CULTURE AND POSTPARTUM DEPRESSSION
PRESENTERS: GLORIA CANTOR MSN, CNS
SY VANG
DSM-IV Criteria for depression:
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depressed mood
decreased interest/enjoyment of usual activities
decrease or increase in appetite
insomnia or hypersomnia
psychomotor agitation or retardation
fatigue or lack of energy
feelings of worthlessness or excessive guilt
decreased concentration or ability to think
recurrent thoughts of death or suicidal ideation
Five or more symptoms must be present for 2 weeks, represent a change from previous functioning and
at least one of the symptoms is either depressed mood or loss of interest/pleasure.
Postpartum Depression:
1)
2)
Can begin 2 weeks postpartum up to one year postpartum
Symptoms consistent with DSM-IV criteria but often excessive guilt or anxiety about baby,
being an adequate mother
3) Prevalence rates estimated at 10% to as high as 40%
4) Immigrant mothers at increased risk of PPD
Common Risk Factors in PPD: (Beck, 2001)
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Prenatal depression
Childcare stress
Life stress
Lack of social support
Prenatal anxiety
Marital dissatisfaction
Previous history of depression
Low self-esteem
Low socio-economic status
Marital status
Unwanted/unplanned pregnancy
Cultural risk factors:
1)
2) Loneliness
3) Fear of failure
4) Helplessness to fulfill traditional role
5) Lack of knowledge
6) Pre-migration trauma
7) Immigration stress
8) Inability to carry out cultural rituals
9) High expectations for new mothers
10) Having a female infant
Cultural factors possibly mitigating development of PPD:
1) Distinct postpartum period for mothers
2) Extended family providing help and care for the new mother
3) Special personal attention to the mother
4) Social seclusion
5) Mentoring of the new mother by older women
Cultural differences in explaining PPD
1) Typically non-biological
2) Role conflicts
3) Advice conflicts
4) Lack of support
Barriers to seeking treatment:
1) Somatization of emotional problems
2) Cultural norms
3) Lack of knowledge
4) Language barriers
5) Fear of being labeled “mentally ill”
6) Family disapproval
7) Religious beliefs
Health Professional Barriers:
1) Lack of knowledge about PPD and its cultural presentations
2) Failure to ask
3) Failure to refer
4) Language barriers
5) Cultural biases
6) Lack of time
BIBLIOGRAPHY
Nahas, V and Amasheh, N. (1999). Culture Care Meanings and Experiences of Postpartum Depression
among Jordanian Australian Women: A Transcultural Study. Journal of Transcultural Nursing 10, 3745.
Fonte, J. and Horton-Deutsch, S. (2005). Treating Postpartum Depression in Immigrant Muslim
Women. Journal of the American Psychiatric Nurses Association 11 (1), 39-44.
Beck, C. (2001). Predictors of Postpartum Depression: An Update. Nursing Research, 50, 275-285.
Goyal, D., Murphy, S. , and Cohen, J. (2006). Journal of Obstetric, Gynecologic, and Neonatal
Nursing, 35, 98-104.
Nahas, V. and Amasheh N. (1999). Postpartum Depression: The lived experiences of Middle Eastern
Migrant Women in Australia. 44(1), 65-74.
Dindar, I. And Erdogan, S. (2007) Screening of Turkish Women for Postpartum Depression Within the
First Postpartum Year: The Risk Profile of a Community Sample. Public Health Nursing 24(2) 176183.
Maternidad Latina (2007) Postpartum Latinas Cry for Mental Health Services. North Carolina Healthy
Start Foundation Newsletter, November-December 2007.
Stuchbery, M, Matthey, S, and Barnett, B. (1998) Postnatal Depression and Social Supports in
Vietnamese, Arabic and Anglo-Celtic Mothers. Social Psychiatry and Psychiatric Epidemiology,
33(10) 483-490.
Wisner, K, et al. (2002) Postpartum Depression. New England Journal of Medicine, 347 (3) 194-199.
Kendall-Tackett, K. (1994) Postpartum Rituals and The Prevention of Postpartum Depression: A
Cross-Cultural Perspective. Newsletter of the Boston Institute for the Development of Infants and
Parents, 13 (1) 3-6.