Perinatal Depressive Symptoms among Women in North-Eastern Thailand : Risk Factors, Support and Prevention

Abstract: Perinatal depressive symptoms among women remain a global burden. Improvements in self-efficacy among public health professionals (PHPs) in primary healthcare settings to detect and manage perinatal depressive symptoms among women are needed.The aims of this thesis were to: identify prevalence and risk factors associated with perinatal depressive symptoms among women; to explore and describe life situation and support among women with antenatal depressive symptoms (ADS) and their partners; and to improve self-efficacy of PHPs in detection and management of perinatal depressive symptoms in Sakonnakhon province in Thailand. Qualitative and quantitative studies with different types of data collection methods were used.Study I determined prevalence of ADS and associated risk factors among 449 Thai women in late pregnancy using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence was 46.8% and associated risk factors were insufficient money, being a teenager, low psychological well-being, low self-esteem and low sense of coherence.Study II explored and described life situation and support during pregnancy among women with ADS and their partners using semi-structured interviews. Four categories emerged: Having obstacles in life, Facing life situation, Enhancing confidence and Dissatisfaction with help.Study III determined risk factors associated with postpartum depressive symptoms at one month among 319 women and at three months among 276 women. Risk factors at one month were antenatal psychological well-being, non-exclusive breastfeeding, low personal income and caregiver not a mother; risk factors at three months were unintended pregnancy, low personal income/month, low self-esteem, low psychological well-being and low maternal competence.Study IV evaluated a self-efficacy improvement programme (SIP) intended to increase PHPs’ self-efficacy in efforts to detect and manage perinatal depressive symptoms among women. After the SIP, PHPs in the intervention group (n=33) had higher self-efficacy scores than PHPs in the control group (n=33). Four categories emerged in qualitative evaluation: Having confidence, Changing knowledge and attitudes, Increasing perception of an important role, and Increasing awareness of performed function.Women who are at increased risk for perinatal depressive symptoms should be screened using the EPDS. Health care professionals should involve expectant fathers in ANC process. The SIP enhances PHPs’ ability to detect and manage perinatal depressive symptoms.