Postpartum depression in cambodia women = trầm cảm sau sinh ở phụ nữ campuchia

ABSTRACT Cambodia is one of the developing countries where postpartum depression has a high predictive rate.. This study was the first study which explored the rate of postpartum depress

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 2

1.3 Research Objectives 3

1.4 Scope of the Research 3

1.5 Significance of the Research 4

PART II - LITERATURE REVIEW Error! Bookmark not defined 2.1 What is postpartum depression? Error! Bookmark not defined 2.2 Measures of Postpartum Depression Error! Bookmark not defined 2.3 Prevalence of postpartum depression around the world Error! Bookmark not

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2.4 Effect of post-partum depression on the child Error! Bookmark not defined 2.4 Risk factors in postpartum depression: Error! Bookmark not defined PART III - RESEARCH METHODOLOGY Error! Bookmark not defined 3.1 Sample and data collection Error! Bookmark not defined 3.2 Instrument and Scales Error! Bookmark not defined 3.3Ethics Error! Bookmark not defined 3.4 Data Analysis Error! Bookmark not defined PART IV - RESULTS Error! Bookmark not defined 4.1 Demographic characteristics Error! Bookmark not defined 4.2 Preliminary analyses: Mean levels of variables Error! Bookmark not

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4.3 Primary analyses: Prediction of postpartum depression, and anxiety Error!

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PART V - DISCUSSION Error! Bookmark not defined PART VI - CONCLUSION AND RECOMMENDATION Error! Bookmark not

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6.1 Conclusion: Error! Bookmark not defined 6.2 Recommendations Error! Bookmark not defined

REFERENCES 5

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

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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

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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

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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 min 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 3 to 6 months

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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

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