Postpartum depression: a cross-cultural perspective

Abstract

The postpartum period represents a time of increased risk for psychiatric disorders. Mood disorders include postpartum blues, transient depressive symptoms occurring between postpartum days 3–12 in 50%–80% of new mothers. There is consensus that the incidence of new onset of depression using standard clinical interviews is between 10%–15% in North American and European women who give birth. Therefore postpartum depression is a frequent and significant risk for the new mother. Detection of postpartum depression by primary care providers requires recognition of symptoms of depression or the screening of women with standardized instruments. These tasks are complicated when assessing women from different cultures. This article gives practical recommendations for the many obstetricians who treat women from different cultures. Somatization is a prominent expression of depression in Hispanic, Asian, and African cultures. Complaints of sadness and feelings of guilt are more characteristic of depression in Western cultures than in Hispanic, Asian, or African cultures. The Edinburgh Postnatal Depression Scale (EPDS), a widely used self-report screening instrument, does not detect depression in Japanese women and caution needs to be exercised in using it to screen women from non-Western cultures. Low rates of postpartum depression are reported in some studies of Asian women in their native country in contrast to high rates of depression in some immigrant populations. The stress of acculturation could contribute to these differences. Postpartum rituals practiced in several different cultures (Hispanic, Asian, African) can assist the woman in the transition to motherhood. When practiced by immigrant women these rituals could alleviate the acculturation stress. As the United States and Europe become increasingly multicultural, clinicians will want to be aware of the role of culture in the rite of passage to parenthood and in postpartum practices, so that they can better mobilize the woman’s internal and external resources.