Development of a Strategic Tool for Shared Decision-Making in the Use of Antidepressants among Patients with Major Depressive Disorder: A Focus Group Study.

Shared decision-making (SDM) has been recognized as an important tool in the mental health field and considered as a crucial component of patient-centered care. Therefore, the purpose of this study was to develop a strategic tool towards the promotion and implementation of SDM in the use of antidepressants among patients with major depressive disorder. Nineteen doctors and 11 major depressive disorder patients who are involved in psychiatric outpatient clinic appointments were purposively selected and recruited to participate in one of six focus groups in a large teaching hospital in Malaysia. Focus groups were transcribed verbatim and analyzed using a thematic approach to identify current views on providing information needed for SDM practice towards its implementation in near future. Patients’ and doctors’ views were organized into six major themes, which are; summary of treatment options, correct ways of taking medication, potential side effects of treatments related to patients, sharing of case study related to the treatment options, cost of treatment options, and input from pharmacist. The information may be included in the SDM tool which can be useful to inform further research efforts and developments that contribute towards the successful implementation of SDM into clinical practice.

Prevalence of postpartum depression in a hospital setting among Malaysian mothers.

INTRODUCTION: Postpartum depression (PPD) is a disorder that affects not only mothers, but also can lead to family, social, economic and vocational breakdown. The objective of this study was to determine the prevalence and factors associated with postpartum depression among mothers in an urban hospital setting in Malaysia. METHODS: In this cross-sectional study, mothers attending routine visits at six to eight weeks postpartum at a postnatal clinic were assessed on socio-demographic data, obstetric history, social support, breastfeeding status and psychiatric history. Mini International Neuropsychiatric Interview (M.I.N.I.) was administered to establish a diagnosis of postpartum depression. RESULTS: A total of 411 subjects participated in the study. The prevalence rate of postpartum depression was 6.8%. Univariate analysis found that being a housewife, having a cesarian section, low social support, family history of depression, previous history of depression and non-exclusive breastfeeding were significantly associated with postpartum depression. Predictors for postpartum depression were non-exclusive breastfeeding (P < 0.01, OR = 23.7, 95% CI 3.1-179.7) and previous history of depression (P < 0.05, OR = 82.3, 95% CI 1.2-5897.6). DISCUSSION: The prevalence rate of postpartum depression in urban Malaysian mothers was comparable to the rates in other countries. Mothers who did no exclusively breast feeding their babies appeared to have more risk for postpartum depression. Therefore, screening for depression should become a routine during postpartum period and mothers must be encouraged to exclusively breastfeed their babies.