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OJHAS Vol. 10, Issue 4:
(Oct-Dec 2011) |
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| Postpartum
Mental Health among Young Women |
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Amr MA, Assistant
Prof. of Psychiatry, College of Medicine, Mansoura University, Egypt,
Balaha M, Prof. of Obstetrics & Gynecology, College of Medicine, King Faisal
University, Al Ahsa, Saudi Arabia,
Al Moghannum
M, Consultant Obstetrics and Gynecology, Al Ahsa Maternity Hospital, Saudi
Arabia. |
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Address for Correspondence |
Assistant professor of Psychiatry,
Mansoura University,
Egypt.
E-mail:
mostafapsy@yahoo.com |
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Amr MA, Balaha M, Al Moghannum M. Postpartum
Mental Health among Young Women. Online J Health Allied Scs.
2011;10(4):6 |
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Submitted: Oct 7,
2011; Accepted: Jan 10, 2011; Published: Jan 15, 2011 |
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| Abstract: |
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Background:
A number of
studies have highlighted the physical health problems associated with
adolescent pregnancy in Saudi Arabia , However there were few studies
dealing with the postpartum psychiatric disorders .The study aims to
determine the prevalence of postpartum psychological distress and to
evaluate the associated risk factors in a sample of primigravid young
women in Al Ahsa region, Saudi Arabia. Methods: We assessed
the prevalence of postnatal mental health in 190 young mothers attending
the maternity hospital using general health questionnaire. We also
assessed the relationship between socio-demographic, psychiatric and
obstetric risk factors and the mental health. Results: The percent
of women with psychological distress was 35.2%. Significant risk of
psychological distress was associated with several socio-demographic,
psychiatric and obstetric risk factors. Only four items were found to
be significant predictors of postpartum psychological distress; low
family income, poor husband support, birth of female baby and gestational
diabetes. Conclusions: These results
highlighted importance of screening for psychological distress and
its associated risk factors in the implementation of proper perinatal
care for the pregnant Saudi adolescents.
Key Words:
Teenage pregnancy; Postnatal psychiatric disorders; Risk factors
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Teenage pregnancy
is defined as pregnancy in women under the age of 20, although in the
United States, the term usually refers to girls younger than 18 years.
Teenage pregnancy is a worldwide social problem and its incidence shows
marked variation amongst developing countries.(1-2) In Saudi Arabia,
the birth rate per 1000 females aged 15–19 is 114. The average age
at marriage is 14 years, and average age at first pregnancy is 16 years.(3) An increased prevalence of anemia, low-birth-weight (LBW) infants,
pregnancy-induced hypertension (PIH) and cesarean section was found in young
Saudi pregnant women.(4-7)
The birth of
a child especially the first can be a joyous and exciting time, but
following childbirth, some women may experience postpartum disorders
such as the baby blues, postpartum depression (PPD), birth-related post-traumatic
stress disorder, postpartum anxiety and/or panic disorder, postpartum
obsessive-compulsive disorder (OCD) or rarely postpartum psychosis (PPP).
Postpartum psychiatric disorders have been the subject of an increasing number
of publications.(8-10)
The majority of
these studies are Western. In developing countries, many studies have examined
the occurrence of postpartum psychiatric disorders and the focus was on prenatal
and delivery care and on women’s medical and obstetrical problems and on the
baby’s wellbeing.(11-13)
The authors
of this study assumed hypothesis that the risk of developing postpartum
psychiatric disorders is independent of adverse socio demographic, psychiatric
or obstetric risk factors. The aim of this study was to detect the prevalence
of postnatal psychological distress in a sample of primigravid teenagers
in Al Ahsa region, Eastern Province, Saudi Arabia. Also the study aims
to highlight the ability of different risk factors in prediction of
postpartum psychological distress.
This study
was conducted at Al Ahsa Maternity hospital, Saudi Arabia Al-Ahsa, Saudi
Arabia; which is the largest province in the Eastern region with a population
of nearly 1 million with diverse
socioeconomic backgrounds.(2) Maternal services are provided by Al-Ahsa
Maternity Hospital and a network of primary health care centers
(PHCCs). The antenatal care clinics provide regular care for pregnant
women with the use of the classic 13 visits schedule throughout pregnancy.
The postnatal visits were conducted monthly after birth and at times
of neonatal vaccination.
Sample
selection
The sample
comprised all primigravid teenage women who were attended the primary
health care centers for postnatal visits and for infant vaccination
within 2 months after delivery. The cases were evaluated during the
period 2007-09. Women with any chronic medical disease (hypertension,
diabetes, renal, cardiac and sickle cell disease) or multiple births
were excluded from the study. 205 cases were legible teenagers to be
enrolled in the study. Out of them, six cases with incomplete
data cases and nine cases giving birth outside the maternity hospital
were excluded. The remaining 190 cases were enrolled as the study sample.
An informed consent was obtained from each participant before enrollment
in the study.
Study
design
The women
completed a questionnaire designed for this study that covered socio-
demographic (educational level and occupation of the wife and
husband, current residence and level of income) medical, especially
obstetrical (antenatal: pregnancy induced hypertension, gestational
diabetes, antepartum hemorrhage, anemia, premature rupture of membranes;
Perinatal: birth weight, gestational age at birth, mode of delivery,
newborn gender and health status; postnatal: postpartum hemorrhage, fever and continence problems) psychiatric (quality of marital life,
husband support, stressful live events in the last 6 months, family
and past history of psychiatric illness). The women also completed the
General Health Questionnaire (GHQ), a widely used, valid and reliable
indicator of psychological distress and a predictor of psychological
distress . This instrument has previously used in screening for postpartum
psychiatric morbidity.(14-15) The 12-item Arabic version was used in this study. The cut-off score of 12 was adopted
a priori to identify cases.(16) Sensitivity and specificity was 0.83
and 0.80 respectively. The total discriminatory powers of the GHQ-12
were approximately 86%, and have a significant concurrent validity.
Analytical
Procedure
GHQ data were
tabulated and all the included cases were divided according to the score
of GHQ into either cases (GHQ score >12) or non cases (GHQ score
≤12). Independent student t test was used to compare them. All
demographic, psychiatric and obstetric risk factors were explored and
compared in cases and non cases using non parametric analysis; chi-square
and the two-tailed Fisher's exact test. Significance was considered
at P <0.05. Binary logistic regression analysis was used to estimate
the predictability of having postpartum psychological distress after
adjusting for covariates identified in the bivariate analyses. Significance
was based on significant β coefficient and significant odds ratio with
confidence interval (CI) not crossing one. The analysis was done using
the SPSS software package version 16 (Chicago, USA).
A total of
205 young women were invited to take part in the study. The GHQ was
completed for 190 women (the response rate was 92.7%). the mean age
was 17.7 years, ranging from 15.7 to 19.8. All of them were married
and their delivery was conducted at hospital
Point prevalence
of psychological distress
The prevalence
of psychological distress was (35.2%). The mean score of GHQ in the cases was
22.81± 6.44 (range 14-35). On the other hand the mean score in the non cases was
8.98 ± 1.83 (range 5-12), with significant statistical difference. (P< 0.01)
Table 1 summarizes
the socio-demographic and psychiatric characteristics of the study sample.
The majority of mothers (72.1%) had achieved either elementary or secondary
levels of education and 78.4% were housewives. Nightly-two women (48.4%)
were living in urban areas. Only 31.6% of their husbands had achieved
a higher level of education and 5.3 % had unstable jobs. The majority
of cases had good quality of married life; however 31 (16.3% )
of them described this relation as poor and 27.8 % of the sample lack the assistance from husband, 17.9 % had stressful life
events during the previous 6 months,
21.6 % had previous psychiatric disorders and 26.8 % had a family history
of psychiatric disorders. (Table 1)
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Table 1:
Socio-demographic
and psychiatric characteristics in cases with or without psychiatric
disturbance as defined by GHQ |
| |
Total (N=190) |
Non-case (N=123) |
Case (N=67) |
P value |
|
N
(%) |
N (%) |
N (%) |
(X2 or FET) |
|
Husband
education: |
0.68 |
|
<Secondary |
73 (38.4) |
50 (40.7) |
23 (34.3) |
|
Secondary |
57 (30) |
35 (28.5) |
22 (32.8) |
|
>Secondary |
60 (31.6) |
38 (30.9) |
22 (32.8 ) |
|
Husband
occupation: |
0.023 * |
| Professional |
53 (27.9) |
37 (30.1) |
16 (23.9) |
| Employee |
73 (38.4) |
48 (39) |
25 (37.3) |
| Non
governmental |
54 (28.4) |
36 (29.3) |
18 (26.9) |
| Unstable |
10 (5.3) |
2 (1.6) |
8 (11.9) |
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Maternal education: |
0.64 |
| <
Secondary |
39 (20.5) |
25 (21.3) |
14 (20.9) |
|
Secondary |
98 (51.6) |
61 (59.6) |
37 (55.2) |
| >
secondary |
53 (27.9) |
37 (30.1) |
16 (23.9) |
|
Maternal
occupation: |
0.043 * |
|
House wives |
149 (78.4) |
103 (83.7) |
46 (68.7) |
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Working |
3 (1.6) |
2 (1.6) |
1 (1.5) |
|
Students |
38 (20) |
18 (14.6) |
20 (29.9) |
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Current residence |
0.72 |
|
Urban |
92 (48.4) |
60 (48.8) |
32 (47.8) |
|
Rural |
68 (35.8) |
42 (34.1) |
26 (38.8) |
|
Hagar |
30 (15.8) |
21 (17.1) |
9 (13.4) |
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Current
income |
000 ** |
|
Satisfactory |
156 (82.1) |
112 (91.1) |
44 (65.7) |
|
Unsatisfactory |
34 (17.9) |
11 (8.9) |
23 (34.3) |
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Past
history of psychiatric illness |
41 (21.6) |
18 (14.6) |
23 (34.3) |
0.019 * |
|
Family
history of psychiatric illness |
51 (26.8) |
13 (10.6) |
28 (41.8) |
000 ** |
|
Poor
quality of marital life |
31 (16.3) |
17 (13.8) |
14 (20.7) |
0.6 |
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Stressful
life events in last 6 months |
34 (17.9) |
19 (15.4) |
15 (22.4) |
0.72 |
|
Absent
husband support |
53 (27.8) |
20 (16.3) |
33 (49.3) |
000 ** |
|
* Significant;
**Highly Significant |
Table 2 summarizes
the obstetric characteristics of the study sample. Regarding the course
of pregnancy, nearly half of the sample reported anemia (43.2%) whereas
24.2% had gestational diabetes, others include: hypertension,
premature rupture of membranes and antepartum hemorrhage in 17.9, 11.1
and 5.3% respectively. The majority of participants reported a cesarean
mode of delivery ending in a full term newborn with average birth weight
and appropriate Apgar scoring, moreover the newborns had a comparable
sex distribution (55.3 % males and 44.7 % females) but, one tenth of
the newborns (13.2%) were admitted to the NICU. The most common postnatal
complications in the sample were post partum fever (27.4%) followed
by continence problems (13.7%) and post partum hemorrhage (5.8%). (Table
2)
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Table 2: Obstetric
risk factors in cases with or without psychiatric disturbance as defined
by GHQ |
| |
Total (N=190) |
Non-case (N=123) |
Case (N=67) |
P value |
|
N
(%) |
N (%) |
N (%) |
(X2 or FET) |
|
Gestational
diabetes |
46 (24.2) |
14 (11.4) |
32 (47.8) |
0.001** |
|
Pregnancy
induced hypertension |
34 (17.9) |
11 (8.9) |
23 (34.3) |
0.001** |
|
Anemia |
82 (43.2) |
50 (40.7) |
32 (47.8) |
0.82 |
|
Antepartum
hemorrhage (APH) |
10 (5.3) |
5 (4.1) |
5 (7.5) |
0.8 |
|
Premature
rupture of membranes |
21 (11.1) |
11 (8.9) |
10 (14.9) |
0.66 |
|
Low
birth weight |
17 (8.9) |
8 (6.5) |
9 (13.4) |
0.46 |
|
Abnormal
delivery mode |
0.028* |
|
Cesarean |
48 (25.3) |
28 (22.8) |
20 (29.9) |
| Instrumental |
31 (16.3) |
15 (12.2) |
16 (23.9) |
| Low
Apgar score (<7) at 7 minutes |
12 (6.3) |
8 (6.5) |
4 (6) |
0.99 |
| Admission
to NICU |
25 (13.2) |
5 (4.1) |
20 (29.9) |
0.001** |
|
Baby sex (Gender) |
0.001** |
|
Male |
105 (55.3) |
86 (69.9) |
19 (27.4) |
| Female |
85 (44.7) |
37 (30.1) |
48 (71.6) |
|
Postpartum
hemorrhage |
11 (5.8) |
4 (3.3) |
7 (10.4) |
0.24 |
|
Postpartum
fever |
52 (27.4) |
21 (17.1) |
31 (46.3) |
0.001** |
|
Postnatal
continence problems |
26 (13.7) |
16 (13) |
10 (14.9) |
0.98 |
|
* Significant;
**Highly Significant |
Factors
associated with psychiatric disturbance
We compared
the group of mothers with current psychiatric disturbance, according
to the diagnosis generated by GHQ in the eighth week after childbirth,
to the non-cases group. We first tested associations between psychiatric
disturbance and socio-demographic and psychiatric factors. Husband occupation,
maternal occupation and past history of psychiatric illness
showed significant difference (P <0.05) On the other hand the difference
in current income and absent husband support was highly significant
(P <0.01)
We examined
potential relationship associating obstetrical factors with postpartum
psychological distress. Cases reported highly significant more complications
of pregnancy (hypertension, diabetes), cesarean mode of delivery, female
baby sex, admission to the NICU and postpartum fever. (P <0.01).
Table 3 shows
results of the logistic regression analysis. It indicated that, after
adjusting for potential confounders, the main significant determinants
of psychological distress are unsatisfactory family income, poor husband
support, gestational Diabetes, and female baby sex. The
odds of having psychological distress for women who had unsatisfactory
family income are 3.5 times compared with those with satisfactory family
income. (95% CI 1.3 - 9.1). Women who reported gestational diabetes
are 3.4 times more likely to have psychological distress (95% CI 1.96
- 6.01). A significant interaction was found between husband support
and psychological distress. Compared with women without support, women
having support were less likely to have a psychiatric disorder, (95%
CI 2.63 – 17.9). Women who gave birth to female babies reported more
risk to have psychological distress (95% CI 1.19 – 2.41).
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Table 3: Binary
Logistic regression analysis of all the significant predictors for psychological
distress |
|
|
P value |
Odds Ratio |
95% CI |
|
Lower |
Upper |
|
Unsatisfactory
income |
.034 |
3.49 |
1.34 |
9.06 |
|
Family history
of psychiatric illness |
.367 |
.67 |
28 |
1.59 |
|
Poor husband
support |
.000 |
6.88 |
2.63 |
17.96 |
|
Antenatal
PIH |
.436 |
.80 |
.46 |
1.39 |
|
Antenatal
DM |
.044 |
3.43 |
1.96 |
6.01 |
|
Abnormal
delivery mode |
.176 |
.442 |
.14 |
1.44 |
|
Admission
to NICU |
.100 |
.99 |
.83 |
8.81 |
|
Female baby
sex |
.001 |
1.259 |
1.19 |
2.40 |
|
Postpartum
fever |
.356 |
1.52 |
.63 |
3.69 |
Since the mid-20th
century, Saudi Arabia with its oil riches has been in
a socio-demographic, cultural, and economic transformation.
In the last four decades the population has increased from 4 million
(5% urban, 70% illiterate) to 28 million (80 % urban, 81% literate)
with over 50% of the population in Saudi Arabia is now less than 25
years of age.(17)
This fast transformation
and the complex social pattern of the country caused various
conflicts which may affect young women. They are more reluctant to marry
at an earlier age, choosing to pursuit higher education and careers,
less accepting of having their roles restricted to motherhood. The consequences
of these problems would have a substantial effect on the mother, her
child and the family.(18)
This study is
one of very few researches looking at postpartum psychological distress among
women from Middle East.(19-21) Moreover, to our knowledge,
it is the first to show the prevalence and putative risk factors in
young mothers.
Point prevalence
of psychiatric disturbance
The relationship
between motherhood and psychiatric illness has been extensively studied
in recent years. A large review of 20 studies of the prevalence of postpartum
psychiatric illness showed large variations related to differences in
methodology, sample size, assessment techniques (self-report vs. diagnostic
interview), timing of assessment and period of risk.(22)
The findings
of the present study indicate a high prevalence of psychological distress
among a sample of Saudi young mothers: 35.3% according to the GHQ eight
weeks after childbirth. Our results were higher than obtained from a
study of a sample of women in United Arab Emirates (23),
where psychological distress were present in 24% using Self Reporting
Questionnaire score > 6 on day 2 after delivery in 95 women admitted
for childbirth to the New Dubai Hospital. The difference may be due
to the used tool and also our tool; GHQ is brief, simple, and easy to
complete. In a recent study from Saudi Arabia, Belha et al, 2009
(24), reported that the prevalence of psychiatric disorders using a
structured interview was 14% and 16% in young and old mothers respectively
.When subgroups of psychiatric disorders were considered, the anxiety
disorders were higher in the young mothers probably due to significant
increase for the posttraumatic stress disorder and generalized anxiety
disorder.
O’Hara and
Swain (25) found that the prevalence estimates of postpartum psychiatric
disorders were higher in self-report-based studies than in interview
(diagnosis)-based studies. Furthermore, estimates were higher in studies
that used a wide window (e.g. the first 8 weeks) than in those that
used a narrow one (e.g. the first 4 weeks), and the postpartum period
under study made the largest contribution to the prediction of prevalence
estimates, accounting for 17% of the variance.
Factors
associated with psychiatric disturbance
The few
significant psychosocial correlates of postpartum GHQ-defined psychiatric
disturbance in our study are consistent with the findings of one of the previous
studies.(26) Ghubash et al., reported that low family income and lack of
emotional support are probably risk factors which have been previously
identified in a community based survey of psychological distress in women in
Gulf region.(19)
Alami et al.,
used the EPDS to follow a sample of Moroccan women from the first trimester
of pregnancy to 9 months after delivery. The study identified four risk
factors for case and non-case status (EPDS score <12), namely stressful life
events during pregnancy, baby's health problems and poor marital
relationship.(27)
Donaghy suggested
that postpartum depression occurs more frequently in women with less
supportive and understanding husbands, in lower socioeconomic groups, and where
financial constrains such that the women may be forced to go back to work and
therefore , experience guilt and anxiety about leaving the child.(28)
However, in
Lebanon, Chaaya et al., reported no association between depressed mood during
the postpartum and demographic factors such as age, education, residence and
social status.(20)
Several
obstetric factors were recognized to be associated with postpartum depression
such as complications during pregnancy and early post partum period or difficult
labor.(29)
Mothers who
experienced complications during pregnancy such as gestational diabetes in our
study reported significantly more psychological distress. However, mode of
delivery (vaginal versus cesarean) and health status of the infant did not
represent significant risk factors. This confirms previous findings relating the
mother’s general health to postpartum depression.(30)
In a
study comparing Australian and Lebanese women with postpartum depression,
De Costa found that many of the Lebanese women experienced complications
of anemia, antenatal hemorrhage and diabetes.(31)
Kozhimannil
et al., researched the association between pre pregnancy diabetes
or gestational diabetes and perinatal depression in a sample of 11 024
low income pregnant women. They found that women with diabetes compared
with those without diabetes irrespective of age had nearly
double the odds of experiencing depression
during the perinatal period.(32) Medical disorders can alter or disrupt
neurotransmitter functions or can simply act as a severe stressor. Both
mechanisms predispose to general depression or may also act with postpartum
depression. Crowther et al., and Schram et al., reported that diabetes
patients are known to have a worse quality of life and an increased
risk for depressive symptoms than individuals without diabetes.(33,34) However,
Nielson Forman et al., reported no association with postpartum depression and
any obstetric factor.(35)
An interesting
pattern appeared in the analysis of the gender of the children, the risk of
common mental disorder was higher among young mothers with female children. In
many Arab communities, boys in the family are regarded as an asset (who acts as
a future means of security for the parents) whereas girls are regarded as a
liability (a mother sometimes exerts her influence on her husband and other
members of the family through the agency of her eldest son.(36)
Inand et a., observed a
significant excess risk of depression among Turkish women with 3 or more daughters, but not with the same
number of sons, controlling for the gender of previous
children showed that mothers of female babies had higher
risk of depression, which may be important indicators of gender discrimination and
the social status of women.(37) Zhang et al., similarly showed that a husband’s
desire for a boy child was significantly associated with maternal postpartum
depression in China.(38)
Our study has
a number of limitations. First, psychological distress was assessed
by the use of a screening instrument (GHQ-12) instead of a standardized
clinical interview like the Mini International Neuropsychiatric Interview.
Therefore, we cannot interpret our results as a clinical diagnostic judgment. .
Although previous studies have shown that the GHQ-12 is useful in detecting
postpartum depressive disorders, it is not originally designed to identify a
specific psychiatric disorder in the postpartum period.(39,40)
Second,
the assessment of psychological distress was made only in the postpartum
period, and not during pregnancy. In fact, previous studies indicated
that a pre partum depressed mood was a great predictor of developing
postpartum depression.(31) Last, the data were collected during
routine clinic appointments at PHCCs in only one region (Al-Ahsa region),
which potentially limits the generalizability of the current findings.
In conclusion,
the findings of this study represent the first report from Saudi Arabia
of the prevalence of postpartum psychological distress among young mothers
attending the primary health care centers and the identification of
putative risk factors such as low family income, poor husband support,
female baby birth and gestational diabetes. Consequently, in the future,
the implantation of routine screening for psychological distress during
the antenatal visits to primary health care centers in Saudi Arabia
must be addressed.
We are grateful
to the women who participated in our study without whom this research
could not have been conducted. We are appreciating all the efforts done
by the competent nursing staff at the Maternity hospital for their help
in interviewing of cases and data collection. We are also thankful to
Abdulla Al Mukahwi, a demonstrator in Obstetrics and Gynecology Department,
College of medicine, Al Ahsa, as he was a student in the sixth medical
year and during his internship, where he assisted with data collection.
- UNICEF. A league
table of teenage births in rich nations. Innocenti Report Card No. 3;
2001
- U.S. Teenage Pregnancy
Statistics: Overall Trends, Trends by Race and Ethnicity and State-by-State
Information. New York, NY: The Alan Guttmacher Institute; 2004.
- Khoja AT, Farid
AM. Saudi Arabia Family Health Survey, Ministry of Health , Saudi Arabia,
2000
- Mahfouz AAR, El-Said
MM, Al-Erian RAG, Hamid AM. Teenage pregnancy: are teenagers a high risk
group? Eur J Obstet Gynecol Repr Biol 1995;59:17-20.
- Khwaja SS, Al-Sibai
MH, Al-Suleiman SA, El-Zibdeh MY. Obstetric implications of pregnancy
in adolescence. Acta Obstet Gynecol Scand 1986;65:57-61
- Abu-Heija A, Ali
AM, Al-Dakheil S. Obstetrics and perinatal outcome of adolescent
nulliparous pregnant women. Gynecol Obstet Invest 2002;53 (2):90–92.
- Mesleh RA,
Al-Aql AS, Kurdi AM. Teenage pregnancy. Saudi Med J 2001;22:10
- Fergerson SS, Jamieson DJ, Lindsay
M. Diagnosing postpartum depression: can we do better?
Am J Obstet Gynecol 2002;186:899–902.
- Oates MR, Cox JL,
Neema S et al. TCS-PND Group. Postnatal
depression across countries and cultures: a qualitative study. Br J
Psychiatry 2004;Suppl 46:S10–S16
- Wolf AW, De Andraca
I, Lozoff B. Maternal depression in three Latin American samples.
Soc Psychiatry Psychiatr Epidemiol 2002'37: 169–176.
- Abou-Saleh MT,
Ghubash R. The prevalence of early postpartum psychiatric morbidity
in Dubai: a transcultural perspective. Acta Psychiatr Scand 1997;95:428–432.
- Patel V, Rodrigues M, De Souza N. Gender, poverty, and postnatal depression: a study
of mothers in Goa, India. Am J Psychiatry 2002;159:43–47.
- Rahman A, Iqbal Z, Harrington R. Life events, social support and depression in
childbirth: perspectives from a rural community in the developing world. Psychol
Med 2003;33:1161–1167.
- Van Bussel JC,
Spitz B, Demyttenaere K. Women's mental health before, during, and after
pregnancy: a population-based controlled cohort study. Birth. 2006 Dec;33(4):297-302
- Navarro P, Ascaso
C, Garcia-Esteve L, Aguado J, Torres A, Martín-Santos R. Postnatal
psychiatric morbidity: a validation study of the GHQ-12 and the EPDS
as screening tools. Gen Hosp Psychiatry. 2007 Jan-Feb;29(1):1-7
- El-Rufaie
OF, Daradkeh TK.
Validation of the Arabic versions of the thirty- and twelve-item General
Health Questionnaires in primary care patients. Br J Psychiatry.
1996 Nov;169(5):662-664.
- Nation-Master.com. People Statistics by country. Available from:
http://www.nationmaster.com/cat/peo-people
- AL-Sabaie A. Psychiatry
in Saudi Arabia : Cultural Perspectives. Transcultural Psychiatry Research
Review 1989;26:245-262
- Ghubash R, Hamdi
E, Bebbington Pe. The Dubai Community Psychiatric Survey: prevalence
and sociodemographic correlates. Soc Psychiatry Psychiatr Epidemiology
1992:27:53-61.
- Chaaya M, Campbell
OMR, El Kak F, Shaar D, Harb H, Kaddour A. Postpartum depression:
prevalence and determinants in Lebanon. Arch Womens Ment Health
2002;5:65–72.
- Alami KM, Kadri
N, Berrada S. Prevalence and psychosocial correlates of depressed mood
during pregnancy and after childbirth in a Moroccan sample. Arch Womens
Ment Health. 2006:9:343-346
- O’hara MW, Zekoskei
M. Postpartum depression. In: Kumarr, Brockingtiofn, ed. Motherhood
and mental illness 2. Causes and consequences. Oxford Butterworths,
Heinemann. Woollett A, & Phoenix A. 1996.
- Abou-Saleh MT, Karim L, Ghubash R. Post-partum psychiatric admissions in A1 Ain.
Ann Saudi Med 1996:16:355-356.
- Balaha MH, Amr
MA, El-Gilany AH, Al-Sheikh FM. Obstetric and Psychiatric Outcomes
in a Sample of Saudi Teen-Aged Mothers. TAF Prev Med Bull 2009;8(4):285-290
- O’Hara MW, Swain
AM. Rates and risk of postpartum depression— a meta-analysis. Int
Rev Psychiatry. 1996;8:37–54.
- Beck CT.
Postpartum depression: a metasynthesis. Qual Health Res 2002;12:453–472.
- Alami KM, Kadri
N, Berrada S. Prevalence and psychosocial correlates of depressed mood
during pregnancy and after childbirth in a Moroccan sample. Arch Womens
Ment Health 2006:9:343-346
- Donaghy B). Postnatal
depression. Parents and Children. 1988 April/May;17:12-15.
- Josefsson A, Berg
G, Nordin C, Sydsjo G. Prevalence of depressive symptoms in late
pregnancy and postpartum. Acta Obstet Gynecol Scand 2001;80:251–255.
- Gjerdingen DK,
Chaloner KM. The relationship of women’s postpartum mental health
to employment, childbirth and social support. J Fam Pract. 1994;38:465–472.
- De Costa C. Pregnancy
outcomes in Lebanese – born women in Western Sydney. Medical Journal of
Australia. 1991;149(7):457-460
- Kozhimannil, KB,
Pereira MA, Harlow BL. Association Between Diabetes and Perinatal Depression
Among Low-Income Mothers JAMA. 2009;301(8):842-847
- Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect
of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes. NEJM. 2005;352:24
- Schram MT, Baan
CA, Pouwer F. Depression and quality of life in patients with
diabetes: a systematic review from the European depression in diabetes
(EDID) research consortium. Curr Diabetes Rev. 2009;5(2):112-119.
- Nielsen Forman
D, Videbech P, Hedegaard M, Dalby Salving J, Secher NJ. Postpartum
depression: identification of women at risk. BJOG 2000;107:1210–1217.
- Bouhdiba A. The
child and mother in Arab-Muslim society. In LC Brown, Itzkowitz N. (eds.)
Psychological Dimensions of Near Eastern Studies. Princeton. The Darwnin
Press. 1977.
- Inandi T, Elci
OC, Ozturk A, Egri M, Polat A, Sahin TK. Risk
factors for depression in postnatal first year, in eastern Turkey. Int J Epidemiol. 2002 Dec;31(6):1201-1207.
- Zhang R, Chen Q,
Li Y. Study for the factors related to postpartum depression. Zhonghua
Fu Chan Ke Za Zhi 1999;34:231–233
- Kitamura T, Shima
S, Sugawara M, Toda MA. Temporal variation of validity of self-rating
questionnaires: repeated use of the General Health Questionnaire and
Zung’s Self-Rating Depression Scale among women during antenatal and
postnatal periods. Acta Psychiatr Scand 1994;90:446–450.
- Nott PN, Cutts
S. Validation of the 30-item General Health Questionnaire in postpartum
women. Psychol Med 1982;12: 409–413.
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