Perinatal mental distress in a rural Ethiopian community: a critical examination of psychiatric labels

Abstract

Background: Perinatal mental distress poses a heavy burden in low-and middle-income countries (LMICs). This study investigated perceptions and experiences of perinatal mental distress among women in a rural Ethiopian community, in an effort to advance understanding of cross-cultural experiences of perinatal mental distress. Methods: We employed a sequential explanatory study design. From a population-based cohort study of 1065 perinatal women in the Butajira Health and Demographic Surveillance Site, we purposively selected 22 women according to their scores on a culturally validated assessment of perinatal mental distress (the Self-Reporting Questionnaire). We examined concordance and discordance between qualitative semi-structured interview data ('emic' perspective) and the layperson-administered fully-structured questionnaire data ('etic' perspective) of perinatal mental distress. We analysed the questionnaire data using summary statistics and we carried out a thematic analysis of the qualitative data. Results: Most women in this setting recognised the existence of perinatal mental distress states, but did not typically label such distress as a discrete illness. Instead, perinatal mental distress states were mostly seen as nonpathological reactions to difficult circumstances. The dominant explanatory model of perinatal mental distress was as a response to poverty, associated with inadequate food, isolation, and hopelessness. Support from family and friends, both emotional and instrumental support, was regarded as vital in protecting against mental distress. Although some women considered their distress amenable to biomedical solution, many thought medical helpseeking was inappropriate. Integration of perspectives from the questionnaire and semi-structured interviews highlighted the important role of somatic symptoms and nutritional status. It also demonstrated the differential likelihood of endorsement of symptoms when screening tools versus in-depth interviews are used.

Psychometric properties of the Barkin Index of Maternal Functioning with Ethiopian mothers

“…Although not directly associated with our examination of the BIMF, the absence of selfreported depression among the mothers in this research might be important. Other research has indicated that perinatal depression is likely to be approximately 13% among mothers in middleand low-income countries in general [29] and in Ethiopia, specifically [30], and as high as 33%…”

“…Although not directly associated with our examination of the BIMF, the absence of self-reported depression among the mothers in this research might be important. Other research has indicated that perinatal depression is likely to be approximately 13% among mothers in middle- and low-income countries in general [29] and in Ethiopia, specifically [30], and as high as 33% in rural parts of Ethiopia [31]. The discrepancy between those statistics and the mothers’ self-reports in this research suggests that responses on the BIMF in this research might be regarded with a degree of reservation despite the mothers having been assured by the data collectors of confidentiality concerning their responses in order to discourage them from creating an inaccurately favorable impression.…”

Comorbid mental disorders and quality of life of people with epilepsy attending primary health care clinics in rural Ethiopia

“…way in which depression and anxiety manifest and the non-biomedical causal attributions of depressive/anxiety symptoms in this socio-cultural context [43] could have contributed to the low detection by mental health professionals applying Western diagnostic criteria [42]. The diagnosis and presentation of depression in Ethiopian culture appears to include a combination of anxiety, somatic and depressive symptoms rather than typical DSM criteria of depression [44].…”

Developing a Framework to Increase Access to Mental Health Services for Children With Special Needs in Ethiopia

“…Like other developing country children's mental health needs are high and evident from early childhood throughout adolescence. In a recent study, mothers reporting perinatal depressive symptoms indicated that they were more comfortable conceptualizing these experiences as distress brought on by an external source, such as poverty, physical ill-health or supernatural factors rather than being mental health related (Molenaar et al, 2020 ). Authors noted that Westernized explanations of mental health symptomology would be inconsistent with their cultural beliefs.…”

“…Community supports evident in westernized social worker practice, can be seen as similar to the popular practice among Ethiopian Orthodox Christians called Yenesha Abat—which involves a priest serving as a family mentor or guide who makes frequent visits to the home. Again, these similarities appear to be a promising link from a traditional healing relationship to a westernized therapeutic service (Zeleke et al, 2019 ; Molenaar et al, 2020 ).…”