"They should ask about our feelings": Mongolian women's experiences of postpartum depression.

Between 16 and 20% of perinatal women in low- and middle-income countries experience depression. Addressing postpartum depression (PPD) requires an appreciation of how it manifests and is understood in different cultural settings. This study explores postpartum Mongolian women's perceptions and experiences of PPD. We conducted interviews with 35 postpartum women who screened positive for possible depression to examine: (1) personal experiences of pregnancy/childbirth; (2) perceived causes and symptoms of PPD; and (3) strategies for help/support for women experiencing PPD. Unless extreme, depression was not viewed as a disease but rather as a natural condition following childbirth. Differences between a biomedical model of PPD and local idioms of distress could explain why awareness about PPD was low. The most reported PPD symptom was emotional volatility expressed as anger and endorsement of fear- or anxiety-related screening questions, suggesting that these might be especially relevant in the Mongolian context. Psychosocial factors, as opposed to biological, were common perceived causes of PPD, especially interpersonal relationship problems, financial strain, and social isolation. Possible barriers to PPD recognition/treatment included lack of awareness about the range of symptoms, reluctance to initiate discussions with providers about mental health, and lack of PPD screening practices by healthcare providers. We conclude that educational campaigns should be implemented in prenatal/postnatal clinics and pediatric settings to help women and families identify PPD symptoms, and possibly destigmatize PPD. Healthcare providers can also help to identify women with PPD through communication with women and families.

Postpartum depression in Mongolia: A qualitative exploration of health care providers' perspectives.

OBJECTIVE: Postpartum depression (PPD) is defined as depression with symptom onset during pregnancy or within 6 weeks after childbirth. It is now estimated that 16% percent of pregnant women and 20% of postpartum women in low- and middle-income countries experience depression, which can negatively influence everyday functioning, social relationships, and child development. This qualitative study aims to elucidate the perspectives and experiences of Mongolian health care providers regarding PPD. SETTING: This study was conducted in Mongolia's capital city, Ulaanbaatar, at the National Center for Maternal and Child Health (NCMCH), which serves patients from both urban and rural areas. Research on PPD in Mongolia is extremely limited. DESIGN: We conducted three interviews and three focus group discussions (FGDs) with health care providers (N = 15) to explore risk factors, causes, signs and symptoms, lay perceptions, recognition, and treatment in relation to PPD. The interviews and FGDs were audio recorded, transcribed and translated into English. PARTICIPANTS: The providers included five nurse-midwives, one family clinic nurse, four obstetrician-gynaecologists (OB-GYNs), two family physicians, one psychologist, one monk, and one traditional healer. FINDINGS: The majority of providers reported some basic knowledge of PPD, though limited experience in working with PPD patients. Most described signs and symptoms based on their own observations and perceptions rather than what women themselves reported. Providers generally characterised PPD as a multifactorial condition, recognising the role of obstetric, psychologic, socioeconomic and cultural factors in its development. A traditional concept of PPD ("sav khuurukh") was prominently mentioned. Though they had diverse ideas regarding where women seek help for PPD, almost all providers agreed that a critical strategy for identifying PPD is patient-provider discussion. However, such discussions are rare because of providers' lack of confidence in recognising and treating women with PPD, lack of training, time constraints, and/or other related barriers. KEY CONCLUSIONS: The results demonstrate that while providers have some understanding of key aspects of PPD, many lack a clear conception of what defines the condition and how to effectively identify and treat it. IMPLICATIONS FOR PRACTICE: Based on our findings, we make seven recommendations for how to enhance PPD detection and treatment considering local Mongolian culture, practices and context.