Listening to mothers: qualitative studies on motherhood and depression from Goa, India

Abstract

There is little qualitative research on depression in motherhood from non-Western societies. The objective of the study described in this paper was to use qualitative methods to investigate the cultural validity of the construct of postnatal depression (PND) and its social and cultural contexts. The study was nested in a cohort of mothers recruited to study the risk factors and outcome of PND in Goa, India. In-depth interviews were carried out with 39 mothers (19 of whom were found to be suffering from PND as defined by a cut-off score on the Edinburgh PND scale) and their husbands purposively recruited from the cohort. An illness narrative was conducted with mothers who were categorized as suffering from PND and their husbands to elicit their explanatory models. The two groups (PND and non-PND) of mothers were comparable in terms of socio-demographic characteristics. PND mothers had lower levels of practical help and emotional support. The symptoms reported by PND mothers were similar to those recorded in studies with women in other cultures suggesting a universal clinical presentation of PND. Causal attributions for the experience of depression focused on economic difficulties and poor marital relationship. All mothers expressed the need for more practical help and support during the period after childbirth; husbands in both groups were often disengaged from baby care or supporting the mother. The study provides validity for the construct of PND in an Indian setting, but also shows that the emotional distress is interpreted from the context of social adversity, poor marital relationships and cultural attitudes towards gender rather than a biomedical psychiatric category. Contrary to the assumption that sociocultural contexts associated with childbirth in non-Western societies protect mothers from depression, factors unique to the culture such as gender preference and the low involvement of husbands in child-care are major causes of stress to mothers. r

Factors predicting Postnatal Depression immediately after delivery and at 6 weeks : a study from a teaching hospital in southern India

“…Another study had similar findings that noted full time employment to be less frequently associated with depressive symptoms in the postpartum period [26]. Contrary to some studies from the region, our study did not find differences in rates of depressive symptoms according to gender of the new born [18,27]. None of the women reported dissatisfaction with the gender of the newborn and only two of the women had reported marital problems.…”

Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan – a multi-method study

“…This was to avoid the medicalization of a condition that, in the majority of cases, was associated with psychosocial risk factors such as financial difficulties, poor family and marital relationships and inadequate social support (Rahman et al, 2003). Similar studies in India show that while postnatal depression is a valid construct amongst Indian women, the emotional distress is interpreted from the context of social adversity, poor marital relationships and cultural attitudes towards gender rather than a biomedical psychiatric category (Rodrigues et al, 2003). It may be argued that by avoiding the term 'depression', we were perpetuating the stigma attached with this disorder, or worse, being unethical by not disclosing a clinical condition to the sufferer.…”

Poverty and postnatal depression: a systematic mapping of the evidence from low and lower middle income countries

“…Just one study, from Pakistan, did not find an association (Husain et al, 2006b). A clue to better ways of framing and capturing economic stress in research -moving beyond simplistic income measures -is to be found in the two qualitative studies included in our mapping, one from Vietnam (Niemi et al, 2010;Rodrigues et al, 2003) and one from India . Both studies show how women highlight financial or economic "difficulties" as being key to causal models for PND.…”

“…PND can be assessed either clinically or through the use of screening instruments such as the Edinburgh Postnatal Depression Scale (EPDS) (Cox & Holden, 1996;Cox et al, 1987), Beck Depression Inventory (BDI) (Beck et al, 1996), Zung Self-Rating Depression Scale (Zung, 1971), the Kessler Psychological Distress Scale (K10) (Kessler et al, 2002) and the Self-Regulation Questionnaire (SRQ-20) (Harding et al, 1980) among others? Concerns (Kleinman, 1987) that methods developed in HICs might falsely identify PND in "non-Western" settings have been refuted (Cox & Holden, 1996;Halbreich & Karkun, 2006;Patel et al, 1998;Rodrigues et al, 2003). Examination of the issue across 11 countries (10 HICs and 1 low income country (LIC) -Uganda), supported the "universality" of postpartum morbid unhappiness but raised concerns about the cross-cultural equivalence of PND as an illness requiring clinical intervention (Oates et al, 2004).…”