Prevalence and risk factors associated with postpartum depressive symptoms among women in vientiane capital, lao pdr in 2019

MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH AMKHA XAYYABOUAPHA H P PREVALENCE AND RISK FACTORS ASSOCIATED WITH POSTPARTUM DEPRESSIVE SYMPTOMS AMONG WOMEN IN VIENTIANE CAPITAL,LAO PDR, 2019 U H MASTER OF PUBLIC HEALTH MPH CODE: 8720701 HANOI, 2020 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH AMKHA XAYYABOUAPHA PREVALENCE AND RISK FACTORS ASSOCIATED WITH POSTPARTUM DEPRESSIVE SYMPTOMS AMONG WOMEN IN VIENTIANE CAPITAL, LAO PDR, 2019 H P MASTER OF PUBLIC HEALTH U MPH CODE: 8720701 SUPERVISORS: H DR VANPHANOM SYCHAREUN, MD, PhD DEAN OF FACULTY OF PUBLIC HEALTH UNIVERSITY OF HEALTH SCIENCES, LAO PDR ASSOC PROF BUI THI TU QUYEN, MD, PhD HEAD OF BIOSTATISTICS DEPARTMENT FACULTY OF FUNDAMENTAL SCIENCES HANOI UNIVERSITY OF PUBLIC HEALTH HANOI, 2020 ACKNOWLEDGEMENTS First of all, I am very grateful to the Ministry of Health of the Lao PDR, the MCNV, the LEARN project, the Sisattanak District Health Office and the Department of Health, Vientiane Capital, for providing this great opportunity and scholarship for me to develop my skills and knowledge in this Master program at the University of Health Sciences in the Lao PDR and the Hanoi University of Public Health in Vietnam Second, I would like to extend my deepest appreciation and gratitude to my research advisors Dr Vanphanom Sychareun, MD-PhD (Dean, Faculty of Public Health, University of Health Sciences, Lao PDR), Assoc Prof Bui Thi Tu Quyen, H P MD-PhD (Head of Biostatistics Department Faculty of Fundamental Sciences, Hanoi University of Public Health, Vietnam, and Dr Manivone Thikeo, MD, MPH, Ph.D (Lecturer of Public Health and Psychiatry, University of Health Sciences, Lao PDR) for their support and guidance throughout this project Thank you for your patience, support, understanding and constant mentoring of me throughout my studies and completion of my thesis Your encouragement, support and guidance throughout this U study program and my thesis were truly valuable to me Finally, I wish to thank the Head of the Vientiane Capital Health Department, H the directors and health workers of Hadsayfong and Sisattanak District Hospitals as well as the village health volunteers who kindly agreed to help Also, I wish to express my deepest gratitude to all of my research participants who spent their valuable time to help me finish this project I sincerely believe that without your participation, this study would have been impossible to finish Thank you for your time and effort in helping me to get this project done on time A special thank you goes to my parents, husband, children and all of my family members as well as friends for their love, understanding, support, and encouragement throughout the period of my studies in Lao PDR and in Vietnam I sincerely believe that without their help and support throughout these years, I would not have reached this point Mrs Amkha XAYYABOUAPHA CONTENTS CONTENTS i LIST OF FIGURES iv LIST OF TABLES v LIST OF ABBREVIATIONS vi SUMMARY vii INTRODUCTION .1 RESEARCH OBJECTIVES .3 CHAPTER H P LITERATURE REVIEW 1.1 Concept of postpartum depression 1.1.1 Definition of postpartum depression .4 1.1.2 Screening of postpartum depression .5 1.2 Postpartum depression situation U 1.2.1 Postpartum depression situation worldwide 1.2.2 Postpartum depression situation in Lao PDR 1.3 Consequences of depression during postpartum period 10 H 1.4 Prevention of postpartum depression 11 1.5 Risk factors related to postpartum depression 12 1.5.1 Socio-demographic-economic factors 12 1.5.2 Obstetric, pregnancy and pediatric factors 15 1.5.3 Family relationship factors 20 1.6 Introduction of the study site 21 1.7 Conceptual framework 22 CHAPTER 24 SUBJECTS AND METHODS 24 2.1 Research Subjects 24 2.1.1 Inclusion criteria 24 2.1.2 Exclusion criteria 25 i 2.2 Study sites and duration 25 2.3 Research design .25 2.4 Sample size 25 2.5 Sampling method 26 2.6 Data collection 28 2.7 Research variables 28 2.8 Research instruments and measurements 29 2.8.1 Research instruments 29 2.8.2 Reliability test of instruments .31 2.8.3 Measurement 31 H P 2.9 Data analysis methods .33 2.10 Ethical issues 34 CHAPTER 35 RESULTS 35 3.1 General information of respondents 35 3.1.1 Socio-demographic-economic profile distribution of the participants 35 U 3.1.2 Obstetric, pregnancy and pediatric health factors 37 3.1.3 Family relationship characteristics .40 3.1.4 Measuring social support of postpartum mothers .40 H 3.1.5 Level of social support 42 3.1.6 Measuring intimate partner violence using WAST 43 3.2 Postpartum depressive symptoms 44 3.2.1 Edinburgh Postpartum Depression Scale 44 3.2.2 Prevalence of postpartum depressive symptoms 45 3.3 Risk factors associated with postpartum depressive symptoms .46 3.3.1 Univariate analysis of association between socio-demographic-economic factors and postpartum depressive symptoms .46 3.3.2 Univariate analysis of association between obstetric, pregnancy and pediatric health factors and postpartum depressive symptoms 47 3.3.3 Univariate analysis of association between family relationship factors and postpartum depressive symptoms 51 ii 3.3.4 Multivariate logistic regression analysis of the risk factors associated with postpartum depressive symptoms .52 CHAPTER 54 DISCUSSION 54 Limitations and biases 60 CONCLUSION .61 RECOMMENDATIONS 62 REFERENCES 64 ANNEXES 73 Annex 01: VARIABLES .73 Annex 02: QUESTIONNAIRE .80 H P Annex 03: RESULTS OF MSPSS 89 Annex 04: RESULTS OF WAST 91 Annex 05: RESULTS OF EPDS 92 Annex 06: INFORMED CONSENT FORM 94 Annex 07: BIOGRAPHY 95 U Annex 08: LAO ETHICAL CLEARANCE 96 Annex 09: VIETNAM ETHICAL CLEARANCE .97 Annex 10: MAP OF VIENTIANE CAPITAL 98 H Annex 11: REVIEWER COMMENTS .99 Annex 12: MINUTES OF EXPLANATION AFTER THESIS DEFENSE .106 iii LIST OF FIGURES Figure 1.1 Conceptual framework of the study entitled “Prevalence and factors associated with postpartum depressive symptoms among women in Vientiane Capital, Lao PDR, 2019” 23 Figure 2.1 Diagram of sampling method 27 H P U H iv LIST OF TABLES Table 1.1 Summary of previous studies of prevalence and incidence of postpartum depression worldwide, in neighboring countries and in Lao PDR 10 Table 3.1 Socio-demographic-economic profile distribution of the participants 36 Table 3.2 Obstetric profile distribution of sample 37 Table 3.3 Pregnancy profile distribution of sample 38 Table 3.4 Pediatric health profile distribution of sample 39 Table 3.5 Family relationship characteristics 40 Table 3.6 Measuring social support of postpartum mothers using MSPSS 40 H P Table 3.7 Level of social support (using MSPSS) 42 Table 3.8 Measuring intimate partner violence (using WAST) 43 Table 3.9 Exposure to intimate partner violence (IPV) 44 Table 3.10 Edinburgh Postpartum Depression Scale 44 Table 3.11 Prevalence of postpartum depressive symptoms 45 U Table 3.12 Univariate analysis about socio-demographic-economic factors associated with postpartum depressive symptoms 46 Table 3.13 Univariate analysis of association between obstetric factors and H postpartum depressive symptoms .48 Table 3.14 Univariate analysis of association between pregnancy factors and postpartum depressive symptoms .49 Table 3.15 Univariate analysis of association between pediatric health factors and postpartum depressive symptoms .50 Table 3.16 Univariate analysis of association between family relationship factors and postpartum depressive symptoms .51 Table 3.17 Multivariate logistic regression analysis of the risk factors associated with postpartum depressive symptoms .52 v LIST OF ABBREVIATIONS ACOG American College of Obstetricians and Gynecologists BDI-II Beck Depression Inventory II CESD Center for Epidemiologic Studies Depression Scale DEFF Design effect DSM Diagnostic and Statistical Manual of Mental Disorders EPDS Edinburgh Postnatal Depression Scale HUPH Hanoi University of Public Health IPV Intimate partner violence Lao PDR Lao People's Democratic Republic LMIC Low and middle income country MDD Major Depressive Disorder MSPSS Multidimensional Scale of Perceived Social Support NICU Newborn Intensive Care Unit PHQ-9 Patient Health Questionnaire PDS Postpartum depressive symptoms PPD Postpartum depression RMNCH UHS WAST WHO H P U H Reproductive, Maternal, Newborn and Child Health University of Health Sciences Women Abuse Screening Tool World Health Organization vi SUMMARY Postpartum depression (PPD) is a type of mood disorder commonly occurring during the postpartum period PPD affects nearly 20% of postpartum women who live in low and middle-income countries (LMICs) including the Lao PDR However, there is limited data on postpartum depression in the Lao PDR, and it is a challenge to develop an intervention program without data to support it In addition, it would be difficulty to develop proper care and effective prevention, treatment and service delivery to those women who are at risk or have been suffering from PPD Therefore, H P this study aims to examine the prevalence and risk factors associated with postpartum depressive symptoms among women in Vientiane Capital, Lao PDR This was a cross-sectional study in which data was collected from 48 communities in Sisattanak and Hadsayfong Districts, Vientiane Capital, Lao PDR in September 2019 A multistage random sampling method was utilized to select 521 U women who lived in the target villages in two selected districts to participate in this study A face-to-face interview technique and the Edinburgh Postnatal Depression Scale (EPSD) were used to conduct interviews with the participants who had agreed H to be involved in the study The data was entered into EpiData sheets before they were transferred to STATA data analysis software version 14 Univariate and multivariate logistic regressions were then carried out to identify the risk factors associated with postpartum depressive symptoms The results of this study revealed that among the 521 respondents, there were 111 (21.3%) mothers who met the criteria of postpartum depressive symptoms (PDS) The outcome of the multivariate logistic regression analysis found that the risk factors associated with depressive symptoms among women between 04 and 24 weeks after giving birth were: have at least 2-3 living children (AOR: 1.9, 95%CI: 1.1-3.0), have mental health problems during pregnancy (AOR: 3.3, 95%CI: 1.4-7.6), have suffered vii Annex 07: BIOGRAPHY First and family name: Mrs Amkha XAYYABOUAPHA Date and place of birth: 12 February 1988, Vientiane Province Address: Dongkhamxang Village, Hadsayfong District, Vientiane Capital, Lao PDR Nationality: Lao Telephone: +8562029446399 E-mail: Amkhaxbp@gmail.com Work position: Medical doctor H P Work place: Mother and Child Unit, Sisattanak District Hospital Education: Graduated from University of Health Sciences in 2011 Work experience: - September 2011 to September 2013, volunteer doctor at HIV/AIDS U Department, Setthathirat Hospital, Vientiane Capital, Lao PDR - October 2013 to present, working at Sisattanak District Hospital, Vientiane Capital, Lao PDR H 95 Annex 08: LAO ETHICAL CLEARANCE H P U H 96 Annex 09: VIETNAM ETHICAL CLEARANCE H P U H 97 Annex 10: MAP OF VIENTIANE CAPITAL H P Study sites U H 98 Annex 11: REVIEWER COMMENTS H P U H 99 H P U H 100 H P U H 101 H P U H 102 H P U H 103 H P U H 104 H P U H 105 Annex 12: MINUTES OF EXPLANATION AFTER THESIS DEFENSE MINISTRY OF HEALTH FORM HANOI UNIVERSITY OF PUBLIC HEALTH MINUTES OF EXPLANATION AFTER THESIS/PROPOSAL DEFENCE Full name: Amkha Xayyabouapha Thesis title: Prevalence and risk factors associated with postpartum depressive symtoms among woment in Vientiane Capital, Lao PDR, 2019 TT H P Comments Student’s explanations detail Review of Literature/Theoretical framework Should make table of situation I have revised a summary table of PPD of PPD more statistic and easy situation, based on reviewer’s comment to to follow make it more clearly (Page 9) U You have many factors, did not I have moved out some factors in obstetric need to keep some review and pediatric health that have only one article factors that only one article mentioned as reviewer’s comment (place of mentioned birth and birth weight of baby) H Objects and research methods Still confuse about two I have changed the two-population formula to population formula to calculate single population formula to calculate sample sample size, you did not size, based on reviewer’s suggestion (Page compare with districts Explain 23) give more information Explain sampling 50% I have added explanation on the sampling to make the consistency with the sample size calculation (Page 24) 106 Should discuss more about tool I have discussed and added more references that use to measure social about tool which I had used to measure social support support, based on reviewer’s comment (Page 30) Should discuss more about tool I have discussed and added more references that use to measure intimated about tool which I had used to measure partner violence intimate partner violence, based on reviewer’s comment (Page 30) Find some reason of using the I have explained the EPDS cut off point in EPDS with cutoff point page 29 as follow: H P ‘’The EPDS consists of 10 questions, with a cut-off of point 12/13 However, evidence suggests that a failure to detect cases can be reduced to under 10% with a cut-off score of 9/10 Therefore, a threshold of 9/10 may be U appropriate for routine use by primary care workers’’ H Study results Good proportion if you can According to the objectives of this study, we revise your data based on urban did not compare urban and peri-urban and peri-urban Therefore, I keep the study’s results as presented Discussion It is not always to compare with I have revised the discussion section as other, but your just discuss suggestion I have eliminated the un- about your finding it’s enough appropriate comparisons 107 Add more explanation in I have explained more about the study’s discussion findings The discussion section has been updated (Page 43) Conclusions Need to put more I have revised the conclusion section based on the study’s objectives and findings (Page 50) Recommendations Should play for Laos I have revised my recommendation and all of H P them focus on maternal health and situation of postpartum mothers in Lao PDR (Page 51) Day 9th, March, 2020 1st supervisor U H Dr Vanhphanome Sychareun 2nd supervisor Assoc Prof Bui Thi Tu Quyen Student Amkha Xayyabouapha, MD Supporting lecture (if any) Manivone Thikeo, MD, MPH, Ph.D Examiners’ comments (if any): …………………………………………………………………………………… Day month year 2020 On behalf of the committee Dr Sengchanh Kounnavong 108 H P U H 109