There have been no previous studies examining the perspectives of postpartum women and caregivers regarding postpartum depression in Kazakhstan. However, other studies suggest that prevalence rates of postpartum depression in Asian countries may range from 11.0% to 60.8%. Because the negative consequences of postpartum depression on families are well documented, effective policy changes are needed.
Furthermore, the prevalence of postpartum depression was found to be high in both Asia and Europe. Today, only half of postpartum depression cases are diagnosed, while the rest are ignored without attention. Routine screening of postpartum women for depression during their regular visits to a doctor's office significantly improves disclosure of postpartum depression.
Thus, trained health professionals are needed to ensure effective clinical outcomes after the early detection of postpartum depression.
RESEARCH METHODOLOGY 1 Study design1 Study design
Settings
In order to meet the objectives of the research, the subjects for the given study were chosen to be postpartum women and health care providers. Purposive convenience sampling was used to recruit postpartum women and health care providers for the interviews. Participants were at least 18 years old postpartum women at the time of recruitment and health care providers working at the corresponding outpatient clinics, as inclusion criteria.
A purposive convenience sample was used to recruit postpartum women and caregivers, as noted above. The researcher came to the Centers' outpatient clinics every day from Monday to Friday between December 2017 and February 2018 to recruit postpartum women for the interviews. At the Republican Diagnostic Center, postpartum women coming to see a pediatrician or for visits to their children were recruited.
Postpartum women visiting a gynecologist were recruited at the National Research Center for Maternal and Child Health.
Data collection
14 healthcare providers were recruited, including 2 psychologists, 4 gynaecologists, 2 paediatricians, 1 nurse from the Healthy Child Unit and 1 midwife. Taking into account the Kazakhstani context and the diversity of local languages, the impossibility of communicating in English was avoided, as the interview was offered in one of the three most commonly used languages, including Kazakh, Russian or English. Similarly, recruitment and interviewing of caregivers working in the centers took place during working hours, depending on their availability and work schedule.
After a brief explanation of the purpose and important highlights of the study, the interviewer obtained oral informed consent in Russian, Kazakh, or English (Appendix 2) in the case of potential participants. In case informed consent was obtained, interviews were conducted at the coordinated time convenient for the participants.
Data analysis
ETHICAL CONSIDERATIONS
16 There were no known risks to the participants that were expected to be greater than they would normally encounter in their daily lives. Participants were explained in advance all the minimal risks arising from participating in the interview regarding some sensitive questions and time concerns for conducting the interview.
RESULTS
19 Table 2 represents the new themes and categories that are the result of the qualitative analysis of 30 interview transcripts.
Barriers and provision gaps followed by participants’ recommendations for maternal
Category 1: Awareness of postpartum depression
21 healthcare providers responded that women with a complaint of postpartum depression come to their office and try to express their complaints. So four women had no idea whether postpartum depression has a significant impact or not, and nine women responded that this is a fairly widespread situation among women. As health care providers reported, women with postpartum depression are not interested in answering doctors' questions about child care.
Similarly, healthcare providers believed that postpartum depression has a negative impact on the mother's life and health and the child's development, both physically and psychologically. Next, the respondents pointed out that it is also common for women with postpartum depression to be unable to perform tasks. In addition, health care providers noted that women with postpartum depression often have a disrespectful or neglectful attitude toward themselves.
Frequent mood swings, including the whole spectrum of emotions, have been reported as one of the common manifestations of postpartum depression.
Category 3: Understanding of risk factors and perceived causes
This in turn causes not being able to cope with tasks, which is one of the symptoms of postpartum depression, as reported by respondents. However, as health care providers mentioned, not only low SES was cited as a risk factor, but being rich and spoon-fed could be a cause of a woman not being able to handle her new important responsibilities and postpartum depression not develop. 26 Also, as most respondents said, caesarean section, suffering from other chronic conditions, birth complications and difficult painful labor can also be risk factors for postpartum depression.
As one of the gynecologists said, "only progesterone deficiency causes postpartum depression and not other factors". In addition, several women cited poor appearance and extra weight after pregnancy as a potential cause of postpartum depression. Another gynecologist said: "No malnutrition and no other disease affects postpartum depression as much as psychological factors".
The third gynecologist, however, neglected all psychosocial factors and asserted that hormonal imbalance is the only cause of postpartum depression.
Category 4: postpartum depression treatment options
Postpartum women appointed consultation of a psychologist is the first choice to go in case of postpartum depression. Some women named tranquilizers, calming herbs, vitamins as a possible remedy for postpartum depression. Only one woman felt that only at-risk populations should be administered the postpartum depression screening tool.
Women's views on when to screen for postpartum depression were ambivalent. Responses among health care providers regarding who should use the EPDS tool and be able to screen for postpartum depression varied widely. Other health workers (3) also said that doctors should be the first to reveal postpartum depression in patients.
33 Six health care providers stated that they do not work to screen for postpartum depression with the help of official screening tools for postpartum depression. One health care professional said she refers patients she thinks are showing symptoms of postpartum depression to psychologists. Three health care professionals then recalled that postpartum depression is sometimes diagnosed in maternity hospitals.
As healthcare providers have pointed out, there are no postpartum depression protocols in their clinics. The women noted that in light of postpartum depression, there should be more training for health professionals. In addition, health care providers mentioned the lack or absence of social workers even for women with postpartum depression.
Lack of public understanding of postpartum depression also appears to be a problem. So, educational seminars on postpartum depression for health professionals, pregnant and postpartum women should be held.
DISCUSSION
Regarding knowledge about symptoms of postpartum depression, many women pointed out that social relationships and roles might deteriorate in women with postpartum depression. Similar to our findings, Mohammad (2011) found that financial problems can also be a risk factor for postpartum depression. These findings illustrate that healthcare providers and patients have different perceptions of the degree of importance of risk factors for postpartum depression.
Thus, some gynecologists ignore psychosocial factors, saying that they have no influence on the occurrence of postpartum depression. Surprisingly, some women and health professionals emphasized self-management and self-help as treatment for postpartum depression patients. Surprisingly, most respondents agreed that a postpartum depression screening tool is necessary in Kazakhstan and that health policy makers should take this fact into account.
This should be taken into account when developing policies for screening for postpartum depression. Most respondents believed that there are no screening tools and protocol guides for postpartum depression in Kazakhstan. This shows the general picture of the current situation with postpartum depression in the country.
This is consistent with Mohammad's (2011) research showing that this may be a risk factor for postpartum depression. The importance of introducing screening tools and maintaining protocols for the early detection of postpartum depression was a recurring theme among all participants. 43 Poverty occurs both because it is linked to the onset of postpartum depression and because it hinders access to timely mental health care.
In addition, this study explored the cultural adaptation of a widely validated screening tool for postpartum depression in the population of Kazakh women. Furthermore, they highlighted the necessity of introducing postpartum depression screening in the country, and the acceptability and appropriateness of the EPDS questions in the Kazakhstan context.
Informed Consents (English, Russian, and Kazakh versions)
What do you think are major health problems that can be experienced after birth and in the first year. What do you think are the biggest mental health problems that can be experienced after birth and in the first year. types of problems, severity and consequences. Risk factors and perceived causes of postpartum depression Why do you think women may experience postpartum depression.
When a woman experiences postnatal depression, what do you think can be done to help her. When a woman experiences postnatal depression, what do you think local health services can/should do for a woman to help her. Do you believe that all women should be checked for depression during pregnancy or after giving birth?
What do you think about the adequacy of local health services regarding the detection of postnatal depression. what are the local services, gaps in provision, reasons for gaps, what needs to be done to address them). What suggestions do you have for improving the diagnosis of postnatal depression if it is even needed. When do you think it is appropriate for women to complete the EPDS to diagnose the postpartum depression in time.
What do you think about the cultural acceptability of the 10 EPDS items in our country. What do you think are major health problems that women experience after giving birth and in the first year. What do you think are the biggest mental health problems that can be experienced after birth and in the first year.
What types of treatment do you think are available and used in local hospitals and clinics? Who do you think would be the first choice if a woman thinks she has postpartum depression? Who do you think was the first to discover postpartum depression in women?
