7 research outputs found
Health services research into postnatal depression : results from a preliminary cross-cultural study
Background: Little is known about the
availability and uptake of health and
welfare services by women with postnatal
depression in different countries.
Aims: Within the context of a cross-
cultural research study, to develop and
test methods for undertaking quantitative
health services research in postnatal
depression.
Method: Interviews with service
planners and the collation of key health
indicators were used to obtain a profile of
service availability and provision. A service
use questionnaire was developed and
administered to a pilot sample in a number
of European study centres.
Results: Marked differences in service
access and use were observed between
the centres, including postnatal nursing
care and contacts with primary care
services.Rates of use of specialist services
were generally low.Common barriers to
access to care included perceived service
quality and responsiveness. On the basis of
the pilot work, a postnatal depression
version of the Service Receipt Inventory
was revised and finalised.
Conclusions: This preliminary study
demonstrated the methodological
feasibility of describing and quantifying
service use, highlighted the varied and
often limited use of care in this population,
and indicated the need for an improved
understanding of the resource needs and
implications of postnatal depression
Postnatal depression across countries and cultures : a qualitative study
Background: Postnatal depression seems to be a universal condition with
similar rates in different countries. However, anthropologists question the
cross-cultural equivalence of depression,
particularly at a life stage so influenced by
cultural factors.
Aims: To develop a qualitative method to explore whether postnatal depression is universally recognised, attributed and
described and to enquire into people’s
perceptions of remedies and services for
morbid states of unhappiness within the
context of local services.
Method: The study took place in 15 centres in 11 countries and drew on three groups of informants: focus groups with new mothers, interviews with fathers and
grandmothers, and interviews with health
professionals.Textual analysis of these three groups was conducted separately in each centre and emergent themes compared across centres.
Results: All centres described morbid unhappiness after childbirth comparable
to postnatal depression but not all saw this
as an illness remediable by health interventions.
Conclusions: Although the findings of
this study support the universality of a
morbid state of unhappiness following childbirth, they also support concerns
about the cross-cultural equivalence of postnatal depression as an illness requiring the intervention of health professionals;
this has implications for future research
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Measurement of mother-infant interactions and the home environment in a European setting: preliminary results from a cross-cultural study
Background Infant development is adversely affected in the context of postnatal depression. This relationship may be mediated by both the nature of early mother-infant interactions and the quality of the home environment. Aim To establish the usefulness of the Global Ratings Scales of Mother-Infant Interaction and the Infant-Toddler version of the Home Observation for the Measurement of the Environment (IT-HOME), and to test expected associations of the measures with characteristics of the social context and with major or minor depression. Method Both assessments were administered postnatally in four European centres; 144 mothers were assessed with the Global Ratings Scales and 114 with the IT-HOME. Affective disorder was assessed by means of the Structured Clinical Interview for DSM-IV Disorders. Results Analyses of mother-infant interaction indicated no main effect for depression but maternal sensitivity to infant behaviour was associated with better infant communication, especially for women who were not depressed. Poor overall emotional support also reduced sensitivity scores. Poor support was also related to poorer IT-HOME scores, but there was no effect of depression. Conclusions The Global Ratings Scales were effectively applied but there was less evidence of the usefulness of the IT-HOME. Declaration of interest None
Maternal attachment style and depression associated with childbirth ; preliminary results from a European and US cross-cultural study
BACKGROUND:
Insecure attachment style relates to major depression in women, but its relationship to depression associated with childbirth is largely unknown. A new UK-designed measure, the Attachment Style Interview (ASI), has potential for cross-cultural use as a risk marker for maternal disorder.
AIMS:
To establish there liability of the ASI across centres, its stability over a 9-month period, and its associations with social context and major or minor depression.
METHOD:
The ASI was used by nine centres antenatally on 204 women, with 174 followed up 6 months postnatally. Interrater reliability was tested and the ASI was repeated on a subset of 96 women. Affective disorder was assessed by means of the Structured Clinical Interview for DSM-IV.
RESULTS:
Satisfactory interrater reliability was achieved with relatively high stability rates at follow-up. Insecure attachment related to lower social class position and more negative social context. Specific associations of avoidant attachment style (angry-dismissive or withdrawn) with antenatal disorder, and anxious style (enmeshed or fearful) with postnatal disorder were found.
CONCLUSIONS:
The ASI can be used reliably in European and US centres as a measure for risk associated with childbirth. Its use will contribute to theoretically under pinned preventive action for disorders associated with childbirth
Adaptation of the structured clinical interview for DSM-IV disorder for assessing depression in women during pregnancy and postpartum across countries and cultures
Background: To date, no study has
used standardised diagnostic assessment procedures to determine wether rates of perinatal depression vary across cultures.
Aims:To adapt the Structured Clinical Interview for DSM IV Disorders (SCID) for assessing depression and other non-psychotic psychiatric illness perinatally and to pilot the instrument in different centres and cultures.
Method: Assessments using the
adapted SCID and the Edinburgh
Postnatal Depression Scale were conducted during the third trimester of pregnancy and at 6 months postpartum with 296 women from ten sites in eight countries. Point prevalence rates during pregnancy and the postnatal period and adjusted 6-month period prevalence rates were computed for caseness, depression and major depression.
Results: The third trimester and 6-month point prevalence rates for perinatal depression were 6.9 % and 8.0 %,respectively. Postnatal 6-month period prevalence rates for perinatal depression rates ranged from 2.1% to 31.6% across centres and there were significant differences in these rates between centres.
Conclusions: Study findings suggest
that the SCID was successfully adapted for
this context. Further research on
determinants of differences in prevalence of depression across cultures is needed
Contextual assessment of the maternity experience (CAME): development of an instrument for cross-cultural research
Background: There is evidence that
stressors may trigger the onset of a
depressive episode in vulnerable women.
A new UK interview measure, the
Contextual Assessment of the Maternity
Experience (CAME), was designed to
assess major risk factors for emotional
disturbances, especially depression,
during pregnancy and post-partum.
Aims: Within the context of a cross-
cultural study, to establish the usefulness of
the CAME, and to test expected
associations of the measure with
characteristics of the social context and
with major or minor depression.
Method: The CAME was administered
antenatally and postnatally in ten study
sites, respectively to 296 and 249 women.
Affective disorder throughout pregnancy
and up to 6 months postnatally was
assessed by means of the Structured
Clinical Interview for DSM IV Axis I
Disorders.
Results: Adversity, poor relationship
with either a partner or a confidant, and
negative feelings about the pregnancy all
predicted onset of depression during the
perinatal period.
Conclusions: The CAME was able to
assess major domains relevant to the
psychosocial context of the maternity
experience in different cultures.Overall,
the instrument showed acceptable
psychometric properties in its first use in
different cultural settings.Fernand Seguin Research Centre (Montreal,
Canada)