Journal of Child and Family Studies

, Volume 24, Issue 8, pp 2280–2289 | Cite as

The Experience of Perinatal Depression and Implications for Treatment Adaptation: A Qualitative Study in a Semi-rural District in Vietnam

  • Maria NiemiEmail author
  • Mai T. T. Nguyen
  • Trish Bartley
  • Elisabeth Faxelid
  • Torkel Falkenberg
Original Paper


This study sought to provide an understanding of how perinatal depression is experienced, and how interventions targeting it should be adapted to suit the local context. The study was conducted in a semi-rural district in Vietnam. It comprised of individual interviews with nine women who obtained high scores in a depression self-report measure during pregnancy, two focus group discussions (FGDs) with health workers from the local community health stations, and two FGDs with elderly women from the local community. Interviews addressed the experience of depression during pregnancy and FGDs addressed the perceptions of depression and the suitability and provision of a mindfulness intervention. Interventions targeting perinatal depression should take into account the particular social aspects that may be intimately linked to its causation and course. The causation of depression was deemed to be predominantly social, including problems between family members and son preference. The mindfulness intervention was thought suitable for the local context. Delivery through well-supported community meetings was recommended. A locally adapted intervention is thus deemed suitable for the local context, and could be provided as a component of a stepped-care model for depression treatment. The results of this study may not be generalizable beyond the group studied, or the context of Ba Vi, Vietnam.


Perinatal depression Depression intervention Vietnam Mindfulness 



We would like to thank the Swedish National Health Care Sciences Postgraduate School for funding the study, the Hanoi Medical University health systems research team, especially Professor Chuc, for organising the data collection, and Dr. Lan for assisting in conducting the interviews.

Conflict of interest



  1. Araya, R., Rojas, G., Fritsch, R., Gaete, J., Rojas, M., Simon, G., et al. (2003). Treating depression in primary care in low-income women in Santiago, Chile: A randomised controlled trial. Lancet, 361(9362), 995–1000. doi: 10.1016/S0140-6736(03)12825-5.PubMedCrossRefGoogle Scholar
  2. Areias, M. E., Kumar, R., Barros, H., & Figueiredo, E. (1996). Comparative incidence of depression in women and men, during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers. British Journal of Psychiatry, 169(1), 30–35.PubMedCrossRefGoogle Scholar
  3. Astbury, J., & Cabral, M. (2000). Women’s mental health: an evidence based review. Geneva: World Health Organization.Google Scholar
  4. Chapman, J. (2007). The 2005 Pilgrimage and return to Vietnam of exiled Zen Master Thic Nhat Hanh. Singapore: Institute of South-East Asian Studies.Google Scholar
  5. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.PubMedCrossRefGoogle Scholar
  6. Craig, D. (2002). Familiar medicine: Everyday health knowledge and practice in today’s Vietnam. Honolulu: University of Hawaii Press.Google Scholar
  7. Dimidjian, S., & Goodman, S. (2009). Nonpharmacologic intervention and prevention strategies for depression during pregnancy and the postpartum. Clinical Obstetrics and Gynecology, 52(3), 498–515. doi: 10.1097/GRF.0b013e3181b52da6.PubMedCrossRefGoogle Scholar
  8. Dossett, E. C. (2008). Perinatal depression. Obstetrisc and Gynecology Clinics of North America, 35(3), 419–434, viii.Google Scholar
  9. Drummond, L., & Rydstrom, H. (Eds.). (2004). Gender practices in contemporary Vietnam. Singapore: Singapore University Press.Google Scholar
  10. Duncan, L. G., & Bardacke, N. (2010). Mindfulness-based childbirth and parenting education: Promoting family mindfulness during the perinatal period. Journal of Child and Family Studies, 19(2), 190–202. doi: 10.1007/s10826-009-9313-7.PubMedCentralPubMedCrossRefGoogle Scholar
  11. Edhborg, M., Nasreen, H. E., & Kabir, Z. N. (2011). Impact of postpartum depressive and anxiety symptoms on mothers’ emotional tie to their infants 2–3 months postpartum: a population-based study from rural Bangladesh. Archives of Womens Mental Health. doi: 10.1007/s00737-011-0221-7.Google Scholar
  12. Fahey, S. (2002). Vietnam’s women in the renovation era. In K. Sen & M. Stivens (Eds.), Gender and power in affluent Asia. London and New York: Routledge.Google Scholar
  13. Fisher, J. R., de Mello, M. C., Izutsu, T., & Tran, T. (2011). The Ha Noi expert statement: recognition of maternal mental health in resource-constrained settings is essential for achieving the millennium development goals. International Journal of Mental Health Systems, 5(1), 2. doi: 10.1186/1752-4458-5-2.PubMedCentralPubMedCrossRefGoogle Scholar
  14. Frances, A. J. (1994). Diagnostic and statistical manual for mental disorders: DSM-IV. Prepared by the task force on DSM-IV: American Psychiatric Association.Google Scholar
  15. Good, B. J. (1992). Culture and psychopathology: directions for psychiatric anthropology. In T. Schwartz, G. M. White, & C. A. Lutz (Eds.), New directions in psychological anthropology (pp. 181–205). Cambridge: Cambridge University Press.Google Scholar
  16. Graneheim, U. H., & Lundman, B. (2004). Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24(2), 105–112. doi: 10.1016/j.nedt.2003.10.001.PubMedCrossRefGoogle Scholar
  17. Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.PubMedCrossRefGoogle Scholar
  18. Jonzon, R., Vung, N. D., Ringsberg, K. C., & Krantz, G. (2007). Violence against women in intimate relationships: explanations and suggestions for interventions as perceived by healthcare workers, local leaders, and trusted community members in a northern district of Vietnam. Scandinavian Journal of Public Health, 35(6), 640–647. doi: 10.1080/14034940701431130.PubMedCrossRefGoogle Scholar
  19. Kabat-Zinn, J. (1991). Full catastrophe living: How to cope with stress, pain and illness using mindfulness meditation. New York: Delacorte.Google Scholar
  20. Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioural Medicine, 8(2), 163–190.CrossRefGoogle Scholar
  21. Kirmayer, L. J. (2007). Psychotherapy and the cultural concept of the person. Transcultural Psychiatry, 44(2), 232–257. doi: 10.1177/1363461506070794.PubMedCrossRefGoogle Scholar
  22. Kleinman, A. (1986). Social origins of distress and disease: Depression, neurasthenia and pain in modern China. New Haven: Yale University Press.Google Scholar
  23. Kreuger, R. A., & Casey, M. A. (2000). Focus groups: A practical guide for applied research (3rd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  24. Kvale, S. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks: SAGE Publications.Google Scholar
  25. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: replication and exploration of differential relapse prevention effects. Journal of Consulting and Clinical Psychology, 72(1), 31–40. doi: 10.1037/0022-006X.72.1.31.PubMedCrossRefGoogle Scholar
  26. Nguyen, N. L., Hunt, D. D., & Scott, C. S. (2005). Screening for depression in a primary care setting in Vietnam. Journal of Nervous and Mental Disorders, 193(2), 144–147.CrossRefGoogle Scholar
  27. Nguyen, D. V., Ostergren, P. O., & Krantz, G. (2008). Intimate partner violence against women in rural Vietnam-different socio-demographic factors are associated with different forms of violence: need for new intervention guidelines? BMC Public Health, 8, 55. doi: 10.1186/1471-2458-8-55.PubMedCrossRefGoogle Scholar
  28. Niemi, M. E., Falkenberg, T., Nguyen, M. T., Patel, V., & Faxelid, E. (2010a). The social contexts of depression during motherhood: A study of Explanatory Models in Vietnam. Journal of Affective Disorders, 124(1–2), 29–37. doi: 10.1016/j.jad.2009.09.017.PubMedCrossRefGoogle Scholar
  29. Niemi, M., Falkenberg, T., Petzold, M., Chuc, N. T. K., & Patel, V. (2013). Symptoms of antenatal common mental disorders, preterm birth and low birth-weight: A prospective cohort study in a semi-rural district of Vietnam. Journal of Tropical Medicine and International Health, 18(6), 687–695.Google Scholar
  30. Niemi, M., Thanh, H. T., Tuan, T., & Falkenberg, T. (2010b). Mental health priorities in Vietnam: A mixed-methods analysis. BMC Health Services Research, 10, 257. doi: 10.1186/1472-6963-10-257.PubMedCentralPubMedCrossRefGoogle Scholar
  31. Patel, V., & Kirkwood, B. (2008). Perinatal depression treated by community health workers. Lancet, 372(9642), 868–869. doi: 10.1016/S0140-6736(08)61374-4.PubMedCrossRefGoogle Scholar
  32. Patel, V., Rahman, A., Jacob, K. S., & Hughes, M. (2004). Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia. British Medical Journal, 328(7443), 820–823.PubMedCentralPubMedCrossRefGoogle Scholar
  33. Patel, V., Weiss, H. A., Chowdhary, N., Naik, S., Pednekar, S., Chatterjee, S., et al. (2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomised controlled trial. Lancet, 376(9758), 2086–2095. doi: 10.1016/S0140-6736(10)61508-5.PubMedCrossRefGoogle Scholar
  34. Pettus, A. (2003). Between sacrifice and desire: Gender, media and national identity in Vietnam. London and New York: Routledge.Google Scholar
  35. Phan, T., Steel, Z., & Silove, D. (2004). An ethnographically derived measure of anxiety, depression and somatization: the Phan Vietnamese Psychiatric Scale. Transcultural Psychiatry, 41(2), 200–232.PubMedCrossRefGoogle Scholar
  36. Rahman, A., Malik, A., Sikander, S., Roberts, C., & Creed, F. (2008). Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomised controlled trial. Lancet, 372(9642), 902–909. doi: 10.1016/S0140-6736(08)61400-2.PubMedCentralPubMedCrossRefGoogle Scholar
  37. Rydström, H. (2010). Compromised ideals: Family life and the recognition of women in Vietnam. In H. Rydström (Ed.), Gendered inequalities in Asia: Configuring, contesting and recognizing women and men. Copenhagen: NIAS Press.Google Scholar
  38. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2001). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: The Guilford Press.Google Scholar
  39. Taylor, P. (Ed.). (2007). Modernity and re-enchantment in post-revolutionary Vietnam. Singapore: Institute of Southeast Asian Studies.Google Scholar
  40. Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70(2), 275–287.PubMedCrossRefGoogle Scholar
  41. Teasdale, J. D., Segal, Z. V., Williams, J. M., Ridgeway, V. A., Soulsby, J. M., & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615–623.PubMedCrossRefGoogle Scholar
  42. Temple, B. (2002). Crossed wires: Interpreters, translators, and bilingual workers in cross-language research. Qualitative Health Research, 12(6), 844–854.PubMedCrossRefGoogle Scholar
  43. Torres, S. (2009). Vignette methodology and culture-relevance: Lessons learned through a project on successful aging with Iranian immigrants to Sweden. Journal of Cross-Cultural Gerontology, 24(1), 93–114.Google Scholar
  44. Tu, W.-M. (1985). Selfhood and otherness in confucian thought. In A. J. Marsella, G. Devos, & F. L. K. Hsu (Eds.), Culture and self: Asian and western perspectives. New York: Tavistock.Google Scholar
  45. Werner, J. (2008). Gender, household and state: Renovation (Doi Moi) as social process in Viet Nam. In J. Werner & D. Bélanger (Eds.), Gender, household and state: Doi Moi in Viet Nam. London and New York: Routledge.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Maria Niemi
    • 1
    Email author
  • Mai T. T. Nguyen
    • 2
  • Trish Bartley
    • 3
  • Elisabeth Faxelid
    • 4
  • Torkel Falkenberg
    • 5
  1. 1.Department of Public Health SciencesKarolinska InstitutetStockholmSweden
  2. 2.Department of PediatricsHanoi Medical UniversityHanoiVietnam
  3. 3.Centre for Mindfulness Research and PracticeBangor UniversityBangorWales, UK
  4. 4.Division of Global Health (IHCAR), Department of Public Health SciencesKarolinska InstitutetStockholmSweden
  5. 5.Unit for Studies of Integrative Care, Division of Nursing, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden

Personalised recommendations