SOCIAL pregnancy, antenatal women experience some physical

    SOCIAL SUPPORT RELATED TO ANTENATAL MENTAL DISORDERS                                                                                                               A PROPOSAL OF FOURTH YEAR PROJECT SUBMITTED INFULFILLMENT OF REQUIREMENT FOR THE DEGREE OF NURSING   ANIS SABIRAH BINTI ISMAIL (1413864)                                                                                                                  KULLIYYAH OFNURSING                                                              INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA   SEM 1, 2017/ 2018                                               CHAPTER 1INTRODUCTION1.1 BACKGROUNDOF THE STUDYPregnancy periodis the most anticipated time for every woman during their childbearing ages. Althoughmany women have had uneventful pregnancy, some women may face some level ofhealth problems within this period and some of them perceived motherhood periodas ‘suffering, ill-health and even death’ (World Health Organization, n.d.

).  Health can be defined as ‘a state of complete physical,mental and social wellbeing and not merely the absence of disease or infirmity'(World Health Organization, n.d.).

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While maternal health referred to health ofwomen during antepartum, childbirth and postpartum period (World HealthOrganization, n.d.).  In addition,the health of antenatal women is not merely focusing on the physical part only,but it also includes mental, social and spiritual part (Radhakrishnan, 2012).     World Health Organization (n.d.) estimates 10% ofantenatal women having mental disorders worldwide. In Asian countries, it wasfound that 20% of antenatal women experience depression (Roomruangwong &Epperson, 2011).

A recent study conducted in Malaysia showed that 23.4% ofantenatal women have the symptoms of anxiety and 10.3% of them experienceddepression (Fadzil et al., 2017).            Throughoutthe pregnancy, antenatal women experience some physical and psychologicalchanges due to the hormonal changes in the body (Fadzil et al.

, 2017; Radhakrishnan, 2012).Although such changes are considered as normal process in pregnancy, the healthof the mothers will be affected if the mothers unable to cope with the changes.Inability to cope may lead to various physical problems such as backache,fatigue, body aches, urinary incontinence as well as psychological distress(Herath, Balasuriya, & Sivayogan, 2017).            Thereare three forms of antenatal mental disorders which include: anxiety, worry anddepression (Gourounti et al., 2014). Anxiety is defined as feelings of distress,eager and unease about something (Dotson et al., 207; Ghaffar et al.

, 2017). Duringpregnancy, anxiety is referred as pregnancy-specific anxiety and it is differfrom normal anxiety (Stadtlander, 2017).            Worrycan be defined as unease of feeling and thoughts that are not specific andassociated with negative loading (Ternström, Hildingsson, Haines, & Rubertsson,2016).It is further described as the cognitive sides of anxiety and cannot beresolved by individuals on their own. Anxiety and worry are always related with Generalized Anxiety Disorder(GAD) in which the feeling of worry become a significant problem,uncontrollable, that may cause functional impairment and subside at least 6months later (Dotson et al.

, 2017).  Thesymptoms of anxiety and worry include fear regarding the health of the baby,difficult to concentrate, restless and multiple time of having negativethoughts (Stadtlander, 2017).  Thus,worry that exceed the normal physiological thoughts, may generate moreanxieties in antenatal women.            Depressionis referred to a state of sadness, frustration and dislike of involving in anyphysical activities (Ghaffar et al., 2017). The symptoms of depressionidentified by previous study include feeling sad, fatigue, lack of interest,extreme irritability and disturbed sleep (Humayun, Haider, Imran, Iqbal &Humayun, 2013).            Theconsequences include preterm birth, low birth weight, less antenatal clinicvisit, unintended abortion, intra uterine growth retardation and the mothersare prone to stop breastfeed their child earlier (Ola et al., 2011; Radhakrishnan, 2012; Stadtlander, 2017).

            Previousstudies have recognized various factors contributing to antenatal mentaldisorders such as poor socioeconomic development, involve in abuse andviolence, poor health care facilities, young age, fear of delivery, lack ofsocial support and marital difficulties (Dotson et al., 2017; Ghaffar et al.,2017; Gourounti, Anagnostopoulos, & Sandall, 2014). Lack of social supporthas been found as the main factor affecting antenatal mental disorders. Themain factor of good social support is antenatal women have the opportunity toshare their concerns rather than just interventions (Bowen, Baetz, Schwartz, Balbuena, & Muhajarine,2014).

While poor social support increases the psychological stress among antenatalwomen (Ghaffar et al., 2017). 1.2 PROBLEMSTATEMENTS            Mentaldisorders include depression, anxiety and worry (Gourounti et al., 2014).

Thesemental disorders are very common during early onset of pregnancy (Rallis,Skouteris, McCabe & Milgrom, 2014). Previous researchers also found thatthese antenatal mental disorders are related to each other as the pattern ofthem as found in the study are the same in which the symptoms recorded duringearly pregnancy will affect women at later time. Many studies have been conducted on antenatal mentaldisorders and how it relates with social support. However, there were limitedstudies that include all type of mental disorders were carried. Former studiesidentify more on depression disorders, yet anxiety disorders among antenatalwomen remain unclear. Therefore, this shows the need to study about theantenatal anxiety also (Rubertsson et al.

, 2014). A study conducted in Greecefound that the study regarding the association of social support and antenatalmental disorders remain in neglected area as previous study highlighted onlythe relationship of social support and depressive disorders (Gourounti et al.,2014).The association between social support related toantenatal mental disorders are inconsistently found in previous study. A studyconducted by Humayun et al. (2013) in Lahore, Pakistan found that socialsupport during pregnancy is not a significant factor for antenatal depression(P = 0.75).

Whereas antenatal women who participated in Psychotherapy group inCanada recorded to show a significant decrease (p < 0.001) of depression(EPDS score), amount of worry (CWS score) and anxiety (STAI score) throughoutthe pregnancy (Bowen et al., 2014).

Emerging research has shown that maternal health cancause adverse effect on the mother and child (Ghaffar et al., 2017;Stadtlander, 2017). Maternal health should be everyone concerns as it affectsall woman worldwide if left untreated. Even though there were manyinterventions that have been done by health care practitioners in assessing andpreventing antenatal mental disorders, the occurrence of this disorders remainsas previous study proved that many women did not get diagnosed and treated wellduring obstetric care (Rubertsson, Hellström, Cross, & Sydsjö, 2014).Previousresearchers also found that women with mental disorders remain undiagnosedbecause of the health care systems that fails to recognize and detect thesymptoms.

Research on antenatal mental disorders is of greatimportance especially in developing countries. It is reported that one in threeto one in five antenatal women established significant mental health problem inthe developing countries (World Health Organization, 2008). It is noteworthythat in developing countries, research of antenatal mental disorders is aneglected area of research (Ghaffar et al.

, 2017; Humayun et al., 2013; Ola etal., 2011; Roomruanwong & Epperson, 2011; Satyanarayana, Lukose, & Srinivasan,2011). In addition, Roomruanwong & Epperson (2011) reported developingcountries especially in Asian region accommodated more than 60% of populationin the world and many former studies only conducted in Western countries. Asian women may have different ways of interpretingmental disorders as compared to Western women. A study conducted in UnitedStates found that 40% of the respondents self-diagnosed depression, whereas theother denies their diagnosis (Bledsoe et al., 2017). Considering Malaysia as a multicultural country, whichinclude Malay, Chinese, Indian and others, its unique characteristics allowMalaysia to represent one of the Asian countries.

Therefore, this studyaims to examine the association between social support and antenatal mentaldisorders among Malaysian women. 1.3 SIGNIFICANCE OF THESTUDY            There are many significances of thisstudy to antenatal women, health care practitioners, nursing practice andorganization. First and foremost, good availability of the social support mayprevent antenatal mental disorders respectively. Women can take good care ofthemselves and their child if they receive good social support. Population thathave good health could make healthier generations. Antenatal women will be morealert on the symptoms of mental disorders and can prevent it from earlier byseeking medical attention immediately.  Women, partner and family can be educated onthe relationship between social support and antenatal mental disorders.

At thesame time, positive psychological health during pregnancy can be promoted amongantenatal women.             Besides, this study also benefitsthe health care practitioners in preventing antenatal mental disorders. This isbecause, they will be more alert on the symptoms of mental disorders amongantenatal women. It will help them to assess the antenatal women thoroughlysuch as assessing the level of anxiety, worry and depression on every antenatalcheckup. Health care practitioners also can join hands with the government toconduct a mental health programme and apply a standard of care in reducingmortality and morbidity among antenatal women.

            Apart from that, significance of thestudy to nursing practice is they can provide better quality of nursing care tothe patients. For instance, nurses can encourage the family members to alwaysgive supports to the antenatal women and educate them regarding the symptoms ofmental disorders to prevent any adverse effect of antenatal mental disorders.The nurses also can be a good listener to the antenatal women that experiencemental disorders by setting up psychosocial group among them.

Finally, thisstudy will benefit the organizations in a way it will decrease the prevalenceof antenatal mental disorders and in the meantime, it will reduce the costburden of the hospital.  1.4 RESEARCH QUESTIONSQ1: What is the prevalence ofantenatal mental disorders in antenatal Malaysian women in Pahang, Malaysia?Q2:What is the association between socio-demographic and antenatal mentaldisorders among antenatal Malaysian women in Pahang, Malaysia? Q3: What is the association betweensocial support and antenatal mental disorders amongst Malaysian women? 1.5 RESEARCH OBJECTIVES 1.5.

1 General ObjectiveTo examine the relationship between social support andantenatal mental disorders in Malaysian women. 1.5.2 Specific Objectives1. To determine the prevalence ofantenatal mental disorders attending antenatal visit in Pahang, Malaysia.2.

To identify the associationbetween socio-demographic and antenatal mental disorders among antenatalMalaysian women in Pahang, Malaysia.3.To determine association between social support and antenatal mental disorders amongstMalaysian women 1.6 HYPOTHESIS 1.

6.1 Null HypothesisThere is no association between thesocial support with antenatal mental disorders in Malaysian women.  1.6.

2 AlternativeHypothesis There is no association between thesocial support with antenatal mental disorders in Malaysian women.     1.7 OPERATIONALDEFINITIONAntenatal women: Pregnantwomen which include first, second and third trimester. Mental disorders: WorldHealth Organization (2017) define mental disorders as a combination of abnormalthoughts, perceptions, emotions, behavior and relationship with surroundingpeople. This study focuses on depression, anxiety and worry.  Antenatal mentaldisorders: In this study, it refers to pregnantwomen who experience symptoms of anxiety, depression or worries.Social support: Albrecht& Adelman’s study (as cited in Stana, Flynn, Almeida, 2017) define socialsupport as “verbal and nonverbal communication between recipients and providersthat reduces uncertainty about the situation, the self, the other, or therelationship, and functions to enhance a perception of personal control inone’s experience.” In simple words, it is the relationship of recipient withsurrounding and a place for her to depend on.

Socio demographic: Characteristicof a group that is defined by their sociology and demographic criteria. Anxiety:It is referring to feelings of distress, eager and unease about something thatmight happen (Dotson et al., 207; Ghaffar et al., 2017).Depression:A state of sadness, frustration and dislike of involving in any physicalactivities (Ghaffar et al., 2017). Depression also affect thinking process andsomeone’s act.Worries:An unease of feeling and thoughts that are not specific and associated withnegative loading (Ternström, Hildingsson, Haines, & Rubertsson,2016).

  Bledsoe, S. E., Rizo,C. F., Wike, T.

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, & Rich, T. (2017). Normal anxiety of pregnancy. International Journal of ChildbirthEducation, 32(1), 13-15. Gourounti, K.,Anagnostopoulos, F., & Sandall, J. (2014).

Poor marital support associatewith anxiety and worries during pregnancy in Greek pregnant women. Midwifery, 30(6),628-635. Herath, I.

N. S.,Balasuriya, A., & Sivayogan, S. (2017). Physical and psychologicalmorbidities among selected antenatal females in Kegalle district of Sri Lanka:A cross sectional study. Journal of Obstetrics and Gynaecology,1-6.

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, & Krishnadas, R. (2011). Factorsassociated with antenatal mental disorder in West Africa: A cross-sectionalsurvey. BMC pregnancy and childbirth, 11(1), 90. Radhakrishnan, S. A.(2012). Psychological Wellbeing in Pregnancy.

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, Flynn, M.A., & Almeida, E.

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