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 1.2 Research Problem 1.3 Research Objectives 1.4 Scope of the Research 1.5 Significance of the Research 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 លល លលល លលលលលល លលលល ល Circle one *លល លលលលល-ល = លលល លលលលលលល លលល លលលល លលល,លល-លល = លលល លលលលលលល លលល លលលល លល,លល-លល = លលល លលលលលលល លល លលលល លលលល *Score:5-9=mildanxiety;10-14=moderateanxiety;15-21=severeanxiety 54 លលលលលលលលលលល លលល លលល លលលលលលលលលល លល លល លល លល លលលលល លលលលល លលលលល ល VI Postpartum Depression Predictors Inventory (PDPI) – self assessment កកកកកកកកក កកកកក ក During Pregnancy លលល លលលលលលលលល លលលលល Marital Status ក.ក កកកកក ក.ក កកកកកកក ក.ក កកកកកកកកកកកកក ក.ក កកកកកក Single Married/ co-habitating Separated Divorced ក.ក កកកកក Widowed ក.ក កកកកក Partnered លលល លលលលលលលលលល លល Socioeconomic Status ក.ក កកក Low ក.ក កកកក ក.ក កកកក Middle High លលលលល លលលលលលលល លលល 55 Self-esteem ក.កក កកកកក កកកកកកកកកកក កកកក កកកកកកក កកក កកកក?[ Do you feel good about yourself? ក.កក កកកកក កកកកក កកកកកកកក កកកកកក កក? Do you feel worthwhile? ក.កក កកកកក កកកកក កកកក កកក កកកកកក កកកកកក? Do you have good qualities? ] 56 លលលលល លល លល លលលល លលលល លលលលលល លលល Prenatal Depression ក.កក កកកកក កកកកកកកកកកក កកក កក កកកក កកកក កកកកកកក កក កកកកកកក កក?[] [ ] Have you felt depressed during your pregnancy? ក.កក កក កកក កកកក”កកក” កកក? កកកក ?កក កកក ក If yes, when and how long have you been feeling this way? ក.កក កក កកក កកកក”កកក” កកកកកក កកក កកកកក កកក កកកកកកក កកកក កកកក កកកក កកកកក កក? កក កកកក កកកកកក If yes, how mild or sever would you consider your depression? លលលលលល លលលលលលល លលលលលលល លលល Prenatal Anxiety ក.កក កកកកក កកកកកកកកកកក កកកក កក កកក កក កកកកក កកកកកកកកក?[] [ ] Have you been feeling anxious during your pregnancy? កក កកក កកកក”កកក” If yes, កកកកក កកកកកកកកកកក កកកកកកកក កកក ក កកក? កកកក How long have you been feeling this way? លលលលលលលលលលលលលលលលលលល លលលលល លលលល Unplanned/unwanted Pregnancy ក.កក កកកកកកកកកកកកកកកក កក កកកក កកកកកក? [ ] [ ] [ ] [ ] Was the pregnancy planned? ក.កក កកកកកកកកកកកកកកកក កក កក កក កក កកកកកក កកកក? Was the pregnancy unwanted? លល លលលលល លលលលលលល លល លល លលលល លល History of Previous Depression 57 ក.ក កកក កក កក កក ក កកកកកក កកកក កកកក កកកកកកក កក កក កកកក កកកក?[] [ ] Before this pregnancy, have you ever been depressed? ក.កក កក កកក កកកក”កកក” កកកកក កកកកកកកក កកកក កកកក កក កកកក កក កកកកកកកក? [ ] [ ] If yes, when did you experience this depression? ក.កក កកកកក កកកក កក កក កកក កកកកកកកកក កកកក កកកកកកកកកកក កកកក កកក កក កក កក កកកក កកកក កកកកកកកក? [ ] Have you been under a physician‟s care for this past depression? [ ] ក.កក កក កកក កកកក”កកក” កក កក កក កកកក កកកកកក កកកកក? [ ] If yes, did the physician prescribe any medication for your depression? [ ] លលលលល លលលលល លលលល Social Support ពព ពពពព Partner ក.កក កកកកក កកកកកកកកកកក កកកកកកក កកកកកកកកក កកកកក កកកកក កកកកក កកកក កកកកក កកកកក កកកកក កកកក? [ ] Do you feel that you receive adequate emotional support from your partner? [ ] ក.កក កកកកក កកកកកកកកកកក កកកកកកក កកកកកកកកក កកក កកកក កក កកកកក កកកកកកកកក កកកកកក កកកក កកកក កកកក? កកកកកកក កកកកកក កកក កកកកកកកកកកកកកកកកក កកក កកកកកកកកកក[ ] [ ] Do you feel you receive adequate day-to-day task support from your partner?(e.g., help with household chores or babysitting)? ក.កក កកកកក កកកកកកកកកកក កកកកកកកកក កកកកក កកកក កកកក កកក កកកកក កកកក កកកកកកក កកកក? [ ] Do you feel you can rely on your partner when you need help? ក.កក កកកកក កកកកកកកកកកក កកកកកកកកក ក កក កកកកកក កកកក កកកកក កកកក?[] Do you feel you can confide in your partner? [ ] [ ] 58 ពព ពពពព Family ក.កក កកកកក កកកកកកកកកកក កកកកកកក កកកកកកកកក កកកកក កកកកក កកកកក កកកក កកកកក កកកកកកកក កកកក កកកក? [ ] Do you feel that you receive adequate emotional support from your family? [ ] ក.កក កកកកក កកកកកកកកកកក កកកកកកក កកកកកកកកក កកក កកកក កក កកកកក កកកកកកកកក កកកកកក កកកកកកកកក កក កក កកកក?កកកកកកក កកកកកក កកក កកកកកកកកកកកកកកកក កកក កកក កកកកកកក[] [ ] Do you feel you receive adequate day-to-day task support from your family?(e.g., help with household chores or babysitting)? ក.កក កកកកក កកកកកកកកកកក កកកកកកកកក កកកកក កកកកកកកកក កកក កកកកក កកកក កកកកកកក កកកក? [ ] Do you feel you can rely on your family when you need help? [ ] ក.កក កកកកក កកកកកកកកកកក កកកកកកកកក កកក កកកក កកកកកកកក កកក កក កកកក? [ ] [ ] Do you feel you can confide in your family? ពព ពពពព ពព Friends ក.កក កកកកក កកកកកកកកកកក កកកកកកក កកកកកកកកក កកកកក កកកកក កកកកក កកកក កកកកក កកកកកក កកកក កកកក កកកក? [ ] Do you feel that you receive adequate emotional support from your friends? [ ] ក.កក កកកកក កកកកកកកកកកក កកកកកកកកក កកកកក កកកកក កកកកកក កក កកកកកក កកកក កកកកកកក កកកក? [ ] Do you feel you can rely on your friends when you need help? ក.កក កកកកក កកកកកកកកកកក កកកកកកកកក កកក ក កកក កកកក កកកកកក កកកកក កកកក?[] [ ] [ ] Do you feel you can confide in your friends? លលលលលលលល លលលលល/លលលល លលល លលលលលល លល លល Marital/partner satisfaction ក.កក កកកកក កកកក កក កកកកកក កកកកកកកកកកកកកក កកកកក កកកកកក កកកក កកកកកកក? [ ] Are you satisfied with your marriage or living arrangement? 59 [ ] ក.កក កកកកកក កកកកកក កកកក កកកក កក កកកកកកក កកកកកកក ក Are you currently experiencing any marital problems? ក.កកកកកកក កកក កកកកក កកកកកកកកកកកកកកកកក កកកកកក កកក កកកកក កកក កក កកកក កកក?[] Are things going well between you and your partner? កកក? [ ] [ ] លលលលលលលល លលល លលលល លល Life stress ល.លល លលលលលល លលលលលល លលលល លលលលល លលលល លលលលលលលលលល លលលល លលលលលល លល លលលលលល លលលលល លលល លលលល លលលលលលលល? [ ] Are you currently experiencing any stressful events in your life such as: ក.កក កកក កក កក កកកក កកក Financial problems ក.កក កកក កក កកកកកកក កកកកក Marital problems ក.កក កកកកកក កកកក កក កកកកកក កកកក Death in family ក.កក កកកកកក កកក កកក កកកកកក កកកក Serious illness in family ក កក កកកកកកកក Moving ក.កក កកកកក កកកកកកកកក កក Unemployment ក.កក កកកកក កក កក កកក កកកកកក Job change During Postpartum កកកកកកកកកក កកកកក កកកកក ក លលលលលលល លលលល លលលលលលលលលល លលលល លល Child Care Stress 60 ក.កក កកកកក កកកកក កកកកកកកក កក កក កកកកកក កកកក? [ ] [ Is your infant experiencing any health problems? ] ក.កក កកកកក កកកក កកកក កក កក កកកកកកក កកក កកកកកក កកកកក កកកក កក កកក កកកកក កកកកកក?[][] Are having problems with your baby feeding? ក.កក កកកកក កកកក កកកក កក កក កកកកកកក កកក កកកកកកកកកកក កកកក កកកកក? Are you having problems with your baby sleeping? លល លលល លលលលល Infant Temperament ក.កក កកកកក កកកក កកក កកកក កកកកក កកកកក កកកកកក កក? Would you consider your baby irritable or fussy? ក.កក កកកកក កកកកក កកកកក កកក កកកកក? Does your baby cry a lot? ក.កក កកកកក កកកក កកក កកកកកក កកកកក កកកកក កកក? Is your baby difficult to console or soother? លលលលលលល លលល លលលលលលល លលលលល លល Maternity Blues ក.កក កកកកក កកកកកកកក កកកក កកកកកកកកកកកកកកកកកកក កក កកកក កកកកកក កក កក កកក កកកកកកក កកកក កក កកកកកកក កក កកកកកកក កកក? [ ] [ ] Did you experience a brief period of tearfulness and mood swings during the st week after delivery?] 61 ] លលលលល លលលលលល លលលល លលលលល VII Traditional Practices លលល លល លល Traditional Herb/Medication: ក.កកកកកក កកកកក កកកក ក កកកកកក កកកកកកកកកកកកក កកកក កកកកក កកកក? ក Have you used the traditional herb/medication during your postnatal period? ក (Yes) ( )/No (Skip to Question កកក កក កក កកកកកក កកក.ក 7.4)ក.ក កកកកក កកកកកក ក កកកកកក កកកកកក កកកក កកកកក កកកក កក កក កកកកកកកក? What Khmer traditional herb/medication have you used during your postpartum period? ក កក កកកក ក SraaTnammក(rice wine)  ThnamKonKhchey Dam (a kind of Khmer traditional boiling medications from the tree barks, root…) កកកកក កក កកកក កក កក  ( / others please specify : ក.ក កកកកក កកកកកកក កកកក កកកក កកកកកកក កកកក កកកក កក ?កក កកកកកក កកកកក What is the purpose of using such traditional herb/medication? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… លលលលលលល លលលលលល Dietary Food ក.កកកកកកកកកកកក កកកក កកកកកកកកកកក កកកកកកកកកកក កក កកកកកកក កកក? During your postpartum period, have you been on a special diet because you recently had a child? ក កកក (Yes) ក កក (កក កកកកកក កកក.ក)/ No (Skip to Question 7.7) ក.ក កកកកក កកកកកក កកកកកកកកកកក កកកក? What the dietary food have you been on? 62 កកកកកកក ក(withspicyfoods)  កក កកក(with rice wine)  កក កកកកក(withfruits)  កកក កក(withfresh vegetable)  កកកកក(កក កកកក កក/Others កកplease  specify…………………………………………………… ក.ក កកកកក កកកកក កកកក កកកកកកកកកកកកកកកកកកក កកកកក? What is the purpose of being on such dietary food? ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… លលលលល លលលលលល លលលល លលល Daily Practices ក.ក កកកកក កកកកកកកកក កកកកកក កកកកក កកកក កកកកក កកកកកក កក កក កកកក កកក កកក កកកកកកកកកកកកក កក កកកកកក? កកកកកកក កក កកកកកកកកកកកក កកក កកក កកកកក កកកកកកក 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 ក កកក (Yes) កក ក.ក កកកកកកកក កកកកកក កកកកក កកកកក កកកក កកកក? ក (No) What traditional/ritual practices had you had?  កកកកក កក(Hot rock) កកក កកកកកក(Lying by fire)  កកកកកកក កកក កកក(Sexual Abstinence)  កកកកកកកកកកកក កកក ក(Avoid taking bath) ក កក កកក (Steam (Spong)  កក កកកកកកកក(Rest at home)  63 កកកកក កកកកកកកកកកក(Ricebag on abdomen)  កកកកកកក កកកកកក កកកក កកក កកកកក កកកក ក(Coverwith thick cloth)  កក កកក កកកកកក កកក ក(Restrict from doing hard work) ក កកកកក(កក កកកក កក/Are កក thereanyothers (pleasespecify…………………………………………………….…… ……………………………  ……………………………………………………………………………………………………… ក.ក កកកកក កកកកកកក កកកក កកកក កកកកកកកកកកកក កកកកកក កកកកកក កកកក កកកកកកកកកកក ក កកក? What is the purpose of each of these practices, what are you trying to make happen by doing this? …………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… 64 ... practices included taking traditional herbal medicines, maintaining a special diet, or engaging in daily practices such as avoiding drinking cold water, placing rice bags on the abdomen, or lying near... 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. .. (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