Ethnoepidemiology of postnatal depression. Prospective multivariate study of sociocultural risk factors in a Chinese population in Hong Kong.

Background: Although there have been many studies of the biological and psychosocial causations of postnatal depression, studies of sociocultural risk factors are rare.
Aims: To investigate the sociocultural risk factors of postnatal depression using ethnographically informed epidemiological methods.
Method: A total of 959 women were assessed at their first ante-partum visit (baseline), in the third trimester, immediately after delivery, and 3 months postpartum. Six domains of risk factors were examined. The dependent variable was postnatal depression (as defined by the Edinburgh Postnatal Depression Scale) at 3 months post-partum.
Results: Conflict with mother-in-law, marital dissatisfaction, past depression and antenatal depression independently predicted the occurrence of postnatal depression. The cultural practice of peiyue - a Chinese post-partum custom of mandated family support - was associated with better social support and a slightly lower risk of postnatal depression.
Conclusions: Sociocultural aspects of the immediate puerperium shape maternal emotional well-being. In-law conflict is an important source of household distress in many Asian societies. The findings have implications for clinical practice and future studies.