title: Postnatal depressive symptoms amongst women in Central Vietnam: a cross-sectional study investigating prevalence and associations with social, cultural and infant factors.
abstract: BACKGROUND
  This study investigated the prevalence and socio-cultural correlates of postnatal mood disturbance amongst women 18-45 years old in Central Vietnam. Son preference and traditional confinement practices were explored as well as factors such as poverty, parity, family and intimate partner relationships and infant health.
  
  
  METHODS
  A cross-sectional study was conducted in twelve randomly selected Commune Health Centres from urban and rural districts of Thua Thien Hue Province, Vietnam. Mother-infant dyads one to six months postpartum were invited to participate. Questionnaires from 431 mothers (urban n = 216; rural n = 215) assessed demographic and family characteristics, traditional confinement practices, son preference, infant health and social capital. The Edinburgh Postnatal Depression Scale (EPDS) and WHO5 Wellbeing Index indicated depressive symptoms and emotional wellbeing. Data were analysed using general linear models.
  
  
  RESULTS
  Using an EPDS cut-off of 12/13, 18.1% (n = 78, 95% CI 14.6-22.1) of women had depressive symptoms (20.4% urban; 15.8% rural). Contrary to predictions, infant gender and traditional confinement were unrelated to depressive symptoms. Poverty, food insecurity, being frightened of family members, and intimate partner violence increased both depressive symptoms and lowered wellbeing. The first model accounted for 30.2% of the variance in EPDS score and found being frightened of one's husband, husband's unemployment, breastfeeding difficulties, infant diarrhoea, and cognitive social capital were associated with higher EPDS scores. The second model had accounted for 22% of the variance in WHO5 score. Living in Hue city, low education, poor maternal competence and a negative family response to the baby lowered maternal wellbeing.
  
  
  CONCLUSIONS
  Traditional confinement practices and son preference were not linked to depressive symptoms among mothers, but were correlates of family relationships and wellbeing. Poverty, food insecurity, violence, infant ill health, and discordant intimate and family relationships were linked with depressive symptoms in Central Vietnam.
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia. linda.murray@utas.edu.au.|School of Medicine, University of Tasmania, 1/17 Liverpool St, Hobart, Tasmania, 7000, Australia. linda.murray@utas.edu.au.
authors.forename: Linda
authors.initials: L
authors.lastname: Murray
authors.affiliation: School of Public Health and Social Work, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia. m.dunne@qut.edu.au.|Institute of Community Health Research, Hue University of Medicine and Pharmacy, 06 Ngo Quyen St, Hue City, Vietnam. m.dunne@qut.edu.au.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Dunne
authors.affiliation: Institute of Community Health Research, Hue University of Medicine and Pharmacy, 06 Ngo Quyen St, Hue City, Vietnam. vovanthang147@gmail.com.|Faculty of Public Health Hue University of Medicine and Pharmacy, 06 Ngo Quyen St, Hue City, Vietnam. vovanthang147@gmail.com.
authors.forename: Thang
authors.initials: T
authors.lastname: Van Vo
authors.affiliation: Institute of Community Health Research, Hue University of Medicine and Pharmacy, 06 Ngo Quyen St, Hue City, Vietnam. ntaphuong99@gmail.com.|Hue University of Medicine and Pharmacy, 06 Ngo Quyen St, Hue City, Vietnam. ntaphuong99@gmail.com.
authors.forename: Phuong Nguyen Thi
authors.initials: PN
authors.lastname: Anh
authors.affiliation: School of Psychology and Counseling, Queensland University of Technology (QUT), Victoria Park Rd, Kelvin Grove, Queensland, 4059, Australia. n.khawaja@qut.edu.au.
authors.forename: Nigar G
authors.initials: NG
authors.lastname: Khawaja
authors.affiliation: Institute of Community Health Research, Hue University of Medicine and Pharmacy, 06 Ngo Quyen St, Hue City, Vietnam. thanhykhue@yahoo.com.|Hue University of Medicine and Pharmacy, 06 Ngo Quyen St, Hue City, Vietnam. thanhykhue@yahoo.com.
authors.forename: Thanh Ngoc
authors.initials: TN
authors.lastname: Cao
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000523:psychology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000209:etiology; D004522:Educational Status; D004644:Emotions; D004651:Employment; D005190:Family / Q000523:psychology; D005260:Female; D005523:Food Supply; D006801:Humans; D007224:Infant Care / Q000523:psychology; D007231:Infant, Newborn; D007398:Interpersonal Relations; D000066511:Intimate Partner Violence / Q000523:psychology; D016014:Linear Models; D016743:Mental Competency; D009035:Mothers / Q000523:psychology*; D011203:Poverty; D011247:Pregnancy; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data; D018454:Spouses; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data; D014744:Vietnam / Q000453:epidemiology