Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Nursing, Unit for Studies of Integrative Care, Alfred Nobels Allee 23, Huddinge, Sweden.
J Affect Disord. 2010 Jul;124(1-2):29-37. doi: 10.1016/j.jad.2009.09.017. Epub 2009 Oct 24.
Major depression is increasing world-wide, and is the fourth leading cause of the global disease burden. Depression is rarely diagnosed in primary care settings in Vietnam, and those afflicted usually only seek professional care when the illness has become very severe. Depressive disorders affecting mothers are an important cause of low birth-weight, childhood stunting, under nutrition and adverse mental development, and a study has shown a 33% prevalence of postnatal depression symptoms in Ho Chi Minh City.
The aim of this study was to elicit Illness Explanatory Models (EMs) of depression and postnatal depression from nine mothers and nine health workers. The study was conducted in a semi-rural area in Vietnam, and the EMs were elicited through semi-structured interviews where a case vignette of depression was used as the basis of questioning.
The EMs elicited were predominantly somatosocial in nature and the mothers assigned a strong personal responsibility for care. Psychiatric treatment and care was seldom recommended. Lack of communication was described as an important factor concealing depression, and together with the lack of care-seeking can be expected to impede effective treatment.
The results of this study cannot be generalised beyond the group studied, or the context of Ba Vi, though we believe that analytical generalisation to other contexts can be made. CONCLUSION (CLINICAL RELEVANCE): The results of this study highlight the importance of depression and postnatal depression being diagnosed in primary care, and of a cross-sectoral approach for the prevention of depression in Vietnam, which takes into account the social causation of depression in women.
抑郁症在全球范围内呈上升趋势，是全球疾病负担的第四大主要原因。在越南的基层医疗环境中，抑郁症很少得到诊断，而那些受抑郁症影响的人通常只有在病情非常严重时才会寻求专业治疗。影响母亲的抑郁障碍是导致低出生体重、儿童发育迟缓、营养不足和精神发育不良的重要原因，一项研究表明，在胡志明市，产后抑郁症的症状患病率为 33%。
本研究旨在从 9 位母亲和 9 位卫生工作者中引出对抑郁症和产后抑郁症的疾病认知模型（EM）。该研究在越南一个半农村地区进行，通过半结构化访谈引出 EM，使用抑郁症病例简档作为提问的基础。
引出的 EM 主要是躯体社会性质的，母亲强烈承担起照顾的个人责任。很少推荐进行精神病治疗和护理。缺乏沟通被描述为隐藏抑郁症的一个重要因素，再加上缺乏寻求治疗的行为，可能会阻碍有效的治疗。
本研究的结果不能推广到所研究的群体或巴维地区之外，尽管我们相信可以对其他背景进行分析推广。结论（临床相关性）：本研究结果强调了在基层医疗中诊断抑郁症和产后抑郁症的重要性，以及在越南采取跨部门方法预防抑郁症的重要性，这需要考虑到女性抑郁症的社会成因。
