Postpartum depression in cambodia women = trầm cảm sau sinh ở phụ nữ campuchia

VIETNAM NATIONAL UNIVERSITY HA NOI
UNIVERSITY OF EDUCATION

TEP PHARIN

POSTPARTUM DEPRESSION IN CAMBODIA WOMEN

MASTER’S THESIS IN PSYCOLOGY

HANOI, VIETNAM: April, 2016


VIETNAM NATIONAL UNIVERSITY HA NOI
UNIVERSITY OF EDUCATION

TEP PHARIN

POSTPARTUM DEPRESSION IN CAMBODIA WOMEN

MASTER’S THESIS IN PSYCOLOGY
Major: Clinical psychology of children and adolescents
Code: Pilot

Supervisor: Prof. Dr. Bahr Weiss
Dr. Tran Thanh Nam

HANOI, VIETNAM: April, 2016


SUPERVISOR’S RESEARCH SUPERVISION
STATEMENT

TO WHOM IT MAY CONCERN

Name of program: Master‟s degree of Art in Clinical Psychology, specialize in
Child and
Adolescent Clinical Psychology.
Name of candidate: Tep Pharin
Title of research: Post-partum depression in Cambodia women
This is to certify that the research carried out for the above titled master„s
thesis was completed by the above named candidate under my direct supervision.
This thesis material has not been used for any other degree. I played the following
part in the preparation of this thesis:

Supervisor (s)…………………………….
Date………………………………………


ABSTRACT
Cambodia is one of the developing countries where postpartum depression
has a high predictive rate. Unfortunately, there is no data on postpartum depression.
This study was the first study which explored the rate of postpartum depression and
anxiety in women in Cambodia. According to GAD -7 measures, 26% of our
participants had moderate and severe anxiety. According to EPDS, 30% of our
participants had moderate and severe depression. The rate of anxiety and depression
among our participants are very high. Therefore, policy makers, researchers, health
practitioners should pay more attention to the issues in order to improve the life of
women and their infants. There should be more research into these issues in order to
have a better understand of these issues. Particularly, the next research should
include more women, expand the age‟s ranges of participants as well as the
geographic of the participant in order to achieve a more representative sample.

TABLE OF CONTENTS
ABSTRACT .............................................................................................................. iv
Table of Contents ........................................................................................................v
ACKNOWLEDGEMENT ........................................................................................ vi
1.1 Background and Rationale of the Research .......................................................1
1.2 Research Problem ..............................................................................................2
1.3 Research Objectives...........................................................................................3
1.4 Scope of the Research ........................................................................................3
1.5 Significance of the Research .............................................................................4
PART II - LITERATURE REVIEW ........................ Error! Bookmark not defined.
2.1 What is postpartum depression? ...................... Error! Bookmark not defined.
2.2 Measures of Postpartum Depression ............... Error! Bookmark not defined.
2.3 Prevalence of postpartum depression around the world Error! Bookmark not
defined.
2.4 Effect of post-partum depression on the child. Error! Bookmark not defined.
2.4 Risk factors in postpartum depression: ............ Error! Bookmark not defined.
PART III - RESEARCH METHODOLOGY ........... Error! Bookmark not defined.
3.1 Sample and data collection .............................. Error! Bookmark not defined.
3.2 Instrument and Scales ...................................... Error! Bookmark not defined.
3.3Ethics ................................................................ Error! Bookmark not defined.
3.4 Data Analysis ................................................... Error! Bookmark not defined.
PART IV - RESULTS ............................................... Error! Bookmark not defined.
4.1 Demographic characteristics ............................ Error! Bookmark not defined.
4.2 Preliminary analyses: Mean levels of variables ............ Error! Bookmark not
defined.
4.3 Primary analyses: Prediction of postpartum depression, and anxiety ..... Error!
Bookmark not defined.
PART V - DISCUSSION .......................................... Error! Bookmark not defined.

PART VI - CONCLUSION AND RECOMMENDATION ... Error! Bookmark not
defined.


6.1 Conclusion: ...................................................... Error! Bookmark not defined.
6.2 Recommendations ............................................ Error! Bookmark not defined.
REFERENCES ............................................................................................................5


ACKNOWLEDGEMENT
I would first like to thank my thesis advisors Dr. Bahr Weiss and Dr. Nam
Tran who always provided patient and insightful responses whenever I ran into a
trouble spot or had a question about my research or writing. His guidance helped
me in all the time of research and writing of this thesis. I could not have imagined
having a better advisor and mentor for my Ph.D study.
I would also like to acknowledge The University of Education, Vietnam
National University and well as National Institutes of Health give me a chance to
participate in their wonderful Master program. Without they precious training it
would not be possible to conduct this research.
Finally, I must express my very profound gratitude to my parents and to my
husband for providing me with unfailing support and continuous encouragement
throughout my years of study and through the process of researching and writing
this thesis. This accomplishment would not have been possible without them. Thank
you.


PART I - INTRODUCTION
1.1 Background and Rationale of the Research
In modern society, the role of women is increasing, leading to more of a focus
on issues surrounding them. Among the issues, health, especially mental health is

getting more attention from policy makers, researchers, and practitioners. Mental
health becomes an important issue for woman because improving mental health
improves the quality of life for the woman as well as their functioning in society.
According to The National Institute of Mental Health (2015), woman are faced with
many mental health problems, common ones being anxiety, bipolar disorder, attention
deficit hyperactivity disorder, borderline personality disorder, eating disorders,
postpartum depression, depression, and schizophrenia. Among these problems,
postpartum depression is known as one of the most common mental health issues in
mothers and prenatal woman (Hanlon 2013).
Women with postpartum depression experience depression symptoms: sadness,
worries, withdraws, and thoughts harming themselves and their children. Postpartum
depression is different from other kinds of depression because its symptoms start to
develop within one year after the mother gives birth. Because postpartum happens
during a critical time, its effects go beyond the common effects of general depression,
creating significant consequences for the suffering mothers and their children. While
having a baby should be a happy time, postpartum depression makes the mothers suffer
sadness. After giving birth, the mothers need to cover from the labor, experiencing
postpartum depression symptoms prevents them from recovering normally and adds
another burden for them to cope with. The symptoms of postpartum depression also
prevent the suffering mothers from completing their duties with their children, thus
affecting their childrens‟ development. Additionally, its symptoms are opposite from
the typical feelings of new mothers. Instead of being happy to have a baby and feeling
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skilled enough to take care of their children, Bilszta, Ericksen et al. (2010) showed
evidence that woman suffering from postpartum depression have some belief and fear
that prevent them from seeking help, making the effects of the issues even heavier
Postpartum depression is well known in developed countries. O'hara and Swain
(1996) did a meta-analysis of 59 studies. The total participants were 12,810, and their

analysis showed that the prevalence of postpartum depression was 13%. Gavin, Gaynes
et al. (2005) did a more recent systematic review that showed that the frequency of
postpartum depression was 19.2% with 7.1% for major depression and 12.2% for
minor depression. Two large studies done in Europe recently both predicted that the
occurrence of postpartum depression is about 9.2% to 9.6% (Navarro, García-Esteve et
al. 2008, Banti, Mauri et al. 2011). Although the rates vary between these studies, they
show that the prevalence of postpartum depression is quite significant among woman.
Like many other mental health issues, postpartum depression is not getting as
much attention in developing countries as it is in developed countries. In their recent
review the data of postpartum depression in low and middle income country, Parsons,
Young et al. (2012) conclude that much less is known about this issue in developing
countries compared to what has been determined in the high income countries. Among
available data, the rate of postpartum depression in developing countries varies from
4.9% (Nepal) to 33% (Vietnam). Southeast Asia has a significant rate of postpartum
depression: 11.5% (Malaysia), 13.3% (Thailand), 16.3%, and 33% (Vietnam). Besides
having a high rate, most postpartum depression, like other maternal depression,
remains undiagnosed and untreated in middle and low income countries. Therefore,
greater attention needs to be paid to postpartum depression in developing countries.
1.2 Research Problem
Cambodia is one of the developing countries where postpartum depression has a
high predictive rate. Unfortunately, there is no data on postpartum depression. As a
Cambodian woman, I believe that Cambodian woman carry a lot of burdens during the
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time surrounding the birth of a baby. Culture beliefs and practices could put more
stress during the postpartum time for mothers. First, the society is hierarchical, woman
have “double duty” both working and taking care of the family (Ebihara, Mortland et
al. 1994) thus, woman undergo a lot of stress and pressure. The Khmer has a proverb
"num min thom cheang nil" meaning that parents know to choose who to married

better than a child (Ebihara, Mortland et al. 1994). Many married couples in Cambodia
are still arranged, which leads to potential problems including an unhappy married life,
thus reducing the support the women have during their postpartum time. White (2004)
also pointed out some potential harmful traditional practices including a high salt diet
during the postpartum period, drinking Khmer medicines infused in rice wine while
roasting, labor work at home (delivery the child at home). In order to have better
understanding about postpartum depression, our study aims to be the first study to
investigate the rate of and the risk factors surrounding postpartum depression among
Cambodian women. The results of the study will provide information to policy makers
and practitioners to improve the lives of mothers in Cambodia.
1.3 Research Objectives
The aims of this research study are (1) To assess the incidence of postpartum
depression in Cambodian women; (2) To identify risk factors for postpartum
depression in Cambodian women; (3) To assess at the relationships among factors
related to postpartum depression in Cambodian women.
1.4 Scope of the Research
Very little research has been conducted on postpartum depression in Cambodia.
This research study will be focused on a sample of 50 women in a single district on the
province of Kandal (Mukh Kampul district) in Cambodia. Research was collected
during a 1-month time frame in May 2015.This research study will focus on the
potential risk factors of postpartum depression in Cambodian women. The main target
group consists of 50 mothers who delivered their babies in the period of 3 to 6 months.
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1.5 Significance of the Research
Even though the sample of this study is small, it is the first data collected on
postpartum depression in rural areas in Cambodia. This data allows an estimate on the
prevalence and the seriousness of postpartum depression in Cambodia. The result,
therefore, could make policy makers pay more attention to the issue. This data also

tries to provide an understanding of some risk factors for postpartum depression.
Understanding these risk factors would help practitioners in implementing prevention
and intervention strategies to help the postpartum women.

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