Postnatal depression in Japanese women who have given birth in England

https://doi.org/10.1016/S0165-0327(96)01419-XGet rights and content

Abstract

A total of 98 Japanese mothers who became pregnant in England were monitored from 36 weeks gestation to 3 months postpartum. Psychiatric status was assessed by self-report, using a Japanese translation of the Edinburgh Postnatal Depression Scale (EPDS) and by an interview with Japanese psychiatrists, using Japanese translations of the Schedule for Affective Disorders and Schizophrenia (SADS) and Research Diagnostic Criteria (RDC). Rates of depression were similar to those observed in Japanese women having babies in Japan. Twelve mothers (12%) were categorised as having new onsets of depression (six major and six minor depressive disorder) during the 3 months following delivery. Depression was associated with having had a stressful life event or obstetric difficulty but without grandmothers' support – depressed and non-depressed women were equally likely to have had their mothers visit England to attend the delivery. Women who became depressed had significantly higher EPDS scores at 1 month postpartum than those who remained well. However, depressions were not detected when the EPDS was used as a screening instrument. With an EPDS cut-off of greater than 12, the criterion used in western samples, sensitivity was zero. Lowering the criterion to improve the instrument's sensitivity merely reduced its specificity. These results suggest that Japanese women may be less likely to express depressive symptoms by self-report, at least when instruments designed for western samples are used.

Introduction

Postnatal depression is experienced by 10–15% of mothers in the UK and US (e.g., Kumar and Robson, 1984, Watson et al., 1984, O'Hara et al., 1984, Cooper et al., 1988, Cox et al., 1993). Factors associated with postnatal depression reported in these studies include: a previous depressive episode (Paykel et al., 1980, O'Hara et al., 1990, Marks et al., 1992, Kelly and Deakin, 1992); high neuroticism during the pregnancy (Watson et al., 1984, Marks et al., 1992); adverse life events (Paykel et al., 1980, O'Hara et al., 1984, Watson et al., 1984, Marks et al., 1992); poor social support and/or marital problems (Paykel et al., 1980, Kumar and Robson, 1984, Watson et al., 1984). Psychosocial variables, therefore, are considered to be important aetiological factors and the vulnerability–stress model of depression appears to account for postnatal depression as much as for depressions occurring outside childbirth.

Three Japanese studies have assessed psychiatric cases in postnatal women using the same methodology as that used in many Western studies, namely, a Japanese version of the Schedule for Affective Disorders and Schizophrenia (Hosaki et al., 1983) and Research Diagnostic Criteria (Spitzer et al., 1978). Rates of postnatal depression in Japanese women having their babies in Japan appear to be similar to those observed in UK and USA studies, 8–9% at 1 month postpartum (Aoki et al., 1989, Okano and Nomura, 1992) and 14% within 3 months postpartum (Yamashita et al., 1995). This is despite considerable differences between Japan and the west in cultural attitudes towards marriage and childbearing and the social support given to mothers. For example, in Japan 40–50% of marriages are arranged ones, women usually stop work when they get married, divorce is much less common (about 10% of marriages end in divorce) and parenthood outside marriage is still very rare. Social support during childbirth tends be to be provided by the woman's family rather than by her husband. It is customary for pregnant women to return to their family homes to have their babies. They do this at about 32–35 weeks gestation. After delivery, mother and infant are looked after by the woman's family, especially the grandmother, and return to the marital home and husband/father when the baby is a couple of months old. This tradition (satogaeribunben) is still not uncommon, although now, frequently, grandmothers may go to their daughters' homes instead. The husband's place in the family also tends to be different. For example, mother and infant sleep together, usually in the same futon, always in the same room, until the child is at least 3 and often 5 years old. The husband sleeps in a different room during this time. He spends little time with his family, working very long hours and returning home late each evening.

For Japanese women having their babies in London the social support usually provided by the woman's extended family is not available although sometimes the grandmother comes to London to attend the delivery and look after her daughter and the new baby. Meanwhile, husbands, who are usually employed in Japanese businesses, continue to work very long hours, as was their custom in Japan.The women also have to cope with the strangeness of European living and a language which is very different from their own, and which makes communication with possible providers of alternative support, especially midwives and obstetricians, particularly difficult.

In this context, it was considered likely that rates of postnatal depression in Japanese women living in London would be higher than those of Japanese women living in Japan and that satogaeribunben would be associated with reduced rates of depression. The aim of this study was to test these hypotheses. The contribution of psychiatric vulnerability and social stress to psychiatric outcome postpartum was assessed in parturient Japanese women living in London. In addition, rates of postnatal depression in woman whose mothers came to the UK for the delivery were compared with those whose mothers remained in Japan.

Section snippets

Subjects

Subjects were recruited from (a) antenatal classes for pregnant Japanese women and their husbands and (b) an advertisement inserted in a maternity guidebook for pregnant Japanese women in the UK.

Of 116 Japanese women who became pregnant in the Greater London area and were recruited, 98 mothers kept contact with us until the final three postnatal months assessment. The remaining 18 mothers either dropped out or left the UK because of their husbands' work.

Methods

Demographic and personal history details

Incidence of postnatal depression and timing of onset

Twelve (12%) of the 98 mothers interviewed were categorised as RDC cases during the 3 month postnatal follow-up period, six major depressive disorder and six minor depressive disorder. All depressions started after delivery. The peak onset was at 1 month postpartum. Eight out of 12 mothers with postnatal depression became depressed around this time. By the time of the interview at 3 months postnatal, 11 of the 12 mothers were no longer RDC cases.

Demographic and clinical characteristics

Comparisons between mothers who became depressed

Educational and social background

The women were highly educated and most were the wives of businessmen. They were therefore predominantly middle class. However, education levels in Japan are high compared to the UK. Nearly 95% of Japanese adolescents continue on at high school after the age when schooling is no longer compulsory (16 years) and nearly 50–60% of Japanese high school graduates move to higher education such as polytechnic schools, colleges and universities. Thus, the educational characteristics of the women in

Acknowledgements

This project was supported by the Japanese Ministry of Health and Welfare (chief organiser: Professor Nakano, Department of Gynaecology and Obstetrics, Faculty of Medicine, Kyushu University, Japan).

References (26)

  • Aoki, M., Kitamura, T., Simia, S. and Sugawara, M. (1989) Baby blues project. In: K. Okonogi and H. Watanabe (Eds.),...
  • Brugha, T., Bebbington, P., Tennant, C. and Hurry, J. (1985) The list of threatening experiences: a subset of 12 life...
  • Cooper, P.J., Campbell, E.A., Day, A., Kennerley, H. and Bond, A. (1988) Non-psychotic psychiatric disorder after...
  • Cox, J.L., Holden, J.M. and Sagovsky, R. (1987) Detection of postnatal depression: development of the 10-item Edinburgh...
  • Cox, J.L., Murray, D. and Chapman, G. (1993) A controlled study of the onset, duration and prevalence of postnatal...
  • Edwards, D.R.L., Porter, S.A.M. and Stein, G.S. (1994) A pilot study of postnatal depression following Caesarean...
  • Hannah, P., Adams, D., Lee, A., Glover, V. and Sandler, M. (1992) Links between early post-partum mood and post-natal...
  • Hosaki, H., Kitamura, T., Kato, M., Sakio, E., Shima, S. and Takahasi. R. (1983) Schedule for Affective Disorder and...
  • Kelly, A. and Deakin, B. (1992) Postnatal depression and antenatal morbidity. Br. J. Psychiatry 161,...
  • Kitamura, T., Shima, S., Sugawara, M. and Toda, M.A. (1993) Psychological and social correlates of the onset of...
  • Kitamura, T., Sugawara, M., Sugawara, K., Toda, M.A. and Shima, S. (1996) Psychosocial study of depression in early...
  • Kumar, R. and Robson, K. (1984) A prospective study of emotional disorders in childbearing women. Br. J. Psychiatry...
  • Marks, M.N., Wieck, A., Checkley, S.A. and Kumar, R. (1992) Contribution of psychological and social factors to...
  • Cited by (0)

    View full text