Depression in Mongolian women over the first 2 months after childbirth: Prevalence and risk factors

doi:10.1016/j.jad.2008.11.010

Journal of Affective Disorders

Volume 116, Issues 1–2, July 2009, Pages 126-133

https://doi.org/10.1016/j.jad.2008.11.010 Get rights and content

Abstract

Background:

Social, political and economic changes in Mongolia have followed post-Soviet style government policies and contributed to both increased liberalisation and reduced security in employment and family finances. This is the first study to attempt to assess the prevalence of depression in a population of Mongolian women in the post-partum period and assess risk factors, including financial position, associated with the condition.

Methods:

A total of 1044 women who had delivered healthy babies in Ulaanbaatar between October and December 2002 were screened for depression using the WHO Self Reporting Questionnaire between 5 and 9 weeks post-partum. Further details on the mother, her family and social and economic circumstances were simultaneously collected. Analysis of risk factors for probable depression was undertaken using multiple logistic regression techniques.

Results:

The prevalence of depression was 9.1% (95% CLs 7.5%–11.1%). Variables significantly and independently associated with risk of probable maternal depression included economic factors, mother being subject to physical abuse, dissatisfied with the pregnancy, concerned about her baby's behaviour, and her own health problems.

Limitations:

The sample was drawn from a population of mothers all of whom had healthy, full-term babies of normal birth weight. Clinical confirmation of diagnosis was not established.

Conclusions:

Mongolian women with young infants in Ulaanbaatar probably experience depression at rates comparable with other cultures. Factors associated with probable depression were dominated by health, relationships and financial position.

Introduction

The end of seven decades of Soviet Union style socialist government in Mongolia has seen increases in unemployment and violent crime, the former being associated with a culturally-defined emotional fatigue-related illness, “yadargaa”, that contains elements of neurosis but has a more specific holistic meaning for the shamanic, traditional and western-style Mongolian health care services (Kohrt et al., 2004). No statistics exist in Mongolia to enable trends in the incidence of affective disorders to be linked to social change, but depression and anxiety are recognised as health problems and are treated in western style hospitals and clinics by doctors and psychiatrists. Whilst Kohrt et al. (2004) conducted a ‘community epidemiological’ survey of the distribution of yadargaa in both urban and rural Mongolia, no equivalent studies have assessed the prevalence of more formally recognised neurotic conditions such as depression and anxiety. Links between reproduction and depression in women, and the effects on the child and family, so widely recognised in the west, remain unstudied and there is no information available on depression in the early postpartum period.

This paper presents the results of a survey of depressive disorder in a population-based sample of Mongolian women with young infants and assesses factors predictive of depression as diagnosed with a locally-validated screening instrument, the 20-item World Health Organisation's Self Reporting Questionnaire (SRQ-20).

Section snippets

Methods

The present study was nested in a randomised controlled trial designed to assess associations between infant morbidity and the cultural practice of tight infant swaddling over the first few months of life (Manaseki-Holland, 2005). This trial recruited 1274 women delivering babies of normal birth weight (>= 2500 g) and gestational age (>= 37 weeks) and residential in 5 districts of Ulaanbaatar, Mongolia's capital city, between October and December 2002. Recruited subjects were of mean age 26 years

Depression score distribution and caseness

The distribution of depression-related scores at the time the infants were aged 5–9 weeks is presented in Fig. 1. The scores ranged from 0 (11.2% of the women) to 15 (0.2%) with a theoretical maximum of 20 on the SRQ-20.

Employing the SRQ-20 cut-off point of 8.5 validated previously on a comparable sample (Pollock et al., 2006), 95 out of 1044 (9.1%, 95% Confidence Limits 7.5%, 11.1%) of the women met the criterion for depression at 5–9 weeks.

Factors associated with post-partum depression between 5 and 9 weeks

Initial cross-tabulations indicated that associations

Discussion

No previous data are available on the prevalence of depression in community-based populations in Mongolia, in women, or in the postnatal period. This study appears to be the first to make any attempt at an estimate and, consequently, there are no direct comparisons possible for this particular group. Whilst both a few false positives and false negatives will surely have been missed, the 5–9 week (mostly 7 or 8 week) post partum depression rate estimate of 9.1% determined in this study is likely

Role of funding source

The Wellcome Trust provided financial support in the form of Dr Manaseki-Holland's Research Training Fellowship in Clinical Epidemiology, but had no role in the study design, data collection and analysis, or in the preparation of this paper and the decision to submit it for publication.

Conflict of interest

None of the authors have any conflicts of interest in this study or in the report.

Acknowledgements

We are very grateful to all the women participating in this study. We would like to especially thank Dr Yagaantsetseg Jamsran who was responsible for the data collection and data management relating to the postnatal health questionnaires and Dr Tsogzolmaa Bayandorj for overall management of the data and for help in translation.

The then General Director of the Maternal and Child Health Research Centre, Professor Gotov Choijamts, both supported and provided local supervision for this project.

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They correlated positive PPD screenings with various sociodemographic and obstetric/paediatric factors to identify potential risk factors. The results showed evidence for associations between probable PPD, as defined by a positive screen upon administration of a standardized PPD questionnaire, and factors such as the presence of maternal and/or neonatal health problems, dissatisfaction with the pregnancy, previous maternal emotional problems, poor marital and/or family relationships (e.g., physical abuse, conflict, etc.), and unfavourable financial circumstances (e.g., debt, inability to meet needs financially, hunger for lack of money, etc.) (Pollock et al., 2009). These two quantitative studies have yielded valuable information; however, there exists a need for qualitative research that aims to elucidate the perspectives and experiences of health care providers and the public regarding PPD in Mongolia.
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The majority of providers reported some basic knowledge of PPD, though limited experience in working with PPD patients. Most described signs and symptoms based on their own observations and perceptions rather than what women themselves reported. Providers generally characterised PPD as a multifactorial condition, recognising the role of obstetric, psychologic, socioeconomic and cultural factors in its development. A traditional concept of PPD (“sav khuurukh”) was prominently mentioned. Though they had diverse ideas regarding where women seek help for PPD, almost all providers agreed that a critical strategy for identifying PPD is patient-provider discussion. However, such discussions are rare because of providers' lack of confidence in recognising and treating women with PPD, lack of training, time constraints, and/or other related barriers.
The results demonstrate that while providers have some understanding of key aspects of PPD, many lack a clear conception of what defines the condition and how to effectively identify and treat it.
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Brief reportDepression in Mongolian women over the first 2 months after childbirth: Prevalence and risk factors

Abstract

Background:

Methods:

Results:

Limitations:

Conclusions:

Introduction

Section snippets

Methods

Depression score distribution and caseness

Factors associated with post-partum depression between 5 and 9 weeks

Discussion

Role of funding source

Conflict of interest

Acknowledgements

J. Affect. Disord.

Soc. Sci. Med.

J. Affect. Disord.

Gen. Hosp. Psychiatry

The prevalence of early post-partum psychiatric morbidity in Dubai: a transcultural perspective

Acta Psychiatr. Scand.

Sociodemographic and obstetric risk factors for post-partum depressive symptoms in Nigerian women

J. Psychiatr. Pract.

Depression and associated factors among women within their first postnatal year in Erzurum Province in Eastern Turkey

Women Health

A Users Guide to the Self Reporting Questionnaire (SRQ)

Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India

Br. J. Psychiatry

Pre- and postnatal depression and coping: a comparative approach

J. Affect. Disord.

Screening of Turkish women for postpartum depression within the first postpartum year: the risk profile of a community sample

Public Health Nurs.

Validity study of the Self-Reporting Questionnaire (SRQ20) in primary health care in UAE

Int. J. Methods Psychiatry

Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries

Psychol. Med.

Factors associated with depressive symptoms among postnatal women in Nepal

Acta Obstet. Gynecol. Scand.

Prevalence and social correlates of postnatal depression in a low income country

Arch. Womens Ment. Health

Risk factors for depression in postnatal first year, in eastern Turkey

Int. J. Epidemiol.

Risk factors for depression in the first postnatal year: a Turkish study

Soc. Psychiatry Psychiatr. Epidemiol.

Brief report
Depression in Mongolian women over the first 2 months after childbirth: Prevalence and risk factors