Postpartum depression in Cambodia women

VIETNAM NATIONAL UNIVERSITY HA NOI UNIVERSITY OF EDUCATION TEP PHARIN POSTPARTUM DEPRESSION IN CAMBODIA WOMEN MASTER’S THESIS IN PSYCOLOGY HANOI, VIETNAM: April, 2016 VIETNAM NATIONAL UNIVERSITY HA NOI UNIVERSITY OF EDUCATION TEP PHARIN POSTPARTUM DEPRESSION IN CAMBODIA WOMEN MASTER’S THESIS IN PSYCOLOGY Major: Clinical psychology of children and adolescents Code: Pilot Supervisor: Prof Dr Bahr Weiss Dr Tran Thanh Nam HANOI, VIETNAM: April, 2016 SUPERVISOR’S RESEARCH SUPERVISION STATEMENT TO WHOM IT MAY CONCERN Name of program: Master‟s degree of Art in Clinical Psychology, specialize in Child and Adolescent Clinical Psychology Name of candidate: Tep Pharin Title of research: Post-partum depression in Cambodia women This is to certify that the research carried out for the above titled master„s thesis was completed by the above named candidate under my direct supervision This thesis material has not been used for any other degree I played the following part in the preparation of this thesis: Supervisor (s)…………………………… Date……………………………………… ABSTRACT Cambodia is one of the developing countries where postpartum depression has a high predictive rate Unfortunately, there is no data on postpartum depression This study was the first study which explored the rate of postpartum depression and anxiety in women in Cambodia According to GAD -7 measures, 26% of our participants had moderate and severe anxiety According to EPDS, 30% of our participants had moderate and severe depression The rate of anxiety and depression among our participants are very high Therefore, policy makers, researchers, health practitioners should pay more attention to the issues in order to improve the life of women and their infants There should be more research into these issues in order to have a better understand of these issues Particularly, the next research should include more women, expand the age‟s ranges of participants as well as the geographic of the participant in order to achieve a more representative sample TABLE OF CONTENTS ABSTRACT iv Table of Contents v ACKNOWLEDGEMENT vi 1.1 Background and Rationale of the Research .1 1.2 Research Problem 1.3 Research Objectives 1.4 Scope of the Research 1.5 Significance of the Research .4 PART II - LITERATURE REVIEW 2.1 What is postpartum depression? 2.2 Measures of Postpartum Depression 2.3 Prevalence of postpartum depression around the world 2.4 Effect of post-partum depression on the child 2.4 Risk factors in postpartum depression: PART III - RESEARCH METHODOLOGY 13 3.1 Sample and data collection 13 3.2 Instrument and Scales 13 3.3Ethics 15 3.4 Data Analysis 16 PART IV - RESULTS .17 4.1 Demographic characteristics 17 4.2 Preliminary analyses: Mean levels of variables 19 4.3 Primary analyses: Prediction of postpartum depression, and anxiety .24 PART V - DISCUSSION 27 PART VI - CONCLUSION AND RECOMMENDATION .32 6.1 Conclusion: 32 6.2 Recommendations 33 REFERENCES 35 ACKNOWLEDGEMENT I would first like to thank my thesis advisors Dr Bahr Weiss and Dr Nam Tran who always provided patient and insightful responses whenever I ran into a trouble spot or had a question about my research or writing His guidance helped me in all the time of research and writing of this thesis I could not have imagined having a better advisor and mentor for my Ph.D study I would also like to acknowledge The University of Education, Vietnam National University and well as National Institutes of Health give me a chance to participate in their wonderful Master program Without they precious training it would not be possible to conduct this research Finally, I must express my very profound gratitude to my parents and to my husband for providing me with unfailing support and continuous encouragement throughout my years of study and through the process of researching and writing this thesis This accomplishment would not have been possible without them Thank you PART I - INTRODUCTION 1.1 Background and Rationale of the Research In modern society, the role of women is increasing, leading to more of a focus on issues surrounding them Among the issues, health, especially mental health is getting more attention from policy makers, researchers, and practitioners Mental health becomes an important issue for woman because improving mental health improves the quality of life for the woman as well as their functioning in society According to The National Institute of Mental Health (2015), woman are faced with many mental health problems, common ones being anxiety, bipolar disorder, attention deficit hyperactivity disorder, borderline personality disorder, eating disorders, postpartum depression, depression, and schizophrenia Among these problems, postpartum depression is known as one of the most common mental health issues in mothers and prenatal woman (Hanlon 2013) Women with postpartum depression experience depression symptoms: sadness, worries, withdraws, and thoughts harming themselves and their children Postpartum depression is different from other kinds of depression because its symptoms start to develop within one year after the mother gives birth Because postpartum happens during a critical time, its effects go beyond the common effects of general depression, creating significant consequences for the suffering mothers and their children While having a baby should be a happy time, postpartum depression makes the mothers suffer sadness After giving birth, the mothers need to cover from the labor, experiencing postpartum depression symptoms prevents them from recovering normally and adds another burden for them to cope with The symptoms of postpartum depression also prevent the suffering mothers from completing their duties with their children, thus affecting their childrens‟ development Additionally, its symptoms are opposite from the typical feelings of new mothers Instead of being happy to have a baby and feeling skilled enough to take care of their children, Bilszta, Ericksen et al (2010) showed evidence that woman suffering from postpartum depression have some belief and fear that prevent them from seeking help, making the effects of the issues even heavier Postpartum depression is well known in developed countries O'hara and Swain (1996) did a meta-analysis of 59 studies The total participants were 12,810, and their analysis showed that the prevalence of postpartum depression was 13% Gavin, Gaynes et al (2005) did a more recent systematic review that showed that the frequency of postpartum depression was 19.2% with 7.1% for major depression and 12.2% for minor depression Two large studies done in Europe recently both predicted that the occurrence of postpartum depression is about 9.2% to 9.6% (Navarro, García-Esteve et al 2008, Banti, Mauri et al 2011) Although the rates vary between these studies, they show that the prevalence of postpartum depression is quite significant among woman Like many other mental health issues, postpartum depression is not getting as much attention in developing countries as it is in developed countries In their recent review the data of postpartum depression in low and middle income country, Parsons, Young et al (2012) conclude that much less is known about this issue in developing countries compared to what has been determined in the high income countries Among available data, the rate of postpartum depression in developing countries varies from 4.9% (Nepal) to 33% (Vietnam) Southeast Asia has a significant rate of postpartum depression: 11.5% (Malaysia), 13.3% (Thailand), 16.3%, and 33% (Vietnam) Besides having a high rate, most postpartum depression, like other maternal depression, remains undiagnosed and untreated in middle and low income countries Therefore, greater attention needs to be paid to postpartum depression in developing countries 1.2 Research Problem Cambodia is one of the developing countries where postpartum depression has a high predictive rate Unfortunately, there is no data on postpartum depression As a Cambodian woman, I believe that Cambodian woman carry a lot of burdens during the time surrounding the birth of a baby Culture beliefs and practices could put more stress during the postpartum time for mothers First, the society is hierarchical, woman have “double duty” both working and taking care of the family (Ebihara, Mortland et al 1994) thus, woman undergo a lot of stress and pressure The Khmer has a proverb "num thom cheang nil" meaning that parents know to choose who to married better than a child (Ebihara, Mortland et al 1994) Many married couples in Cambodia are still arranged, which leads to potential problems including an unhappy married life, thus reducing the support the women have during their postpartum time White (2004) also pointed out some potential harmful traditional practices including a high salt diet during the postpartum period, drinking Khmer medicines infused in rice wine while roasting, labor work at home (delivery the child at home) In order to have better understanding about postpartum depression, our study aims to be the first study to investigate the rate of and the risk factors surrounding postpartum depression among Cambodian women The results of the study will provide information to policy makers and practitioners to improve the lives of mothers in Cambodia 1.3 Research Objectives The aims of this research study are (1) To assess the incidence of postpartum depression in Cambodian women; (2) To identify risk factors for postpartum depression in Cambodian women; (3) To assess at the relationships among factors related to postpartum depression in Cambodian women 1.4 Scope of the Research Very little research has been conducted on postpartum depression in Cambodia This research study will be focused on a sample of 50 women in a single district on the province of Kandal (Mukh Kampul district) in Cambodia Research was collected during a 1-month time frame in May 2015.This research study will focus on the potential risk factors of postpartum depression in Cambodian women The main target group consists of 50 mothers who delivered their babies in the period of to months 1.5 Significance of the Research Even though the sample of this study is small, it is the first data collected on postpartum depression in rural areas in Cambodia This data allows an estimate on the prevalence and the seriousness of postpartum depression in Cambodia The result, therefore, could make policy makers pay more attention to the issue This data also tries to provide an understanding of some risk factors for postpartum depression Understanding these risk factors would help practitioners in implementing prevention and intervention strategies to help the postpartum women Yes, very often ៤.៥ខ្ញំមនអារេាណ៍េ័យខ្លយឬសលន់លសាល លោយគ្នានលហត៉ុសេប្តឹេប្តូវទាេ់ថ្តលសាះ។ 4.5 * I have felt scared or panicky for no very good reason ចាសមនលប្ចើន Yes, quite a lot ចាសលពេខលះ Yes, sometimes លទេិនមនលប្ចើនលទ No, not much លទ េិនមនទាេ់ថ្តលសាះ No, not at all 50 CONTINUE THE FORMATTING LIKE THIS *៤.៦ លរឿងប្គប់យ៉ងមនការប្គបដណត ប់េកលេើខ្ញំ។ Things have been getting on top of me ចាសភាគលប្ចើនបំស៉ុតខ្ញំគ្នានសេតាភាពលោះប្សាយលរឿងទាំងលនាះទាេ់ថ្តលសាះ Yes, most of the time I haven‟t been able to cope at all ចាសលពេខលះខ្ញំគ្នានសេតាភាពលោះប្សាយលរឿងទាំងលនាះឲ្យបានេអតាេ្េាតាលនាះលទ Yes, sometimes I haven‟t been coping as well as usual លទលសទើរថ្តប្គប់លពេខ្ញំមនសេតាភាពលោះប្សាយលរឿងទាំងលនាះបានេអ No, most of the time I have coped quite well លទខ្ញំមនសេតាភាពលោះប្សាយលរឿងទាំងលនាះបានេអតាេ្េាតា No, have been coping as well as ever *៤.៧ ខ្ញំេិនសបាយចិតតទាេ់ថ្តលសាះថ្ដេល្វើឲ្យខ្ញំពិបាក។ I have been so unhappy that I have had difficulty ចាសលសទើរថ្តប្គប់លពេ Yes, most of the time ចាសលពេខលះ Yes, sometimes េិន ឹកញាប់លទ Not very often លទេិនមនទាេ់ថ្តលសាះ No, not at all *៤.៨ ខ្ញំមនអារេាណ៍លប្កៀេប្កំឬលសាកលៅ។ I have felt sad or miserable ចាសលសទើថ្តប្គប់លពេ Yes, most of the time ចាស ឹកញាប់គួរសេ Yes, quite often េិន ឹកញាប់ណាស់លទ Not very often 51 លទេិនមនទាេ់ថ្តលសាះ No, not at all *៤.៩ ខ្ញំមនអារេាណ៍េិនសបាយចិតតទាេ់ថ្តលសាះថ្ដេល្វើឲ្យខ្ញំយំ។ I have been so unhappy that I have been crying ចាសលសទើថ្តប្គប់លពេ Yes, most of the time ចាស ឹកញាប់គួរសេ Yes, quite often េតងមក េថ្តប៉៉ុលណាាះ Only occasionally លទេិនថ្ដេលសាះ No, never *៤.១០ គំនិតថ្ដេល្វើឲ្យខលួនឯងឈឺចាប់បានលកើតល ើងចំលពាះរូបខ្ញំ។ The thought of harming myself has occurred to me ចាស ឹកញាប់គួរសេ Yes, quite often លពេខលះ Sometimes លសទើរថ្តេិនមន Hardly ever េិនថ្ដេលសាះ Never V កំ ញងពីរសបាតហ៍ច៉ុងលប្កាយលតើអ្នកមនអារេាណ៍រំខ្នលោយបញ្ជាខ្ងលប្កាេលនះ ឹកញាប់ប៉៉ុណាា? Over the last weeks, how often have you been bothered by the following problems? េិនមនលសាះ Not at all 52 ពីរបីដងែ Several days លប្ចើនជាងេួយ លសទើរថ្តរាេ់ដងែ សបាតហ៍ Nearly More than half the days every day ៥.១ មនអារេាណ៍ខវេ់ខ្វយអ្នទះសារឬគ្នាន អារេាណ៍្ូរប្សាេ ០ ១ ២ ៣ ០ ១ ២ ៣ ០ ១ ២ ៣ ០ ១ ២ ៣ ០ ១ ២ ៣ ០ ១ ២ ៣ ០ ១ ២ ៣ បូកជួរឈរ + + Feelingnervous,anxiousoron edge ៥.២េិនអាចបញ្ឈប់ឬប្គប់ប្គងការប្ពួយ បារេាណ៍បាន Not being able to stop or control worrying ៥.៣មនការប្ពួយបារេាណ៍ខ្លំងលពកចំលពាះ លរឿងរា៊វប្គប់យ៉ង Worrying too much about different things ៥.៤មនភាពតានតឹង Trouble relaxing ៥.៥មនអារេាណ៍អ្នទះអ្ថ្នទងថ្ដេល្វើឲ្យ ពិបាកលៅេួយកថ្នលង Being so restless that it is hard to sit still ៥.៦ងាយទទួេរងអារេាណ៍រំខ្នឬឆ្ប់ខឹង Becoming easily annoyed or irritable ៥.៧មនអារេាណ៍េ័យខ្លចហាក់បីដូចជា លរឿងអាប្កក់ណាេួយអាចលកើតល ើង Feeling afraid as if something awful might happen ពិនទញសរ៉ុប៖ = * *Total Score = Add Columns ប្បសិនលបើអ្នកលប្ជើសលរីសយកបញ្ជាខ្ងលេើលតើបញ្ជាទាំងអ្ស់លនាះបងកភាពេំបាកកប្េិតណាដេ់ការងារការលេើេការ ខ៉ុសប្តូវកិចេការសទះឬទំនាក់ទំនងជាេួយអ្នកដ៏ដទ? If you checked off any problems, how difficult have these problems made it for you to your work, take care of things at home, or get along with other people? 53 សូេគូសរងវង់យកេួយ Circle one េិនេំបាក ទាេ់ថ្តលសាះ ពិបាកខលះ ពិបាកណាស់ Somewhat difficult Very difficult Not difficult at all ពិបាកខ្លំង បំស៉ុត Extremely difficult *ពិនទញ៖៥-៩ = ងប់អារេាណ៍កប្េិតប្សាេ, ១០-១៤ = ងប់អារេាណ៍កប្េិតេ្យេ, ១៥-២១ = ងប់អារេាណ៍ ប្សួចប្សាេ់ *Score:5-9=mildanxiety;10-14=moderateanxiety;15-21=severeanxiety 54 VI ការទសេទាយទ៉ុកេ៉ុនពីចំន៉ុចដនការធ្លលក់ទឹកចិតតលប្កាេសំរាេកូន Postpartum Depression Predictors Inventory (PDPI) – self assessment កំ ញងលពេសំរាេកូន During Pregnancy សាា នភាអាពាហ៍ពិពាហ៍ Marital Status លប្ជើសលរីសេួយ ៦.១ លៅេីវ [ ] Single ៦.២ លរៀបការ [ ] Married/ co-habitating ៦.៣ រស់លៅថ្បកគ្នន [ ] Separated ៦.៤ ថ្េងេះ [ ] Divorced ៦.៥ លេម៉ យ [ ] Widowed ៦.៦ ដដគូរ [ ] Partnered សាា នភាពលសដធកិចេ Socioeconomic Status ៦.៧ ទាប [ ] Low ៦.៨ េ្យេ [ ] Middle ៦.៩ ខពស់ [ High ការឲ្យតដេលខលួនឯង 55 ] ចាស(Yes) Self-esteem ៦.១០ លតើអ្នកមនអារេាណ៏េអចំលពាះខលួនអ្នកលទ? លទ(No) [ ] [ ] [ ] [ ] [ ] [ ] Do you feel good about yourself? ៦.១១ លតើអ្នកយេ់ថ្អ្នកមនប្បលយជន៏លទ? Do you feel worthwhile? ៦.១២ លតើអ្នកយេ់ថ្ខលួនអ្នកមនគ៉ុណភាពលទ? Do you have good qualities? ] 56 ការធ្លលក់ទឹកចិតតេ៉ុនលពេសំរាេ Prenatal Depression ៦.១៣ លតើអ្នកមនអារេាណ៏ធ្លលក់ទឹកចិតតកំេ៉ុងលពេអ្នកពលពាះរឺលទ? [ ] [ ] Have you felt depressed during your pregnancy? ៦.១៤ ប្បសិនលបើ”ចាស” លតើវាលកើតល ើងលពេណា?យូរប៉៉ុណាាលហើយ? If yes, when and how long have you been feeling this way? ៦.១៥ ប្បសិនលបើ”ចាស” លតើវា្ូរប្សាេ រឺ្ែន់្ែរលពេថ្ដេអ្នកគិតដេ់ការធ្លលក់ទឹកចិតតលនាះ? If yes, how mild or sever would you consider your depression? ការងប់បារេាណ៏េ៉ុនលពេសំរាេ Prenatal Anxiety ៦.១៦ លតើអ្នកមនអារេាណ៏ខវេ់ខ្វយកំេ៉ុងលពេអ្នកពលពាះលទ? [ ] [ ] Have you been feeling anxious during your pregnancy? ប្បសិនលបើ”ចាស” If yes, លតើអ្នកមនអារេាណ៏ថ្បបលនះយូរប៉៉ុណាាលហើយ? How long have you been feeling this way? ការពលពាះលោយដចដនយឫេិនមនគំលរាង Unplanned/unwanted Pregnancy ៦.១៧ លតើការពលពាះលនះអ្នកមនគំលរាងលទ? [ ] [ ] [ ] [ ] Was the pregnancy planned? ៦.១៨ លតើការពលពាះលនះអ្នកគ្នានគំលរាងថ្េនលទ? Was the pregnancy unwanted? ប្បវតតិដនការធ្លលក់ទឹកចិតត History of Previous Depression 57 ៦.១៩ េ៉ុនលពេអ្នកពលពាះ លតើអ្នកធ្លលប់មនការធ្លលក់ទឹកចិតតលទ? [ ] [ ] Before this pregnancy, have you ever been depressed? ៦.២០ ប្បសិនលបើ”ចាស” លតើអ្នកមនបទពិលសា្ន៏ធ្លលក់ទឹកចិតតលនះលពេណា? [ ] [ ] If yes, when did you experience this depression? ៦.២១ លតើអ្នកធ្លលប់ទទួេបានការថ្ងទាំពីប្គូលពទយលទ សំរាប់ការធ្លលក់ទឹកចិតតពីេ៉ុនេកលនាះ? [ ] Have you been under a physician‟s care for this past depression? [ ] ៦.២២ ប្បសិនលបើ”ចាស” លតើប្គូលពទយបានសតេ់ថ្នំចំលពាះការធ្លលក់ទឹកចិតតរបស់អ្នកលទ? [ ] If yes, did the physician prescribe any medication for your depression? [ ] ការគ្នំប្ទពីសងគេ Social Support ពីដដគូ Partner ៦.២៣ លតើអ្នកមនអារេាណ៏ថ្ អ្នកទទួេបានការគ្នំប្ទថ្សនកអារេាណ៏ប្គប់ប្គ្នន់ពីដដគូអ្នកថ្ដរលទ? [ ] Do you feel that you receive adequate emotional support from your partner? [ ] ៦.២៤ លតើអ្នកមនអារេាណ៏ថ្ អ្នកទទួេបានការជួយល្វើកិចេការពីេួយដងែលៅេួយដងែពីដដគូរបស់អ្នកប្គប់ប្គ្នន់ថ្ដរលទ? ឧទាហរណ៏៖ ការជួយកិចេការសទះ ការលេើេថ្ងកូនលៅជាលដើេ។ [ ] [ ] Do you feel you receive adequate day-to-day task support from your partner?(e.g., help with household chores or babysitting)? ៦.២៥ លតើអ្នកមនអារេាណ៏ថ្ អ្នកអាចពឹងពាក់ដដគូរបស់អ្នកលពេអ្នកប្តូវការជំនួយលទ? [ ] Do you feel you can rely on your partner when you need help? [ ] ៦.២៦ លតើអ្នកមនអារេាណ៏ថ្ អ្នកអាចទ៉ុកចិតតដដគូរបស់អ្នកថ្ដរលទ? [ [ ] Do you feel you can confide in your partner? 58 ] ប្គួសារ Family ៦.២៧ លតើអ្នកមនអារេាណ៏ថ្ អ្នកទទួេបានការគ្នំប្ទថ្សនកអារេាណ៏ប្គប់ប្គ្នន់ពីប្គួសារអ្នកថ្ដរលទ? [ ] Do you feel that you receive adequate emotional support from your family? [ ] ៦.២៨ លតើអ្នកមនអារេាណ៏ថ្ អ្នកទទួេបានការជួយល្វើកិចេការពីេួយដងែលៅេួយដងែពីប្គួសាររបស់អ្នកប្គប់ប្គ្នន់ ថ្ដរលទ?ឧទាហរណ៏៖ ការជួយកិចេការសទះ ការលេើថ្ងកូនលៅជាលដើេ។ [ ] [ ] Do you feel you receive adequate day-to-day task support from your family?(e.g., help with household chores or babysitting)? ៦.២៩ លតើអ្នកមនអារេាណ៏ថ្ អ្នកអាចពឹងពាក់ប្គួសាររបស់អ្នកលពេអ្នកប្តូវការជំនួយលទ? [ ] Do you feel you can rely on your family when you need help? [ ] ៦.៣០ លតើអ្នកមនអារេាណ៏ថ្ អ្នកអាចទ៉ុកចិតតប្គួសាររបស់អ្នកថ្ដរលទ? [ ] [ ] Do you feel you can confide in your family? េិតតេ័កត Friends ៦.៣១ លតើអ្នកមនអារេាណ៏ថ្ អ្នកទទួេបានការគ្នំប្ទថ្សនកអារេាណ៏ប្គប់ប្គ្នន់ពីេិតតេ័កតអ្នកថ្ដរលទ? [ ] Do you feel that you receive adequate emotional support from your friends? [ ] ៦.៣២ លតើអ្នកមនអារេាណ៏ថ្ អ្នកអាចពឹងពាក់េិតតេ័កតរបស់អ្នកលពេអ្នកប្តូវការជំនួយលទ? [ ] Do you feel you can rely on your friends when you need help? ៦.៣៣ លតើអ្នកមនអារេាណ៏ថ្ អ្នកអាចទ៉ុកចិតតេិតតេ័កតរបស់អ្នកថ្ដរលទ? [ ] [ ] [ ] Do you feel you can confide in your friends? ភាពជាបតីប្បពនធ/ដដគួរនិងការលព ចិតត Marital/partner satisfaction ៦.៣៤ លតើអ្នកលព ចិតតជាេួយការលរៀបអាពាហ៏ពិពាហ៏ ឬការលរៀបចំជីវិតរស់លៅថ្បបលនះលទ? [ Are you satisfied with your marriage or living arrangement? 59 ] [ ] ៦.៣៥ លតើងាីៗលនះអ្នកជួបបញ្ជារវាងបតីប្បពនធអ្នកលទ? [ ] [ ] [ ] [ ] Are you currently experiencing any marital problems? ៦.៣៦លតើប្គប់យ៉ងដំលណើរការេអលទរវាងអ្នកជាេួយនិងដដគូរអ្នករបស់អ្នក? Are things going well between you and your partner? ភាពតានតឹងកនញងជីវិត Life stress ៦.៣៧ លតើងាីៗលនះអ្នកជួបបទពិលសា្ន៏ដនភាពតាន់តឹងចិតតកនញងជីវិតរបស់អ្នកដូចខ្ងលប្កាេលនះលទ ? [ ] Are you currently experiencing any stressful events in your life such as: [ ] ៦.៣៨ បញ្ជាប្បាក់កាស [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Financial problems ៦.៣៩ បញ្ជារវាងបតីប្បពនធ Marital problems ៦.៤០ មនសមជិកសាល ប់កនញងប្គួសារ Death in family ៦.៤១ មនសមជិកឈឺ្ែន់កនញងប្គួសារ Serious illness in family ៦ ៤២ ការចាកលច Moving ៦.៤៣ ភាពអ្ត់ការងារល្វើ Unemployment ៦.៤៤ ការផ្លលស់បតូរការងារ Job change During Postpartum កំ ញងលពេលប្កាយសំរាេកូន ភាពតាន់តឹងចិតតលេើការថ្ងទាំកូន Child Care Stress 60 ៦.៤៥ លតើកូនរបស់អ្នកមនបញ្ជាស៉ុខភាពថ្ដរលទ? [ ] [ ] ៦.៤៥ លតើអ្នកជួបបញ្ជាអ្វីលទជាេួយនឹងការចិញ្េឹេបីបាច់កូនតូចរបស់អ្នកលនះ ? [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Is your infant experiencing any health problems? ] Are having problems with your baby feeding? ៦.៤៦ លតើអ្នកជួបបញ្ជាអ្វីលទជាេួយនឹងការលគងរបស់កូនអ្នកលនះ? Are you having problems with your baby sleeping? និសេ័យទារក Infant Temperament ៦.៤៧ លតើអ្នកគិតថ្កូនតូចរបស់អ្នកឆ្ប់ខឹងឬេួរល ៉ លទ ? Would you consider your baby irritable or fussy? ៦.៤៨ លតើកូនរបស់អ្នកយំលប្ចើនលទ? Does your baby cry a lot? ៦.៤៩ លតើអ្នកគិតថ្កូនរបស់អ្នកពិបាកេួងលទ? Is your baby difficult to console or soother? ភាពជាមត យនិងភាពលប្កៀេប្កំ Maternity Blues ៦.៥០ លតើអ្នកមនបទពិលសា្ន៏លសាកលៅកនញងកំ ញងលពេខលីេួយនិងការផ្លលស់បតូរអារេាណ៏កនញងកំ ញងលពេ សបាតហ៏ទីេួយបនាទប់ពីសំរាេកូនលទ? [ ] [ ] Did you experience a brief period of tearfulness and mood swings during the 1st week after delivery?] 61 VII ការអ្ន៉ុវតតថ្បបប្បដពណី Traditional Practices ថ្នំប៉ុរាណ Traditional Herb/Medication: ៧.១ លតើអ្នកលប្បើថ្នំប៉ុរាណរឺលទលៅកំ ញងលពេអ្នកសំរាេកូនលនះ? Have you used the traditional herb/medication during your postnatal period? ចាស (Yes)  7.4)  លទ(រំេងលៅសំនួរ ៧.៤)/No (Skip to Question ៧.២ លតើប្បលេទថ្នំប៉ុរាណអ្វីថ្ដេអ្នកកំព៉ុងលប្បើប្បាស់លៅលពេលនះ? What Khmer traditional herb/medication have you used during your postpartum period? ប្សាថ្នSំ raaTnamm (rice wine)  ថ្នំកូនខេីោំ  ThnamKonKhchey Dam (a kind of Khmer traditional boiling medications from the tree barks, root…)  លសេងៗ(សូេបញ្ជាក់/ others please specify : ៧.៣ លតើអ្នកមនលគ្នេបំណងអ្វីថ្ដេលប្បើប្បាស់ថ្នំប៉ុរាណទាំងលនាះ? What is the purpose of using such traditional herb/medication? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ការតេចំណីអាហារ Dietary Food ៧.៤លៅកំ ញងលពេអ្នកសំរាេលនះ លតើអ្នកមនការតេចំណីអាហារអ្វីលទ? During your postpartum period, have you been on a special diet because you recently had a child?  ចាស (Yes)  លទ (រំេងលៅសំនួរ ៧.៧)/ No (Skip to Question 7.7) ៧.៥ លតើអ្នកតេប្បលេទអាហារអ្វីខលះ? What the dietary food have you been on? 62 អាហារហិេ(withspicyfoods)  ប្សាស(with rice wine)  ថ្សលលឈើ(withfruits)  បថ្នល(withfresh vegetable)  លសេងៗ(សូេបញ្ជាក់/Others please specify……………………………………………………  ៧.៦ លតើអ្វីជាបំណងអ្នកកនញងការតេអាហារទាំងលនាះ? What is the purpose of being on such dietary food? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ការអ្ន៉ុវតតប្បចាំដងែ Daily Practices ៧.៧ លតើអ្នកមនការអ្ន៉ុវតតន៏តាេថ្បបប្បដពណីលដើេបីជួយអ្នកនិងកូនអ្នកលទលៅកំ ញងលពេ សំរាេលនះ? ឧទាហរណ៏៖ លជៀសលរៀងការសឹកទឹកប្តជាក់ជាលដើេ។ Have you used any traditional/ritual practices during your postpartum period to help you or your child? For instance, Khmer mothers sometimes GIVE AN EXAMPLE: avoid drinking cold water ចាស (Yes)   លទ (No) ៧.៨ លតើការអ្ន៉ុវតតន៏ថ្បបប្បដពណីមនអ្វីខលះ? What traditional/ritual practices had you had?  សងកត់ងា (Hot rock) អាំងលេលើង( Lying by fire)  តបការរួេដំលណក (Sexual Abstinence)  លជៀសវាងការងូតទឹក (Avoid taking bath) ឆ្ពង់(Steam (Spong)   សំរាកលៅសទះ(Rest at home) 63  សងកត់ទឹកកកលេើលពាះ(Rice bag on abdomen)  លសលៀកសំលេៀកបំពាក់លខ្អាវប្កាស់ៗ(Cover with thick cloth) េិនល្វើការ្ែន់ៗ(Restrict from doing hard work) លសេងៗ(សូេបញ្ជាក់/Are thereanyothers  (pleasespecify…………………………………………………….…… …………………………… ……………………………………………………………………………………………………… ៧.៩ លតើអ្នកមនលគ្នេបំណងថ្បបណាលេើការអ្ន៉ុវតតន៏ខ្ងលេើ លហើយអ្វីថ្ដេអ្នកចង់ល ើ ជាេួយការពាយេទាំង លនះ? What is the purpose of each of these practices, what are you trying to make happen by doing this? …………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… 64