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Social support and incidence of depression among postpartum mother lived in the extended family as Indonesian culture
Nurmaulid
Corresponding author
nurmaulid@unhas.ac.id

Corresponding author.
, Erfina, Ismail Marlian Nur
Faculty of Nursing, Hasanuddin University, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The postnatal period is well established as an increased time of risk for the development of serious mood disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> Postpartum depression &#40;PPD&#41; is &#8220;a mood disorder that can begin any time during the first year after delivery&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a> The number of depression postpartum was increased&#44; globally&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> Worldwide&#44; about 10&#37; of pregnant women and 13&#37; of women who have just given birth experience a mental disorder&#44; primarily depression&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">3</span></a> Limited report of postpartum depression in Indonesia&#46; Nevertheless&#44; some studies have been conducted to determine the incidence of postpartum depression in several regions in Indonesia&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">4&#44;5</span></a> Incidence of depression postpartum in Denpasar City around 20&#46;5&#37;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">4</span></a> and Makassar City was 19&#46;7&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Untreated postpartum depression &#40;PPD&#41; can have adverse long-term effects&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a> Postpartum depression will have an impact on mothers&#44; infants&#44; and other family members&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a> Mothers will have difficulty in nurturing and establish an adequate emotional bond to the baby and other children and can experience emotional disturbances&#44; language delays&#44; and cognitive impairment in infants&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">6</span></a> Furthermore&#44; in severe conditions&#44; the mother can bring up the desire to end suffering through a way that endangers herself and her child&#46;<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several researchers studied the relationship between social support and depressive symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a> Social support is an action that is given in the form of verbal or nonverbal information or advice that has emotional benefits over the effects of behavior on the part of the recipient&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> Some studied reported that certain dimensions of social support were significantly associated with depressive symptoms&#44; while others were not&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#44;10</span></a> Living in an extended family has greatly positive effects on postpartum maternal depression due to more assistance from relatives or other families&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Indonesia is a large country with approximately 250 million people&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a> In Indonesia&#44; family support is the most significant source of social support and extended family structures are common&#46; Grandparents&#44; aunts&#44; uncles&#44; and cousins&#44; often living together in one place&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a> Although there are recently published articles of social support and postpartum depression&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#44;13&#8211;16</span></a> There are few studies about correlation social support and postpartum depression who lived in the extended family as Indonesian culture&#46; Therefore&#44; this study aimed to explore correlation between social support and incidence of depression among postpartum mother lived in Indonesia&#39;s extended family&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0025" class="elsevierStylePara elsevierViewall">A cross-sectional descriptive study was undertaken at two highest birth rate primary health services work area&#46; Fifty-seven eligible samples were recruited with cluster sampling with inclusion criteria&#58; first week postpartum&#44; no postpartum complication&#44; living with extended family and willing to be participant&#46; Social support was assessed with Postpartum Social Support Questionnaire &#40;PSSQ&#41;&#44; a standard tool in order to evaluate social support during postpartum period&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> This questionnaire consisted of 50 items were rationally generated that tapped into the two major domains of support&#44; emotional and instrumental&#44; provided by a partner &#40;spouse&#41;&#44; family&#44; and friends&#46; Items were generated to include those aspects of support that would be specific to the postpartum period&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a> The instrument had been translated into Bahasa &#40;Indonesia language&#41; and back translated into English and validity test has been carried out &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;805&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Each item assesses the frequency of occurrence of a specific socially supportive behavior using a 7-point Likert scale&#44; where 1 equals &#8220;almost never&#8221; and 7 equals &#8220;very often&#8221;&#46; The scale was constructed to yield four subscale scores including partner support &#40;15 items&#41;&#44; parent support &#40;11 items&#41;&#44; parent-in-law support &#40;9 items&#41;&#44; and extended-family and friends support &#40;13 items&#41;&#46; There also were two items assessing general support&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Postpartum depression was examined with <span class="elsevierStyleItalic">Edinburgh Postnatal Depression Scale</span> &#40;EPDS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">18</span></a> The EPDS is a 10-item self-report scale that measures the intensity of depressive symptoms experienced within the past 7 days&#46; Each statement is rated on a scale from 0 to 3 &#40;&#8220;yes&#44; most of the time&#8221; to &#8220;no&#44; not at all&#8221;&#41;&#44; resulting in a possible total score range from 0 to 30&#46; Seven of the 10 items are reverse scored&#46; A cut-off score of 13 or greater is used to indicate PPD&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Data analyses were descriptive statistics summarized socio-demographic&#44; rates of depression&#44; and social support&#46; Chi-square analyses were then used to compare rates of social support across postpartum depression&#46; Overall statistical significance was at the two-sided 5&#37; level &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Within and between group effect-sizes &#40;Cohen&#39;s <span class="elsevierStyleItalic">d</span>&#41; &#40;Cohen&#44; 1988&#41; and 95&#37; confidence intervals &#40;CI&#41; were calculated using the observed data&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The research received ethics review and approval from The Research Ethics Committee of Faculty of Medicine&#44; Hasanuddin University&#44; Indonesia&#46; Data were collected through questionnaires with no harmful effects on respondents&#46; Ethical conduct was applied throughout the study process&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Result</span><p id="par0050" class="elsevierStylePara elsevierViewall">Descriptive statistics for sample characteristics are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The subjects who participated in this study were 57 postpartum mothers from a primary health center&#46; The mean age was 29 years with range 16&#8211;40 years&#46; Dominant have low education &#40;35&#46;1&#37;&#41;&#44; and majority were a housewife &#40;89&#46;5&#37;&#41;&#46; Related to parity&#44; majority sample was multiparous &#40;73&#46;3&#37;&#41;&#44; giving birth with vaginal birth &#40;91&#46; 2&#37;&#41; and average has two children&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> describes the descriptive statistic for the main variables in this study&#46; The percentage of mothers who get low &#40;42&#46;1&#37;&#41; and moderate &#40;45&#46;6&#41; social support is almost equal&#46; 35 respondents &#40;61&#46;4&#37;&#41; experienced postpartum depression&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the correlation between social support and incidence of postpartum depression among postpartum mother lived in Indonesia&#39;s extended family&#46; The result revealed a significant correlation between social support and incidence of postpartum depression &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;030&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">This study contributes new information regarding social support and incidence of depression among postpartum mother lived in the extended family as Indonesian culture&#46; All the participants are living with extended family&#46; The results of this study found that social support given to postpartum mothers from husband and parents is moderate support&#44; while in-law support and family and friends support get high support&#46; This study confirms that all the family members who live together in one house support mother during the postpartum period&#46; Living together with extended family greatly positive effects to postpartum maternal depression due to more assistance from relatives or other families&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">One study describes that primiparous outside Singapore receive less support&#46; In contrast to this study&#44; those who received less support were multiparous mothers&#46; The reason was mothers feel that the social support provided is limited and will even worse if mothers live far from&#44; parents&#44; in-laws&#44; and family&#44; and friends while other mothers feel stressed because they have to face suggestions received from their husbands and parents&#44; which are conflicting&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">19</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Age is one of the factors that can influence the incidence of postpartum depression&#46; The results of this study indicate that most mothers experience postpartum depression at the age of 20&#8211;35 years&#46; Young adults are an introduction to problems&#44; where age is needed emotional support&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a> Someone in this age experiences changes in responsibility from a student to an independent adult by determining a new lifestyle&#44; taking on new responsibilities and making new commitments so that at this age can be depressed&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Social support is an action that is given in the form of verbal or nonverbal information or advice that has emotional benefits over the effects of behavior on the part of the recipient&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a> This study showed that there was a significant correlation between social support and postpartum depression&#46; Some studied reported that certain dimensions of social support were significantly associated with depressive symptoms&#44; while others were not&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">8&#44;10</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Husband support greatly influences the psychosocial adaptation faced by postpartum mothers&#46; The role of the couple is considered important to taking care of the baby&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a> Less support from partners is due to responsibility for working to family life &#8212; however&#44; the incidence of postpartum depression experienced by the housewife&#46; More children will increase the burden of mothers in caring for their children and could be a trigger of postpartum depression&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">After the baby birth&#44; the mother-in-law often comes and gives support&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a> The study found that the support provided by in-laws was high support&#46; However&#44; this study is not in line with one study revealed that for some mothers&#44; in-laws are a source of stress and feel that in-laws always control and criticize the potential of mothers&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0095" class="elsevierStylePara elsevierViewall">This study can be summarized that more than half of postpartum reported incidence of depression and have moderate social support&#46; There was a statistic correlation between social support and postpartum depression&#46; Social supports that are appropriate in frequency&#44; type&#44; and the amount may help mothers to receive the emotional&#44; psychological&#44; and physical supports that they need&#46; Nurses should be able to screen for and recognize symptoms of depression in the postpartum period&#46; Furthermore&#44; maternity nurses should implement family center care and empowered family to give social support during childbearing to prevent the incidence of postpartum depression&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The purpose of this study was to explore the correlation between social support and incidence of depression among postpartum mother lived in Indonesia&#39;s extended family&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional descriptive study was undertaken in this study&#46; Fifty-seven eligible samples were recruited with cluster sampling at two primary health services in Makassar&#46; The correlation between social support and incidence of postpartum depression was analyzed using chi-square&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The results showed the mean age was 29 years&#46; Dominant have low educational &#40;35&#46;1&#37;&#41;&#46; Majority of mothers was a housewife &#40;89&#46;5&#37;&#41;&#46; Majority sample was multiparous &#40;73&#46;3&#37;&#41;&#44; giving birth with vaginal birth &#40;91&#46;2&#37;&#41; and average has two children&#46; The result revealed a significant correlation between social support and incidence of postpartum depression &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;030&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The result highlights important issues related to social support and postpartum depression&#46; Family-center care nursing and social support during childbearing are needed to prevent the incidence of postpartum depression&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
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            "identificador" => "abst0015"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the International Conference on Women and Societal Perspective on Quality of Life &#40;WOSQUAL-2019&#41;&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
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                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Type of birth</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pervaginam&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cesarean section&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t" scope="col">Not depression&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Depression&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="3" align="left" valign="middle">0&#46;030</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Moderate&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">High&nbsp;\t\t\t\t\t\t\n
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Original language: English
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