Stewart Robert C, Umar Eric, Gleadow-Ware Selena, Creed Francis, Bristow Katie
Department of Mental Health and Wellbeing, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
Department of Mental Health, College of Medicine, University of Malawi, Zomba, Malawi.
Arch Womens Ment Health. 2015 Apr;18(2):177-185. doi: 10.1007/s00737-014-0431-x. Epub 2014 Jun 25.
Quantitative studies have demonstrated that depression and anxiety in the perinatal period are common amongst women in low- and middle-income countries and are associated with a range of psychosocial and health-related stressors. In this exploratory qualitative study conducted in southern Malawi, we investigated the thoughts and emotions experienced by women in pregnancy and the postnatal period, their expectations of support from husband and others, problems and difficulties faced and the impact of these on psychological wellbeing. We conducted 11 focus group discussions with a total of 98 parous women. A thematic analysis approach was used. Three major themes were identified: pregnancy as a time of uncertainty, the husband (and others) as support and stressor, and the impact of stressors on mental health. Pregnancy was seen as bringing uncertainty about the survival and wellbeing of both mother and unborn child. Poverty, lack of support, HIV, witchcraft and child illness were identified as causes of worry in the perinatal period. Husbands were expected to provide emotional, financial and practical support, with wider family and friends having a lesser role. Infidelity, abuse and abandonment were seen as key stressors in the perinatal period. Exposure to stressors was understood to lead to altered mental states, the symptoms of which are consistent with the concept of common perinatal mental disorder. This study confirms and expands on evidence from quantitative studies and provides formative data for the development of a psychosocial intervention for common perinatal mental disorder in Malawi.
定量研究表明，低收入和中等收入国家的女性在围产期抑郁和焦虑很常见，且与一系列心理社会及健康相关压力源有关。在马拉维南部进行的这项探索性定性研究中，我们调查了女性在孕期和产后的想法和情绪、她们对丈夫及其他人支持的期望、面临的问题和困难以及这些对心理健康的影响。我们与总共98名经产妇进行了11次焦点小组讨论。采用了主题分析法。确定了三个主要主题：孕期是充满不确定性的时期、丈夫（及其他人）既是支持者也是压力源、压力源对心理健康的影响。孕期被视为给母亲和未出生孩子的生存及幸福带来不确定性。贫困、缺乏支持、感染艾滋病毒、巫术和孩子生病被确定为围产期担忧的原因。人们期望丈夫提供情感、经济和实际支持，大家庭和朋友的作用较小。不忠、虐待和遗弃被视为围产期的关键压力源。接触压力源被认为会导致精神状态改变，其症状与常见围产期精神障碍的概念相符。本研究证实并扩展了定量研究的证据，并为马拉维常见围产期精神障碍的心理社会干预措施的制定提供了形成性数据。
