The estimated prevalence of PPD among Kazakh women exceeds the average reported prevalence of PPD in Western countries. The World Health Organization (n.d.) estimates the worldwide prevalence of PPD at 13%, while in developing countries, this percentage increases to 19.8%. The idea of the emotional rather than somatic nature of PPD was strengthened by revealing the importance of social support and life events in the incidence of depressive conditions (O'Hara, et.al., 1983, Hopkins et.al., 1984, Cutrona and Troutman, 1986).
The compilation reinforced the evidence for the emotional nature of PPD, highlighting the busy life events, history of depression, poor relationship with the partner and inadequate social support as the main predictors of PPD (O'Hara and Swain, 1996). However, the subsequent revealed only weak effect of PPD on the additional cognitive and behavioral developmental indicators, such as hyperactivity, aggression and neuroticism (Beck, 1998). Interestingly, the prevalence of PPD was estimated at 10% (Rees, 1971), showing that modern PPD prevalence in developed countries remains at approximately the same level as in the 1970s.
Modern state of PPD
Predictors
3 it was concluded that positive emotional reactions are not created between the baby and the depressed mother, denying the woman the satisfaction of motherhood, while negatively affecting the development of the child's behavior. Unemployment showed a protective effect in the studies of Inandi et.al. 2005) in Turkey, France and Sweden, respectively. For example, cesarean section was found to increase the probability of PPD in the prospective cohort study of Sword et.al. 2007), while the previous cross-sectional study by Chen and Wang (2002) and the longitudinal study by Durik et.al. 2000) found no significant association.
Interventions
Effects
However, pharmacological treatment of PPD requires high-quality studies to draw clear conclusions, with placebo control and consideration of long-term effects. The recent longitudinal study of 9848 women suffering from various levels of PPD and 8287 children in the UK by Netsi et.al. 2018) found the following negative effects: conduct disorders, lower math grades at age 16, increased risk of depression at age 18. The latter two effects show that the effects of PPD can extend throughout the lives of affected children, once again underscoring the importance of treating PPD at the earliest possible time.
Postpartum depression in Kazakhstan
Study Aims
Study design
Study Population
Variables
The first category is sociodemographic data, which includes the following parameters: age of the participants, place of residence, nationality, marital status, educational and employment status of the participant and her partner, maternity leave status, family income level, living environment (separate or with parents of one or the other partner) and satisfaction with the environment and the final number of children. All variables in this section are categorical, except numerical age and number of children. Participant's relationships with extended family were rated on a 5-point scale from "very bad" to "very good", having a friend was a yes-no question.
The availability of support from different sources was evaluated using a four-point scale, from 'Never' to 'Always'. The last part of the questionnaire consists of variables assessing the mother's pregnancy and motherhood experiences: age and gender of a child, whether the pregnancy was planned, who named a child, mode of delivery, presence of the partner during childbirth, gestational age and weight at birth, complications during and after childbirth, the frequency of the child's crying, breastfeeding status, previously diagnosed depression, satisfaction with one's own body, perceived competence as a mother, attendance at check-ups and satisfaction with medical services.
Data entry and analysis
Ethical considerations
The obtained data is protected, kept strictly confidential and locked, and the electronic database is protected by a password.
Exclusion and inclusion criteria
The chi2 test showed that the ability to rely on the partner to solve problems was associated with PPD (p=0.001). It can be hypothesized that support for the mother-in-law was part of the term 'social support', which was often cited as a predictor of PPD. The evidence of the effect of. Relationships with mothers-in-law are inconsistent, with studies confirming or refuting the effect of relationships on PPD risk.
A systematic review of Fisher et.al. 2011), suggests that having “hostile mothers-in-law” increases the risk of PPD 2.1–4.4 times for women from low- and lower-middle-income countries. The novelty of this study is the division of partner support into three components, ie. In a systematic review of 59 studies, O'Hara and Swain (1996) find that low social support is a strong predictor of PPD.
Limitations of the study
20 were not found to be significant, indicating that emotional support is less important for protection against PPD. Large meta-analyses of the PPD field, namely O'Hara and Swain (1996), Beck agree that history of past depression is a strong predictor of future PPD. More recent studies support this result, with Silverman et.al. 2014), suggesting that not only the individual's history, but also the family's history of depression may serve as a risk factor.
This finding is consistent with the study by Wisner et.al. 2006), who found that primiparity is associated with the increased risk of PPD. A recent study by Iwata et.al. 2016) elucidate this relationship further and find that the first two months after delivery is the time of greatest susceptibility among primiparous women to PPD. Alternatively, suffering from PPD during the first birth may prevent women from having more children, which in turn may result in the above trend.
The only source of data in the current study is the self-reported characteristics of the participating women. Furthermore, despite the fact that the EPDS scale is a validated tool for identifying PPD symptoms, the dependent variable, the participant's depressive status, is not checked by health professionals. The reason for this limitation is partly the time, location and bureaucratic limitations of the study.
Recruitment permission was obtained only at two clinics, while recruitment outside Astana city was too time-consuming. Finally, the results of the study do not distinguish between different ages of the infant. The degree of postpartum depression can be different at different moments before delivery, especially in first-time mothers Iwata et.al.
However, it should be noted that the children's ages are distributed with a high degree of uniformity, which helps to avoid possible biases in the sample in terms of the ages of the infants.
Strengths of the study
22 A more thorough study of PPD in Kazakhstan and Central Asia will be of great value in helping society and the government provide a better maternity experience for women in Kazakhstan. Several properties were discovered through the research, which are valuable not only for Kazakhstan, but also for the PPD field. First, the current research adds to the evidence that instrumental social support also has a strong protective effect against PPD.
Third, this study identified possible associated factors of PPD that may have been rooted in the cultural peculiarities of the society living in this geographic area. Thus, it can be assumed that in countries with more established gender equality, such important risk factors as the relationship with the mother-in-law and the frequency of sharing household responsibilities with the husband/partner may not be as strong a predictor of PPD as in more westernized countries. cultures. Fourth, emotional support and instrumental support were tested separately as factors related to PPD, which revealed a greater effect of instrumental support compared to emotional support.
The present research has shed light on this area, suggesting that the instrumental support of partner and family members has the most significant protective effect. The current research project had two main objectives - to estimate the prevalence and find the predictors of PPD in Kazakhstan. The results obtained, especially the alarming prevalence of PPD of 28.7%, provide the valuable insight into the PPD issue in Kazakhstan.
The current research results can serve as additional justification of the current plans to make psychological consultations more accessible to the population (ibid.). In addition, the significant predictors of PPD were identified in this study, namely lack of support from family members in childcare, insufficient assistance from partner in household duties, inability to rely on the partner in solving problems, poor relations with mother-in-law, primiparity and previous diagnosis of depression. This information can help potential policy makers and practitioners to develop effective intervention strategies, while these results can be valuable for the general population to be more aware of the disease and its potential risks.
Finally, the value of this research for the field of PPD has been demonstrated and further research directions will be suggested.
Recommendations for future studies
Prevalence of and sociodemographic and obstetric factors associated with postpartum depression: differences between ethnic Han and Kazak women in northwest China. Prevalence and risk factors for postpartum depression in a population-based sample of women in Tangxia Community, Guangzhou. Prevalence, continuation, and identification of postpartum depressive symptomatology among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women: results from a prospective cohort study.
Prevalence of postpartum depressive symptoms during the first 6 months postpartum: Association with maternal age and parity. Predictive validation study of the Edinburgh Postnatal Depression Scale in the first week after birth and risk analysis for postnatal depression. Family history, not lack of medication use, is associated with the development of postpartum depression in a high-risk sample.
Employment, income, and education and the risk of postpartum depression: The Osaka Maternal and Child Health Study. Incidence and risk factor of postpartum depressive symptoms in women: a population-based prospective cohort study in a rural district in Bangladesh. Netmums: a phase II randomized controlled trial of a guided online behavioral activation treatment for postpartum depression.
The role of body image in prenatal and postpartum depression: a critical review of the literature. Directions: To rate your relationships with family members, please circle one answer before each statement. The data obtained would be useful for the creation of effective intervention programs, the creation of preventive policies and to help diagnose postpartum depression.
APPENDIX 1 Supplementary tables
APPENDIX 2 Questionnaires
APPENDIX 3 Informed consent forms
