries (LMIC).
Search strategy:
We systematically searched nine electronic databases and the grey literature using a predefined search strategy.
Selection criteria:
Studies were included if they assessed pregnant or postpartum migrants from LMIC, used a structured tool and a case-control, cross-sectional, cohort or intervention study design.
Data collection and analysis:
Data was double-extracted. We calculated pooled prevalence of depression and weighted mean anxiety and depression scores. We calculated crude odds ratios from risk factor studies and summarised intervention studies descriptively.
Main results:
Forty studies were identified from 10 123 references. Pooled prevalence was 31% [95% condidence interval (CI) 23%-40%] for any depressive disorder and 17% (95% CI 12-23%) for major depressive disorder. Previous depression and lower social support were associated with perinatal depression. There were insufficient data to assess the burden of anxiety, post-traumatic stress disorder or psychosis in this population.
Conclusions:
One in three migrant women from LMIC experiences symptoms of perinatal depression. Social support is an important protective factor. Evidence on LMIC women relocating to other LMIC is lacking. Given the adverse consequences of perinatal mental illness on women and their children, further research in low-resource settings is a priority.
Tweetable abstract:
One in three migrant women from low- and middle-income countries has symptoms of perinatal depression.
... Bunu destekler şekilde çalışmamızda aktif iş yaşamı olan annelerin eğitim düzeyinin, evlenme yaşının, sezaryen tercihinin daha yüksek; çocuk sayının, depresyon ve kaygı düzeylerinin daha düşük olduğu bulundu ve bu sonuçlar daha önceki bazı çalışmaların bulgularıyla uyumluydu (36,37). Çalıştığımız hastanenin hizmet verdiği çevrede geleneklerden kaynaklı olarak, erkek çocuğun daha tercih edilir olmasına rağmen (37,38) bizim çalışmamızda çocuğun cinsiyeti her iki dönem için de, belirgin bir stres kaynağı olmamıştır. Bu durum çalışma grubumuzdaki çoğu kişinin eğitim düzeyinin yüksekliğiyle ilişkili gibi görünmektedir. ...
Purpose: In this study, we aimed to determine the change in depression and anxiety levels of mothers during prepartum and postpartum periods. Methods: Among the mothers who admitted Dicle University Hospital in their third trimester between June 2008 and January 2009 and did not have any physical disorder were enrolled in the study. After their initial evaluation during the third trimester the mothers were re-evaluated in their second and third month after birth. Results: Mean age of the mothers was 28.2±4.2 years. Prepartum and postpartum evaluations of the mothers with BDI revealed 31% and 29% depression ratios, respectively. According to the STAI-I when evaluated at prepartum and postpartum periods, 47% and 49% of the mother were significantly anxious. It was 71% and 63% for prepartum and postpartum evaluations with STAI-II, respectively. There were statistically significant difference between prepartum and postpartum periods in terms of upper threshold of the BDI and STAI-II scores (p=0.002 and p=0.014). Conclusion: Mothers seem to be under as high risk for depression and anxiety at prepartum period as they are at postpartum period. In general, the mothers who had higher levels of depression and anxiety before delivery tend to have also higher levels at postpartum period.
... From these 44 studies, a further 20 were excluded. We excluded three studies with a response rate less than 50% (Bandyopadhyay et al., 2010;Lansakara et al., 2010;Stewart et al., 2008), seven studies that were based on self-selected volunteers (Choi et al., 2012;Christensen et al., 2011;Fan, 2007;Goyal et al., 2006;Heilemann et al., 2004;Lucero, Beckstrand et al., 2012;Shellman et al., 2014), two studies that recruited both first and second generations of immigrant mothers (Goyal et al., 2012;Kuo et al., 2004), one study that examined migrants from other parts of the same country (Danaci et al., 2002), and two studies that used scales other than EPDS or CES-D (Hung et al., 2012;Tobin et al., 2014). ...
The aims of this systematic review and meta-analysis were threefold: to estimate the prevalence of postpartum depressive symptoms in immigrant women, compare this prevalence to non-immigrant women, and determine risk factors for postpartum depressive symptoms in immigrant women. Literature searches were conducted in PubMed, Embase, PsycINFO, Web of Science, Scopus, ResearchGate and Google Scholar databases from 1950 until October 2014. Twenty-four studies met the inclusion criteria of which 22 (12 cross-sectional and 10 prospective cohort) contributed data for meta-analyses. Heterogeneity and publication bias were assessed. The prevalence of postpartum depressive symptoms in immigrant women was 20% (95% confidence interval [CI] 17-23%, 18 studies, N = 13,749 women). Immigrant women were twice more likely to experience depressive symptoms in the postpartum period than non-immigrant women (pooled unadjusted odds ratio [OR] = 2.10 [95% CI 1.62-2.73, 15 studies, N = 50,519 women] and adjusted OR = 2.18 [95% CI 1.60-2.96, 7 studies, N = 35,557 women]). There was, however, evidence of publication bias with the pooled adjusted OR reduced to 1.63 (95% CI 1.22-2.17) after adjustment for bias. Risk factors associated with postpartum depressive symptoms among immigrant women included shorter length of residence in the destination country, lower levels of social support, poorer marital adjustment, and perceived insufficient household income. This study suggests that postpartum depression is a common condition among immigrant women. Moreover, immigrant women are at higher risk of postpartum depression than non-immigrant women. Further prospective studies on the risk factors of postpartum depression among immigrant women verified by a clinical diagnosis are needed.
... In Iran, the disease manifests itself mainly with somatization of depressive symptoms and feelings of guilt [63]. There is an intense criticism, resentment and hostility from society when a baby girl is born [21,36,46]. ...
It is a well known fact that postpartum depression (PPD) is a global phenomenon that women may experience, regardless of cultural identity and beliefs. This literature review presents the cultural beliefs and postnatal practices around the world, in each continent and people's origins, looking through the extent to which they contribute positively or negatively to the onset of the disease. 106 articles were used in this research, through a systematic electronic search of Pubmed (Medline) and Scopus. Comparison is also made between the prevalence, the risk factors and the different ways of appearance of the disease around the world and among immigrants. Finally, the initiatives and interventions made so far by the governments and institutions with a view to prevent and address this global problem are presented. The results showed (a) that different cultures share the same risk factors towards the disease (b) significant differences in the prevalence of the disease among both Western and non Western cultures and between the cultures themselves (c) more tendencies for somatization of depressive symptoms in non-Western cultures, (d) different postnatal practices between cultures, which are not always effective (e) the more non-West a culture is, the less interventions concern on mental health; the same phenomenon is observed on populations burdened by immigration. The beliefs held by culture should be taken seriously in detecting of PPD, as well as the assessment of the needs of women who have recently given birth.
... It is a marriage between a man and a woman who are introduced by their parents on the basis of caste, education, family background and mutual family suitability. No significant difference was reported on the level of postpartum depressive symptomatology among immigrant Asian Indian in Northern California (Goyal et al., 2006). ...
The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries.
A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview.
The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression.
All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results.
The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended.
Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
... The participants who had maternity blues tended to have PPD. 5 Another study assessing the incidence of PPD symptomatology in a sample of immigrant Asian Indian women found that there was a minor depressive symptomatology rate of 28% and an additional major depressive symptomatology rate of 24%. 6 Different health care attitudes in different cultures and distance from family leading to homesickness could be the possible reasons. However, no consistent association of PPD has been found with maternal education. ...
Post partum depression (PPD) is an important complication of child-bearing. It requires urgent interventions as it can have long-term adverse consequences if ignored, for both mother and child. If PPD has to be prevented by a public health intervention, the recognition and timely identification of its risk factors is must. We in this review have tried to synthesize the results of Asian studies examining the risk factors of PPD. Some risk factors, which are unique to Asian culture, have also been identified and discussed. We emphasize on early identification of these risk factors as most of these are modifiable and this can have significant implications in prevention of emergence of post partum depression, a serious health issue of Asian women.
The perinatal period encompassing pregnancy and the postpartum phase is a critical juncture in every woman's life that can significantly influence mental health and well-being across cultures. The secondary research paper aims to comprehensively study the interplay between social-cultural factors and perinatal mothers' mental health outcomes. By achieving the objectives of analyzing social support networks, unraveling cultural influences, and also further examining the impact of societal stigma, it has been concluded from past research that there is a deep impact of social constructs on women's mental health. Every woman has to encounter the influence of varied aspects such as patriarchy, the family system, the pressure of roles and responsibility in marriage, the desire for male offspring by in-laws, the stringent code of behavior for being a daughter in law and the primary responsibilities of parenting her children. The social dynamics have also been undertaken to analyze the effect of sub-cultural characteristics of race, religion, caste, creed in Indian culture on the health and wellbeing of perinatal women. The review of research studies identifies certain cultural practices, community support systems, and other social-cultural challenges that affect parental mental health. The study further offers valuable insights for healthcare providers and researchers to develop more effective strategies for supporting the mental health and well-being of pregnant and perinatal mothers. The studies suggest that collaborating with experts in various fields like anthropology, sociology, psychology and public health can contribute to the development of effective interventions tailored to the unique needs and experiences of different cultures.
Background:
There are one billion migrants globally, of whom 82 million are forced migrants. Pregnant migrants face pre-migration stressors such as conflict, transit stressors including poverty, and post-migration stressors including navigating the immigration system; these stressors can make them vulnerable to mental illness. We aimed to assess the global prevalence of and risk factors for perinatal mental health disorders or substance use among women who are migrants.
Methods:
In this systematic review and meta-analysis, we searched OVID MEDLINE, Embase, PsycINFO, CENTRAL, Global Health, Scopus, and Web of Science for studies published from database inception until July 8, 2022. Cohort, cross-sectional, and interventional studies with prevalence data for any mental illness in pregnancy or the postnatal period (ie, up to a year after delivery) or substance use in pregnancy were included. The primary outcome was the prevalence of perinatal common mental health disorders among women who are migrants, globally. Data for study quality and risk factors were also extracted. A random-effects meta-analysis was used to calculate pooled prevalence estimates, when appropriate. Sensitivity analyses were conducted according to study quality, sample representativeness, and method of outcome assessment. Risk factor data were synthesised narratively. This study is registered with PROSPERO, CRD42021226291.
Findings:
18 650 studies were retrieved, of which 135 studies comprising data from 621 995 participants met the inclusion criteria. 123 (91%) of 135 studies were conducted in high-income host countries. Five (4%) of 135 studies were interventional, 40 (30%) were cohort, and 90 (66%) were cross-sectional. The most common regions of origin of participants were South America, the Middle East, and north Africa. Only 26 studies presented disaggregated data for forced migrants or economic migrants. The pooled prevalence of perinatal depressive disorders was 24·2% (range 0·5-95·5%; I2 98·8%; τ2 0·01) among all women who are migrants, 32·5% (1·5-81·6; 98·7%; 0·01) among forced migrants, and 13·7% (4·7-35·1; 91·5%; 0·01) among economic migrants (p<0·001). The pooled prevalence of perinatal anxiety disorders was 19·6% (range 1·2-53·1; I2 96·8%; τ2 0·01) among all migrants. The pooled prevalence of perinatal post-traumatic stress disorder (PTSD) among all migrant women was 8·9% (range 3·2-33·3; I2 97·4%; τ2 0·18). The pooled prevalence of perinatal PTSD among forced migrants was 17·1% (range 6·5-44·3; I2 96·6%; τ2 0·32). Key risk factors for perinatal depression were being a recently arrived immigrant (ie, approximately within the past year), having poor social support, and having a poor relationship with one's partner.
Interpretation:
One in four women who are migrants and who are pregnant or post partum experience perinatal depression, one in five perinatal anxiety, and one in 11 perinatal PTSD. The burden of perinatal mental illness appears higher among women who are forced migrants compared with women who are economic migrants. To our knowledge, we have provided the first pooled estimate of perinatal depression and PTSD among women who are forced migrants. Interpreting the prevalence estimate should be observed with caution due to the very wide range found within the included studies. Additionally, 66% of studies were cross-sectional representing low quality evidence. These findings highlight the need for community-based routine perinatal mental health screening for migrant communities, and access to interventions that are culturally sensitive, particularly for forced migrants who might experience a higher burden of disease than economic migrants.
Funding:
UK National Institute for Health Research (NIHR); March of Dimes European Preterm Birth Research Centre, Imperial College; Imperial College NIHR Biomedical Research Centre; and Nuffield Department of Population Health, University of Oxford.
Background: Evidence that the birth process of physically active women go through more easily than inactive women goes back to ancient times. As a result, women's orientation to physical activity during pregnancy indicates that they will have a very beneficial and comfortable period both before and after pregnancy. Aim: The aim of this study was to examine the effect of exercise on the anxiety levels of pregnant and non-pregnant women in terms of various variables. Methods: Pregnant Information Form and Cambridge Anxiety Scale created by the researchers were used as data collection tools in the study. Data collection tools were applied by the researcher using face to face interview method. In the analysis of the data obtained in the study, percentage and frequency descriptive statistical methods to determine the distribution of the personal information of the participants, T-test, One Way Anova Test First of all, Kaiser-Mayer-Olkin (KMO) and Bartlett tests were used to measure the conformity of the expressions to the factor analysis, reliability and validity of the anxiety scale used. After it was determined that the validity condition was met, the mean and standard deviation values for the scale expressions were calculated. Conclusion: According to the findings, the anxiety levels of the participants; According to the results of the analysis on whether there is a significant difference according to their age, average age, education level, income status, number of children, current health status, frequency of doing sports, type of sport, motivating factors for sports, anxiety levels for themselves during the pandemic process, during the pandemic process. It has been determined that there is a significant difference according to their anxiety levels for their babies, their pregnancy status and their relationship with sports. Result: It was determined that the level of anxiety did not differ according to the number of pregnancies, the number of miscarriages, the duration of pregnancy and social security status. Keywords: Pregnancy, Exercise, Anxiety.
Cite as: Görücü, A.,Uslu, Ö.S., Uslu, Mustafa.(2021)The Effect of Exercise on Anxiety Levels of Pregnant and Non-Pregnant Women, Pakistan Journal of Medical and Health Sciences 15(10):2900-2910,
October 2021 DOI: 10.53350/pjmhs2115102900
Background
The prevalence of Postpartum Depression (PPD) in the world is estimated to range from 10 to 30%. In India, about 22% of mothers suffer from postpartum depression.
Purpose
Study objective is to examine the prevalence and covariates of postpartum depression among new mothers; and find the association between the indices of social support, partner support and attention shifting with experience of postpartum depression.
Methods
A cross-sectional hospital-based study design was used. The sample for this study included 240 postnatal mothers from Pune urban areas selected randomly from three hospitals who attended postnatal check-ups or immunizations in the city. Postpartum depression was assessed using Marathi validated Edinburgh Postpartum Depression Scale (EPDS). Support from the respondent woman’s mother, mother-in law, husband, relatives was assessed for estimating Social Support Index. The husband’s support was assessed for Partner Support Index; and shift of attention from mother to baby was for Attention Shift Index. Mothers who scored ≥13 on the EPDS scale were categorised as depressed. Reliability and validity of the scales and indices was checked using Chronbach’s alpha. Univariate, bivariate, and logistic regression were used to determine the association of various indices with PPD.
Results
Of the 240 mothers surveyed, 63 (26.3%) mothers scored ≥13 on EPDS and thus, were categorised as depressed. A strong statistical association was found between social support with postpartum depression (AOR:3.037; 95% CI:1.486-6.208) and unadjusted models (UOR: 2.269; 95% CI:1.056-4.87), partner support (AOR:4.979;95%CI:1.348-18.388) and attention shift from mother to baby with PPD (Both adjusted to AOR:2.618; 95%CI:1.441-4.858; and unadjusted UOR: 2.373; 95%CI:1.072-5.254). However, no significant association was found between socio-demographic variables and postpartum depression.
Conclusion
Higher levels of postpartum depression in urban mothers affect the women and their children’s health. Screening of expecting mothers for possible symptoms of depression during antenatal care could reduce the chances depression during postpartum period. Considering its prevalence, depression should be addressed in national mental health programmes. More robust research is required for better understanding of the factors responsible for postpartum depression in urban India.
Background
Maternal mental health in the postpartum period is essential for the optimal development of the newborn. Despite this, a shortage of concrete evidence exists regarding it.
Methods
PubMed, Scopus, and EMBASE were investigated with no time limitation. A manual search for a reference list of articles was also done. Relevant data were extracted using the Meta XL package and analysis was done using Stata-11 meta-prop package. Heterogeneity was checked with Cochran's Q-statistics and the Higgs I 2 test.
Results
Sixteen studies were included. The average prevalence of postpartum depression was 21.9%. The pooled prevalence was found to be higher in studies assessed with SRQ-20, i.e 24.6% than studies assessed using PHQ-9, which was 18.9%. Moreover, the pooled prevalence was slightly higher in southern Ethiopia (22.6%) than Addis Ababa (21.2%). Poor marital relation (pooled aOR= 3.56) (95% CI: 2.50, 4.63), unplanned pregnancy (pooled aOR=3.48) (95% CI: 2.18, 4.79), previous history of depression (pooled aOR= 4.33) (95% CI: 2.26, 6.59), poor social support (pooled aOR= 4.5) (95% CI: 3.34, 5.56), and domestic violence were among the associated factors for postpartum depression.
Conclusion
More than one in five women were found to have postpartum depression and factors such as poor marital relations, history of depression, poor social support, domestic violence, and unplanned pregnancy were observed to be associated with it. Therefore, maternal postnatal care services should integrate this essential health concern.
Background:
Maternal mental health in the postpartum period is essential for the optimal development of the newborn. Despite this, a shortage of concrete
evidence exists regarding it.
Methods:
PubMed, Scopus, and EMBASE were investigated with no time limitation. A manual search for a reference list of articles was also done. Relevant
data were extracted using the Meta XL package and analysis was done using Stata-11 meta-prop package. Heterogeneity was checked with
Cochran's Q-statistics and the Higgs I 2 test.
Results:
Sixteen studies were included. The average prevalence of postpartum depression was 21.9%. The pooled prevalence was found to be higher in
studies assessed with SRQ-20, i.e 24.6% than studies assessed using PHQ-9, which was 18.9%. Moreover, the pooled prevalence was slightly
higher in southern Ethiopia (22.6%) than Addis Ababa (21.2%). Poor marital relation (pooled aOR= 3.56) (95% CI: 2.50, 4.63), unplanned
pregnancy (pooled aOR=3.48) (95% CI: 2.18, 4.79), previous history of depression (pooled aOR= 4.33) (95% CI: 2.26, 6.59), poor social support
(pooled aOR= 4.5) (95% CI: 3.34, 5.56), and domestic violence were among the associated factors for postpartum depression.
Conclusion:
More than one in five women were found to have postpartum depression and factors such as poor marital relations, history of depression, poor
social support, domestic violence, and unplanned pregnancy were observed to be associated with it. Therefore, maternal postnatal care services
should integrate this essential health concern.
Keywords: Postpartum depression, A low-income country, Ethiopia
Introduction: Failure in social support is one of the important factors in developing postpartum depression. Since mothers with premature or sick babies have higher levels of anxiety during postpartum period in comparison with other members, they need more social support. So, in this study we decided to evaluate the relation between postpartum depression and the level of social support in mothers who have premature newborns. Methods: This descriptive-correlative study was conducted on 100 mothers who had premature newborns and were discharged from the Neonatal Intensive Care Unit of Shahid Sadoughi Hospital in 2016. The sampling was conducted using the available sampling method. Mothers were asked to complete the social support and postpartum depression questionnaire. . All collected data were entered to the SPSS v.17 and analyzed by the analytic and descriptive statistical indices. The significance level was set at p-value<0.05. Results: The final results revealed that social support had a significant association (p-value<0.05) with the number of mother’s child, her husband’s job, and family economic status . Furthermore, the findings revealed that postpartum depression had a significant association with the father's job, the educational status of father, and the economic status of family. Conclusion: It can be concluded that the more social support leds to the less incidence of postpartum depression.
Background: Postpartum depression also known as postnatal depression is a non-psychotic depressive disorder of variable severity and it can begin as early as after delivery and can persist indefinitely if untreated. The objective of this study was to determine the prevalence of postpartum depression by Edinburgh postnatal depression scale and to evaluate the factors predisposing to postpartum depression.Methods: The present prospective observation study was conducted in the Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College, Jabalpur from 1st March 2015 to 31st August 2016. Participants were screened for postnatal depression using EPDS. A risk factor questionnaire that covered key socio-demographic and obstetrics factors were also completed by all the subjects. Main outcome measure: prevalence of a score of 13 or higher, on the EPDS. The data of the present study was recorded into computer and after proper validation, error checking, coding and decoding, the data was compiled and analysed using the SPSS Window, Appropriate univariate and bivariate analysis were carried out using the fisher exact test or Chi-square test for categorical variables.Results: The present study concludes that the prevalence of postpartum depression is 12.8% (64/500) amongst postnatal women admitted of Obstetrics unit of NSCB Medical College, Jabalpur (Madhya Pradesh) since the prevalence of an EPDS score ≥13 (which is suggestive of PPD) was found in a significant proportion of women, screening for PPD is indicated in all postpartum subjects to identify and promptly treat these women. Identification of a clear association between certain risk factors and PPD will lead to a prompter diagnosis of PPD.
Background & Aim: Childbearing is a potentially traumatic event in the lives of women and can lead to post traumatic stress disorder in some women. This study aimed to determine the prevalence and predisposing factors of post traumatic stress disorder after childbearing in women in Bushehr.
Methods & Materials: In this cross-sectional study, 400 women who attended the medical centers 6-8 weeks after delivery were recruited to the study. Participants with traumatic delivery were included in the study. They completed the posttraumatic symptoms scale-I (PSS-I), and predisposing factors questionnaire. Data were analyzed in two groups of women with the PTSD and without PTSD using Chi-square and Fisher&aposs exact test with P=0.05.
Results: The results of this study showed that 54.4% of women had experienced a traumatic delivery and one-third of the women were affected to PTSD after childbearing. There were significant differences between obstetrical factors including complications of pregnancy, wanted pregnancy, post-partum complications, interval of the last two pregnancies less than two years neonatal factors including type of feeding, issues of child care, birth weight and psychological factors including stressful life events, and maternity social support with the PTSD (P
Purpose:
The purpose of this review was to evaluate studies that examined the relationship between acculturation and postpartum depression (PPD) among immigrant and/or refugee women in the United States.
Methods:
A systematic, computer-assisted search of quantitative, English-language, peer-reviewed, published research articles was conducted in the Scopus, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Maternity and Infant Care databases using the keyword terms of "postpartum depression" and "perinatal depression" in combination with "acculturation." Studies were included if they were conducted in the United States.
Results:
Seven studies met inclusion criteria. Three studies used longitudinal designs and four used cross-sectional designs. All were conducted with Hispanic women. Only one study used a diagnostic tool to measure PPD; the remaining studies used screening tools to measure postpartum depressive symptoms. Most studies used country of birth, country of residence, and language preferences to measure acculturation. Five studies reported acculturation was positively related to risk of postpartum depressive symptoms, and two studies reported no relationship.
Clinical implications:
Higher levels of acculturation were related to higher risk of postpartum depressive symptoms in Hispanic women living in the United States. Nurses should have an understanding of stressors of immigrant women to guide their assessment and screening for postpartum depressive symptoms and make appropriate referrals. More research is needed to confirm the relationship between acculturation and PPD among immigrant women from different cultural backgrounds.
Untreated postpartum depression (PPD) poses a threat to the maternal-child bond and the well-being of the entire family. Examine specific cultural factors and mental health help-seeking behaviors among these culturally diverse populations in an effort to improve PPD identification and treatment. Sexual addiction, which is also known as hypersexual disorder, is associated with severe psychosocial problems and risk-taking behaviors. Although sexual addiction is not included in the Diagnostic and Statistical Manual of Mental Disorders, several screening questionnaires have been developed for the diagnosis of sexual addiction or hypersexual disorder. The addition of electronic health records provides opportunity for more rapid and comprehensive communication between patients' primary and SUD care providers while promoting a collaborative care environment. Consider how to protect your patients' information in this era of collaborative care while maintaining rapid communication among healthcare providers.
Introduction: Pregnancy and postpartum period are considered as a stressful time in woman's life. Maternal disease and unexpected perinatal complaint increased the risk of post traumatic stress disorder. This study was done to determine the prevalence of Post Traumatic Stress Disorder (PTSD) after childbirth in pre-eclampsia and its related factors. Methods: This descriptive analytical study was conducted on 122 pregnant women with pre-eclampsia in labor wards of governmental hospitals of Mashhad, Iran in 2013. The prevalence of PTSD was determined by perinatal post-traumatic stress questionnaire (PPQ) and confirmed by psychiatrist interview. Related factors of demographic, obstetric and psychosocial support were also noted. Data were analyzed using SPSS software version 16, Spearman correlation coefficient, chi-square, Mann-Whitney u and independent t-test. P value less than 0.05 was considered significant. Results: 33 cases (26%) of women with pre-eclampsia, suffered from PTSD after childbirth that PTSD was confirmed by psychiatric interview in 20 women (65%). There were significant differences between mode of delivery, depression in week 6 of postpartum, social support in weeks 2 and 6 of postpartum and PTSD (p<0.05). Conclusion: The prevalence of PTSD after childbirth in pre-eclampsia is high. Cesarean delivery, reduction of postpartum social support and postpartum depression make women with pre-eclampsia susceptible to PTSD.
Questa rassegna propone un’analisi della letteratura sulla depressione post-partum (PPD) nelle donne immigrate e rifugiate, e sui possibili fattori ostacolanti la ricerca di cure. La ricerca bibliografica condotta nelle banche dati PsychInfo e Medline, relativamente agli anni 2004-2013, ha individuato 51 articoli. I risultati hanno evidenziato: 1) la peculiarita dei bisogni e dei fattori di rischio per la PPD nelle donne immigrate; 2) la specificita dei fattori culturali coinvolti, sebbene a oggi poco studiati; 3) l’esiguita di studi relativi al ruolo del supporto sociale nella ricerca di cure; infine, 4) la necessita di ricerche future sulle loro percezioni, sul supporto sociale, sugli ostacoli alla ricerca di cure al fine di pianificare possibili strategie e programmi d’intervento.
Background: Risk for anxiety and depression is increased in women with high‑risk pregnancy. The aim of this study was to evaluate anxiety and depression in women with mild and severe preeclampsia at admission and 6 weeks postpartum. Materials and Methods: In this cohort study, 122 preeclamptic women who were admitted to the Public hospital and Tamin Ejtemaee hospital of Mashhad were included. Selection was done by convenience sampling method. Beck Depression Inventory II (BDI‑II) and Spielberger State‑Trait Anxiety Inventory (STAI) were completed at admission and 6 weeks after delivery. Data were analyzed by SPSS 16 using Chi‑square, Fisher's exact test, Mann‑Whitney U test, and Repeated measurement. Results: The mean depression score was 4.81 ± 4.09 at admission and 11.17 ± 5.5 at 6 weeks postpartum. The mean of trait anxiety was 42.5 ± 10.5 at admission and 32.3 ± 6.5 at 6 weeks postpartum, and the mean of state anxiety score at admission was 43.09 ± 9.5 and at 6 weeks postpartum was 31.99 ± 5.9. There was a significant difference between the scores of depression (F = 3.8, P < 0.001), state anxiety (F = 1.52, P < 0.001), and trait anxiety (F = 1.5, P < 0.001) at admission and 6 weeks postpartum. No significant differences were found between severity of preeclampsia and the scores of depression, state anxiety, and trait anxiety at admission and 6 weeks postpartum. Conclusions: The mean score of state and trait anxiety decreased significantly in preeclamptic women from admission to 6 weeks postpartum, but the mean score of depression increased. Severity of preeclampsia was not an independent risk factor of depression and anxiety.
In this systematic review, we provide an overview of the literature on depression among Asian-Americans and explore the possible variations in depression prevalence estimates by methodological and demographic factors.
Six databases were used to identify studies reporting a prevalence estimate for depression in Asian-American adults in non-clinical settings. Meta-analysis was used to calculate pooled estimates of rates of depression by assessment type. Statistical heterogeneity was assessed for subgroup analyses by gender, age, ethnicity, and other participant characteristics.
A total of 58 studies met the review criteria (n = 21.731 Asian-American adults). Heterogeneity across the studies was considerably high. The prevalence of major depression assessed via standardized clinical interviews ranged between 4.5% and 11.3%. Meta-analyses revealed comparable estimated prevalence rates of depression as measured by the Center for Epidemiologic Studies Depression Scale (35.6%, 95% CI 27.6%-43.7%) and the Geriatric Depression Scale (33.1%, 95% CI 14.9%-51.3%). Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino).
There appears to be wide variability in the prevalence rates of depression among Asian-Americans in the US. Practitioners and researchers who serve Asian-American adults need to be sensitive to the potential diversity of the expression of depression and treatment-seeking across Asian-American subgroups. Public health policies to increase Asian-American access to mental health care, including increased screening, are necessary. Further work is needed to determine whether strategies to reduce depression among specific Asian racial/ethnic groups is warranted.
AimThe post-partum period is a stressful time of change, particularly for immigrant women, but, to the best of the present authors' knowledge, the subject has not been explored. This study aimed to examine immigrant women's post-partum stress, depression, and levels of social support, and to determine the predictors of post-partum stress for Vietnamese immigrant women in Taiwan.MethodsA cross-sectional design was used. In this descriptive survey, 208 Vietnamese immigrant women were telephone interviewed by a trained Vietnamese research assistant during one of their 6 weeks post-partum. Data were collected through telephone interviews using three questionnaires, including the Hung Postpartum Stress Scale, Beck Depression Inventory, and Social Support Scale.ResultsThe result shows that Vietnamese women had low level post-partum stress scores. Participants' family support rated higher than friend support. The incidence of depression was 0.5%. Social support, number of post-partum days, and family income were found to be predictors for post-partum stress, accounting for 26.6% of the variance. The Vietnamese immigrant women experienced significant stress regarding their maternal roles and received most of their support from their families rather than from friends.Conclusion
Nurses caring for this cohort should therefore consider these factors in order to help them cope with their post-partum stress. Healthcare providers should offer available resources to these immigrant women and their spouses during this critical period in their lives. For instance, antenatal education classes could be provided to help immigrant women manage and overcome post-partum issues.
According to the World Health Organization, unipolar depression was the third most important cause of disease worldwide in 2004. The faculty of this lesson review available treatment options, describe unmet needs, recommend augmentation strategies, and discuss some of the newer treatment options. Untreated postpartum depression (PPD) poses a threat to the maternal-child bond and the well-being of the entire family. Examine specific cultural factors and mental health help-seeking behaviors among these culturally diverse populations in an effort to improve PPD identification and treatment. Sexual addiction, which is also known as hypersexual disorder, is associated with severe psychosocial problems and risk-taking behaviors. Although sexual addiction is not included in the Diagnostic and Statistical Manual of Mental Disorders, several screening questionnaires have been developed for the diagnosis of sexual addiction or hypersexual disorder.
Background: While studies in CES-D (Center for Epidemiolgic Studies Depression Scale) have consistantly reported a four factor contruct for European-background Americans, inconsistent factor structures were reported for other populations. The purpose of this study is to examine the factor structure of the CES-D among Asian American adults residing in Baltimore-Washington DC metropolitan area, which has the fastest growing Asian population.
Method: 877 Asian Americans, 18 or more years old, completed a self-reported questionnaire at several community organizations, churches, and local ethnic businesses. Construct validity was assessed using exploratory factor analysis (EFA) and tested using confirmatory factor analysis (CFA) on a separate subset of Asian Americans (Korean, Chinese, and Vietnamese).
Results: EFA showed a two factor construct for the 20 item scale. The 16 items of the interpersonal, depressed affect, and somatic-retardation components were loaded as a single factor. The other factor consisted the 4 items of the positive affect component. CFA for the two factor model fit consistently across the three subgroups of Asian Americans.
Conclusions: Depression structure of Asian American adults differ from those of European-American adults. Study data suggest further studies of cultural background in understanding of the concept of depression. We speculate that interpersonal issues closely associate with emotional and physical depression for Asian Americans who often experience more interdependent cultural-influences than those of individualism. Further studies with non-immigrant groups by those in homelands, are suggested to confirm the two factor model, which may help identify unique acculturation stressors and mental health issues among Asian American immigrants.
Accurate assessment of ethnic minority clients is often hindered by clinician bias and lack of culturally sensitive instruments. Multicultural guidelines can enhance clinician awareness and sensitivity in conducting assessments with diverse populations. These guidelines are illustrated using an Asian Indian American character from Lahiri's (2008) novel Unaccustomed Earth.
La evaluación precisa de clientes pertenecientes a minorías étnicas se ve con frecuencia dificultada por el sesgo de los especialistas clínicos y la falta de instrumentos culturalmente sensibles. Las directrices multiculturales pueden ampliar la conciencia de los especialistas y su sensibilidad al llevar a cabo evaluaciones con poblaciones diversas. Estas directrices se ilustran usando un personaje indoasiáticoamericano extraído de la novela Unaccustomed Earth de Lahiri (2008).
Background
Women of reproductive age constitute a significant proportion of immigrants from South Asia to high-income countries. Pregnancy, childbirth and the postpartum period place increased demands on women׳s psychological resources and relationships. The aim of this review was to evaluate the available evidence about the prevalence, nature and determinants of postpartum mental health problems among South Asian women who have migrated to high-income countries.
Methods
Using a systematic strategy, CINAHL, Medline, PsychInfo and Web of Science databases were searched.
Results
Fifteen studies conducted in different high-income countries met inclusion criteria. Prevalence estimates of clinically significant symptoms of postpartum depression (CSS-PPD) varied widely (1.9–52%): the most common estimates ranged from 5 to 20%. Five studies found approximately a two-fold increase in risk of CSS-PPD (Odds Ratios 1.8–2.5) among overseas born women with a South Asian subgroup. The most common determinants appeared to be social factors, including social isolation and quality of relationship with the partner. Barriers to accessing health care included lack of English language proficiency, unfamiliarity with local services and lack of attention to mental health and cultural factors by health care providers.
Limitations
The settings, recruitment strategies, inclusion and exclusion criteria, representative adequacy of the samples and assessment measures used in these studies varied widely. Many of these studies did not use formally validated tools or undertake specific subgroup analyses.
Conclusions
Reductions in postpartum depression could be achieved by increasing awareness of available services and ensuring health care professionals support the mental health of women from diverse cultural and linguistic backgrounds.
Female migration represents a major public health challenge faced today because its heterogeneity and gender issues placing immigrant women among the most vulnerable and at-risk group. To identify and analyze studies dealing with immigrant women's perspectives with prenatal and postpartum health care. A systematic literature review was conducted to assess studies published between 2000 and 2010 using Cumulative Index to Nursing and Allied Health Literature, EMBASE, PubMed and Cochrane Database of Systematic Reviews. The studies explored the relation between socio-demographic characteristics of immigrant women participants and its impact on the main factors identified as influencing prenatal and postpartum care, characterizing the manifested knowledge and behaviors expressed and describing the women's experience with health care services and the incidence of postpartum depression symptoms. The less favorable socio-economic status of migrant women participants seems to have been influential in the quality of health service in prenatal and postpartum periods. The language barrier was the main negative factor interfering with communication between women and health professionals, followed by health care professionals' lack of cultural sensitivity, leading to women's reluctance in using health services.
Customs traditionally followed by Indian women during pregnancy, birth and early parenthood have been documented. An exploratory investigation of the extent to which some of these traditional beliefs, customs and practices are currently adhered to was undertaken by interviewing Indian mothers living in Johannesburg and its environs about 3 months after delivery. Results indicate that while some traditional customs are still adhered to by most Indian women, others are not so strictly followed. Since most customs relate to activities conducted at home rather than while in hospital for delivery, medical care would not be expected to influence their practice.
In 1998 ethnic minorities comprised 28% of the US population, and India is the third most common country of origin for immigrants. Many recently immigrated South Asian Indian patients are seen in health care settings in the United States. To deliver health care effectively to these patients, it is helpful for physicians to understand common cultural beliefs and practices of South Asian Indian patients.
Two illustrative cases are reported. One author's observations of the care of pregnant and parturient women in India and similar experiences in our own office spurred a literature search of the cultural behaviors surrounding sexuality, fertility, and childbirth. A literature search was conducted in Index Medicus, Grateful Med, and the catalogue of the University of Pennsylvania Arts and Sciences library, using the terms "Indian," "South Asian," "male and female gender roles," "gynecology in third world," "sexuality," "sexual health," "women's health," "women's health education," "obstetrical practices/India," and "female roles/India."
Issues surrounding sexuality and childbirth that arise during the US physician-South Asian Indian patient encounter might not correspond to the commonly held knowledge, beliefs, and behaviors of the US health care system. Common cultural beliefs and behaviors of South Asian Indian patients around sexuality and childbirth experience include the role of the individual patient's duty to society, the patient's sense of place in society, lack of formal sexual education, prearranged marriages, importance of the birth of the first child, little premarital contraceptive education, dominance of the husband in contraceptive decisions, and predominant role of women and lack of role for men (including the husband) in the childbirth process.
Lack of understanding of the Indian cultural mores surrounding sexual education, sexual behavior, and the childbirth experiences can form barriers to Indian immigrants in need of health care. These misunderstandings can also lead to patient dissatisfaction with the health provider and health system, underutilization of health services, and poorer health outcomes for Indian immigrants and their families. For this reason, it is important to teach cultural issues during undergraduate, graduate, and continuing medical education.
The literature on postpartum psychiatric disorders (PPD) is reviewed with particular reference to recent advances in the field. Despite the prevailing tendency to consider PPD as a manifestation of other pre-existing psychiatric disorders (i.e. affective, schizophreniform, organic, neurotic, etc.) a growing number of studies point to the uniqueness and specificity of postpartum symptomatology. Theories of etiology, psychosocial as well as biological, are still wide-ranging and unconvicing. Attempts to predict PPD and/or to identify mothers-to-be at risk are based largely on retrospective studies or else are hindered by the use of nonspecific instruments. Society's implicit belief in the “joys of motherhood” may have further contributed to the obscurity surrounding these frequently occurring disorders. Interventions follow conventional methods of psycho- and pharmacotherapy but the multidisciplinary treatment approach especially for women with acute PPD who require hospital admission is gaining wider acceptance. The inpatient psychiatric mother-baby intensive care unit model is part of this approach.
Objective
To evaluate the use of a standard pen‐and‐paper test versus the use of a checklist for the early identification of women at risk of postpartum depression and to investigate the experiences of nurses in using the checklist.
Design
A prospective cohort design using repeated measures.
Setting
The booking‐in prenatal clinic at a regional hospital in Victoria, Australia, and the community‐based postpartum maternal and child health service.
Participants
107 pregnant women over 20 years of age.
Main Measures
Postpartum Depression Prediction Inventory (PDPI), Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS), demographic questionnaire, and data on the outcome from the midwives and nurses.
Results
The PDPI identified 45% of the women at risk of depression during pregnancy and 30% postpartum. The PDSS and EPDS both identified the same 8 women (10%), who scored highly for depression at the 8‐week postpartum health visit. Nurses provided 80% of the women with anticipatory guidance on postpartum depression in the prenatal period and 46% of women at the 8‐week postpartum health visit. Nurse counseling or anticipatory guidance was provided for 60% of the women in the prenatal period.
Conclusion
The PDPI was found to be a valuable checklist by many nurses involved in this research, particularly as a way of initiating open discussion with women about postpartum depression. It correlated strongly with both the PDSS and the EPDS, suggesting that it is useful as an inventory to identify women at risk of postpartum depression.
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
Background Community-based epidemiological data on post-partum depression from developing countries are scarce.
Aims To determine the incidence of and risk factors for developing post-partum depression in a cohort of women living in rural south India.
Method We assessed 359 women in the last trimester of pregnancy and 6-12 weeks after delivery for depression and for putative risk factors.
Results The incidence of post-partum depression was 11% (95% CI 7.1-14.9). Low income, birth of a daughter when a son was desired, relationship difficulties with mother-in-law and parents, adverse life events during pregnancy and lack of physical help were risk factors for the onset of post-partum depression.
Conclusions Depression occurred as frequently during late pregnancy and after delivery as in developed countries, but there were cultural differences in risk factors. These findings have implications for policies regarding maternal and childcare programmes.
Measured attitudes of 182 college students toward traditional and current norms of arranged marriages and mate selection in India. Analysis of responses to the question on mate selection indicated that male Ss, non-Brahmins, Hindus, and Ss from high income families tended to be more liberal and express more independent attitudes than their counterparts. A majority of the Ss stated that they would like to have the opportunity to meet their future spouse, while only about one-fifth of the Ss supported the traditional practice of not meeting future spouse before marriage. In general, the study supports the thesis that the forces of modernization are resulting in liberal attitudes toward mate selection among Indian college students. (26 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examines a variety of sources including anthropological and sociological literature, literary works, and reports in the news media to develop a cultural profile of South Asian immigrants to the United States and to examine some of their mental health needs. South Asian family structure and values are examined in relation to those of the American counseling community. The authors conclude that counselors and therapists need to be aware of the client's degree of acculturation and type of ethnic identity when responding to the mental health needs of South Asian immigrants. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article describes maternal and child care practices among women from India. As in all cultures, certain beliefs exist surrounding what facilitates a good pregnancy and its outcome, as well as negative sanctions. These practices continue to influence many immigrant women to whom western practices are either unknown or unacceptable. An understanding of the traditional belief system of such women can ease their adaptation into the Canadian and U.S. health care systems.
Objective: To investigate the relationship between maternity blues and postpartum depression in mothers discharged early from the hospital and those discharged after the customary length of hospital stay.
Design: A descriptive correlation design.
Setting: 550-bed community and teaching hospital in the midwestern United States.
Participants: 49 privately paying, primiparous, American-born women, 18 years of age or older, with uncomplicated pregnancies and vaginal deliveries of healthy neonates weighing 2,600-4,000 g.
Measures: Stein Maternity Blues Scale and Beck Depression Inventory were used to collect data.
Results: No significant differences found between the two groups of mothers; significant relationships found between maternity blues at 1 week after delivery and postpartum depression at 6 and 12 weeks after delivery.
Conclusions: Early discharge appears to pose no threat to psychologic well-being. Primiparas experiencing more severe maternity blues are at increased risk for postpartum depression.
The β-adrenergic signal transduction pathway in the heart consists of three major components, namely β-adrenergic receptors,
guanine nucleotide-binding proteins (G-proteins), and adenylyl cyclase.β-adrenergic receptors, which recognize and bind catecholamines
in the myocardium, are primarily of two types: β1-adrenoceptors andβ2-adrenoceptors. Two major types of G-proteins, namely
stimulatory (Gs) and inhibitory (Gi) proteins, are expressed in the heart. Although five isoforms of adenylyl cyclase have
been detected in the heart, type Vand type VI are present in abundance. While β-adrenergic receptors are coupled to adenylyl
cyclase through Gs-proteins, Gi-proteins are known to regulate the adenylyl cyclase activity. β-adrenergic receptors are regulated
by β-adrenoceptor kinase and β-arrestin present in the myocardium. Although β-adrenoceptors have been detected in fetal heart,
their coupling with Gs-proteins and adenylyl cyclase is weak during early embryonic and fetal life. β2-adrenoceptors, unlikeβ1-adrenoceptors,
have been shown to play an important role in catecholamine action in neonatal hearts in comparison to the adult myocardium.
Both types V and VI of adenylyl cyclase are expressed weakly in neonatal heart, but type V isoform is predominant in the adult
heart. The attenuated responses of the aging heart to catecholamines are explained on the basis of depressed adenylyl cyclase
and increased Gi-protein contents since no changes in β-adrenoceptors or Gs-proteins were seen in the aged myocardium. The
status of different components of the β-adrenergicreceptor system in both fetal and aging hearts is considered to provide
clues regarding defects in the signal transduction mechanisms in heart failure.
Depression is a pervasive illness with a wide distribution and is reported to be statistically more prevalent among women. The present study was undertaken to seek an understanding of depression in a sample of Asian Indian women. The research questions were (a) What sociocultural factors do adult depressed Indian women report as influences in the depression, and (b) how do these reported factors influence their treatment-seeking behavior? The setting was Madurai, India. The purposive, convenience sample comprised 30 Tamil-speaking married or widowed Hindu women ranging in age from 26 to 65 who had been diagnosed with depression. Tape-recorded interviews were conducted. Content analysis was completed on the data. Results indicate that cultural dictation of female role and lack of continued financial and emotional support, predominantly from spouses and other family members, were influential factors in depression. These along with religion and philosophy often influenced the decision to seek health care.
To investigate the relationship between maternity blues and postpartum depression in mothers discharged early from the hospital and those discharged after the customary length of hospital stay.
A descriptive correlation design.
550-bed community and teaching hospital in the midwestern United States.
49 privately paying, primiparous, American-born women, 18 years of age or older, with uncomplicated pregnancies and vaginal deliveries of healthy neonates weighing 2,600-4,000 g.
Stein Maternity Blues Scale and Beck Depression Inventory were used to collect data.
No significant differences found between the two groups of mothers; significant relationships found between maternity blues at 1 week after delivery and postpartum depression at 6 and 12 weeks after delivery.
Early discharge appears to pose no threat to psychologic well-being. Primiparas experiencing more severe maternity blues are at increased risk for postpartum depression.
The purpose of this phenomenological study was to describe the essential structure of the lived experience of postpartum depression. Seven mothers who had suffered from postpartum depression were interviewed regarding their subjective experiences. Data were analyzed using Colaizzi's (1978) method of phenomenology. Forty-five significant statements were extracted and clustered into 11 themes. These results were integrated into the essential structure of postpartum depression. Postpartum depression was a living nightmare filled with uncontrollable anxiety attacks, consuming guilt, and obsessive thinking. Mothers contemplated not only harming themselves but also their infants. The mothers were enveloped in loneliness and the quality of their lives was further compromised by a lack of emotions and all previous interests. Fear that their lives would never return to normal was all-encompassing.
The literature on postpartum psychiatric disorders (PPD) is reviewed with particular reference to recent advances in the field. Despite the prevailing tendency to consider PPD as a manifestation of other pre-existing psychiatric disorders (i.e. affective, schizophreniform, organic, neurotic, etc.) a growing number of studies point to the uniqueness and specificity of postpartum symptomatology. Theories of etiology, psychosocial as well as biological, are still wide-ranging and unconvicing. Attempts to predict PPD and/or to identify mothers-to-be at risk are based largely on retrospective studies or else are hindered by the use of nonspecific instruments. Society's implicit belief in the "joys of motherhood" may have further contributed to the obscurity surrounding these frequently occurring disorders. Interventions follow conventional methods of psycho- and pharmacotherapy but the multidisciplinary treatment approach especially for women with acute PPD who require hospital admission is gaining wider acceptance. The inpatient psychiatric mother-baby intensive care unit model is part of this approach.
Postpartum emotional disorders generally fall into one of three categories: "blues," depressions, or psychoses. Such postpartum syndromes are described as to their presenting symptomatology, phenomenology, treatment, and prognosis. The role of the appropriate use of psychotropic medication in these conditions, after proper diagnosis, is also discussed. This overview is meant to be helpful to consultation-liaison psychiatrists and to other psychiatrists who work closely with obstetricians and primary care physicians.
The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
One negative outcome of the post-partum period is the occurrence of post-partum depression. While the incidence levels are high in the U.S. for the 'Blues' and the 'moderate level depression disorder', the nature of this phenomenon--as a disease and as an illness--remains unclear. It is suggested that an anthropological perspective incorporating symbolic behavior and biological processes may more effectively address the problem than isolated biological and psycho-social research. Theories of etiology based strictly in biological mechanisms have resulted in a treatment bias towards pharmacological intervention; this paper suggests that more attention should be given to the impact of the cultural patterning of the post-partum period, e.g. the structure, organization of the family group and role expectations. A review of the anthropological literature on childbirth provides little evidence for post-partum depression. Our own observations and an examination of the cross-cultural literature have identified common elements in the social structuring of the post-partum period. They include: (1) cultural patterning of a distinct post-partum period; (2) protective measures designed to reflect the vulnerability of the new mother; (3) social seclusion; (4) mandated rest; (5) assistance in tasks from relatives and/or midwife; (6) social recognition of new social status through rituals, gifts or other means. A hypothesis is proposed that a relationship exists between post-partum social organization/mobilization and post-partum depression. The experience of 'depression' in the U.S. may represent a culture bound syndrome resulting from the lack of social structuring of the post-partum events, social recognition of the role transition for the new mother and instrumental support and aid for the new mother.
A meta-analysis of 19 studies was conducted to determine the magnitude of the effect of postpartum depression on maternal-infant interaction during the first year after delivery. Maternal-infant interaction was divided into three subcategories: maternal interactive behavior, infant interactive behavior, and dyadic interactive behavior. Substantive, methodological, and miscellaneous variables were extracted and coded by both the researcher and two research assistants. Combinations were calculated as unweighted, weighted by sample size, and weighted by the quality index score. Effects for maternal interactive behavior ranged from .32 to .36 for the r index, .68 to .78 for the d index, and .33 to .38 for the Fischer's Z. For infant interactive behavior, effects ranged from .35 to .38, .75 to .83, and .37 to .41 for the r, d, and Fisher's Z indexes, respectively. Effects for dyadic interactive behavior ranged from .47 to .50 for the r index, 1.07 to 1.15 for the d index, and .51 to .55 for Fisher's Z. Results of the meta-analysis indicate that postpartum depression has a moderate to large effect on maternal-infant interaction. Nursing interventions for depressed mother-infant dyads during the first year after delivery are addressed.
Using the grounded theory method, a substantive theory of postpartum depression was developed. Data were obtained through participant observation in a postpartum depression support group over an 18-month period. In addition, 12 in-depth taped interviews were conducted with mothers who had attended the support group. Analysis of the data by the constant comparative method revealed loss of control as the basic social psychological problem. Women suffering from postpartum depression attempted to cope with the problem of loss of control through the four-stage process of teetering on the edge. The stages that emerged from the data included (a) encountering terror, (b) dying of self, (c) struggling to survive, and (d) regaining control.
A phenomenological study was conducted to investigate the meaning of postpartum depressed mothers' interactions with their infants and older children. A purposive sample of 12 mothers participated. Nine theme clusters emerged when the formulated meaning were organized into categories. Participants were overwhelmed by the responsibilities of caring for their children. Guilt, irrational thinking, loss and anger filled their day-to-day interactions with their children. Mothers went through the motions, acting like robots while caring for their infants. At times, to survive, they erected a wall to separate themselves emotionally from their children and consequently failed to respond to their infants' cues. Detrimental relationships with their older children materialized as mothers were enveloped by postpartum depression.
Evidence of postpartum depression in Western culture has been widely documented in the literature. The conclusion reached by many researchers is that women are vulnerable to depression following childbirth to some extent. It has been suggested that postpartum depression is a culture-bound syndrome that develops because of lack of supportive rites and rituals surrounding childbirth. The present study was undertaken to explore postpartum depression in Hmong women living in the U.S. and the influence of cultural practices on postpartum depression. The results indicate that cultural beliefs and practices help the Hmong women adjust to the postpartum period. Whatever symptoms of depression they reported were related to living in a different culture and different environment, and using a language to which they were not accustomed.
This article describes maternal and child care practices among women from India. As in all cultures, certain beliefs exist surrounding what facilitates a good pregnancy and its outcome, as well as negative sanctions. These practices continue to influence many immigrant women to whom western practices are either unknown or unacceptable. An understanding of the traditional belief system of such women can case their adaptation into the Canadian and U.S. health care systems.
PIP
An understanding of the traditional practices associated with pregnancy and delivery in immigrant women's countries of origin is essential for US and Canadian health care professionals who attend these women. This article, intended for North American nurses and other health workers, reviews pregnancy, childbirth, and newborn care practices in India. Although most Indian women believe they have little or no control over pregnancy and its outcomes, certain beliefs, customs, and taboos surround pregnancy and the perinatal period. Among the practices discussed in this article are consumption of "hot" versus "cold" foods during pregnancy, reduced food consumption during pregnancy, son preference, uses of herbal medicines, home delivery by a traditional birth attendant, exclusion of men from most aspects of childbirth, the role of extended family, confinement after delivery, delayed onset of breast feeding, and rituals aimed at warding off the "evil eye." An appreciation of these customs helps ensure the provision of appropriate care that facilitates integration of traditional and Western practices.
In this study of 192 cases of post partum psychosis, the mean age of cases was 24.2 years. A past history of post partum psychosis was present in 16 cases (8.3%). As per the RDC categories, a majority of patients had unspecified functional psychosis and developed psychosis after the birth of first child. There was a positive correlation between the birth of female child and psychosis. The majority of cases developed psychosis within first 2 weeks after delivery. There were several other statistically significant differences when these cases were compared with non-puerperal, disease-matched controls.
The adverse, short-term effects of postpartum depression on maternal-infant interaction have been repeatedly documented. Are there long-term sequelae for children whose mothers had experienced postpartum depression? The purpose of this meta-analysis was to determine the magnitude of the effect of postpartum depression on the cognitive and emotional development of children older than the age of 1 year. Nine studies which met the sample criteria were included in this meta-analysis. Results indicated that postpartum depression had a small but significant effect on children's cognitive and emotional development. The r indicator for effect size ranged from .18 to .22 whereas the d indicator ranged from .36 to .45. Implications for future research are addressed.
Mood disturbance occurs commonly during the postpartum period. The symptoms may be transient and relatively mild (as in postpartum blues) or may be associated with significant impairment of functioning (as in postpartum depression and puerperal psychosis). Despite the prevalence of postpartum mood disorders, depressive symptoms that emerge during the puerperium are often overlooked. Puerperal affective illness places the mother at risk for the development of recurrent depression and has also been associated with significant long-term effects on child development and behavior. Therefore, the prompt recognition and efficacious treatment of puerperal mood disorders are essential in order to avoid adverse outcomes for both mother and infant. This article discusses the evaluation of postpartum mood disturbance and offers guidelines for the treatment of affective illness during the puerperium.
Because the onset of mood and anxiety disorders often occurs during the childbearing years, many women may be taking psychotropic medications for these disorders when they conceive. These medications easily diffuse across the placenta, and their impact on the fetus is of concern. But discontinuation may lead to relapse, in which case psychiatric symptoms may affect the fetus. Thoughtful treatment planning presents a dilemma to the clinician. Limited data suggest heightened vulnerability to relapse of mood and anxiety disorders in women during the postpartum period. Pregnancy appears to exacerbate symptoms of obsessive-compulsive disorder, while panic disorder patients may remain well after discontinuing medication. Future studies should address the prevalence and relapse rates of mood and anxiety disorders, particularly after medication discontinuation, among pregnant women.
Postnatal depression affects 15% of all women derived. Good practice in antenatal and postnatal care suggests that regular contact should take place with members of the primary health care team (PHCT) but, despite this, many cases of postnatal depression are probably not detected. It is also widely perceived that depressed women consult more frequently about themselves and their babies, but it is not clear whether the number of contacts with the primary health care team as a whole reflects this.
To determine whether the use of the Edinburgh Postnatal Depression Scale (EPNDS) at postnatal examination would detect women not recognized as depressed by the PHCT. To determine whether the number of contacts with the PHCT could be used as a screening tool for postnatal depression.
The EPNDS was administered at postnatal examination to 176 women delivering their babies between 1 April 1995 and 31 October 1995. Contacts with PHCT members were recorded up to the 42nd day after delivery, together with their assessment of the subjects' mental health.
Of 30 women scoring > or = 12 on the EPNDS, only 13 were perceived to be depressed by the PHCT. The team as a whole identified more depressed women than any individual professional group. There was no significant difference in the number of contacts made with professionals by women who were or were not depressed. Asian women were more likely to be depressed than women from other ethnic groups.
Despite the PHCT as a whole identifying more depressed women than any individual group, more than half were not identified by professionals. Tools such as the EPNDS should be used routinely in primary care; there is an urgent need to validate the EPNDS for non-Caucasian women.
What is unique to PPD is the dyadic nature of the phenomenon.
This study discovers, describes, and explains the personal experiences, perceptions, and care meanings of Jordanian women who have suffered postpartum depression. Most postpartum cases often are misdiagnosed as exclusively psychological and untreated by health care professionals without consideration to the cultural meanings of this problem. Understanding the experiences of these women is important, as their expressions often are contextually and culturally influenced. Using Leininger's Theory of Culture Care Diversity and Universality, a purposive sample of 22 Jordanian women diagnosed with postpartum depression, living in Sydney, were interviewed. The ethnonursing research method and data analysis procedures were used. Results revealed that Jordanian mothers experienced severe loss of control over emotions of loneliness, hopelessness, and feelings of being a bad mother. Three major themes focusing on the care meanings and experiences of Jordanian women are discussed: (a) Care means strong family support and kinship during the postpartum period, (b) care is carrying out and fulfilling traditional gender roles as mother and wife, and (c) care is preservation of Jordanian childbearing customs as expressed in the celebration of the birth of the baby.
A 14-item Sexual Coercion Inventory (SCI) was administered to an urban university sample in Western India. Twenty-six percent of the sample reported a total of 160 incidents of sexual coercion ranging in severity from unwanted kissing to sexual intercourse. The most common outcome was intercourse and was followed by kissing and fondling. No gender differences were discovered regarding victim status or types of coercion tactics experienced. A MANOVA analysis found no overall gender effect, but marital status and protected class membership did have a significant effect with people who are married and protected class members reporting more sexual coercion. Reasons for the lack of an overall gender effect and limitations of this research are discussed.
To examine the social, cultural and religious factors underlying postpartum depression within a cultural cross-section of Jewish Jerusalem women.
A prospective, repeated-measures study of 327 women. The Edinburgh Postpartum Depression Scale (EPDS) was administered immediately postpartum and 6-10 weeks later. Detailed sociodemographic information included perceptions of the pregnancy, community supports and religious affiliation. Odds ratios, 95% confidence interval and P values were calculated for all covariates. Multiple logistic regression was performed to estimate the degree of independent association between religiosity and postpartum depression.
Postpartum depressive symptoms significantly associated with secular affiliation (odds ratio [OR] 2.9 [1.3-6.3] and tended toward an inverse association with orthodox affiliation (OR 0.6 [0.3-1.3]). Across secular, traditional, religious and orthodox groups, there was a decreasing trend in EPDS mean scores. Other predictors of depressive symptoms were psychiatric history, immigrant status and poor support with newborn care.
Our study sample was particularly suitable for the assessment of cultural and religious elements of postpartum depression. We found religiosity, with its associated social and community structuring and well-defined social roles, to be significantly associated with self-reported postpartum depressive symptoms. These findings suggest that cultural factors, including role definitions, community support and rituals, may explain discrepancies found in the incidence of postpartum depression.
We evaluated perceptions and experiences of bearing sons and daughters among 42 women in Punjab, Pakistan, with special emphasis on son preference, changes in women's status within the marital family and resulting health effects. Data were collected through repeated, in-depth interviews in Urdu or Punjabi in an urban area in Lahore and a village 40 km. outside of Lahore. For triangulation purposes, four focus group discussions were performed with additional women, as well as in-depth interviews with eight mothers-in-law, three traditional practitioners and three medical practitioners. In general, these women felt that they had limited control over their lives, and this was exemplified by early marriages, high expectations on newly wed women to conceive and poor access to contraceptives. Women frequently expressed a strong preference for sons, mostly for economic reasons, reflecting women's subordinate position in society and the low economic value placed on women's work. Mothers of sons mainly discussed health problems during pregnancy and health effects of repeated childbearing. Mothers of daughters and women without children spoke of harassment in the family as well as in society. The results should be of importance in the public health planning in Pakistan as well as for those engaged in women's health issues internationally.
Approximately 400,000 mothers in the United States experience postpartum depression each year. However, only a small proportion of these women are identified as depressed by health care professionals.
To improve detection of this postpartum mood disorder, the purpose of this study was to assess the psychometric properties of a newly devised instrument, the Postpartum Depression Screening Scale (PDSS), a 35-item Likert-type self-report instrument.
Content validity was supported through the literature and the judgments rendered by a panel of five content experts and a focus group. The PDSS was administered to 525 new mothers.
Confirmatory factor analysis provided empirical support for the existence of the hypothesized seven dimensions. A Tucker-Lewis goodness-of-fit index of 0.87 and a root mean square residual of 0.05 were judged supportive of model fit. Item response theory techniques provided further construct validity support for finer interpretations of the respective seven dimensions. Analysis of the Likert 5-point response categories further supported meaningful score interpretations. Alpha internal consistency reliabilities ranged from 0.83 (sleeping/eating disturbances) to 0.94 (loss of self).
Empirically, all of the reliability and validity analyses supported the score interpretations posited for the PDSS. Currently, the sensitivity, specificity, and positive predictive value of the PDSS are being determined.
Up to 50% of all cases of postpartum depression go undetected. The Edinburgh Postnatal Depression Scale (EPDS) has been the only instrument available that was specifically designed to screen for this mood disorder. None of the items on the EPDS, however, are written in the context of new motherhood.
The purpose of this study was to further assess the construct validity of the newly designed Postpartum Depression Screening Scale (PDSS) along with its sensitivity, specificity, and predictive values.
A total sample of 150 mothers within 12 weeks postpartum participated in the study. Each mother completed in random order three questionnaires: The PDSS, EPDS, and The Beck Depression Inventory-II (BDI-II). Immediately after completing these three questionnaires, each woman was interviewed by a nurse psychotherapist using the Structural Clinical Interview for DSM-IV Axis 1 Disorders.
Twelve percent (n = 18) of the mothers were diagnosed with major postpartum depression, 19% (n = 28) with minor postpartum depression, and 69% (n = 104) with no depression. The PDSS was strongly correlated with both the BDI-II (r = 0.81) and the EPDS (r = 0.79). The ability of the PDSS to explain variance in diagnostic classification of postpartum depression above that explained by the BDI-II and EPDS (i.e., incremental validity) was assessed using hierarchical regression. After explaining variance in group classification by the other two depression instruments, the PDSS explained an additional 9% of the variance in depression diagnosis. Using receiver operating characteristic (ROC) curves, a PDSS cut-off score of 80 (sensitivity 94% and specificity 98%) is recommended for major postpartum depression and a cut-off score of 60 (sensitivity 91% and specificity 72%) for major or minor depression.
Based on the results of this psychometric testing, the PDSS is considered ready for use in routine screening of mothers.
Postpartum depression affects approximately 13% of mothers but up to 50% of all cases of this tragic illness can go undetected.
The purpose of this study was to compare the performance of a newly created instrument, the Postpartum Depression Screening Scale (PDSS), with the Edinburgh Postnatal Depression Scale (EPDS) and a general depression scale, the Beck Depression Inventory-II (BDI-II).
In this methodological design a total of 150 new mothers completed these three instruments in random order, followed immediately by a DSM-IV diagnostic interview. Using the LABROC I program, the areas under each of the instrument's Receiver Operator Characteristic (ROC) curves were compared to determine if they were significantly different.
Eighteen (12%) of the women were diagnosed with major postpartum depression, 28 women (19%) with minor postpartum depression, and 104 women (69%) with no depression. Compared to the EPDS, the PDSS had a significantly larger area under the ROC curve when screening for major or minor postpartum depression. When using the published recommended cut-off scores for major depression for the three instruments, the PDSS achieved the highest combination of sensitivity, 94%, and specificity, 98%. When detecting women with major or minor postpartum depression, the PDSS again yielded the highest combination of sensitivity (91%) and specificity (72%) of the three instruments. The PDSS identified 17 (94%) of the women diagnosed with major postpartum depression, the EPDS identified 14 of these women (78%), and the BDI-II identified 10 of the 18 women (56%).
If mothers identified as "most depressed" are substantially determined by the instrument used, the implications for both research and clinical practice are significant. Researchers and clinicians need to be aware of the differential sensitivity of depression instruments which, while supposedly measuring the same construct, are focused on different components of this mood disorder.
