Abstract
BackgroundMost women with postpartum depression (PPD) in low- and middle-income countries remain undiagnosed and untreated, despite evidence for adverse effects on the woman and her child. The aim of this study was to identify the coping strategies used by women with PPD symptoms in rural Ethiopia to inform the development of socio-culturally appropriate interventions.MethodsA population-based, cross-sectional study was conducted in a predominantly rural district in southern Ethiopia. All women with live infants between one and 12 months post-partum (n = 3147) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those scoring five or more, ‘high PPD symptoms’, (n = 385) were included in this study. The Brief Coping with Problems Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis.ResultsConfirmatory factor analysis of the brief COPE scale supported the previously hypothesized three dimensions of coping (problem-focused, emotion-focused, and dysfunctional). Emotion-focused coping was the most commonly employed coping strategy by women with PPD symptoms. Urban residence was associated positively with all three dimensions of coping. Women who had attended formal education and who attributed their symptoms to a physical cause were more likely to use both problem-focused and emotion-focused coping strategies. Women with better subjective wealth and those who perceived that their husband drank too much alcohol were more likely to use emotion-focused coping. Dysfunctional coping strategies were reported by women who had a poor relationship with their husbands.ConclusionsAs in high-income countries, women with PPD symptoms were most likely to use emotion-focused and dysfunctional coping strategies. Poverty and the low level of awareness of depression as an illness may additionally impede problem-solving attempts to cope. Prospective studies are needed to understand the prognostic significance of coping styles in this setting and to inform psychosocial intervention development.
Highlights
Most women with postpartum depression (PPD) in low- and middle-income countries remain undiagnosed and untreated, despite evidence for adverse effects on the woman and her child
Given the challenges associated with safety and acceptability of psychotropic medicines in the perinatal period, there is a need for contextually appropriate psychosocial interventions [17, 18]
There was a 100% response rate in the women screened for Postpartum Depression (PPD) symptoms
Summary
Most women with postpartum depression (PPD) in low- and middle-income countries remain undiagnosed and untreated, despite evidence for adverse effects on the woman and her child. The aim of this study was to identify the coping strategies used by women with PPD symptoms in rural Ethiopia to inform the development of socio-culturally appropriate interventions. Postpartum depression (PPD) is a major public health concern in low and middle income countries (LMICs) [1]. PPD is the most common mental health problem in the perinatal period, with a weighted mean prevalence estimate of 19.8% (95% confidence interval 19.5 to 20.0%) in community studies from LMICs [2]. There is burgeoning evidence for effective psychosocial interventions for PPD that can be provided by non-mental health professionals in middle-income countries [19,20,21], but little from rural, low income country settings. Adaptation and successful implementation of a psychosocial intervention requires an understanding of women’s existing coping mechanisms within that context
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