SOCIAL SUPPORT RELATED TO ANTENATAL MENTAL DISORDERS
A PROPOSAL OF FOURTH YEAR PROJECT SUBMITTED IN
FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF NURSING
ANIS SABIRAH BINTI ISMAIL (1413864)
INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA
SEM 1, 2017/ 2018
OF THE STUDY
is the most anticipated time for every woman during their childbearing ages. Although
many women have had uneventful pregnancy, some women may face some level of
health problems within this period and some of them perceived motherhood period
as ‘suffering, ill-health and even death’ (World Health Organization, n.d.). Health can be defined as ‘a state of complete physical,
mental and social wellbeing and not merely the absence of disease or infirmity’
(World Health Organization, n.d.). While maternal health referred to health of
women during antepartum, childbirth and postpartum period (World Health
Organization, n.d.). In addition,
the health of antenatal women is not merely focusing on the physical part only,
but it also includes mental, social and spiritual part (Radhakrishnan, 2012).
World Health Organization (n.d.) estimates 10% of
antenatal women having mental disorders worldwide. In Asian countries, it was
found that 20% of antenatal women experience depression (Roomruangwong &
Epperson, 2011). A recent study conducted in Malaysia showed that 23.4% of
antenatal women have the symptoms of anxiety and 10.3% of them experienced
depression (Fadzil et al., 2017).
the pregnancy, antenatal women experience some physical and psychological
changes due to the hormonal changes in the body (Fadzil et al., 2017; Radhakrishnan, 2012).
Although such changes are considered as normal process in pregnancy, the health
of the mothers will be affected if the mothers unable to cope with the changes.
Inability to cope may lead to various physical problems such as backache,
fatigue, body aches, urinary incontinence as well as psychological distress
(Herath, Balasuriya, & Sivayogan, 2017).
are three forms of antenatal mental disorders which include: anxiety, worry and
depression (Gourounti et al., 2014). Anxiety is defined as feelings of distress,
eager and unease about something (Dotson et al., 207; Ghaffar et al., 2017). During
pregnancy, anxiety is referred as pregnancy-specific anxiety and it is differ
from normal anxiety (Stadtlander, 2017).
can be defined as unease of feeling and thoughts that are not specific and
associated with negative loading (Ternström, Hildingsson, Haines, & Rubertsson,
It is further described as the cognitive sides of anxiety and cannot be
resolved by individuals on their own.
Anxiety and worry are always related with Generalized Anxiety Disorder
(GAD) in which the feeling of worry become a significant problem,
uncontrollable, that may cause functional impairment and subside at least 6
months later (Dotson et al., 2017). The
symptoms of anxiety and worry include fear regarding the health of the baby,
difficult to concentrate, restless and multiple time of having negative
thoughts (Stadtlander, 2017). Thus,
worry that exceed the normal physiological thoughts, may generate more
anxieties in antenatal women.
is referred to a state of sadness, frustration and dislike of involving in any
physical activities (Ghaffar et al., 2017). The symptoms of depression
identified by previous study include feeling sad, fatigue, lack of interest,
extreme irritability and disturbed sleep (Humayun, Haider, Imran, Iqbal &
consequences include preterm birth, low birth weight, less antenatal clinic
visit, unintended abortion, intra uterine growth retardation and the mothers
are prone to stop breastfeed their child earlier (Ola et al., 2011; Radhakrishnan, 2012; Stadtlander, 2017).
studies have recognized various factors contributing to antenatal mental
disorders such as poor socioeconomic development, involve in abuse and
violence, poor health care facilities, young age, fear of delivery, lack of
social support and marital difficulties (Dotson et al., 2017; Ghaffar et al.,
2017; Gourounti, Anagnostopoulos, & Sandall, 2014). Lack of social support
has been found as the main factor affecting antenatal mental disorders. The
main factor of good social support is antenatal women have the opportunity to
share their concerns rather than just interventions (Bowen, Baetz, Schwartz, Balbuena, & Muhajarine,
While poor social support increases the psychological stress among antenatal
women (Ghaffar et al., 2017).
disorders include depression, anxiety and worry (Gourounti et al., 2014). These
mental disorders are very common during early onset of pregnancy (Rallis,
Skouteris, McCabe & Milgrom, 2014). Previous researchers also found that
these antenatal mental disorders are related to each other as the pattern of
them as found in the study are the same in which the symptoms recorded during
early pregnancy will affect women at later time.
Many studies have been conducted on antenatal mental
disorders and how it relates with social support. However, there were limited
studies that include all type of mental disorders were carried. Former studies
identify more on depression disorders, yet anxiety disorders among antenatal
women remain unclear. Therefore, this shows the need to study about the
antenatal anxiety also (Rubertsson et al., 2014). A study conducted in Greece
found that the study regarding the association of social support and antenatal
mental disorders remain in neglected area as previous study highlighted only
the relationship of social support and depressive disorders (Gourounti et al.,
The association between social support related to
antenatal mental disorders are inconsistently found in previous study. A study
conducted by Humayun et al. (2013) in Lahore, Pakistan found that social
support during pregnancy is not a significant factor for antenatal depression
(P = 0.75). Whereas antenatal women who participated in Psychotherapy group in
Canada recorded to show a significant decrease (p < 0.001) of depression (EPDS score), amount of worry (CWS score) and anxiety (STAI score) throughout the pregnancy (Bowen et al., 2014). Emerging research has shown that maternal health can cause adverse effect on the mother and child (Ghaffar et al., 2017; Stadtlander, 2017). Maternal health should be everyone concerns as it affects all woman worldwide if left untreated. Even though there were many interventions that have been done by health care practitioners in assessing and preventing antenatal mental disorders, the occurrence of this disorders remains as previous study proved that many women did not get diagnosed and treated well during obstetric care (Rubertsson, Hellström, Cross, & Sydsjö, 2014).Previous researchers also found that women with mental disorders remain undiagnosed because of the health care systems that fails to recognize and detect the symptoms. Research on antenatal mental disorders is of great importance especially in developing countries. It is reported that one in three to one in five antenatal women established significant mental health problem in the developing countries (World Health Organization, 2008). It is noteworthy that in developing countries, research of antenatal mental disorders is a neglected area of research (Ghaffar et al., 2017; Humayun et al., 2013; Ola et al., 2011; Roomruanwong & Epperson, 2011; Satyanarayana, Lukose, & Srinivasan, 2011). In addition, Roomruanwong & Epperson (2011) reported developing countries especially in Asian region accommodated more than 60% of population in the world and many former studies only conducted in Western countries. Asian women may have different ways of interpreting mental disorders as compared to Western women. A study conducted in United States found that 40% of the respondents self-diagnosed depression, whereas the other denies their diagnosis (Bledsoe et al., 2017). Considering Malaysia as a multicultural country, which include Malay, Chinese, Indian and others, its unique characteristics allow Malaysia to represent one of the Asian countries. Therefore, this study aims to examine the association between social support and antenatal mental disorders among Malaysian women. 1.3 SIGNIFICANCE OF THE STUDY There are many significances of this study to antenatal women, health care practitioners, nursing practice and organization. First and foremost, good availability of the social support may prevent antenatal mental disorders respectively. Women can take good care of themselves and their child if they receive good social support. Population that have good health could make healthier generations. Antenatal women will be more alert on the symptoms of mental disorders and can prevent it from earlier by seeking medical attention immediately. Women, partner and family can be educated on the relationship between social support and antenatal mental disorders. At the same time, positive psychological health during pregnancy can be promoted among antenatal women. Besides, this study also benefits the health care practitioners in preventing antenatal mental disorders. This is because, they will be more alert on the symptoms of mental disorders among antenatal women. It will help them to assess the antenatal women thoroughly such as assessing the level of anxiety, worry and depression on every antenatal checkup. Health care practitioners also can join hands with the government to conduct a mental health programme and apply a standard of care in reducing mortality and morbidity among antenatal women. Apart from that, significance of the study to nursing practice is they can provide better quality of nursing care to the patients. For instance, nurses can encourage the family members to always give supports to the antenatal women and educate them regarding the symptoms of mental disorders to prevent any adverse effect of antenatal mental disorders. The nurses also can be a good listener to the antenatal women that experience mental disorders by setting up psychosocial group among them. Finally, this study will benefit the organizations in a way it will decrease the prevalence of antenatal mental disorders and in the meantime, it will reduce the cost burden of the hospital. 1.4 RESEARCH QUESTIONS Q1: What is the prevalence of antenatal mental disorders in antenatal Malaysian women in Pahang, Malaysia? Q2: What is the association between socio-demographic and antenatal mental disorders among antenatal Malaysian women in Pahang, Malaysia? Q3: What is the association between social support and antenatal mental disorders amongst Malaysian women? 1.5 RESEARCH OBJECTIVES 1.5.1 General Objective To examine the relationship between social support and antenatal mental disorders in Malaysian women. 1.5.2 Specific Objectives 1. To determine the prevalence of antenatal mental disorders attending antenatal visit in Pahang, Malaysia. 2. To identify the association between socio-demographic and antenatal mental disorders among antenatal Malaysian women in Pahang, Malaysia. 3. To determine association between social support and antenatal mental disorders amongst Malaysian women 1.6 HYPOTHESIS 1.6.1 Null Hypothesis There is no association between the social support with antenatal mental disorders in Malaysian women. 1.6.2 Alternative Hypothesis There is no association between the social support with antenatal mental disorders in Malaysian women. 1.7 OPERATIONAL DEFINITION Antenatal women: Pregnant women which include first, second and third trimester. Mental disorders: World Health Organization (2017) define mental disorders as a combination of abnormal thoughts, perceptions, emotions, behavior and relationship with surrounding people. This study focuses on depression, anxiety and worry. Antenatal mental disorders: In this study, it refers to pregnant women who experience symptoms of anxiety, depression or worries. Social support: Albrecht & Adelman's study (as cited in Stana, Flynn, Almeida, 2017) define social support as "verbal and nonverbal communication between recipients and providers that reduces uncertainty about the situation, the self, the other, or the relationship, and functions to enhance a perception of personal control in one's experience." In simple words, it is the relationship of recipient with surrounding and a place for her to depend on. Socio demographic: Characteristic of a group that is defined by their sociology and demographic criteria. Anxiety: It is referring to feelings of distress, eager and unease about something that might happen (Dotson et al., 207; Ghaffar et al., 2017). Depression: A state of sadness, frustration and dislike of involving in any physical activities (Ghaffar et al., 2017). Depression also affect thinking process and someone's act. Worries: An unease of feeling and thoughts that are not specific and associated with negative loading (Ternström, Hildingsson, Haines, & Rubertsson, 2016). Bledsoe, S. E., Rizo, C. F., Wike, T. L., Killian-Farrell, C., Wessel, J., Bellows, A. M. O., & Doernberg, A. (2017). Pregnant adolescent women's perceptions of depression and psychiatric services in the United States. Women and Birth. Dotson, C. L., Davidson, W., & Rich, T. (2017). Normal anxiety of pregnancy. International Journal of Childbirth Education, 32(1), 13-15. Gourounti, K., Anagnostopoulos, F., & Sandall, J. (2014). Poor marital support associate with anxiety and worries during pregnancy in Greek pregnant women. Midwifery, 30(6), 628-635. Herath, I. N. S., Balasuriya, A., & Sivayogan, S. (2017). Physical and psychological morbidities among selected antenatal females in Kegalle district of Sri Lanka: A cross sectional study. Journal of Obstetrics and Gynaecology, 1-6. Ola, B., Crabb, J., Tayo, A., Ware, S. H. G., Dhar, A., & Krishnadas, R. (2011). Factors associated with antenatal mental disorder in West Africa: A cross-sectional survey. BMC pregnancy and childbirth, 11(1), 90. Radhakrishnan, S. A. (2012). Psychological Wellbeing in Pregnancy. Asian Journal of Nursing Education and Research, 2(4), 4. Rallis, S., Skouteris, H., McCabe, M., & Milgrom, J. (2014). A prospective examination of depression, anxiety and stress throughout pregnancy. Women and Birth, 27(4), e36-e42. Roomruangwong, C., & Epperson, C. N. (2011). Perinatal depression in Asian women: prevalence, associated factors, and cultural aspects. Asian Biomedicine, 5(2), 179-193. Rubertsson, C., Hellström, J., Cross, M., & Sydsjö, G. (2014). Anxiety in early pregnancy: prevalence and contributing factors. Archives of women's mental health, 17(3), 221-228. Satyanarayana, V. A., Lukose, A., & Srinivasan, K. (2011). Maternal mental health in pregnancy and child behavior. Indian journal of psychiatry, 53(4), 351. Stadlander, L. (2017). Anxiety and pregnancy. International Journal of Childbirth Education, 32(1), 32-34. Stana, A., Flynn, M. A., & Almeida, E. (2017). Battling the Stigma: Combat Veterans' Use of Social Support in an Online PTSD Forum. International Journal of Men's Health, 16(1), 20. Ternström, E., Hildingsson, I., Haines, H., & Rubertsson, C. (2016). Pregnant women's thoughts when assessing fear of birth on the Fear of Birth Scale. Women and Birth, 29(3), e44-e49. World Health Organization. (n.d.). Maternal mental health. Retrieved from http://www.who.int/mental_health/maternal-child/maternal_mental_health/en/ World Health Organization. (n.d.). Mental disorders. Retrieved from http://www.who.int/mediacentre/factsheets/fs396/en/