Ethnoepidemiology of postnatal depression. Prospective multivariate study of sociocultural risk factors in a Chinese population in Hong Kong.

BACKGROUND Although there have been many studies of the biological and psychosocial causations of postnatal depression, studies of sociocultural risk factors are rare. AIMS To investigate the sociocultural risk factors of postnatal depression using ethnographically informed epidemiological methods. METHOD A total of 959 women were assessed at their first ante-partum visit (baseline), in the third trimester, immediately after delivery, and 3 months postpartum. Six domains of risk factors were examined. The dependent variable was postnatal depression (as defined by the Edinburgh Postnatal Depression Scale) at 3 months post-partum. RESULTS Conflict with mother-in-law, marital dissatisfaction, past depression and antenatal depression independently predicted the occurrence of postnatal depression. The cultural practice of peiyue - a Chinese post-partum custom of mandated family support - was associated with better social support and a slightly lower risk of postnatal depression. CONCLUSIONS Sociocultural aspects of the immediate puerperium shape maternal emotional well-being. In-law conflict is an important source of household distress in many Asian societies. The findings have implications for clinical practice and future studies.