VIETNAM NATIONAL UNIVERSITY HA NOI UNIVERSITY OF EDUCATION TEP PHARIN POSTPARTUM DEPRESSION IN CAMBODIA WOMEN MASTER’S THESIS IN PSYCOLOGY HANOI, VIETNAM: April, 2016 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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. Bahr Weiss Dr. Tran Thanh Nam HANOI, VIETNAM: April, 2016 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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……………………………………… LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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. LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com TABLE OF CONTENTS ABSTRACT.
iv Table of Contents .1 Background and Rationale of the Research .4 Scope of the Research .5 Significance of the Research .4 PART II - LITERATURE REVIEW .1 What is postpartum depression? .2 Measures of Postpartum Depression .3 Prevalence of postpartum depression around the world .4 Effect of post-partum depression on the child.4 Risk factors in postpartum depression: .9 PART III - RESEARCH METHODOLOGY .1 Sample and data collection .2 Instrument and Scales .16 PART IV - RESULTS .2 Preliminary analyses: Mean levels of variables .3 Primary analyses: Prediction of postpartum depression, and anxiety .27 PART VI - CONCLUSION AND RECOMMENDATION .35 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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. 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. LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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 1 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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 19.1% 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 9.6% (Navarro, García-Esteve et al.
2008, Banti, Mauri et al. 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. Southeast Asia has a significant rate of postpartum depression: 11. 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.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 2 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com 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. 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.
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.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.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. 3 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.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. 4 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com PART II - LITERATURE REVIEW 2.1 What is postpartum depression? Postpartum depression (PPD) is a type of clinical depression that occurs after a woman gives birth. It also called postnatal depression.
Its symptoms include the same symptoms as other forms of depression, such as sadness, anhedonia, low self-esteem, changes in eating and sleeping habits, lack of energy, reduced interest in sex, and irritability. Although the majority of women who experience PPD have mild symptoms postpartum that disappear over the course of several weeks after birth, postpartum depression can be severe and last a number of months. PDD often begins within the first few weeks after giving birth, but research studies have found that about half of cases of PDD actually begin prior to giving birth (Chen et al., 2008; Yonkers et al. According to the American Psychiatric Association Diagnostic Statistical Manual of Mental, Fifth Edition (DSM-5), post-partum depression is defined as a major or minor depressive episode affecting women within four weeks after childbirth but it is commonly believed by clinicians and researchers to occur anytime within the first year postpartum (APA, 2013).2 Measures of Postpartum Depression The mostly widely used measure to assess postpartum depression is the Edinburgh Postpartum Depression Scale.
It has been used in many research studies and many countries around the world. It was first developed by Scottish health centers in Edinburgh and Livingston. It has 10 items that are rated with a 0, 1, 2, 3 Likert scale on the severity of the PPD symptoms. The total score is calculated by adding up the points together from the total of 10 questions.
In addition, the Postpartum Depression Screening Scale (PPDS) (Beck & Gable, 2000) is sometimes used to screen for PPD. The PPDS is a longer questionnaire than the EPDS. It contains containing 35items and produces 7 subscales. These subscales include disturbance in (1) Sleeping and Eating; 5 LUAN VAN CHAT LUONG download : add luanvanchat@agmail.com (2) Anxiety / Insecurity, (3) Emotional Lability, (4) Mental Confusion, (5) Loss of Self, (6) Guilt and shame, (7) Suicidal Thoughts.