Academic journal article Bulletin of the World Health Organization

Common Perinatal Mental Disorders in Northern Viet Nam: Community Prevalence and Health Care Use/ Troubles Mentaux Perinataux Communs Dans le Nord Du Viet Nam: Prevalence Communautaire et Utilisation Des Soins De Sante/ Trastornos Mentales Perinatales Frecuentes En El Norte De Viet Nam: Prevalencia En la Comunidad Y USO De la Atencion Sanitaria

Academic journal article Bulletin of the World Health Organization

Common Perinatal Mental Disorders in Northern Viet Nam: Community Prevalence and Health Care Use/ Troubles Mentaux Perinataux Communs Dans le Nord Du Viet Nam: Prevalence Communautaire et Utilisation Des Soins De Sante/ Trastornos Mentales Perinatales Frecuentes En El Norte De Viet Nam: Prevalencia En la Comunidad Y USO De la Atencion Sanitaria

Article excerpt

Introduction

Common perinatal mental disorders in women are associated with reduced social participation and caregiving capacity and constitute a significant public health problem. In high-income countries, about 10% of pregnant women and 13% of mothers of infants have significant mental health problems, depression and anxiety being the most common. (1,2) Rates are much higher in resource-constrained countries. Among women attending antenatal services, screening criteria for depression were met by 16% in Tamil Nadu, (3) 25% in rural Pakistan (4) and 23% in Goa. (5) Such criteria were met by 34.7% of mothers of infants in a poor South African township (6) and by 40% in Rawalpindi, Pakistan. (7) Even in these contexts, most evidence is derived from women attending hospitals, which are only accessible to relatively advantaged urban dwellers. (3,5,8,9) Little research has been conducted among the poorest rural-dwelling women who give birth in local health centres or without skilled attendants at home. (4)

Evidence is emerging that mental disorders contribute to maternal mortality and morbidity in Viet Nam. Of 796 pregnancy-related deaths in seven provinces in 2000-2001, up to 16.9% were attributed to suicide. The prevalence of suicide was highest in the poorest rural provinces, where health services were limited. Psychiatric illness and exposure to family violence were not assessed, but the authors concluded that "community behaviours towards women" must be considered as a potential contributing factor. (10) In 2000, 506 mothers of 6-week-old infants attending Ho Chi Minh City immunization clinics were surveyed using a translated, culturally-verified and back-translated form of the Edinburgh Postnatal Depression Scale (EPDS). (8,11) In the absence of local validation, a clinical cut off score of 12 points was used. The average EPDS score was 9.49 ([+ or -] 6.32) points, and 32.8% of the women scored > 12; 19.4% acknowledged thoughts of not wanting to live anymore (translated Item 10), 64% of them at least quite frequently. In the Young Lives longitudinal study of childhood poverty, 20% of mothers of 6-month-old infants met the "caseness" criteria of the Self-Reporting Questionnaire for psychiatric screening of the World Health Organization (WHO). (12,13) In the only investigation of antenatal mood conducted to date, EPDS scores > 12 were found less frequently among socioeconomically-advantaged women attending clinics at a tertiary-level Hanoi hospital, which suggests a social gradient in prevalence. (14) None of these studies used diagnostic interviews to confirm screening data, and this may have yielded overestimates.

Viet Nam has well-developed public and primary health care systems: most women (88%) have a skilled attendant at birth, and infant immunization coverage is > 90%. (15) Iron deficiency anaemia associated with hookworm infection and low meat consumption are prevalent in pregnant women (54%) and those who have recently given birth (62%), especially in rural provinces. (16) With the introduction of a national iodized salt programme, the prevalence of antenatal iodine deficiency and hypothyroidism in women decreased, but it has recently increased again, especially in the delta regions. National antenatal dietary supplementation programmes have been implemented to reduce the prevalence of these conditions, but for reasons as yet unknown, the uptake of free or subsidized supplements is incomplete. Mental health is not considered in initiatives to make pregnancy safer in Viet Nam, and its role as a determinant of participation in preventive health care is overlooked.

The primary objective of this study was to establish the prevalence and determinants of common perinatal mental disorders in women living in rural and urban provinces in northern Viet Nam. A secondary objective was to investigate whether such disorders, socioeconomic status or exposure to violence were associated with the use of psychiatric and preventive health care

Methods

Setting

The study was conducted in one urban and one rural province in northern Viet Nam. …

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