Yoneda Kyoko, Hababeh Majed, Kitamura Akiko, Seita Akihiro, Kamiya Yasuhiko
Department of Health, Headquarters, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan; Nagasaki University School of Tropical Medicine and Global Health, Nagasaki, Japan.
Department of Health, Headquarters, United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Amman, Jordan.
Lancet. 2021 Jul;398 Suppl 1:S28. doi: 10.1016/S0140-6736(21)01514-2.
Postpartum depression (PPD) is a major public health concern because it adversely affects maternal health and children's physical and mental development. The prevalence of PPD in Arab countries is higher than the worldwide prevalence. Additionally, refugee women are more likely to develop PPD than women in the general population, but little research of refugee women in Arab countries is available. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) have provided primary health care to Palestine refugees since 1950 and began the Mental Health and Psychosocial (MHPSS) programme in Jordan in 2017 to enhance the psychosocial and social wellbeing of Palestine refugees. We assessed the prevalence of PPD and examined associated factors among Palestine refugee women living in Amman, Jordan.
This cross-sectional descriptive study was done between April 21 and May 21, 2018. Eligible participants were Palestine refugee mothers who had given birth 3-16 weeks previously and were attending any of five UNRWA health centres in Amman that were launching the MHPSS programme. Data were gathered in face-to-face structured interviews that included the Edinburgh Postpartum Depression Scale (EPDS) to assess PPD, the Maternal Social Support Scale to assess levels of perceived social support, and a structured questionnaire about sociodemographic, obstetric or paediatric, psychological, and social factors. Participants with scores greater than 12 in the EPDS were classified as having depressive symptoms. Logistic regression was used to identify factors associated with depressive symptoms. The study protocol was approved by the Department of Health, UNRWA Headquarters, Amman, Jordan, and Nagasaki University. Each participant provided written informed consent.
251 women participated in the study, with a mean age of 27·2 years (range 18-42, SD 5·43). 123 (49%) women were classified as having PPD. Logistic regression showed that factors associated with PPD were perceived low levels of social support (adjusted odds ratio 3·76, 95% CI 1·92-10·93) and experiencing stressful life events (one event 3·92, 1·51-9·91; two events 5·77, 2·33-14·27; and three or more events 14·8, 5·23-41·89).
The prevalence of PPD among Palestine refugee women in Amman was higher than that reported in a previous study of the general childbearing population (women aged 18-45 years) in Irbid in Jordan (22%, Mohammad et al. Midwifery 2011; 27: e238-45) but similar to findings in the West Bank (47%, Quandil et al. BMC Pregnancy Childbirth 2016; 16: 375) and in Syrian refugee women in Jordan (49·6%, Mohammad et al. Res Nurs Health 2011; 41: 519-245). Our findings highlight the need to address this disorder in Palestine refugee mothers. Periodical PPD screening, raising awareness about PPD, providing information to husbands and families, and building a support system for mothers could alleviate the risk of PPD. Future studies should examine whether factors of antenatal depression, which were not assessed in this study, correlate with having PPD to clarify the need for early intervention in mothers.
Nagasaki University.
产后抑郁症（PPD）是一个重大的公共卫生问题，因为它会对产妇健康以及儿童的身心发展产生不利影响。阿拉伯国家产后抑郁症的患病率高于全球患病率。此外，难民妇女比普通人群中的妇女更易患产后抑郁症，但针对阿拉伯国家难民妇女的研究较少。自1950年以来，联合国近东巴勒斯坦难民救济和工程处（近东救济工程处）一直为巴勒斯坦难民提供初级卫生保健服务，并于2017年在约旦启动了心理健康和社会心理支持（MHPSS）项目，以提高巴勒斯坦难民的社会心理和社会福祉。我们评估了约旦安曼的巴勒斯坦难民妇女中产后抑郁症的患病率，并研究了相关因素。
这项横断面描述性研究于2018年4月21日至5月21日进行。符合条件的参与者是在3 - 16周前分娩、并在安曼五家启动MHPSS项目的近东救济工程处卫生中心中的任何一家就诊的巴勒斯坦难民母亲。数据通过面对面的结构化访谈收集，访谈内容包括用于评估产后抑郁症的爱丁堡产后抑郁量表（EPDS）、用于评估感知社会支持水平的产妇社会支持量表，以及一份关于社会人口学、产科或儿科、心理和社会因素的结构化问卷。EPDS得分大于12分的参与者被归类为有抑郁症状。采用逻辑回归分析来确定与抑郁症状相关的因素。该研究方案得到了约旦安曼近东救济工程处总部卫生部和长崎大学的批准。每位参与者均提供了书面知情同意书。
251名妇女参与了该研究，平均年龄为27.2岁（范围18 - 42岁，标准差5.43）。123名（49%）妇女被归类为患有产后抑郁症。逻辑回归分析显示，与产后抑郁症相关的因素包括感知到的社会支持水平较低（调整后的优势比为3.76，95%置信区间为1.92 - 10.93）以及经历过应激性生活事件（发生一件事的优势比为3.92，1.51 - 9.91；发生两件事的优势比为5.77，2.33 - 14.27；发生三件或更多事件的优势比为14.8，5.23 - 41.89）。
安曼的巴勒斯坦难民妇女中产后抑郁症的患病率高于此前对约旦伊尔比德一般育龄人群（18 - 45岁妇女）的一项研究中报告的患病率（22%，Mohammad等人，《产科学》2011年；27：e238 - 45），但与约旦河西岸的研究结果（47%，Quandil等人，《BMC妊娠与分娩》2016年；16：375）以及约旦的叙利亚难民妇女中的患病率（49.6%，Mohammad等人，《护理与健康研究》2011年；41：519 - 245）相似。我们的研究结果凸显了应对巴勒斯坦难民母亲中这一疾病的必要性。定期进行产后抑郁症筛查、提高对产后抑郁症的认识、向丈夫和家庭提供信息以及为母亲建立支持系统，可能会降低产后抑郁症的风险。未来的研究应考察本研究中未评估的产前抑郁症因素是否与产后抑郁症相关，以明确对母亲进行早期干预的必要性。
长崎大学。
