Social and economic development and pregnancy mental health: secondary analyses of data from rural Vietnam

Abstract

Background: This study aimed to establish whether changes in the socioeconomic context were associated with changes in population-level antenatal mental health indicators in Vietnam. Methods: Social, economic and public policies introduced in Vietnam (1986-2010) were mapped. Secondary analyses of data from two cross-sectional community-based studies conducted in 2006 (n = 134) and 2010 (n = 419), involving women who were ≥ 28 weeks pregnant were completed. Data for these two studies had been collected in structured individual face-to-face interviews, and included indicators of antenatal mental health (mean Edinburgh Postnatal Depression Scale Vietnam-validation (EPDS-V) score), intimate partner relationships (Intimate Bonds Measure Vietnam-validation) and sociodemographic characteristics. Socioeconomic characteristics and mean EPDS-V scores in the two study years were compared and mediation analyses were used to establish whether indicators of social and economic development mediated differences in EPDS-V scores. Results: Major policy initiatives for poverty reduction, hunger eradication and making domestic violence a crime were implemented between 2006 and 2010. Characteristics and circumstances of pregnant women in Ha Nam improved significantly. Mean EPDS-V score was lower in 2010, indicating better population-level antenatal mental health. Household wealth and intimate partner controlling behaviours mediated the difference in EPDS-V scores between 2006 and 2010. Conclusions: Changes in the socioeconomic and political context, particularly through policies to improve household wealth and reduce domestic violence, appear to influence women's lives and population-level antenatal mental health. Cross-sectoral policies that reduce social risk factors may be a powerful mechanism to improve antenatal mental health at a population level.

Violence and adversity among pregnant women and new mothers in central Vietnam

“…This strategy would rely on improved multi-sectoral action and collaboration. This result is in line with a recent study that suggested that IPV could be reduced by improving household wealth because this change would have a positive impact on women's socioeconomic and political contexts (Stocker et al, 2020). Le et al (2019) (Tokhi et al, 2018).…”

“…A recent national survey in 2020 examining violence against women in Vietnam found that two in three women (62.9%) experienced at least one type of IPV in their lifetime (emotional IPV -47%, physical IPV -26.1%, sexual IPV -13.3%) (United Nations Population Fund Vietnam, 2020). Further, mounting evidence shows the adverse maternal outcomes of p-IPV exposure in Vietnam including common mental disorders (CMD) (Hoang et al, 2016), especially postnatal depression (PPD) and anxiety (Fisher et al, 2010;Murray et al, 2015;Stocker et al, 2020) and having suicidal ideation (Fisher et al, 2013c).…”

“…Importantly, offering counselling and social services to both victims and perpetrators of IPV/ CM might help stop the cycle of violence in women's lives and promote better coping and recovery from these experiences (Bui et al, 2018;World Health Organization, 2016). However, in low-and middle-income settings, the proportion of perpetrators of IPV who receive appropriate health and social welfare services is very low (Stocker et al, 2020). Greater effort should be focused on social services for perpetrators including mental health counselling and alcohol treatment.…”

Using the WHO Self-Reporting Questionnaire-20 (SRQ-20) to Detect Symptoms of Common Mental Disorders among Pregnant Women in Vietnam: a Validation Study

“…In this context, research suggests that 10% of pregnant women experience some type of mental disorder. 1 , 2 However, a review by Fisher et al revealed that approximately 15% of women in low- and middle-income countries (LMICs) experience common mental disorders (CMDs), such as depression, anxiety and adjustment disorders, antenatally and 20% postnatally. 1 Despite the disproportionate burden of CMDs among pregnant women in LMICs, the perinatal mental health of women in such contexts has received significantly less scholarly attention.…”

“… 1 Notably, women who experience CMDs during pregnancy are less likely to attend antenatal care and more likely to report substance misuse and lower than expected weight gain. 2 This may not only result in adverse obstetric outcomes for the woman, such as intrauterine growth restriction, but can have adverse consequences for the child. Wachs et al have shown that children of depressed mothers living in LMICs experience cognitive and motor delay, as well as undernutrition and stunting.…”