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                             Postnatal Depression in
                           Hong Kong Chinese Women.
 August 1999                                                                                   HSRC # 621019
 Postnatal depression in Hong Kong Chinese women.
 Chung T1 and Lee TS 2
   Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong
   Department of Psychiatry, The Chinese University of Hong Kong

 INTRODUCTION                                                     months of delivery, or (4) did not supply written informed
 It is now generally recognised that around 10% of recently       Sociodemographic data were collected at the baseline
 delivered women in western societies suffer from postnatal       assessment. Exposure to psychosocial risk
 depression (PND), a persistent state of malignant sadness        factors of PND were assessed in multiple waves: book-in,
 that undermines the mother's confidence, disrupts marriage       third trimester, post-delivery and at three months postpartum.
 and adversely affects the new-born development.                  Multiple regression analysis was used to assess the
 Despite decades of research, it remains unclear if PND is a      relationship between sociodemographic characteristics and
 universal condition. Much of what is known and understood        psychosocial risk factors and the level of depression at
 about PND is based on biomedical studies conducted in            three-month postpartum.
 western developed countries. A series of anthropological         The prevalence and incidence rates of depressive and other
 investigations suggested that PND was rare in non-western        psychiatric disorders were measured at three-month
 societies, where the postpartum care was highly ritualised. It   postpartum using a two-phase design. In the first stage,
 has even been argued that PND is a culture bound syndrome        participants were screened for psychiatric morbidity using
 of the western world.                                            the 12-item General Health Questionnaire (GHQ). In the
 There is relatively little reliable data on the postpartum       second stage, all high scorers and about 10% of low scorers
 psychological health of Chinese women.                           were examined by a psychiatrist using the Structured Clinical
                                                                  Interview for DSM-III-R (SCID) to establish psychiatric
 AIMS AND OBJECTIVES                                              diagnosis. The prevalence and incidence of PND and other
 The objectives of the study were:                                psychiatric disorders were estimated using a reverse
                                                                  weighting technique.
 a) To determine the prevalence of PND in Hong Kong
    Chinese                                                       RESULTS
                                                                  Prevalence and Incidence
 b) To identify the putative risk factors for PND in Hong         About 6% of the study participants met the DSM-III-R
    Kong                                                          criteria of major depression and a further 5% met criteria of
                                                                  minor depression (depressive disorder NOS) within the first
 c) To assess the impact of peiyue on the prevalence of PND       three months after delivery. About 90% of PND began after
    in Hong Kong                                                  delivery with a three-month incidence of 10.4%. About 13%
                                                                  of the participants suffered one or more DSM diagnoses
 METHODS                                                          within the first three months after childbirth.
 This epidemiological study was prospective, longitudinal         The prevalence estimates of the present study fall within the
 and observational in design. A representative sample of 959      range of prevalence reported by most western studies (10%
 Chinese women was studied from the antenatal booking visit       to 20%).
 to 3 months postpartum. All Chinese women who attend the         Apart from PND, our participants also suffered from other
 booking visit at the PWH were included in the study.             mood disorders. Although not as common as major or minor
 Women were only excluded from the study if they (1) were         depression, dysthymia (0.7%) and adjustment disorder with
 not of Chinese ethnicity, (2) did not have long-term             depressed mood (1.2%) were diagnosed among the study
 residential rights, (3) were leaving Hong Kong within 12         participants. Apart from depressive disorders, anxiety
                                                                  disorder (0.4%) was also detected among study population.
 The results of the present study illustrated that a range of
 psychiatric disorders occurred in childbearing women in           Prediction of PND
 Hong Kong. Although not as common as PND, they warrant            To remove the confounders and to identify the more
 the same attention and enthusiasm in detection and                prominent determinants of PND, multiple linear regression
 treatment. While perinatal psychiatric morbidity is mostly        was performed. Two regression equations were constructed
 depression and postnatal in onset, a small but significant        to model the level of PND in Chinese women.
 proportion of morbidity is antenatal in onset or non-             In the first regression model, eight factors were found to
 depressive in nature. Hence, to avoid confusion, PND may          account for the variation in depression among postnatal
 be better termed perinatal depression.                            women. The model shows that women who are more
 Clinicians should also be educated that PND is not the only       depressed during pregnancy are more likely to be depressed
 possible condition for recently delivered mothers, as             postpartum. PND is not merely a postnatal morbidity. Rather,
 dysthymia, anxiety disorders and other psychiatric disorder       it is an extension of unhappiness dating back to the
 may begin in pregnancy and postpartum.                            beginning of the pregnancy. A clinically depressed mother
                                                                   is likely to have some degree of depression in early
 Risk Factors for Chinese Women                                    pregnancy.
 The results of the univariate analysis showed that 22
 psychosocial factors were significantly associated with           SUMMARY
 postpartum depression. Apart from the cultural factors that
 are unique to the local Chinese societies, almost all the         This study not only affirmed the previous findings that PND
 significant correlates of the univariate analysis have been       can be preceded by antenatal depression, it showed that
 reported in the western literature.                               prenatal depression is the most predictive correlate of PND.
 According to the results of the univariate analysis, a recently   Above all putative psychosocial risk factors, the level of
 delivered Chinese woman is more likely to be depressed if         depression at booking and late pregnancy explained most of
 she is 18 or younger in age, in financial difficulties, failed    the variance. Hence, even without knowledge of the status
 breast feeding, has poor marital relationship or in-law           of psychosocial risk factors, one can still have a reasonably
 relationship, inadequate social support and concurrent life       good idea of postnatal psychological well being by
 events during pregnancy. She is also more likely to be            administering the Beck Depression Inventory at booking and
 depressed if she has history of depression, deliberate self-      in later pregnancy.
 harm or medical diseases. It is likely that her depression is
 preceded by pre-natal depressive symptoms or prolonged            ACKNOWLEDGEMENTS
                                                                   1. The authors wish to acknowledge the HSRC grant number
 Impact of peiyue                                                  HSRF No 6900489 and referee of the grant for their support of
 Furthermore, if a woman is not assisted by a close relative or    this study. The authors also acknowledge Terry Wu Leing
 friend in the first postnatal month according to the tradition    Wai-Chun and Winnie Lam Wai Sheung for their excellent
 of peiyue, she is more likely to be depressed. The effect of      work as research nurses.
 the traditional practise of peiyue may be mediated through
 social support and good in-law relationships.

                                                       Key Messages
         1. Postnatal depression (PND) affects about 12 % of Hong Kong Chinese
         2. Risk factors reported in the west also apply in Hong Kong
         3. Cultural practices such as peiyue appears to protect against PND
         4. Antenatal depression is the greatest predictor of PND

 HSRC Reports: the dissemination of research which is funded and assessed by the Health Services Research Committee (Hong
 Kong). Aim: to increase the availability of research outcomes to health care practitioners. Funded: by the Health Services
 Research Committee. Address 5/F Hospital Authority Building, 147B Argyle Street, Kowloon, Hong Kong. Tel 852 23006311 Fax
 852 2895 2167, Email shli@ha.org.hk Editor Jan Johnston

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