Postpartum Depression : A Study Among Malay Women Attending Urban and Rural Health Centres in Kedah, North West of Peninsular Malaysia

Aims: To determine the rates and influence of various putative risk factors (sociodemographic, life events, measures of social support, obstetrics, neonatal and cultural variables) of postpartum depression among Malay women attending rural and urban health centres in Kedah, North West of Peninsular Malaysia; and to compare the findings to other available local and international studies.
Method: This two-stage population survey was conducted between July and December 2002. Malay women between 4 to 12 weeks postpartum attending designated urban and rural health centres in Kedah were randomly selected. Details of the independent risk factors were assessed using specifically designed questionnaires, the Malay version of the MOS Social Support Survey and items adopted from the Postpartum Depression Predictors Inventory. Double screening test strategy using the Malay versions of the
Edinburgh Postnatal Depression Scale (EPDS) and Beck Depression Inventory I1 (BDI-11) was employed in the first stage. Those scoring either 2 12 on EPDS or 210 on BDI-I1
(or both) were interviewed using the Composite International Diagnostic Interview (CIDI) and 17 items Hamilton Rating Scale for Depression (HRSD). Diagnosis of
postpartum depression was only made if the women fulfilled the required criteria [pitt’s criteria (1968) and the Tenth Edition of the International Classification of Disease -
Diagnostic Criteria for Research 1993 (ICD 10: DCR 10) criteria for depressive episode]. Results: 354 women were finally recruited and 58 (16.38%) of them fulfilled the criteria for postpartum depression. The rates were higher among rural women (21.08%) compared to their urban counterparts (1 1.24%). 22 independent variables with p 5 0.05 on univariate analyses were then entered into Stepwise Multiple Logistic Regression (Forward Likelihood Ratio). 8 predictor variables specifically polygamous marriage, low
total household income, non-spontaneous vaginal delivery, presence of financial problem, existence of infant’s health or feeding problems, low scores on the overall support index
of the MOS Social Support Survey and taking selected diet during the postpartum period, were finally identified and linked to higher propensity to develop postpartum depression. Methodological issues, limitations and recommendations were discussed. Conclusions: Postpartum depression is a reality among Malay women attending both
urban and rural health centres in Kedah, North West of Peninsular Malaysia. Its rate is comparable to other international figures and certainly not as low as previously
anticipated. Finally, despite possessing some similar correlates and risk factors described in other western studies, postpartum depression among Malay women is also shaped by their own unique socio-cultural characteristics.