Measuring and Understanding Various Aspects of Postpartum Distress in Makkah, Saudi Arabia

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Copyright: Hariri, Nahla
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Abstract
Postpartum Distress is a significant public health problem, in Saudi Arabia, with no documented studies for Makkah. This study comprised of two phases. First, the quantitative study which aimed to assess 1) the prevalence of Postpartum Distress in women using a combination of measures, an approach previously not used with Arabic women, 2) valid cut-off scores for the Edinburgh Postnatal Depression Scale (EDPS) and Being a Mother-13 Scale (BaM-13), 3) transient and enduring distress. Second, the qualitative study to explore the conceptualisation of Postpartum Depression (PPD) and accessibility to primary mental health services. A questionnaire was administered to 354 women attending primary health care centres. Participants completed four measures: EPDS, Faces Scales, Matthey Generic Mood Question (MGMQ) and BaM-13). Two weeks later, the measures were repeated with 185 women through telephone interviews. They also responded to the Mini-International Neuropsychiatric Interview and attributional probing. 11 women and 9 primary health care providers were interviewed in-depth to understand conceptualisation of PPD and accessibility to services. The prevalence of Depression was 19.5% using usual DSM criteria in which 16.2% had Major Depression and 3.2% had Minor Depression. Using attributional probing, the Major Depression rate dropped from 16.2% to 8.1%. The impact of Anxiety appears to be less than Depression (24.9% to 15.1%). Prevalence based on self-reported measures was also examined. Based on the validated cut-off score of EPDS in this study (7 or more), approximately 29% of women scoring high on Time 1 no longer scored high two weeks later. Comparison of four self-report measures to screen performance was also tested. Women identified symptoms of PPD; most did not acknowledge it as an illness. Social and supernatural causes were considered as major contributors to PPD. Stigma and transport were significant barriers for accessibility. The prevalence rate of PPD was high especially among Saudi women, yet they did not recognise PPD as an illness. EPDS and BaM-13 showed good psychometric properties. However MGMQ performed well in detecting Postpartum Distress on the other measures. Culture and religion underpin how PPD is conceptualised and have an influence on accessibility. Early screening integrated with maternal and child health services Postpartum Distress is recommended.
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Author(s)
Hariri, Nahla
Supervisor(s)
Razee, Husna
Matthey, Stephen
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Publication Year
2015
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Thesis
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PhD Doctorate
UNSW Faculty
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