Mental health stigma and health-seeking behaviors amongst pregnant women in Vietnam: a mixed-method realist study
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Cited by 3 publications
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Health systems responsiveness towards needs of pregnant women in Vietnam
Background Health systems that are responsive to maternal mental health recognise the importance of integrating mental health services into maternal care. Studies from Vietnam have reported particularly high rates of common perinatal mental health disorders (CPMDs) in both rural and urban areas of the country. Despite the increasing burden of maternal mental health conditions, there is currently no guidance on the screening for CPMDs within maternal care, both antenatal and postnatal. In this paper, we report the findings from a survey that examined health systems responsiveness to the needs of pregnant women at the primary care-level in Vietnam, utilising the WHO’s validated responsiveness questionnaire. Methods Cluster sampling was used in two districts, in Bac Giang Province. Data were collected using the WHO responsiveness tool, including questions on the domains of responsiveness relating to pregnant women’s last antenatal visit. SPSS (version 24) software was used for data entry and analysis, respectively. Bivariate and multivariable logistic regression were computed to identify the associated factors of health system responsiveness in maternity care at 95% CI. Results We found that the overall mean health systems responsiveness score was 2.86 (out of maximum 4), with 30.4% pregnant women rating responsiveness as “poor” for maternal health care (based on the cutoff point of 60 for overall score). The three highest scoring domains were “social support”, “trust”, and “dignity” and lowest scoring domains were “choice of providers”, “prompt attention”, and “communication”. There is a strong preference for seeking maternal health care at private facilities which meet women’s needs of “confidentiality” and “basic amenities”. Household income was found to have a significant impact on the six responsiveness domains. Finally, only a small proportion of pregnant women self-reported having CPMDs and accessed mental health facilities. Conclusions These findings highlight the need to improve the responsiveness of the Vietnamese health system to meet pregnant women’s expectations, mainly in relation to prompt attention and communication. This study also highlights the importance of specifically targeting efforts towards improving the responsiveness of the public health sector. Integrating maternal and mental health at the primary care-level can be one approach to tackle the mental health treatment gap experienced by pregnant women in Vietnam. This can promote early detection and intervention of CPMDs, but may also contribute towards reducing mental health-related stigma. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-024-12040-6.
Health systems responsiveness towards needs of pregnant women in Vietnam
Background Health systems that are responsive to maternal mental health recognise the importance of integrating mental health services into maternal care. Studies from Vietnam have reported particularly high rates of common perinatal mental health disorders (CPMDs) in both rural and urban areas of the country. Despite the increasing burden of maternal mental health conditions, there is currently no guidance on the screening for CPMDs within maternal care, both antenatal and postnatal. In this paper, we report the findings from a survey that examined health systems responsiveness to the needs of pregnant women at the primary care-level in Vietnam, utilising the WHO’s validated responsiveness questionnaire. Methods Cluster sampling was used in two districts, in Bac Giang Province. Data were collected using the WHO responsiveness tool, including questions on the domains of responsiveness relating to pregnant women’s last antenatal visit. SPSS (version 24) software was used for data entry and analysis, respectively. Bivariate and multivariable logistic regression were computed to identify the associated factors of health system responsiveness in maternity care at 95% CI. Results We found that the overall mean health systems responsiveness score was 2.86 (out of maximum 4), with 30.4% pregnant women rating responsiveness as “poor” for maternal health care (based on the cutoff point of 60 for overall score). The three highest scoring domains were “social support”, “trust”, and “dignity” and lowest scoring domains were “choice of providers”, “prompt attention”, and “communication”. There is a strong preference for seeking maternal health care at private facilities which meet women’s needs of “confidentiality” and “basic amenities”. Household income was found to have a significant impact on the six responsiveness domains. Finally, only a small proportion of pregnant women self-reported having CPMDs and accessed mental health facilities. Conclusions These findings highlight the need to improve the responsiveness of the Vietnamese health system to meet pregnant women’s expectations, mainly in relation to prompt attention and communication. This study also highlights the importance of specifically targeting efforts towards improving the responsiveness of the public health sector. Integrating maternal and mental health at the primary care-level can be one approach to tackle the mental health treatment gap experienced by pregnant women in Vietnam. This can promote early detection and intervention of CPMDs, but may also contribute towards reducing mental health-related stigma. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-024-12040-6.
Social support and symptoms of antenatal depression among women screened for gestational diabetes mellitus: A cross-sectional study in Northern Vietnam (the VALID II study)
Objectives This study from Northern Vietnam aims to assess the association between social support and symptoms of depression among pregnant women screened for gestational diabetes mellitus (GDM). Methods A cross-sectional study was conducted among 823 pregnant women in Thai Binh, Vietnam. The women were screened for GDM and structured questionnaire were used to collect data on social support factors, GDM factors, and symptoms of depression. The diagnosis of GDM was based on the 2-hour 75-g OGTT according to WHO 2013 criteria. The Edinburg Postpartum Depression Scale (EPDS) with a cut-off of 10 and the Multidimensional Perceived Social Support Scale (MSPSS) were used to assess depression symptoms and perceived social support, respectively. Logistic regression analysis was conducted to measure the associations between social support, GDM-related factors, and symptoms of depression. The relationship between social support score and symptoms of depression was evaluated using Spearman’s correlation. The strength of the associations were measured by adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results The prevalence rates of GDM and symptoms of depression were 22.2% (95%CI: 19.4–25.2) and 23.0% (95%CI: 20.1–26.0), respectively. Women who had moved away from their commune of birth and women who reported another person than their husband to be the primary person to confide in had increased odds of depression (aOR = 1.74; 95%CI:1.19–2.56 and aOR = 2.36; 95%CI:1.48–3.75, respectively). A reported lack of social support was strongly associated with increased odds of depression symptoms among both women with gestational diabetes mellitus (aOR = 6.16, 95% CI:2.35–16.12) and without gestational diabetes mellitus (aOR = 2.81; 95%CI: 1.67–4.75). When analysing the correlation between social support and depression symptoms, a negative correlation was found, with decreasing depression scores as the social support score increased. Conclusion The prevalence of symptoms of depression was high in our study, and women in Northern Vietnam who feel well-supported socially are less likely to report symptoms of depression. This finding applies both to women with and without GDM.
Mental health literacy and the public perception of persons with depression and schizophrenia in Vietnam
BackgroundVietnam’s mental health care system is undergoing significant changes since the government has initiated large-scale programs to reform and develop the mental health care infrastructure. Cultural belief systems on mental illnesses influence help-seeking behavior and compliance. This study investigates the belief systems about people with schizophrenia and depression among people living in the Hanoi area.Method1077 Vietnamese participants answered two open-ended questions after reading an unlabeled vignette describing a character with the symptoms of schizophrenia or depression. The answers were analyzed using thematic analysis.ResultsOf all participants, 88,4% associated the presented cases with a mental illness, with 91,5% in the case of schizophrenia and 85,1% in the case of depression, so both disorders were conceptualized as mental illnesses. 18,6% mentioned depression when presented with the depression vignette, while only 3,6% recognized schizophrenia in the schizophrenia condition.ConclusionsAlmost 9 out of 10 participants considered the presented cases as an example of mental illness, suggesting a high mental health awareness among our participants. The majority did not identify the presented cases as examples of schizophrenia or depression, reflecting little familiarity with Western mental health concepts. It could be interpreted as a sign of relatively low mental health literacy among the study participants.
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