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  1. Postnatal depression and its associated factors in women from different cultures
    Abdollahi F, Lye MS, Md Zain A, Shariff Ghazali S, Zarghami M
    Iran J Psychiatry Behav Sci, 2011;5(2):5-11.
    PMID: 24644441
    OBJECTIVE: Postpartum depression (PPD) is a common health problem which affects women in the postpartum period. This is a brief note on its associated factors in women from different cultures.
    METHODS: A literature review was performed in MEDLINE and Pubmed from 1991 to 2008 and Magiran from 1991 to 2009. Additional articles and book chapters were referenced from these sources.
    RESULTS: The prevalence of postpartum depression has been reported to be from 0.5% to 60% globally, and from 3.5% to 63.3% in Asian countries, in which Malaysia and Pakistan had respectively the lowest and highest rates. One of the factors contributing to PPD in Asian societies can be that women may not have the empowerment to reject traditional rituals that are imposed on them by their caregivers. Unsatisfactory pre-existing relationships between the mothers and their caregivers resulting in mothers experiencing difficulties during their confinement period may be another factor. Thirdly, some features of these traditional rituals may be the cause of tension, stress and emotional distress. Emotional conflicts caused by insistence on practice of traditional rituals during the postpartum period may lead to mental breakdown.
    CONCLUSION: Health care professionals should be aware that the phenomenon in Asian cultures is as prevalent as European cultures. Moreover, further research needs to be conducted on the global prevalence of the experiences of childbearing women with depressive symptoms.
    KEYWORDS: Cultures; Postpartum depression; Risk factors
    Matched MeSH terms: Depression, Postpartum*
  2. Fulltext Prediction of incidence and bio-psycho-socio-cultural risk factors of post-partum depression immediately after birth in an Iranian population
    Abdollahi F, Zarghami M, Sazlina SG, Zain AM, Mohammad AJ, Lye MS
    Arch Med Sci, 2016 Oct 1;12(5):1043-1051.
    PMID: 27695496
    INTRODUCTION: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. The purpose of the present study was to determine the incidence of early PPD and possible relevant risk factors among women attending primary health centers in Mazandaran province, Iran for the first time.
    MATERIAL AND METHODS: A longitudinal cohort study was conducted among 2279 eligible women during weeks 32-42 of pregnancy to determine bio-psycho-socio-cultural risk factors of depression at 2 weeks post-partum using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS). Univariate and hierarchical multiple logistic regression models were used for data analysis.
    RESULTS: Among 1,739 mothers whose EPDS scores were ≤ 12 during weeks 32-42 of gestation and at the follow-up study, the cumulative incidence rate of depression was 6.9% (120/1,739) at 2 weeks post-partum. In the multivariate model the factor that predicted depression symptomatology at 2 weeks post-partum was having psychiatric distress in pregnancy based on the General Health Questionnaire (GHQ) (OR = 1.06, (95% CI: 1.04-1.09), p = 0.001). The risk of PPD also lower in those with sufficient parenting skills (OR = 0.78 (95% CI: 0.69-0.88), p = 0.001), increased marital satisfaction (OR = 0.94 (95% CI: 0.9-0.99), p = 0.03), increased frequency of practicing rituals (OR = 0.94 (95% CI: 0.89-0.99), p = 0.004) and in those whose husbands had better education (OR = 0.03 (95% CI: 0.88-0.99), p = 0.04).
    CONCLUSIONS: The findings indicated that a combination of demographic, sociological, psychological and cultural risk factors can make mothers vulnerable to PPD.
    KEYWORDS: depression; incidence; post-partum
    Matched MeSH terms: Depression, Postpartum*
  3. State of the Science on postpartum depression: what nurse researchers have contributed--part 1
    Beck CT
    MCN Am J Matern Child Nurs, 2008 Mar-Apr;33(2):121-6.
    PMID: 18327112 DOI: 10.1097/01.NMC.0000313421.97236.cf
    Postpartum depression has been described as a thief that steals motherhood. It can result in tragedy and sometimes in headline-gripping maternal suicide or infanticide. Because one of the highest priorities for nursing is to continually advance the knowledge that underlies nursing practice, it is essential that we understand what nurse researchers have done to advance the knowledge base of postpartum depression. This integrative review is a two-part series for MCN that summarizes 141 postpartum depression studies conducted by nurse researchers from around the globe, including United States, Australia, Canada, China (Hong Kong, Taiwan), Finland, Iceland, Sweden, Turkey, and Malaysia. Specific areas of postpartum depression to which nurse researchers have devoted their primary attention include epidemiology, risk factors, transcultural perspectives, instrument development, screening, interventions, and mother-infant interactions.
    Matched MeSH terms: Depression, Postpartum/ethnology; Depression, Postpartum/nursing; Depression, Postpartum/prevention & control*; Depression, Postpartum/psychology
  4. Risk of postnatal depression after emergency delivery
    Koo V, Lynch J, Cooper S
    J Obstet Gynaecol Res, 2003 Aug;29(4):246-50.
    PMID: 12959147
    AIM: To identify whether women having emergency delivery are at increased risk of developing postnatal depression (PND).

    METHODS: This is a retrospective comparative cohort study design. Two hundred and fifty Malaysian women were part of a previous study examining the prevalence of PND in a multiracial country and the effects of postnatal rituals. All women were at least 6 weeks post-partum when asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and birth data were obtained.

    RESULTS: Data collected were divided into two groups: 55 emergency delivery and 191 non-emergency delivery. There were four missing data. There was no significant difference in the mean age, parity, gestational period, baby birthweight, 5 min baby Apgar score and EPDS scores of the two groups. However, the analysis of PND indicated that women with emergency delivery had a relative risk of 1.81 compared with women with non-emergency delivery. The comparison of the two groups using chi2 indicated a significant (chi2 = 3.94, d.f. = 1, P = 0.04) increase in the presence of PND in the emergency delivery.

    CONCLUSION: When compared with women having non-emergency delivery, women having emergency delivery had about twice the risk of developing PND. Special attention to this group appears warranted.

    Matched MeSH terms: Depression, Postpartum/etiology; Depression, Postpartum/epidemiology*
  5. Fulltext Postpartum mental health in relation to sociocultural practices
    Abdollahi F, Etemadinezhad S, Lye MS
    Taiwan J Obstet Gynecol, 2016 Feb;55(1):76-80.
    PMID: 26927254 DOI: 10.1016/j.tjog.2015.12.008
    OBJECTIVES: Cultural practices have been found to positively impact the mothering experience. This study sought to identify the relationship between sociocultural practices and postpartum depression (PPD) in a cohort of Iranian women for the first time.
    MATERIALS AND METHODS: In a longitudinal cohort design, 2279 pregnant women attending primary health centers of Mazandaran province in Iran were recruited using stratified random sampling method. Data were collected using the Edinburgh Postnatal Depression Scale and researchers developed validated cultural practices questionnaire at 3 months after delivery. Data were analyzed using Chi-square test and multiple logistic regression models.
    RESULTS: The prevalence of PPD was 19% among 1910 women who were followed postdelivery in this study. Cultural practices were not associated with lower odds of PPD in multiple logistic regression model after adjustment for all sociodemographic factors. The results of this study do not also provide any evidence to support that sex of baby is associated with the greater risk of PPD.
    CONCLUSIONS: Cultural practices could not be perceived as protective mechanisms that protect women from PPD in this traditional society. However, health professionals should be familiar with postpartum beliefs and practices that could support mothers in the postpartum period.
    KEYWORDS: culture; depression; postpartum; practices
    Matched MeSH terms: Depression, Postpartum*
  6. Stability of depressive symptoms over 3 months post-partum
    Abdollahi F, Zarghami M, Sazlina SG, Lye MS
    Early intervention in psychiatry, 2017 Feb;11(1):57-62.
    PMID: 25582677 DOI: 10.1111/eip.12215
    AIM: Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum.
    METHODS: From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models.
    RESULTS: The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression.
    CONCLUSION: Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.
    Matched MeSH terms: Depression, Postpartum/diagnosis*; Depression, Postpartum/epidemiology; Depression, Postpartum/psychology*
  7. Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms
    Halbreich U, Karkun S
    J Affect Disord, 2006 Apr;91(2-3):97-111.
    PMID: 16466664 DOI: 10.1016/j.jad.2005.12.051
    BACKGROUND:
    The prevalence of postpartum depression (PPD) is currently considered to be 10-15%. Most studies were performed with a brief unidimensional instruments (mostly the Edinburgh Postnatal Depression Scale-EPDS) with focus on depression and not on other symptoms and disorders. Most cited studies were conducted in Western economically developed countries.

    METHODS:
    We reviewed the literature on prevalence of postpartum depression and depressive symptoms in a wide range of countries.

    RESULTS:
    143 studies were identified reporting prevalence in 40 countries. It is demonstrated that there is a wide range of reported prevalence of PPD ranging from almost 0% to almost 60%. In some countries like Singapore, Malta, Malaysia, Austria and Denmark there are very few reports of PPD or postpartum depressive symptoms, whereas in other countries (e.g. Brazil, Guyana, Costa Rica, Italy, Chile, South Africa, Taiwan and Korea) reported postpartum depressive symptoms are very prevalent.

    CONCLUSIONS:
    We believe that the widely cited mean prevalence of PPD-10-15% is not representative of the actual global prevalence and magnitude of the problem, due to the wide range of reports. The variability in reported PPD might be due to cross-cultural variables, reporting style, differences in perception of mental health and its stigma, differences in socio-economic environments (e.g. poverty, levels of social support or its perception, nutrition, stress), and biological vulnerability factors. The elucidation of the underlying processes of this variability as well as the diversity of postpartum normal versus abnormal expressions of symptoms may contribute to better understanding of the diversified ante, peri- and postpartum phenomena.
    Matched MeSH terms: Depression, Postpartum/diagnosis; Depression, Postpartum/epidemiology*; Depression, Postpartum/psychology
  8. Fulltext A review on the prevalence of depression in Malaysia
    Mukhtar F, Oei TPS
    Current Psychiatry Reviews, 2011;7:234-238.
    DOI: 10.2174/157340011797183201
    Transforming western technology to Eastern populations, including Malaysia, presents important implications in understanding the development, maintenance, and treatment of depression. The present paper aims to review the literature on the prevalence of depression studies in Malaysia. PsycINFO, Medline databases, local journals, and 13 published articles, were included in the current review. Findings were presented in three categories i.e., 'prevalence of depression in primary care', 'general community', and 'among clinical population'. Major limitations of previous studies were noted, and thus, problems associated with the implementation and future direction of clinical and research on depression in Malaysia, was provided. In short, the contribution of empirical research on the prevalence of depression has remained inconsistent and fragmented and it is therefore, a time to venture modification. © 2011 Bentham Science Publishers.
    Matched MeSH terms: Depression, Postpartum
  9. The relationship between post-natal depression, somatization and behaviour in Malaysian women
    Grace J, Lee KK, Ballard C, Herbert M
    Transcult Psychiatry, 2001;38:27-34.
    DOI: 10.1177/136346150103800103
    This study evaluated the rate of post-natal depression (PND) in a Malaysian population, investigated the relationship between belief systems and PND, and examined the relationship between PND and somatization. The sample included 154 consecutive attendees for a 6-week post-natal check at a general hospital well-baby clinic in Kuala Lumpur. Patients were assessed using the Edinburgh Post-Natal Depression Score (EPNDS), the Bradford Somatisation Inventory (BSI), and a questionnaire to assess beliefs about pregnancy and childbirth. The rate of PND was 3.9%. EPNDS and BSI were moderately correlated. Women who practised specific post-natal practices had a higher EPNDS and BSI than those who did not. The rate of PND is lower than in Western studies but similar to that seen in other Asian countries. The correlation between BSI and EPNDS suggest that the BSI will not detect cases missed by the EPNDS. © 2001, Sage Publications. All rights reserved.
    Matched MeSH terms: Depression, Postpartum
  10. Depression Following Major Life Transitions in Women: A Review and Theory
    Moustafa AA, Crouse JJ, Herzallah MM, Salama M, Mohamed W, Misiak B, et al.
    Psychol Rep, 2020 Oct;123(5):1501-1517.
    PMID: 31470771 DOI: 10.1177/0033294119872209
    Depression can occur due to common major life transitions, such as giving birth, menopause, retirement, empty-nest transition, and midlife crisis. Although some of these transitions are perceived as positive (e.g., giving birth), they may still lead to depression. We conducted a systematic literature review of the factors underlying the occurrence of depression following major life transition in some individuals. This review shows that major common life transitions can cause depression if they are sudden, major, and lead to loss (or change) of life roles (e.g., no longer doing motherly or fatherly chores after children leave family home). Accordingly, we provide a theoretical framework that explains depression caused by transitions in women. One of the most potential therapeutic methods of ameliorating depression associated with life transitions is either helping individuals accept their new roles (e.g., accepting new role as a mother to ameliorate postpartum depression symptoms) or providing them with novel life roles (e.g., volunteering after retirement or children leave family home) may help them overcome their illness.
    Matched MeSH terms: Depression, Postpartum/etiology; Depression, Postpartum/epidemiology; Depression, Postpartum/psychology
  11. Breastfeeding and postnatal depression: a prospective cohort study in Sabah, Malaysia
    Yusuff AS, Tang L, Binns CW, Lee AH
    J Hum Lact, 2016 May;32(2):277-81.
    PMID: 26644418 DOI: 10.1177/0890334415620788
    BACKGROUND: Postnatal depression is a disorder that can lead to serious consequences for both the mother and infant. Despite the extensively documented health benefits of breastfeeding, its association with postnatal depression remains uncertain.
    OBJECTIVE: To investigate the relationship between full breastfeeding at 3 months postpartum and postnatal depressive symptoms among mothers in Sabah, Malaysia.
    METHODS: A prospective cohort study of 2072 women was conducted in Sabah during 2009-2010. Participants were recruited at 36 to 38 weeks of gestation and followed up at 1 and 3 months postpartum. Depressive symptoms were assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale (EPDS). Repeated-measures analyses of variance was performed to compare the depression scores over time and between subgroups of breastfeeding mothers.
    RESULTS: Approximately 46% of women were fully breastfeeding their infants at 3 months postpartum. These mothers had significantly (P < .001) lower mean EPDS scores at both 1 and 3 months postpartum (mean ± SD, 4.14 ± 4.12 and 4.27 ± 4.12, respectively) than others who did not initiate or maintain full breastfeeding for 3 months (4.94 ± 4.34 and 5.25 ± 4.05, respectively). After controlling for the effects of covariates, the differences in EPDS scores remained statistically significant (P = .001) between the 2 breastfeeding groups.
    CONCLUSION: Full breastfeeding appeared to be negatively associated with postnatal depressive symptoms for mothers residing in Sabah.
    Study site: 5 maternal and child health clinics in Kota Kinabalu and Penampang Districts of Sabah, Malaysia
    Matched MeSH terms: Depression, Postpartum; Depression, Postpartum/diagnosis; Depression, Postpartum/epidemiology; Depression, Postpartum/prevention & control*
  12. Prevalence and risk factors for postnatal depression in Sabah, Malaysia: a cohort study
    Mohamad Yusuff AS, Tang L, Binns CW, Lee AH
    Women Birth, 2015 Mar;28(1):25-9.
    PMID: 25466643 DOI: 10.1016/j.wombi.2014.11.002
    BACKGROUND: Postnatal depression can have serious consequences for both the mother and infant. However, epidemiological data required to implement appropriate early prevention are still lacking in Malaysia.
    AIM: To investigate the prevalence of postnatal depression within six months postpartum and associated risk factors among women in Sabah, Malaysia.
    METHODS: A prospective cohort study of 2072 women was conducted in Sabah during 2009-2010. Participants were recruited at 36-38 weeks of gestation and followed up at 1, 3 and 6 months postpartum. The presence of depressive symptoms was assessed using the validated Malay version of the Edinburgh Postnatal Depression Scale. Logistic regression analyses were performed to ascertain risk factors associated with postnatal depression.
    FINDINGS: Overall, 14.3% of mothers (95% confidence interval (CI) 12.5-16.2%) had experienced depression within the first six months postpartum. Women depressed during pregnancy (odds ratio (OR) 3.71, 95% CI 2.46-5.60) and those with consistent worries about the newborn (OR 1.68, 95% CI 1.16-2.42) were more likely to suffer from depression after childbirth. Women whose husband assisted with infant care (OR 0.43, 95% CI 0.20-0.97) and mothers who were satisfied with their marital relationship (OR 0.27, 95% CI 0.09-0.81) appeared to incur a reduced risk of postnatal depression.
    CONCLUSION: A substantial proportion of mothers suffered from postnatal depression in Sabah, Malaysia. Screening and intervention programmes targeting vulnerable subgroups of women during antenatal and early postpartum periods are recommended to deal with the problem.
    KEYWORDS: EPDS; Malaysia; Postnatal depression; Prevalence; Risk factors
    Study site: five maternal and child health clinics in Kota Kinabalu and Penampang Districts of Sabah, Malaysia
    Matched MeSH terms: Depression, Postpartum/diagnosis*; Depression, Postpartum/epidemiology*; Depression, Postpartum/psychology
  13. Fulltext Bio-psycho-socio-demographic and Obstetric Predictors of Postpartum Depression in Pregnancy: A prospective Cohort Study
    Abdollahi F, Rohani S, Sazlina GS, Zarghami M, Azhar MZ, Lye MS, et al.
    Iran J Psychiatry Behav Sci, 2014;8(2):11-21.
    PMID: 25053953
    OBJECTIVE:
    There are various attempts to confirm variables that could predict postpartum depression in advance. This study determined antenatal risk factors for postpartum depression in women at risk of developing this disorder.

    METHODS:
    A prospective cohort study was conducted with 2279 eligible women who attended at Mazandaran province' primary health centers from 32-42 weeks of pregnancy to eighth postpartum weeks. The women were screened for symptoms of depression using the Iranian version of Edinburgh Postnatal Depression Scale. An Edinburgh Postnatal Depression Scale score of > 12 indicated possible postpartum depression. Univariate and multiple logistic regression models were used for data analysis.

    RESULTS:
    A total of 2083women during 32-42 weeks of gestation participated in this study and were followed up to 8-week postpartum. Four hundred and three (19.4%) mothers yielded scores above the threshold of 12. Depression and general health state in pregnancy based on Edinburgh Postnatal Depression Scale (OR = 1.35, CI = 1.3-1.4) and General Health Questionnaire-28 (OR = 1.03, CI = 1.01-1.04), respectively were significant independent antenatal risk factors of depression symptoms at 8-week postpartum. Mothers who lived in nuclear families (OR = 1.38, CI = 1.04-1.84), whose husbands had lower educational status (OR = 0.95, CI = 0.91-0.99), and with delayed prenatal care (OR = 1.01, CI = 1.001-1.03) were more susceptible to postpartum depression.

    CONCLUSION:
    A comprehensive antenatal assessment focused on psychiatric problems, environmental and obstetric factors would benefit pregnant women in the prevention of postpartum depression.

    KEYWORDS:
    Cohort Study; Postpartum Depression; Prediction; Risk Factors
    Matched MeSH terms: Depression, Postpartum
  14. Fulltext Magnitude and risk factors for postpartum symptoms: a literature review
    Norhayati MN, Hazlina NH, Asrenee AR, Emilin WM
    J Affect Disord, 2015 Apr 1;175:34-52.
    PMID: 25590764 DOI: 10.1016/j.jad.2014.12.041
    BACKGROUND: The prevalence of postpartum depression worldwide varies from 0.5% to 60.8% in the first 12 months postpartum using self-reported questionnaire. This review aims to update the current magnitude of postpartum depression based on self-reported questionnaire and clinical interview and explore its associated factors in developed and developing countries.
    METHODS: A literature search conducted between 2005 and 2014 identified 203 studies, of which 191 used self-reported questionnaire in 42 countries and 21 used structured clinical interview in 15 countries. Nine studies used a combination of self-reported questionnaire and clinical interview.
    RESULT: The prevalence of postpartum depression varies from 1.9% to 82.1% in developing countries and from 5.2% to 74.0% in developed countries using self-reported questionnaire. Structured clinical interview shows a much lower prevalence range from 0.1% in Finland to 26.3% in India. Antenatal depression and anxiety, previous psychiatric illness, poor marital relationship, stressful life events, negative attitude towards pregnancy, and lack of social support are significant contributors to postpartum depression.
    LIMITATION: All studies are included irrespective of the methodological quality, such as small sample size and their inclusion could affect the generalizability of the results.
    CONCLUSION: The current prevalence of postpartum depression is much higher than that previously reported, and similar risk factors are documented. A culturally sensitive cut-off score with adequate psychometric properties of the screening instruments should be available. In future studies, examining the physical, biological, and cultural factors in qualitative studies and in those with adequate methodological qualities is recommended.
    KEYWORDS:Epidemiology; Postpartum depression; Prevalence; Risk factors
    Matched MeSH terms: Depression, Postpartum/complications; Depression, Postpartum/epidemiology*
  15. Comparison of Patient Health Questionnaire-9, Edinburgh Postnatal Depression Scale and Hospital Anxiety and Depression - Depression subscale scores by administration mode: An individual participant data differential item functioning meta-analysis
    Harel D, Wu Y, Levis B, Fan S, Sun Y, Xu M, et al.
    J Affect Disord, 2024 Sep 15;361:674-683.
    PMID: 38908554 DOI: 10.1016/j.jad.2024.06.033
    Administration mode of patient-reported outcome measures (PROMs) may influence responses. We assessed if Patient Health Questionnaire-9 (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS) and Hospital Anxiety and Depression Scale - Depression subscale (HADS-D) item responses and scores were associated with administration mode. We compared (1) self-administration versus interview-administration; within self-administration (2) research or medical setting versus private; and (3) pen-and-paper versus electronic; and within interview-administration (4) in-person versus phone. We analysed individual participant data meta-analysis datasets with item-level data for the PHQ-9 (N = 34,529), EPDS (N = 16,813), and HADS-D (N = 16,768). We used multiple indicator multiple cause models to assess differential item functioning (DIF) by administration mode. We found statistically significant DIF for most items on all measures due to large samples, but influence on total scores was negligible. In 10 comparisons conducted across the PHQ-9, EPDS, and HADS-D, Pearson's correlations and intraclass correlation coefficients between latent depression symptom scores from models that did or did not account for DIF were between 0.995 and 1.000. Total PHQ-9, EPDS, and HADS-D scores did not differ materially across administration modes. Researcher and clinicians who evaluate depression symptoms with these questionnaires can select administration methods based on patient preferences, feasibility, or cost.
    Matched MeSH terms: Depression, Postpartum/diagnosis; Depression, Postpartum/psychology
  16. Fulltext Prevalence and risk factors of postpartum depression, general depressive symptoms, anxiety and stress (PODSAS) among mothers during their 4-week postnatal follow-up in five public health clinics in Perak: A study protocol for a cross-sectional study
    Mohammad Redzuan SA, Suntharalingam P, Palaniyappan T, Ganasan V, Megat Abu Bakar PN, Kaur P, et al.
    BMJ Open, 2020 Jun 21;10(6):e034458.
    PMID: 32565453 DOI: 10.1136/bmjopen-2019-034458
    INTRODUCTION: Postpartum depression, general depressive symptoms, anxiety and stress (PODSAS) are often overlooked, and may cause morbidity to new mothers, their babies and families. This study aims to determine the point prevalence of depression (post partum and general), anxiety and stress among mothers in five public health clinics in Perak at 4 weeks postdelivery and identify their associated risk factors. Findings from this study will be used to identify the needs for early screening and detection, encourage development of interventions to reduce its occurrence and support mothers with PODSAS.

    METHODS AND ANALYSIS: This cross-sectional study will recruit 459 postpartum mothers during their 4-week postnatal follow-up in five selected public health clinics in Perak from September 2019 to May 2020. Participants will be mothers aged 18 years and above at 4 weeks postdelivery who are able to understand the English and Malay languages. Non-Malaysians and mothers with known diagnosis of psychotic disorders will be excluded from the study. Sociodemographic information and possible risk factors of the participants will be captured via a set of validated questionnaires, postpartum depression (PPD) will be measured using the Edinburgh Postpartum Depression Scale questionnaire and general depressive symptoms, anxiety and stress will be measured using the 21-item Depression, Anxiety and Stress Scale. Data analysis will be conducted using SPSS V.25.0 (IBM). Besides descriptive statistics, multivariable regression analyses will be done to identify possible risk factors and their independent associations with depression (PPD and general depressive symptoms, combined and separately), anxiety and stress.

    ETHICS AND DISSEMINATION: The study protocol was reviewed and approved by the Medical Research Ethics Committee, Ministry of Health Malaysia on 7 August 2019. Results of this study will be reported and shared with the local health stakeholders and disseminated through conference proceedings and journal publications.

    REGISTRATION NUMBER: This study is registered in the Malaysian National Medical Research Register with the ID: NMRR-19-868-47647.

    Matched MeSH terms: Depression, Postpartum/diagnosis*; Depression, Postpartum/epidemiology*
  17. State of the science on postpartum depression: what nurse researchers have contributed-part 2
    Beck CT
    MCN Am J Matern Child Nurs, 2008 Mar-Jun;33(3):151-6; quiz 157-8.
    PMID: 18453904 DOI: 10.1097/01.NMC.0000318349.70364.1c
    This two-part series summarizes 141 postpartum depression studies that have been conducted by nurse researchers from around the globe. Studies contributing to the knowledge base of postpartum depression were conducted in the following nine countries: United States, Australia, Canada, China (Hong Kong, Taiwan), Finland, Iceland, Sweden, Turkey, and Malaysia. Part 1 of this series addressed the contributions of nurse researchers in the areas of epidemiology, risk factors, and transcultural perspectives related to postpartum depression. This article is Part 2, and it describes what nurse researchers have contributed to the following aspects of postpartum depression: instrumentation/screening, interventions, mother-infant interactions, family dynamics, breastfeeding, preterm births, biological factors, clinicians' knowledge, and mothers' use of health services.
    Matched MeSH terms: Depression, Postpartum/diagnosis; Depression, Postpartum/nursing*; Depression, Postpartum/psychology
  18. Fulltext Postnatal depression and socio-cultural practices among postnatal mothers in Kota Bahru, Kelantan, Malaysia
    Azidah AK, Shaiful BI, Rusli N, Jamil MY
    Med J Malaysia, 2006 Mar;61(1):76-83.
    PMID: 16708738 MyJurnal
    This is a cross sectional study to determine the relationship of postnatal depression (PND) and socio-cultural practices post-delivery among women in Kota Bharu, Kelantan. Four hundred and twenty one pregnant women were screened for depression between 36 - 42 weeks of pregnancy, 1 week and 4 - 6 weeks postpartum using Edinburgh Postnatal Depression Scale (EPDS). The women also completed questionnaires on socio-demography, psychosocial support and traditional postnatal care. The prevalence of PND at 4-6 weeks postpartum was 20.7%. Depressive symptoms at the end of pregnancy (p<0.05) and one week postpartum (p<0.05), worry about the baby (p<0.05), use of traditional medication (p<0.05) and traditional massage (p<0.05) were significantly associated with PND.
    Study site: Maternal and Child Health Clinics (Klinik Kesihatan), Kota Bharu, Kelantan, Malaysia
    Matched MeSH terms: Depression, Postpartum/ethnology*; Depression, Postpartum/epidemiology; Depression, Postpartum/therapy
  19. Fulltext Validation of the Malay version of Edinburgh Postnatal Depression Scale for postnatal women in Kelantan, Malaysia
    Abdul Kadir A, Nordin R, Ismail SB, Yaacob MJ, Wan Mustapha WMR
    Asia Pac Fam Med, 2004;3(1&2):9-18.
    Aim. Validation of the Malay version of the Edinburgh Postnatal Depression Scale (EPDS)
    Methods. A validation study was done involving 52 mothers who were at 4-12 weeks post-delivery. The women completed the Malay versions of EPDS and the 30-item General Health Questionnaire (GHQ). They were then assessed with the Hamilton Depression Rating Scale (HDRS) and Clinical Interview Schedule (CIS). Psychiatric diagnoses were made based on ICD-10 criteria. The validity of EPDS was tested against this clinical diagnosis and the concurrent validity against the Malay version of 30-item GHQ and HDRS scores was also evaluated.
    Results. The best cut-off score of the Malay version of EPDS was 11.5 with the sensitivity of 72.7% and specificity of 92.6 %.
    Conclusion. The Malay version of EPDS is a valid and reliable screening tool for PND.
    Matched MeSH terms: Depression, Postpartum
  20. Fulltext Psychometric performance of the Medical Outcome Study (MOS) Social Support Survey among Malay postpartum women in Kedah, north west of Peninsular Malaysia
    Wan Mahmud WMR, Amir A, Mahmood NM
    Malaysian Journal of Psychiatry, 2004;12:38-44.
    Aim: To evaluate the psychometric performance of the Malay version of the Medical Outcome Study (MOS) Social Support Survey among a sample of postpartum Malay women in Kedah, North West of Peninsular Malaysia.
    Materials and methods: 354 women between 4 to 12 weeks postpartum were recruited for the validation study. They were given questionnaires on socio-demography, the Malay versions of the MOS Social Support Survey, the Edinburgh Postnatal Depression Scale (EPDS) and the 21-items Beck Depression Inventory-II (BDI-II). 30 of the participants, who were bilingual, were also given the original English version of the instrument. A week later, these women were again asked to complete the Malay version of MOS Social Support Survey.
    Results: The median number for item 1 (the single item measure of structural support) was 3 (inter-quartile range = 2 - 4). Extraction method of the remaining 19 items (item 2 to item 20) using principle component analyses with direct oblimin rotation converged into 3 dimensions of functional social support (informational support, affectionate support / positive social interaction and instrumental support) with reliability coefficients of 0.93, 0.74 and 0.72 respectively. Overall the scale displayed good internal consistency (Cronbach's alpha = 0.93), parallel form reliability (0.98) and test-retest reliability (0.97) (Spearman's rho; p<0.01). Its validity was confirmed by the negative correlations between the overall support index (total social support score) and all the three dimensions of functional support with the Malay versions of EPDS and BDI-II. The overall support index also displayed low but significant correlations with the single measure structural social support in the instrument (Spearman's rho = 0.14; p <0.01).
    Conclusions: The MOS Social Support Survey demonstrated good psychometric properties in measuring social support among postpartum Malay women in Kedah, North West of Peninsular Malaysia and could potentially be used as a simple instrument in primary care settings.
    Matched MeSH terms: Depression, Postpartum
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