Diagnosis for postnatal depression

Oates et al’s (2004) study suggests that morbid unhappiness is recognised universally and appears to have broadly similar attributions and characteristics. However, it is not necessarily recognised by all countries and cultures as an illness remediable by intervention and requiring assistance from health care professionals. Oates et al’s (2004) study, suggests that CALD new mothers and their relatives may connect the causes of psychological distress to personal relationships and social networks rather than to mental health issues. In this context, remedies are viewed as predominantly personal and psychosocial rather than as mental health related issues in need of health professional intervention.

The following signs may alert health professionals that a woman has postnatal depression when she (Ministry of Health, 2014):

• Has experienced depression during pregnancy.
• Experiences feelings of hopelessness.
• Believes that she just can’t cope.
• Feels angry and irritated but is not sure why.
• Feels overly anxious about her baby.
• Feels tearful, alone, guilty and unsupported.
• Has difficulty sleeping even when her baby sleeps.
• Has thoughts of harming herself or her baby.
• Feels that she is being a bad mother and that somehow she has to cope.
• Does not realise that she is suffering from postnatal depression.

Any woman who has a baby is quite likely to feel some of these things at some time. Postnatal depression is when these feelings do not go away after a day or two.

In many Asian, Middle Eastern and African societies, the shame and stigma associated with mental illness, absence of appropriate words to describe psychological conditions during pregnancy, inability to associate depression with mental illness due to a lack of mental health awareness, and early parenthood may lead to the somatising of postnatal depression (Queensland Health- Multicultural Services, 2009).

Approaches to cultural assessment
(Beyondblue, 2007, p. 5)

When undertaking psychosocial assessments with women from CALD backgrounds, health professionals could also consider:

• How women from diverse backgrounds may present with emotional distress or mental health problems. For example, chronic or poorly-localised physical symptoms may be the first indicators.
• Ways to involve others with cultural expertise, such as trusted family members, community health workers, professional interpreters and bilingual workers.
• It is best to approach the assessment in a conversational manner that communicates your concern and interest. Some women may be reluctant to disclose personal information. It may take several sessions to undertake a comprehensive cultural assessment.
• The Patient Health Questionnaire 3 (PHQ-3) or 9 (PHQ-9).
• The Edinburgh Postnatal Depression Scale (EDPS) has validated translated versions in the following languages: Arabic, Chinese, Korean, French, German, Japanese, Malay, Portuguese, Punjabi, Spanish, Turkish and Vietnamese.