Paternal and Maternal Psychological Distress and Their Coping Mechanisms During Antenatal Period

1. Paternal and Maternal Psychological Distress and Their Coping Mechanisms During Antenatal Period Dr Christopher Kueh Boon Leng Master in Medicine (Family Medicine) UKM Supervisor: Dr Aida Jaffar

2. Introduction • Pregnancy and the transition to parenthood involve major psychological changes in future parents & these changes have been linked to an increase in anxiety rates & depression symptoms. (Condon et al., 2004) • Psychological distress is defined as emotional suffering characterized by symptoms of depression & anxiety and sometimes somatic symptoms that may vary across cultures. (Benoit et al., 2013)

3. Introduction (cont) • Prevalence of psychological distress is generally higher in women than men in all age groups and in most countries. • Epidemiologic studies have demonstrated that women experience depression about twice as frequently as men (Weisman et al., 1996; Hasin et al., 2005) --> there is however a growing awareness that the incidence of depression in men is markedly underestimated because of diagnostic bias.

4. Introduction (cont) According to Relier (2001), anxiety is a dimension of stress that occurs in response to internal or external stimuli and can result in physical, emotional, cognitive & behavioral symptoms. Depression and anxietycan cause a stressful pregnancy that can result in fetal distress, preterm delivery, LBW, postpartum disorders & other delivery complications.

5. Introduction (cont) • There is lack of local study on both paternal & maternal psychological distress during antenatal period & associated sociodemographic factors. • Data obtained will help primary care doctors to be more aware of psychological distress not only among pregnant mothers, but also targeted on expectant fathers as well.

6. Literature Review The prevalence of Antenatal Depression Symptoms (ADS) of mothers at second and third trimester of pregnancy in Kota Bharu District was 25.7% (Mirsanjari et al., 2012). The overall rate of paternal depression was 10.4% globally, with a U.S. rate of 14.1% vs. 8.2% in other countries (Clinical Psychiatry News, Vol. 38, No. 12). Prevalence of anxiety disorders during pregnancy among the blacks was reported to be 40% (Barnett, 1996) & among Hispanic women 51% (Zayas et al., 2002). Prevalence was found to be high among women of low socioeconomic status (Seguin et al., 1995).

7. Literature Review (cont) It is widely recognized that paternal mental ill health could increase the risk of behavioral and emotional problems in children (Ramchandani et al., 2008). Koh et al. (2014) identified significant demographic risk factors for paternal depression during antenatal period & such knowledge contributes to the effective design of screening, prevention & intervention strategies & also helps in the identification of high risk groups.

8. Literature Review (cont) Maternal depression during pregnancy was the strongest predictor of maternal postpartum depression (Josefsson et al., 2002) According to Koh et al. (2014), paternal depression in late pregnancy could significantly predict higher level of depression among expectant fathers in postpartum period, thus indicating that paternal depression screening & interventions should be done as early as in early pregnancy --> to prevent detrimental effect on their spouse & children' development.

9. Literature Review (cont) • Men are more likely to engage in withdrawal, diversion or distracting behavior as means of coping with depression. (Kleinke et al., 1982; Brownhill et al., 2005)

10. General Objective To determine the prevalence of paternal and maternal psychological distress and their coping mechanisms during antenatal period among attendees of Maternal and Child Health Clinic (MCHC) Jawa, Kuching

11. Specific Objectives 1. To determine the prevalence of paternal and maternal depression, anxiety and stress during antenatal period 2. To determine the association between paternal psychological distress and maternal psychological distress during antenatal period 3. To determine the association between paternal and maternal psychological distress during antenatal period and their sociodemographicfactors

12. Specific Objectives (cont) 4. To determine the difference between paternal and maternal coping mechanisms with their psychological distress 5. To determine the correlation between paternal and maternal psychological distress and their coping mechanisms

13. Methodology Study design: Cross Sectional Study Research setting: Government Maternal and Child Health Clinic (MCHC) Jawa, Kuching

14. Inclusion Criteria All antenatal mothers and fathers aged 18 years and above attending MCHC Jawa Consented for participation

15. Exclusion Criteria 1. Patients with diagnosed psychiatric illnesses 2. Patients who cannot read, understand or write English or Malay

16. Sampling Sampling frame: All antenatal mothers and fathers aged 18 years and above attending MCHC Jawa Sampling method: Systematic random sampling - every 3rd patient visiting the clinic will be sampled every day (Monday to Friday)

17. Sampling Size Z1-α= 1.96; p-value= 0.05 Z1-β=0.84; β=0.20; 0.80 power will be desired _ P= (P1 + P2)/2 Lwanga & Lameshow. 1991. Sample size determination in health studies. A practical manual. WHO Geneva

18. Sampling Size (cont) P1 = 0.257 (prevalence of antenatal maternal depression in Kota Bharu district 25.7%) (Mirsanjari et al., 2012) P2 = 0.104 (prevalence of antenatal paternal depression globally 10.4%) (Clinical Psychiatry News, Vol. 38, No. 12) • Calculated sample size = 98 • Final sample size = 118 (adding a 20% non-response rate)

19. Data Collection Patient'sSociodemographic Data Collected using standardized form Data collected: Age, gender, ethnic, religion, education level, occupation, marital status, household monthly income, number of children, comorbidities For maternal: Gravida/Para, LNMP & EDD/rEDD

20. Data Collection (cont) DASS 21 questionnaire • A 21-item self report questionnaire designed to assess the severity of the core symptoms of Depression, Anxiety and Stress • Although DASS may contribute to the diagnosis of anxiety or depression, it is not designed as a diagnostic tool

21. Data Collection (cont) CISS questionnaire • A self-rated questionnaire of 48-item in predicting various types of coping mechanisms • Available in English and Malay languages - both are validated • Cannot be downloaded for free and thus questionnaire needs to be purchased prior to study

22. Data Collection Flowchart Identify patients for sampling according to inclusion & exclusion criteria Collection of sociodemographic data; Self-administered questionnaires given to patients Explanation of study given to patients and consent taken Treat / refer appropriately for patients with high DASS scores Data entered and analyzed with SPSS Version 21 Report writing and presentation

23. Statistical Analysis SPSS (Statistical Package for Social Studies) Version21 will be used to perform the statistical analysis for the data collected. The significance level is set at p< 0.05 & the confidence interval is 95%.

24. Ethical Consideration Patients will be given explanation regarding purpose of study, the way it is conducted & type of data collected as well as benefits of the study. Patients have to give consent before they participate. No discrimination in giving treatment if patients refuse to join the study.

25. Ethical Consideration (cont) • DASS 21 questionnaire will be used & permission to be obtained from the author. • Patients with high DASS scores will be treated appropriately/referred to a psychiatrist for confirmation of an underlying depression or anxiety disorder. • For the approval of Research & Ethical Committee UKM and MOH.

26. Estimated Cost

27. Gantt Chart

28. Thank You