OBJECTIVE: To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. METHODS: Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. FINDINGS: Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CONCLUSION: CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

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Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

Objective: The Edinburgh Postnatal Depression Scale (EPDS) is the most widely used screening tool for postpartum depression (PPD). We systematically reviewed the published evidence on its validity in detecting PPD and antepartum depression (APD) up to July 2008.

Method:  Systematic review of validation studies of the EPDS included 1987–2008. Cut-off points of 9/10 for possible PPD, 12/13 for probable PPD and 14/15 for APD were used.

Results:  Thirty-seven studies met the inclusion criteria. Sensitivity and specificity of cut-off points showed marked heterogeneity between different studies. Sensitivity results ranged from 34 to 100% and specificity from 44 to 100%. Positive likelihood ratios ranged from 1.61 to 78.

Conclusion:  Heterogeneity among study findings may be due to differences in study methodology, language and diagnostic interview/criteria used. Therefore, the results of different studies may not be directly comparable and the EPDS may not be an equally valid screening tool across all settings and contexts.

A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women.

Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries.

Magnitude and risk factors for postpartum symptoms: a literature review.

Postpartum depression in Asian cultures: A literature review

The aim was to assess the clinical applications of anxiety social support stressors and self-esteem as well as the Postpartum Depression Risk Scale (PDRS) measured during pregnancy and postpartum for screening postpartum depression. A questionnaire regarding anxiety social support stressors and self-esteem was administered to 400 women during 36-40 weeks of gestation and 6-8 weeks postpartum prospectively using factor analysis. The enrolled women were interviewed 6-8 weeks postpartum by psychiatrists using a diagnostic system of the Diagnostic and Statistical Manual for Mental Disorders Fourth Edition (DSM-IV) for diagnosis of postpartum depression. Multiple logistic regression was used to identify the significant predictors for postpartum depression and then developed to be the PDRS and tested for clinical benefit. Of 400 enrolled women 40 (10%) were diagnosed with minor or major postpartum depression. After factor analysis 10 items of anxiety 10 items of social support four items of stressors and five items of self-esteem were identified with a standardized reliability coefficient of 0.85 0.82 0.81 and 0.82 during pregnancy and of 0.84 0.82 0.85 and 0.84 during the postpartum period respectively. During pregnancy a significant predictor was anxiety about postpartum depression but postpartum significant predictors were anxiety and social support which were generated to be PDRS. The clinical benefit of PDRS as a measure was better postpartum than during pregnancy. Anxiety and social support were identified as the predictors of postpartum depression. The development of the PDRS is clinically beneficial and useful during pregnancy and postpartum for the screening of postpartum depression in Thai women. (authors)

Clinical applications of anxiety, social support, stressors, and self-esteem measured during pregnancy and postpartum for screening postpartum depression in Thai women.

This study aimed to validate and determine an appropriate cut-off score on the Thai Edinburgh Postnatal Depression Scale (EPDS) as a screen for postpartum depression. A prospective cohort of postpartum women at 6-8 weeks were tested using the EPDS and clinically interviewed by psychiatrists to establish a DSM-IV diagnosis of major or minor depressions in a university hospital in Southern Thailand. Of 351 postpartum women interviewed, 38 postpartum women met the criteria for depressive disorders, major depression in four women (1%) and minor depressive disorder in 34 women (10%). The area under the curve was 0.84 (95% confidence interval 0.76-0.91). Using an EPDS cut-off sum score of 6/7, major and/or minor depression was detected with a sensitivity of 74%, specificity of 74%, positive predictive value of 26% and negative predictive value of 95%. When the cut-off score was higher, the sensitivity was lower but the specificity was higher. The Thai version of the EPDS is a valid self-report instrument and is useful in Thailand where no other screening instrument for postpartum depression is available.

Validation of the Thai Edinburgh Postnatal Depression Scale for screening postpartum depression.

To validate a Postpartum Depression Screening Scale (PDSS) for screening postpartum depressive disorder in Songkhla Thai population, a screening test was conducted. A Thai version of the PDSS was developed using back translation and pre-tested on a prospective cohort of 400 postpartum women at 6-8 weeks from November 2003 to September 2004 in a university hospital, Southern Thailand. The diagnosis of postpartum depression was determined using DSM-IV diagnostic criteria for minor and major depressive disorders. The alpha reliability for the total PDSS was 0.9. The recommended cut-off scores of 51 for screening major or minor depressive disorders and of 90 for screening major depressive disorder. Area under the receiver operating characteristics (ROC) curve was 0.8 for major and minor depressive disorders and 0.9 for major depressive disorder. In conclusion, this is a useful and beneficial instrument as there is no other Thai version validated instrument for postpartum depression.

Development of Postpartum Depression Screening Scale (PDSS): a Thai version for screening postpartum depression.

Objective: To study the primary clinical characteristics and prevalence of post-traumatic disorder (PTSD) symptom  among patients with substance-related disorder living within the areas of Thailand, affected by insurgency. Material and Method: This study was a descriptive, cross-sectional survey based on self-administered questionnaires which included questions relating to: personal information, traumatic experiences and the Thai version of post-traumatic stress disorder check-list (Thai PCL.) The subjects were patients with substance-related disorders at Thanyarak Pattani Hospital. This information was gathered by psychiatric nurses during the period within the periods 1st of April through 30th of June, 2016. Descriptive statistics were used to analyze the demographic characteristics of the patients Results: Ninety-two patients were enrolled in the study, all male with a mean age of 28.8±7.3 years. They were mostly single, Muslim and had graduated from elementary school. Most of them denied a family history of addiction, however, many indicated one or more male siblings had misused some illegal drug. No psychiatric disorder was diagnosed or recorded by the hospital. The most common substances used among these substance-related disorders patients were methamphetamines (36.9%) and opioids (30.4%) with “heavy use”. The prevalence of PTSD symptoms by the Thai PCL screening test was 4.3% (n=4). The 4 patients with a positive PCL result, reported that they felt terrified whenever violent situations in the unrest areas were announced. Three of them also stated for always felt extreme panic in order to delay evacuation, as well as experiencing a direct threat to their own life, or that of their family, having seen serious injuries and/or death of their peers and neighbors. Conclusion: The most common substances used in the areas affected by the insurgency of southern Thailand were methamphetamines and opioids. There was no dual diagnosis of psychiatric disorders recorded and the prevalence of PTSD symptoms among patients with substance related disorders was 4.3%. Most of those, who were suspected of having PTSD, had experienced threats to themselves or family, witnessed serious injuries or the death of peers and neighbors.

http://smj.medicine.psu.ac.th/index.php/smj/article/viewFile/694/703

Post-Traumatic Stress Disorder Symptoms among Patients with Substance-Related Disorders in the Restive A

Objective: This quasi-experimental research aimed to compare the frustration of restrained psychiatric patients in Songklanagarind Hospital before and after feedback. Material and Method: The research was a quasi-experimental research and pretest-posttest experimental design. The subjects were 40 restrained psychiatric patients who were frustrated after restrained by guards and staff members. Patients who co-operated in answering the questionnaire were included in the study. The data were analyzed using descriptive statistics and paired t-test. Results: It was found that, sixty percent were males, the average ages were 40.85 (standard deviation; S.D.= 15.15) years, fifty percent were Bipolar disorder, cause of restrained was aggressive behavior and the feedback program released the frustration in patients who were frustrated after being restrained. The levels of frustration after feedback was significantly lower than that before feedback (p<0.001). Conclusion: The feedback program can reduce frustration in patients who were frustrated after being restrained. Therefore, the program can be used to reduce frustration in patients who are restrained.

http://smj.medicine.psu.ac.th/index.php/smj/article/download/71/72

Arnont Vittayanont

Papers

Clinical applications of anxiety, social support, stressors, and self-esteem measured during pregnancy and postpartum for screening postpartum depression in Thai women.

Validation of the Thai Edinburgh Postnatal Depression Scale for screening postpartum depression.

Development of Postpartum Depression Screening Scale (PDSS): a Thai version for screening postpartum depression.

Post-Traumatic Stress Disorder Symptoms among Patients with Substance-Related Disorders in the Restive A

Effect of Feedback on Frustration of Restrained Psychiatric Patients in Songklanagarind Hospital