Another report has been published about postpartum depression, this time from Qatar. The researchers gave questionnaires to 285 postpartum mothers from South Asian backgrounds and found that about 1 in 3 were depressed. “Depression” was considered to exist if the scores on the Edinburgh Postnatal Depression Scale were equal or greater than 10. In other studies cited for comparison, the cut-off was higher, at 12 or 13, but the authors failed to mention this. Instead, they said, “the prevalence of depressive symptoms in this study was higher than in other regional studies and sends an alarming message to policy makers and health professionals alike.” This comes across to me as sheer dishonesty. Of course you will get a higher prevalence if your cut-off threshold is lower!
Also, just in general, these questionnaire studies can be sketchy.
The most interesting part of this article was the association between postpartum “depression” and “a history of anxiety” during the current pregnancy. It was the strongest association: mothers with a history of anxiety during the pregnancy were four times more likely to develop postpartum depression than mothers without such a history. Why?
The researchers decline to explain how this history of anxiety was measured, but given that their questionnaire was short (22 items), including all demographic questions, it was probably a single item. Just over half the mothers (159) reported anxiety during pregnancy (132 did not report anxiety, which adds up to more than the 285 mothers who were interviewed, but let’s just ignore that for now).
Maybe the mothers were asked, “Did you experience any anxiety during your pregnancy?” Of course, ALL mothers experience anxiety during pregnancy, but only half said yes. Why? What were they anxious about? Why did the other half say no?
The Edinburgh Postnatal Depression Scale also includes several questions about anxiety, for instance, “I have been anxious or worried for no good reason.” No good reason. Maybe that evaluation was implied in the general question about anxiety. Were you [unusually or unnecessarily] anxious during your pregnancy?
The ambiguity of these questions makes them vulnerable to response bias. A mother who thinks she has no good reason for the anxiety she’s feeling after her baby is born (after all, the baby is fine, right? She should be happy) might also say that yes, she was anxious during her pregnancy (even though there turned out to be nothing to worry about!). A mother in a different frame of mind might say no, I have not been anxious for no good reason (after all, I’ve just had a baby – what better reason could there be?) and no, I was not anxious during my pregnancy (no more than might be expected, anyway). And hey ho, there’s a correlation between prenatal anxiety and postnatal depression!
Even so, it was interesting to read about South Asian mothers in Qatar. For working age adults there, there are about 4 men to every women. That’s because most of the population is immigrants who are there to work, and most of these are men. There is also a number of female immigrants who are domestic workers and as such not subject to the same rights and protections as other workers. However, I think the mothers in this sample were not domestic workers, because of those who were working, their incomes were much higher. Also, domestic workers in Qatar tend to be from the Philippines and Indonesia rather than South Asia.
Nor is the law in Qatar particularly friendly to women. Women get arrested and jailed for reporting rape. Pregnant women who were unmarried at the time of conception get put in jail, and abortion is mostly illegal.
What are those mothers doing in Qatar? What are they anxious about? How long are they going to stay there for? Best wishes to them and their babies, in any case.
Mohamed, H. (2016). Prevalence of postnatal depression and associated risk factors among South Asian mothers living in a newly developing country. Asian Journal of Pharmaceutical and Clinical Research.