Postnatal depressive symptoms amongst women in Central Vietnam: a cross-sectional study investigating prevalence and associations with social, cultural and infant factors

Abstract

BackgroundThis study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18–45 years old in Central Vietnam. Son preference and traditional confinement practices were explored as well as factors such as poverty, parity, family and intimate partner relationships and infant health.MethodsA cross-sectional study was conducted in twelve randomly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province, Vietnam. Mother-infant dyads one to six months postpartum were invited to participate. Questionnaires from 431 mothers (urban n = 216; rural n = 215) assessed demographic and family characteristics, traditional confinement practices, son preference, infant health and social capital. The Edinburgh Postnatal Depression Scale (EPDS) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing. Data were analysed using general linear models.ResultsUsing an EPDS cut-off of 12/13, 18.1 % (n = 78, 95 % CI 14.6 - 22.1) of women had depressive symptoms (20.4 % urban; 15.8 % rural). Contrary to predictions, infant gender and traditional confinement were unrelated to depressive symptoms. Poverty, food insecurity, being frightened of family members, and intimate partner violence increased both depressive symptoms and lowered wellbeing. The first model accounted for 30.2 % of the variance in EPDS score and found being frightened of one’s husband, husband’s unemployment, breastfeeding difficulties, infant diarrhoea, and cognitive social capital were associated with higher EPDS scores. The second model had accounted for 22 % of the variance in WHO5 score. Living in Hue city, low education, poor maternal competence and a negative family response to the baby lowered maternal wellbeing.ConclusionsTraditional confinement practices and son preference were not linked to depressive symptoms among mothers, but were correlates of family relationships and wellbeing. Poverty, food insecurity, violence, infant ill health, and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam.

Gender preference and perinatal depression in Turkey: A cohort study

“…Child gender preference is an important issue in some cultures [5,7] and it has been reported as a risk modifier for antenatal and postnatal depression in studies in some countries [7,17], although is generally under-researched. Findings to date have tended to come from societies where there are marked contrasts between the implications of a male or female child, and the exposure has received little or no investigation in Western settings where preferences, if present, are assumed not to have meaningful impact.…”

“…Specifically, Xie et al [33] suggested that the association between the gender of the baby and postnatal depression found in their study was not due to the baby’s gender itself, but rather the social context and reactions of relatives to the baby. In a recent study, preference for a male child, previously suggested to be influential in Vietnam, was not linked to depressive symptoms; instead, poor family relationships and negative reactions to the infant were associated with lowered maternal wellbeing [7]. Intense levels of postpartum support from relatives have been described as a ‘double edged sword’ [18], and being in a close relationship with disapproving or emotionally cold relatives during the postnatal period may act as a substantial stressor.…”

“…For postnatal depression, a meta-analysis concluded a period prevalence in the three months after birth of 19.2% [1], although there is potentially substantial international variation [2] with particularly high prevalences in Asian countries such as Israel (22.6%), Taiwan (36.6%), Turkey (33,1%; 26,1%) and Vietnam (29.9%) [3–7]. Multiple contributory factors include life stress, marital conflict, maternal self-esteem, and lack of social support [8,9].…”

“…However, male gender preference exists in many non-Western cultures [7,13,14,15] and several studies in these settings have found evidence that the birth of a female child when a male child is desired, is associated with postnatal depression [16,17]. Evidence from India [17] and China [18] has also suggested that spousal disappointment with the gender of the baby is significantly associated with postnatal depression in the mother, specifically if the baby is a girl and if the mother has already had a female child.…”

“…Evidence from India [17] and China [18] has also suggested that spousal disappointment with the gender of the baby is significantly associated with postnatal depression in the mother, specifically if the baby is a girl and if the mother has already had a female child. Furthermore, a direct association between male gender preference and antenatal depression has been reported [19], although not by all studies [7, 20]. It has been suggested that the negative reaction of family members towards the birth of a female baby in these contexts may be influential in initiating or exacerbating depression [11, 21].…”