Depressed mothers in Qatar

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.

https://www.flickr.com/photos/yimhafiz/7271752756
A shopping village in Doha with a fake sky

 

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 rapePregnant 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.

Reference

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.

http://innovareacademics.in/journals/index.php/ajpcr/article/viewFile/12900/7892

Uneducated mothers cannot “transcend their everyday experiences”

hb_29_100_48In Brazil, researchers interviewed six mothers and concluded that uneducated mothers find it difficult “to transcend their everyday experiences”.  Educated mothers, on the other hand, were able to consider complex aspects of their interactions with their babies and thereby “transcend” primary care considerations.

They reached this conclusion with the help of a French software analysis package called Alceste, which can eat up any kind of text and spit back out blocks of words categorized by their proximity.  The current researchers plugged in their six interviews and the computer spat back two categories.  The first included words like PUT, SLEEP, TIME, WALK and CRYING; the second category included words like ISSUE, MOTHER, THINK, EXPERIENCE, and BOND.  Without any further analysis, the researchers concluded that the first category was the everyday of the uneducated, whereas the second category was the transcendence of the educated.  It seems as if this was a conclusion that the researchers had in mind before they started the study.

One of the mothers in the study, the least educated, was 32 years old, with 5 children and an income two thirds of the minimum wage.  She is likely to be under immediate day-to-day pressures, and more so than the post-graduate mother of two with an income almost ten times greater.  She’s going to have less time to sit about ruminating about the quality of her bonding experience with her baby.  If there’s a difference in the way the two mothers talking about their relationships with their children, there’s no reason to suppose that it’s formal education that makes the difference.

The researchers seemed to be frustrated at the way some mothers (especially the uneducated ones) answered their questions:

It was noticed, when interviewing mothers, that some of them had difficulty in answering the questions formulated from reflections, getting quite restricted to the facts and personal experiences of the “here and now”. So they spoke from their practices and held in the minutiae of routine care for their babies, often at the expense of what was required of them.

This is perhaps the most interesting part of the study.  Mothers were asked about bonding with their babies, the parent-child relationship, what’s important for development.  In response, they spoke about the here and now.  They did not speak in the abstract.  They did not talk about theories or beliefs, even though that’s what the researchers seemed to want from them.

Maybe that’s because, after all, there is only the here and now when it comes to mothers and children.  When people talk about motherhood in abstract terms, it seems so bland and irrelevant compared to the immediacy of a child demanding something.  Maybe bonding is like culture – it only exists to the observer.  To the mother in the middle of it, there’s no bonding, there’s only getting up at night in response to a crying baby – there’s only constant vigilance to know where the baby is – there’s only patience as a rough toddler tries to climb on you while you’re picking up the laundry.

The researchers wanted their mothers to transcend the everyday, and those with an education were able to oblige to some extent.  But what does that tell us about motherhood?

References

Oliveira, A. D., Chaves Maia, E. M., & Alchieri, J. C. (2016). What do mothers say about the mother and baby relation?. Journal of Nursing UFPE on line, 10(9), 3212-3222