THE EUROPE TRANSCULTURAL STUDY OF POSTNATAL DEPRESSION TCSPND RESULTS AND RECOMMENDATIONS

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THE EUROPE TRANSCULTURAL STUDY OF POSTNATAL
DEPRESSION (TCS-PND) RESULTS AND
RECOMMENDATIONS Prof. John Cox Secretary
General, W.P.A. Immediate Past President, Royal
College of Psychiatrists, UK
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• BACKGROUND TO THE STUDY
• PERINATAL MENTAL HEALTH EUROPE AND WPA
• Louis Victor Marcé/Paris
• Esquirol
• Channi Kumar

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MARCÉ SOCIETY 1980 EPDS TRANSLATED INTO 25
LANGUAGES PERINATAL MENTAL HEALTH ACTIVE
RESEARCH GROUPS AND PUBLICATIONS IN ALL WPA ZONES
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WORLD MAP
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EPDS LANGUAGES
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QUANTITATIVE RESEARCH

• INCIDENCE - NEW ONSET DEPRESSION
• PREVALENCE - ALL DEPRESSIONS AT A
• PERIOD OF TIME
• 10 or less 11 or more
• London 1968 Scotland
• Uganda 1973 Stoke
• Japan Melbourne
• Malta Capetown
• Sweden

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PROF. CHANNI KUMAR (1938 2000) INSTITUTE OF
PSYCHIATRY GEORGE WINOKUR, U.S. CHANNI KUMAR,
U.K. IAN BROCKINGTON, U.K. JAMES HAMILTON,
U.S. ROBERT KENDELL
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BRICE PITTS SEMINAL PAPER (1968) Atypical
depression following childbirth 10.8 of women
clinical Depression at 6/52 post partum
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• BRICE PITT (1968), LONDON 10.8
• UGANDA
• 72-74 OXFORD (DOCTORAL THESIS PSYCHIATRIC
  MORBIDITY AND CHILDBEARING A STUDY OF 263
  SEMI-RURAL UGANDAN WOMEN)
• EDINBURGH WITH R. E. KENDELL PROSPECTIVE STUDY
• EDINBURGH POSTNATAL DEPRESSION SCALE (E.P.D.S.)
• 10-ITEM SELF-REPORT SCALE

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INTERNATIONAL COLLABORATORS EUROPE (SWEDEN
JANSSON WICKBERG) JAPAN (OKANO) AUSTRALIA
(BOYCE, BRYANNE BARNETT) U.S. (MICHAEL OHARA
KATHY WISNER)
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• 1995
• INTERNATIONAL NETWORKS
• CULTURAL INFLUENCES
• ANTHROPOLOGICAL APPROACH AND CHALLENGE (STERN
  KRUCKMAN)
• CHILDBIRTH AS A RITE DE PASSAGE
• TREATMENT GAP LARGE
• WHAT IS CAUSE OF ADVERSE EFFECT OF PND ON CHILD
  DEVELOPMENT?
• VARIETY OF MATERNITY AND MENTAL HEALTH SERVICES

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GRANT ? E.U. BIOMED 2 TRANSCULTURAL STUDY OF PND
WITHIN EUROPE HEALTH SYSTEMS HARMONISATION OF
RESEARCH METHODS AND PROMOTION OF MOTHER-CHILD
HEALTH. CENTRES FRANCE, U.K.,
IRELAND ITALY, PORTUGAL, SWEDEN, SWITZERLAN
D, AUSTRIA NETHERLANDS, UGANDA, JAPAN AND
USA
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• PRIMARY AIM
• TO EXAMINE HOW THERE MAY BE IMPORTANT VARIATIONS
  IN KEY DETERMINANTS
• EARLY CHILDHOOD EXPERIENCES
• SOCIAL AND FAMILY SUPPORTS
• MARITAL PROBLEMS
• SERVICE IMPLICATIONS/COSTS

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• PHASE I HARMONISE AND VALIDATE RESEARCH METHODS
• PHASE II FIELD WORK/EPIDEMIOLOGICAL STUDY OF
  PND
• APPLICATION OF RESEARCH METHODS AND EXPERTISE
  DEVELOPED IN PHASE I

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• STUDY INSTRUMENTS
• SCID
• CSRI CLIENT SERVICE RECEIPT INVENTORY
• EPDS
• CONTEXTUAL ASSESSMENT OF MATERNITY EXPERIENCE
  (C.A.M.E.)
• ATTACHMENT STYLE INTERVIEW
• RATING OF MOTHER/INFANT INTERACTION

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ALL MODIFIED WHEN NECESSARY. TRANSLATED (FRENCH,
ITALIAN, GERMAN, PORTUGUESE) PILOTED KEY
REFERENCE MARKS ET AL (2004), BRITISH JOURNAL
OF PSYCHIATRY. VOL. 184, SUPP. 46.
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• QUALITATIVE STUDY
• EXPLORE CROSS-CULTURAL EQUIVALENCE OF CONCEPT OF
  POSTNATAL DEPRESSION

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• SPECIAL FEATURES
• USE OF ANTHROPOLOGICAL APPROACH
• E.G. QUALITATIVE METHODS
• SYSTEMS OF MEANING
• EMIC PERSPECTIVES
• EXPERTISE IN UGANDA (STELLA NEEMA)
• TRAIN CENTRES IN QUALITATIVE RESEARCH METHODS
• AWARENESS OF LIMITATIONS OF EXISTING RESEARCH
  METHODS FOR CROSS-CULTURAL RESEARCH

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A focus group is a data collection technique or
method A focus group is a group of people who
possess certain characteristics, who provide data
of a qualitative nature in a focused
discussion Focus groups are excellent for
getting an indication of how persuasive an idea,
value, or behaviour is likely to be in a
population, and for understanding how deeply
feelings run about products, issues, or public
figures.
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The underlying principle of report us that the
report communicates useful information to an
identifiable audience for a specific
purpose. (Krueger, 1988) The decision
about whether or not to use the focus group
approach must be guided by the purpose of the
project and the resources available The
limitations of focus groups can affect the
results and validity of the study, but many of
the limitation can be controlled
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• Asking questions in a variety of ways can make
  the session more interesting and provide greater
  depth to the information
• Synergism, when the groups combined efforts
  comprise more than the sum of individual
  contributions
• Snowballing, or triggering responses from group
  members
• Stimulation from other group members
• Security of the group setting
• Spontaneity of responses
• Expediency, in that several people are seen
  together.

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• Speed, in terms of the collation of data from
  several people. Despite these advantages, the
  ultimate success of data collection often depends
  upon careful planning and facilitation.

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• IN THIS APPROACH THE INFORMANT IS THE TEACHER
  AND THE INTERVIEWER THE PUPIL
• APPROACH COMBINED PHENOMONOLOGY AND GROUNDED
  THEORY
• THE INFORMANTS DESCRIPTION OF THE EXPERIENCE IS
  THE DATA.
• TRIANGULATION
• SATURATION OF THEMES

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FOCUS GROUP 4-6 WOMEN BABIES 5-7 MONTHS KEY
INFORMANT INTERVIEWS 3 FATHERS 3
GRANDPARENTS 3 CLINICIANS 3 ADMINISTRATORS
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INTERVIEW GUIDE TEXTUAL ANALYSIS
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RESULTS

• Morbid unhappiness recognised by all centres.
• Portugal, Switzerland, Uganda, UK Asians, not
  used the term Postnatal depression
• Social causes predominated. Lack of social
  support, family conflict, sleeplessness, problems
  with the baby.
• Remedies in the psychosocial domain.

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CULTURAL DIFFERENCES

• Gender of baby
• Postpartum rituals and taboos
• Local, culture-bound mental disorders, eg amakaro
  in Uganda

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• BEFORE
• DOING THE MONTH IN CHINA
• SATOGERI BUNBEN, JAPAN
• 10 DAYS IN MATERNITY UNIT
• 6/52 POSTNATAL CHECK-UP, ENGLAND
• HIGH STATUS
• NAMING CEREMONY, UGANDA

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UNHAPPINESS IN PREGNANCY UNHAPPINESS IN
PUERPERIUM CONCEPT OF PND
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CONCLUSIONS FUTURE DIRECTIONS FOR
INTER-SECTIONAL COLLABORATION CULTURALLY
SENSITIVE RESEARCH METHODS NOW AVAILABLE ACROSS
BROAD DOMAINS. THIS IS THE LEGACY OF PHASE I OF
THE EU TRANS-CULTURAL PND STUDY WHO IS FOR PHASE
II?
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POSTNATAL DEPRESSION A CULTURE BOUND DISORDER