Poor Marital Relationship Research Articles

Postpartum Depression and Its Impact of the Mother Child Relationship

Introduction: Depression is one of the main complications of the postpartum period [1]. Yet it is often insufficiently prevented, diagnosed and treated. Objectives: To determine the prevalence of postpartum depression and its impact on the mother-baby relationship, and to identify associated risk factors. Materials and Methods: Descriptive and analytical cross-sectional study, over a three-month period from January 1 to March 31, 2022, of postpartum women using a hetero-questionnaire (socio-demographic data); Edinburgh Postpartum Depression Scale (EPDS) and Postpartum Bonding Questionnaire (PBQ). Results: We enrolled 227 patients. The mean age of our patients was 28.8 ± 5.76 years.53.7% of our patients were primiparous, and 83.3% wanted their current pregnancy. 13.7% had given birth prematurely. The prevalence of postpartum depression was 21.1% and correlated with celibacy, low educational level, lack of desire for pregnancy and poor marital relationship. Post-partum depression is said to have an impact on family dynamics, mainly on the mother-baby relationship, and later on the child's psychological balance and development, as assessed by the PBQ. The PBQ came back disturbed in our study. Conclusion: Therapeutic, preventive and even curative measures should be proposed for postpartum women, from educational measures for women and their close circle, psychotherapeutic means to well timed and appropriate drug prescription before complications set in.

Prevalence of Postnatal Depression in Fathers: A Systematic Review and Meta-Analysis

Abstract Background and Aim Postnatal depression (PND) can affect both genders, but the common misconception is that it only affects mothers. Increasing literature reports that 10% of the fathers experience PND after childbirth. This systematic review and meta-analysis aim to determine the pooled estimated prevalence of PND among fathers in the postnatal period and identify its risk factors. Materials and Methods The electronic databases PubMed, ProQuest, BASE, DOAJ, ResearchGate, Semantic Scholar, and BioMed Central were searched for related open-access articles published between January 2010 and March 2021. Finally, 15 articles met inclusion criteria. A random-effects model was used to calculate pooled estimates and 95% confidence intervals. Results The pooled prevalence of PND in fathers was 24.06%. Partner's depression, lack of social support, poor marital relationship, low income, and low education were all shown to raise the risk of PND in fathers. Conclusion PND in fathers is a serious concern. Early identification and treatment decrease the detrimental impact on mother and child while further improving quality of life.

Construction and validation of a personalized prediction model for postpartum anxiety in pregnant women with preeclampsia.

Preeclampsia is a pregnancy-specific multi-system disease with multi-factor and multi-mechanism characteristics. The cure for preeclampsia is to terminate the pregnancy and deliver the placenta. However, it will reduce the perinatal survival rate, prolong the pregnancy cycle, and increase the incidence of maternal complications. With relaxation of the birth policy, the number of elderly pregnant women has increased significantly, and the prevalence rate of preeclampsia has increased. Inappropriate treatment can seriously affect the normal postpartum life of pregnant women. Studies have shown that postpartum anxiety in women with preeclampsia can affect physical and mental health, as well as infant growth and development. To analyze the factors influencing preeclampsia in pregnant women complicated with postpartum anxiety, and to construct a personalized predictive model. We retrospectively studied 528 pregnant women with preeclampsia who delivered in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January 2018 and December 2021. Their basic data were collected, and various physiological and biochemical indicators were obtained by laboratory examination. The self-rating anxiety scale was used to determine whether the women had postpartum anxiety 42 d after delivery. The independent factors influencing postpartum anxiety in early pregnant women with eclampsia were analyzed with multifactor logistic regression and a predictive model was constructed. The Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to evaluate the calibration and discrimination of the predictive model. Eighty pregnant women with preeclampsia admitted to our hospital from January 2022 to May 2022 were retrospectively selected to verify the prediction model. We excluded 46 of the 528 pregnant women with preeclampsia because of loss to follow-up and adverse outcomes. A total of 482 cases completed the assessment of postpartum anxiety 42 d after delivery, and 126 (26.14%) had postpartum anxiety. Bad marital relationship, gender discrimination in family members, hematocrit (Hct), estradiol (E2) hormone and interleukin (IL)-6 were independent risk factors for postpartum anxiety in pregnant women with preeclampsia (P < 0.05). Prediction model: Logit (P) = 0.880 × marital relationship + 0.870 × gender discrimination of family members + 0.130 × Hct - 0.044 × E2 + 0.286 × IL-6 - 21.420. The area under the ROC curve of the model was 0.943 (95% confidence interval: 0.919-0.966). The threshold of the model was -1.507 according to the maximum Youden index (0.757), the corresponding sensitivity was 84.90%, and the specificity was 90.70%. Hosmer-Lemeshow χ2 = 5.900, P = 0.658. The sensitivity, specificity and accuracy of the model were 81.82%, 84.48% and 83.75%, respectively. Poor marital relationship, family gender discrimination, Hct, IL-6 and E2 are the influencing factors of postpartum anxiety in preeclampsia women. The constructed prediction model has high sensitivity and specificity.

Prevalence of and relevant factors for depression and anxiety symptoms among pregnant women on the eastern seaboard of China in the post-COVID-19 era: a cross-sectional study

BackgroundAntenatal depression and anxiety symptoms may have negative consequences for both mothers and offspring, and upward trends in the prevalence of these symptoms were especially apparent during the COVID-19 epidemic. The purpose of this study was to evaluate the prevalence of and relevant factors influencing depressive and anxiety symptoms in Chinese pregnant women in the post-COVID-19 era.MethodsWe conducted an online survey of 1,963 pregnant women in Jiangsu Province, using a cross-sectional design, and collected their general demographic data. The nine-item Patient Health Questionnaire 9 (PHQ-9) was used to evaluate depression symptoms, and the seven-item Generalized Anxiety Disorder 7 (GAD-7) was used to measure anxiety symptoms.ResultsThe prevalence of reported antenatal depressive symptoms, anxiety symptoms, and depression combined with anxiety symptoms was 25.2%, 27.9%, and 18.6%, respectively. Of the respondents, the prevalence of moderate to severe depression, and anxiety was 7.9% and 7.7%, respectively. Binary logistic regression analysis demonstrated that age, low level of education, rural area, unemployment, pregnancy complications, poor marital relationship, and fair household income were positively association with both depressive and anxiety symptoms (all P < 0.05). The proportion of women reporting anxiety symptoms in the third trimester was 1.91-fold higher than in first trimester. Parity was a relevant factor for depression and anxiety symptoms (all P < 0.05).ConclusionsIn the post-COVID-19 era, the prevalence of depression and anxiety symptoms in pregnant women was higher than expected, and it is vital to establish hospital, community, and family psychological health screening systems based on relevant factors and enhance early preventive measures.

Antenatal depression is associated with perceived stress, family relations, educational and professional status among women in South of China: a multicenter cross-sectional survey.

Antenatal depression is a commonly seen mental health concern for women. This study introduced a multicenter cross-sectional survey with a large sample to provide new insights into pregnant women's depression, its socio-demographic and obstetric characteristics correlates, and its perceived stress among Chinese pregnant women. This study conducted an observational survey according to the STROBE checklist. The multicenter cross-sectional survey was performed from August 2020 to January 2021 by distributing paper questionnaires among pregnant women from five tertiary hospitals in South China. The questionnaire included socio-demographic and obstetrics information, the Edinburgh Postnatal Depression Scale, and the 10-item Perceived Stress Scale. For the analyses, the Chi-square test and Multivariate logistic regression were utilized. Among 2014 pregnant women in their second/third trimester, the prevalence of antenatal depression was 36.3%. 34.4% of pregnant women reported AD in their second trimester of pregnancy, and 36.9% suffered from AD in third trimester of pregnancy. A multivariate logistic regression model indicated that unemployed women, lower levels of education, poor marital relationships, poor parents-in-law relationships, concerns about contracting COVID-19, and higher perceived stress could aggravate antenatal depression among participants (p<0.05). There is a high proportion of antenatal depression among pregnant women in South China, so integrating depression screening into antenatal care services is worthwhile. Maternal and child health care providers need to evaluate pregnancy-related risk factors (perceived stress), socio-demographic factors (educational and professional status), and interpersonal risk factors (marital relations and relationship with Parents-in-law). In future research, the study also emphasized the importance of providing action and practical support to reduce the experience of antenatal depression among disadvantaged sub-groups of pregnant women.

Association of marital relationships with obstetrical history and physical and psychosocial factors of pregnant women in urban areas: A cross-sectional analysis from the perspective of adaptation to pregnancy

Objectives This study aimed to determine the association of marital relationships with pregnant women's obstetrical history, physical and psychosocial factors, and characteristics of women and husbands from the perspective of adaptation to pregnancy. Moreover, it sought to offer suggestions regarding support for couples during pregnancy in urban areas.Methods We distributed self-reported questionnaires to pregnant women who participated in antenatal classes, organized by Public Interest Incorporated Foundation A, in four designated cities in the Kansai region of Japan. We investigated women's obstetrical history, physical and psychosocial factors, and characteristics of women and husbands using the Japanese Prenatal Self-Evaluation Questionnaire (Relationship with Husband) (J-PSEQ). Of the 778 women, 413 (53.1%) responded. After applying the exclusion criteria, 388 participants were eligible for analysis (valid response rate: 93.9%). Based on their J-PSEQ scores, participants were divided into two groups: poor marital relationship and normal or good marital relationship. Logistic regression analysis was performed to examine the factors related to the quality of marital relationships from the perspective of adaptation to pregnancy.Results Based on the J-PSEQ scores, 93 (24.0%) participants were categorized into the poor marital relationship group, and 295 (76.0%) were categorized into the normal or good marital relationship group. For the poor marital relationship group, the logistic regression analysis showed that the odds ratios (confidence intervals) for "pregnancy after infertility treatment," "easily angered and irritated," and "husband's health: somewhat poor" were 2.54 (1.38-4.66), 3.55 (1.86-6.78), and 3.54 (1.06-11.87), respectively. Women who described household finances, husbands' working conditions, and lack of support to be the most stressful factors were more likely to have poor marital relationships. The factors associated with normal or good marital relationships included women experiencing physical discomfort, women not engaging in Satogaeri Shussan (staying at women's parents' homes before and after birth), husbands taking paternity leave after childbirth, and husbands having good health.Conclusions This study revealed that the factors associated with poor marital relationships in terms of adaptation to pregnancy were pregnancy after infertility treatment, anger and irritation in women, and poor health of husbands. Healthcare professionals may need to focus more closely on supporting such couples in urban areas during pregnancy.

Diagnosis and Management of Postpartum Depression

Postpartum Depression (PPD) is a severe mental health problem that affects up to 15% of mothers. It is highly prevalent, and its drawbacks are not limited to the affected mothers. It also extends to their offspring, causing disturbances in their development. Recent research has identified several psychosocial and biological risk factors for PPD, including past depression, stressful life events, poor marital relationships, and social support. The obstetrician, pediatrician and primary health care physicians have a crucial role in screening for and treating PPD. This review aims to provide a holistic approach for PPD diagnosis and management.

Relationship between inflammatory biomarkers, vitamin D levels, and depressive symptoms in late pregnancy and during the postpartum period: a prospective, observational study

BackgroundPerinatal depression impacts maternal and fetal health, and exhibits a high rate of continuity postpartum. Not only does it impair the maternal quality of life, it also increases the risk of adverse birth and developmental problems in offspring. Vitamin D deficiency and excessive inflammation have been associated with perinatal depression. There is a scarcity of evidence regarding the biological causes of maternal depression in Iraq, therefore, the present study aims to assess perinatal depressive symptoms associations with inflammatory markers and vitamin D levels, and to investigate the interaction between vitamin D and the inflammatory markers. A prospective, observational study design was utilized to recruit healthy pregnant women from private obstetrics clinic in Baghdad, Iraq, from April to September 2021. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms during the third trimester and at 6 months postpartum. Serum levels of interleukin (IL)-6, C-reactive protein (CRP), and 25-hydroxy vitamin D (25-OH-D) were quantified, using a fully automated chemiluminescence immunoassay analyzer.ResultsEighty patients were eligible for inclusion. The antenatal EPDS scores demonstrated a significant association with square root IL-6 (B = – 0.025, p = 0.040) and no association with CRP or vitamin D levels. The severity of postpartum depressive symptoms tended towards a positive association, with larger increases of CRP concentration (p = 0.065). In contrast, the association between marital relationship quality and CRP was statistically significant (p = 0.001). There was a statistically significant association between CRP and vitamin D concentration (p = 0.041). Antepartum EPDS significantly predicted the postpartum EPDS score (p = 0.000, B = 0.180, R2 for the model = 0.976, CI (0.17–0.19)).ConclusionsThe study findings show a significant association between third trimester depressive symptoms and IL-6 concentration. CRP and vitamin D levels do not correlate with perinatal depressive symptoms and a poor marital relationship significantly elevates the CRP level. In addition, vitamin D level was associated with CRP level and antepartum depressive symptoms predict postpartum EPDS score. Future studies involving a larger population and including women with pregnancy complications would provide a further insight into the role of inflammation and vitamin D deficiency in the etiology of perinatal depression.

Improved Interhemispheric Functional Connectivity in Postpartum Depression Disorder: Associations With Individual Target-Transcranial Magnetic Stimulation Treatment Effects.

Postpartum depression (PPD) is a depressive condition that is associated with a high risk of stressful life events, poor marital relationships, and even suicide. Neuroimaging techniques have enriched our understanding of cerebral mechanisms underlying PPD; namely, abnormalities in the amygdala-insula-frontal circuit might contribute to the pathogenesis of PPD. Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) is a recently validated neuroscience-informed accelerated intermittent theta-burst stimulation repetitive transcranial magnetic stimulation (rTMS) protocol. It has been shown to be effective, safe, tolerable, and rapid acting for treating treatment-resistant depression, and may be a valuable tool in the treatment of PPD. The purpose of the current study was to detect inter-hemispheric connectivity changes and their relationship with the clinical treatment effects of rTMS. Resting-state fMRI data from 32 patients with PPD treated with SAINT were collected and compared with findings from 32 age matched healthy controls. Voxel-mirrored homotopic connectivity (VMHC) was used to analyze the patterns of interhemispheric intrinsic functional connectivity in patients with PPD. Scores on the 17-item Hamilton Depression Rating Scale, Edinburgh Postnatal Depression Scale (EPDS) scores, and the relationships between these clinical characteristics and VMHC were the primary outcomes. Patients with PPD at baseline showed reduced VMHC in the amygdala, insula, and medial frontal gyrus compared with the HCs. These properties showed a renormalization after individualized rTMS treatment. Furthermore, increased connectivity between the left and right insula after SAINT was significantly correlated with the improvement of EPDS scores. Our results reveal the disruptions in the intrinsic functional architecture of interhemispheric communication in patients with PPD, and provide evidence for the pathophysiological mechanisms and the effects of rTMS.

Evaluation of Sociocultural, Obstetric, and Child Related Factors Associated with Postpartum Depression in Bushehr, Southwest of Iran

Background Postpartum depression (PPD) can have serious consequences for both the mother and infant. We aimed to investigate the prevalence of postnatal depression and associated sociocultural, obstetrics and child-related factors among Iranian women. Materials and Methods: This is a cross-sectional study carried out in Bushehr, Iran. 290 women from 10 public health centers were selected through stratified random sampling. Data were collected using a self-administered questionnaire from women within 12 weeks postpartum in 2019. PPD was assessed using Edinburgh Post Natal Depression Scale (EPDS), and score of >12 was considered having PPD. Results: The mean age of the respondents was 28.48 ± 5.50 years. The prevalence of depression was 24.1% in 12 weeks after delivery. Higher social support was associated with lower PPD [OR: 0.92, 95% CI: 0.88, 0.95; p <0.001]. The risk of developing PPD was 4.84 times higher in mothers with cesarean section [OR: 4.84, 95% CI: 1.89, 12.36; p =0.001], 5.19 times higher with preterm birth [OR: 5.19, 95% CI: 1.44, 18.27; p =0.01], 4.47 times higher with a history of depression [OR: 4.47, 95% CI: 1.40, 14.24; p =0.009]. The women who were satisfied with their marital relationship [OR: 0.16, 95% CI: 0.02, 0.96; p=0.04], and the baby's sleep habits [OR: 0.36, 95% CI: 0.15, 0.82; p =0.01] were less likely to suffer from PPD. Conclusion Postpartum depression was found common among mothers. The poor social support, poor marital relationship, cesarean section, preterm birth, positive history of depression, and adverse baby's sleep habits were associated with PPD. The vulnerable women should monitor their mental status and should be educated about the effective intervention strategies.

Antenatal depression and its association with adverse birth outcomes in low and middle-income countries: A systematic review and meta-analysis.

Depression in pregnancy (antenatal depression) in many low and middle-income countries is not well documented and has not been given priority for intervention due to competing urgencies and the belief that it does not immediately cause fatalities, which mainly emanated from lack of comprehensive research on the area. To fill this research gap, this systematic review was conducted to investigate the burden of antenatal depression and its consequences on birth outcomes in low- and middle-income countries. We systematically searched the databases: CINHAL, MEDLINE, EMCare, PubMed, PSyc Info, Psychiatry online, and Scopus for studies conducted in low and middle-income countries about antenatal depression and its association with adverse birth outcomes. We have included observational studies (case control, cross-sectional and cohort studies), written in English-language, scored in the range of "good quality" on the Newcastle Ottawa Scale (NOS), and were published between January 1, 2007 and December 31, 2017. Studies were excluded if a standardized approach was not used to measure main outcomes, they were conducted on restricted (high risk) populations, or had fair to poor quality score on NOS. We used Higgins and Egger's to test for heterogeneity and publication bias. Primary estimates were pooled using a random effect meta-analysis. The study protocol was registered in PROSPERO with protocol number CRD42017082624. We included 64 studies (with 44, 035 women) on antenatal depression and nine studies (with 5,540 women) on adverse birth outcomes. Antenatal depression was higher in the lower-income countries (Pooled Prevalence (PP) = 34.0%; 95%CI: 33.1%-34.9%) compared to the middle-income countries (PP = 22.7%, 95%CI: 20.1%-25.2%) and increased over the three trimesters. Pregnant women with a history of economic difficulties, poor marital relationships, common mental disorders, poor social support, bad obstetric history, and exposure to violence were more likely to report antenatal depression. The risk of having preterm birth (2.41; 1.47-3.56) and low birth weight (1.66; 1.06-2.61) was higher in depressed mothers compared to mothers without depression. Antenatal depression was higher in low-income countries than in middle-income countries and was found to be a risk factor for low birth weight and preterm births. The economic, maternal, and psychosocial risk factors were responsible for the occurrence of antenatal depression. While there could be competing priority agenda to juggle for health policymakers in low-income countries, interventions for antenatal depression should be reprioritized as vitally important in order to prevent the poor maternal and perinatal outcomes identified in this review.

Knowledge among Nurses Regarding Post-Partum Depression in a Tertiary Hospital Setting of Nepal

Introduction: Postpartum depression is an important health problem which influences well-being, quality and security of life and may cause more serious problems than major depression occurring in normal life periods. It has an adverse influence on self-esteem, skills, child care, familial responsibility and roles of the mother. The aim of the study was to find out nurses’ knowledge regarding postpartum depression.&#x0D; Material And Method: Descriptive study design was used to find out the knowledge regarding postpartum depression among nurses. Seventy-four nurses were selected from general and critical care units of a hospital by non probability enumerative sampling technique for the study. Data was collected by pre tested self-administered semi-structured questionnaire and collected data was analyzed by descriptive statistics (frequency, percentage, mean and standard deviation) with SPSS version 20.&#x0D; Results: Fifty percent of respondents knew postpartum depression (PPD) is a type of mood disorder associated with childbirth. Majority of respondents knew poor marital relationship (85%), unwanted and unplanned pregnancy (83.88%), previous mental illness (78.40%) and lack of family support (66.20%) are risk factors of PPD. Regarding symptoms of PPD respondents knew low energy (78.37%), extreme sadness (68.91%), changes in sleeping and eating pattern (67.56%) and crying (66.21%). Eighty percentages of the respondents knew PPD can be identified by observation and antidepressant drug (88%) and psychotherapy (83.78%) are medical management of PPD. Majority of respondents knew nursing management of PPD are maintaining close observation of mother (93.24%), maintaining safe environment (86.48%) and family counseling (83.78%). Eighty one percentage respondents knew poor mother infant attachment is main consequence of PPD in child and poor relationship (54.05%), suicide (33.79%) and harm to baby (12%) in mother. Fifty four percentages had low knowledge regarding PPD.&#x0D; Conclusion: It is concluded that knowledge regarding PPD is inadequate among nurses. It is recommended that hospital management should provide in-service education to nurses to uplift their professional knowledge regarding PPD and encourage applying knowledge in practice during care of women with PPD.

“Being a mom = having all the feels”: social support in a postpartum depression online support group

ABSTRACTPostpartum depression represents one of the most common complications associated with childbirth, with current estimates placing its prevalence between 13% and 19% among recent mothers. Literature suggests severe implications for both mothers and children, and identifies stressful life events, poor marital relationships, lower socioeconomic status, and lack of social support as major predictors of a PPD diagnosis. This study sought to investigate types of social support sought and received by women with PPD. In contrast with previous research, informational support was found to be the most frequently used type of support, followed by emotional support and network/community support. Selective coding revealed two overarching themes in the PPD support group: social construction of motherhood, and social barriers to treatment. The study makes policy recommendations, including suggestions to facilitate women’s access to health care and support both in offline and online settings.

The Mutual Influence Between Marital Quality and Child Oppositional Defiant Disorder Symptoms in Chinese Families: Do Child and Parent’s Gender Matter?

Frequent exposure to poor marital relationship is closely associated with behavioral and emotional problems in children, including oppositional defiant disorder (ODD) symptoms. However, the longitudinal links between parental marital quality and child ODD symptoms, and whether these links vary by child or parent gender remain unclear. In the present study, we aimed to examine the bidirectional associations between parental marital quality and child ODD symptoms and whether the associations differed across parent and child gender. The sample included 253 children with ODD and their parents and teachers from Mainland China. Parental marital quality and child ODD symptoms were measured at two waves (T1, T2), roughly 1 year apart. Results from cross-lagged analyses showed bidirectional associations between parental marital quality and child ODD symptoms in the whole sample. Specifically, more child ODD symptoms predicted poorer parental marital quality, and lower levels of parental marital quality predicted subsequent increase in child ODD symptoms. Multigroup path analysis indicated that these associations differed across child gender. That is, girls but not boys’ ODD symptoms predicted poorer parental marital quality; marital quality predicted subsequent ODD symptoms for boys but not for girls. There was no difference in the association between marital quality and child ODD symptoms for mothers and fathers. Results highlight the importance of considering child gender in understanding the bidirectional relations between parental marital quality and child ODD symptoms.

Postpartum Depression and Role of Social Demographic and Obstetric Factors

Objective: To determine the prevalence and psycho-socio-demographic predictors of postpartum depression. Design: Hospital based descriptive observational prospective study. Setting: Tertiary care hospital. Population: Day 2 postpartum women. Method: 800 women were selected randomly and divided into two groups. Group A consisted of women delivered by caesarean section and group B of women delivered vaginally. These women were screened with Edinburgh postnatal depression scale and were evaluated. Result: Out of total, 22.5 % women in group A and 21.5% in group B were found to be depressed (overall incidence being 22%). In group A the main reason for depression was poor health or death of the child( 58.14%). They were of age group 20-24 years (57.14%), para 2 (57.14%) and belonged to upper-lower socio-economic status (53.57%). In group B the reason was sex of the child (54.44%). They were of age group 25-29 years (75%), para 3 (75%) and belonged to upperlower socio-economic status (75%). The history of depression in the family was not known to the women in both the groups. Conclusion: Rate of postpartum depression is high. The causes can be multiple including ill health of the baby and mother, sex of the child, family problems in the form of poor marital relationship, low socioeconomic condition etc. Women should be screened and counseled during the antenatal and postnatal period. Family support should be encouraged.

Self-harm attempters’ perception of community services and its implication on service provision

ObjectiveThis study aimed at exploring the attempters’ perception of community social services included any barriers to seeking help and services. MethodThe participants were patients with self-harming behavior aged 15 years or above. A set of guiding questions were designed to explore the general barriers and accessibility to community social services. A voice recording was made, which was later converted into a text transcript and then preceded for content analysis with co-occurrence and similarity matrix interpretation. Two males and nine females with a history of self-harm aged between 24 and 58 years were recruited for the interviews. ResultThe participants had diverse experiences and backgrounds, and attitudes toward community social services. However, there was a shared perception of the need to enhance community social services. There were four main themes and 12 sub themes identified. The main theme included the service availability, service accessibility, affordability and acceptability. For details, participants were unaware of the available types of care/social services in the community, and were unaware about the nearby social services. They also suggested extending service hours and focused services should be offered to help people with different backgrounds and needs. Actually, those with experience of service utilization had both positive and negative perspectives and they gave suggestions for service delivery, mainly extending service hours and offering focused services such as for gambling control and financial planning. In view of interaction with service providers, counseling skills and trust were highly appreciated by the participants. ConclusionThe results identified common circumstances of falling into financial hardship (gambling) and social fragmentation (divorce, poor family relationships, and poor marital relationships), which also suggested to enhance services on center location, service arrangement, and skill of caregivers.

Sexual intimacy and marital relationships in a low-income urban community in India

Data from a six-year study of married women’s sexual health in a low-income community in Mumbai indicated that almost half the sample of 1125 women reported that they had a negative view of sex with their husbands. Qualitative interviews and quantitative survey data identified several factors that contributed to this diminished interest including: a lack of foreplay, forced sex, the difficulty of achieving privacy in crowded dwellings, poor marital relationships and communication, a lack of facilities for post-sex ablution and a strong desire to avoid conception. Women’s coping strategies to avoid husband’s demands for sex included refusal based on poor health, the presence of family members in the home and non-verbal communication. Factors that contributed to a satisfactory or pleasurable sexual relationship included greater relational equity, willingness on the part of the husband to not have sex if it is not wanted, a more ‘loving’ (pyaar karna) approach, women able to initiate sex and greater communication about sexual and non-sexual issues. This paper examines the ecological, cultural, couple and individual dynamics of intimacy and sexual satisfaction as a basis for the development of effective interventions for risk reduction among married women.

THE RELATIONSHIP BETWEEN POST PARTUM DEPRESSION WITH MOTHER-BABY EMOTIONAL BONDING, BREASTFEEDING ABILITY, MARRIAGE SITUATION RELATIONSHIP IN PUSKESMAS MALANG REGION

A woman's transition into motherhood brings about physical and psychological changes. The changes require adjustments to her daily roles and activities. If the postpartum mother is not able to adapt well, then there will be a mood disorder. Depression is a part of mood disorder. The impact of postpartum depression will disrupt the mother-infant bonding, breastfeeding self-efficacy and the changing of marriage partnership. The purpose of this research was to analyze the impacts most affected by the incidence of postpartum depression in the working area of public health Malang City. The research used descriptive correlational method with cross sectional, with purposive sampling of 70 respondents in the period April 26th, 2017 - May 30th, 2017. The results are 93% of post-partum mothers experience moderate depression affecting low breast-feeding ability 54.3%, poor marital relationship situation 52.9% and moderate emotional bonding disturbances 47.1%. The result of bivariate analysis is known to the effect of postpartum depression, namely breastfeeding ability (p value = 0,011), marital relationship situation (p value = 0.014), emotional bond (p value = 0,021). The results of logistic regression test showed that the impact most influenced by postpartum depression was the ability of breastfeeding (p value = 0,011; ExpB 6,394). Postpartum mothers can predict the incidence of depression by looking at three aspects directly including the breastfeeding self-efficacy, marriage partnership and mother-infant bonding. Of the three aspects of the most influential is the breastfeeding self-efficacy. In the next research should be done at a wider population level in order to be able to cover the area of Malang generally.

Background factors associated with problem avoidance behavior in healthy partners of breast cancer patients.

We evaluated avoidance behaviors of healthy partners of breast cancer patients and sought to (1) describe men's perception of their own avoidance behavior and (2) identify the background factors associated with such behavior. An Internet-based survey was conducted, and analysis was performed on the responses of 368 male spouses of female breast cancer patients. Thirty to forty percent of spouses had some type of problem avoidance behavior toward their wives. There was a high correlation (r=0.70, P<.001) between problem avoidance behavior at the time of diagnosis and subsequent problem behavior (mean follow-up period after diagnosis: 1.3+1.1years). The characteristics of spouses with avoidant behaviors included having wives with recurrence, having wives treated with anticancer drug therapy or total resection, and having their own experience of cancer. Covariance structure analysis revealed 2 factors related to the background of spouses with problem avoidance behavior: (1) having a sense of difficulty in coping (beta=0.68, P<.001) and (2) having a poor marital relationship (beta=-0.27, P<.001). Our findings suggest that problem avoidance behavior among healthy male partners of breast cancer patients is common and correlates with difficulty coping and a poor marital relationship. It is important to address both the problem avoidance behavior itself and to support couples early, before this behavior surfaces.

Maternal screening for early postnatal vulnerability.

Research has highlighted the wide impact of maternal mental health problems during and beyond the postpartum period and the public health role of community health professionals in early detection of women who may be at risk. This paper aims to describe, explore and test an a priori hypothesised conceptual model of postnatal experience, identifying the relationships between postnatal mental vulnerability and postnatal adjustment to maternal roles and attitudes, marital/partner-relationship and sense of coherence. Three validated self-report questionnaires (WAST, MAMA, SOC) measuring the variables of the encompassing framework and EPDS were administered in random order. The conceptual models were tested using the software IBM SPSS Statistics and LISREL and the tests performed were: Student's ttest, chi-square tests, Explanatory factor analysis using a Varimax rotation Principal Components Method, Confirmatory analysis -known as structural equation modelling- of principal components. Psychometric scores indicate high correlation between WAST, MAMA, SOC and EPDS. An exploratory factor analysis confirmed the role of SOC, specific MAMA subscales (maternal roles and attitudes, body image, sex, breasts, nausea) and WAST (relationship tension and emotional and physical abuse) subscales (KMO measure of sampling adequacy=0.735 and Bartlett's test of sphericity=184,786, df=36, p<0.0005). The latent variables confirmed with SEM were marital relationship, maternity experience and self-efficacy (Chi-square=28.45, df=24, P-value=0.24, RMSEA=0.046 p<0.05). Marital Relationship (Factor I: Eigenvalue=3.066) concerning lack of or disappointment with partner support, poor marital relationship and emotional/physical abuse has been associated with high levels of postpartum anxiety and depression. Maternity Experience (Factor II: Eigenvalue=1.280) representing postnatal roles and attitudes towards their infant can be as useful as mood changes for evaluation of mothers. Self-Efficacy (Factor III: Eigen- value=3.144) and especially attitudes regarding body image, sex and coping resources and options of dealing with the stressor, has been demonstrated that serve as a mediator or buffer for psychological distress. The results of this study have implications for the prevention and intervention of postnatal adjustment difficulties both of which need to be intensified in order to minimise perinatal mental vulnerability.