Research and Training Center for Community Development

Thị Trấn Trùng Khánh, Vietnam

Research and Training Center for Community Development

Thị Trấn Trùng Khánh, Vietnam

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Tran T.D.,Monash University | Tran T.,Research and Training Center for Community Development | Fisher J.,Monash University
BMC Psychiatry | Year: 2013

Background: Depression and anxiety are recognised increasingly as serious public health problems among women in low- and lower-middle income countries. The aim of this study was to validate the 21-item Depression Anxiety and Stress Scale (DASS21) for use in screening for these common mental disorders among rural women with young children in the North of Vietnam.Methods: The DASS-21 was translated from English to Vietnamese, culturally verified, back-translated and administered to women who also completed, separately, a psychiatrist-administered Structured Clinical Interview for DSM IV Axis 1 diagnoses of depressive and anxiety disorders. The sample was a community-based representative cohort of adult women with young children living in Ha Nam Province in northern Viet Nam. Cronbach's alpha, Exploratory Factor Analyses (EFA) and Receiver Operating Characteristic (ROC) analyses were performed to identify the psychometric properties of the Depression, Anxiety, and Stress subscales and the overall scale.Results: Complete data were available for 221 women. The internal consistency (Cronbach's alpha) of each sub-scale and the overall scale were high, ranging from 0.70 for the Stress subscale to 0.88 for the overall scale, but EFA indicated that the 21 items all loaded on one factor. Scores on each of the three sub-scales, and the combinations of two or three of them were able to detect the common mental disorders of depression and anxiety in women with a sensitivity of 79.1% and a specificity of 77.0% at the optimal cut off of >33. However, they did not distinguish between those experiencing only depression or only anxiety.Conclusions: The total score of the 21 items of the DASS21-Vietnamese validation appears to be comprehensible and sensitive to detecting common mental disorders in women with young children in primary health care in rural northern Vietnam and therefore might also be useful to screen for these conditions in other resource-constrained settings. © 2013 Tran et al.; licensee BioMed Central Ltd.


Tran T.D.,Monash University | Tran T.,Research and Training Center for Community Development | Fisher J.,Monash University
Journal of Affective Disorders | Year: 2012

Background: Perinatal non-psychotic common mental disorders (PCMDs) are less well recognised in men than in women. However, there are adverse consequences of PCMD for men, their partners and their infants. There is a need for simple, readily administered screening tools for use in research and primary health care for men, including in low income settings. The aim of this study was to validate three scales for screening PCMDs in men in northern Vietnam. Methods: Translated and culturally verified versions of the Edinburgh Postnatal Depression Scale (EPDS), Zung's Self-rated Anxiety Scale (Zung SAS), and the General Health Questionnaire 12 items (GHQ-12) were validated against a gold-standard diagnostic tool, the Structured Clinical Interview for DSM IV diagnoses in a community-based sample of 231 Vietnamese men who were partners of pregnant women or women who had recently given birth. Post-hoc analyses, Receiver Operating Characteristic (ROC) analyses, and Cronbach's alpha were performed to examine the validity and internal reliability of the three scales. Results: The prevalence of PCMDs in men was 17.8% (95%CI: 13.3-22.3). The AUROC of the EPDS 76.7% (95%CI: 67.9-85.5), the Zung SAS was 77.5% (95%CI: 68.9-86.0) and the GHQ-12 was 79.2% (95%CI: 71.2-87.1). The selected cut-off point to detect clinically significant symptoms in men using the EPDS was 4/5 (Sensitivity (Se) 68.3% and specificity (Sp) 77.4%), the Zung SAS was 35/36 (Se 70.7% and Sp 79.0%) and the GHQ-12 was 0/1 (Se 75.6% and Sp 74.7%). Conclusions: PCMDs in men are an unrecognised public health problem in northern Vietnam. Overall the cut off scores to detect clinically significant symptoms are lower than those reported in high income settings. Cut off scores on the EPDS and Zung SAS are slightly higher in men than in women in northern Vietnam, but these scales are suitable for use with men in this setting. Although not suitable to detect PCMD in women, the GHQ-12 is suitable to detect PCMD in men. © 2011 Elsevier B.V.


Fisher J.,Monash University | Tran T.D.,Monash University | Nguyen T.T.,Research and Training Center for Community Development | Tran T.,Research and Training Center for Community Development
Journal of Affective Disorders | Year: 2012

Background: To establish the prevalence and correlates of the perinatal common mental disorders of depression and anxiety (PCMD) and alcohol dependence (AD) in men in northern Viet Nam. Methods: A cross-sectional study of men whose wives were > 28 weeks pregnant or mothers of newborns recruited from randomly-selected rural and urban communes. Data sources were Structured Clinical Interviews for DSM IV; CAGE assessment of alcohol use and study-specific questionnaires. Odds ratios and 95% CIs were calculated by multiple logistic regressions. Results: Overall, 231/360 eligible men were recruited, of whom 17.7% [95% CI, 12.8-22.7] were diagnosed with a PCMD; 33.8% [95% CI, 27.9-40.1] with AD (CAGE score ≥ 2) and 6.9% [95% CI, 4.3-11.0] with co-morbid PCMD and AD. PCMD were associated with experiences of coincidental life adversity, intimate partner violence, age > 30; an unwelcome pregnancy and primiparity. AD was more common among men with low education, living in the poorest households and in unskilled work. Conclusions: Common mental disorders and AD are prevalent, but currently unrecognised among men in northern Viet Nam whose wives are pregnant or have recently given birth. © 2012 Elsevier B.V.


Fisher J.,Monash University | Tran T.,Monash University | Biggs B.,Royal Melbourne Hospital | Tran T.,Research and Training Center for Community Development | And 4 more authors.
Bulletin of the World Health Organization | Year: 2011

Objective To establish iodine status among pregnant women in rural northern Viet Nam and explore psychosocial predictors of the use of iodized salt in their households. Methods This prospective study included pregnant women registered in health stations in randomly-selected communes in Ha Nam province. At recruitment (< 20 weeks of gestation), sociodemographic factors, reproductive health, intimate partner relationship, family violence, symptoms of common mental disorders and use of micronutrient supplements were assessed. During a second assessment (> 28 weeks of gestation) a urine specimen was collected to measure urinary iodine concentration (UIC) and iodized salt use was assessed. Predictors were explored through univariable analyses and multivariable linear and logistic regression. Findings The 413 pregnant women who provided data for this study had a median UIC of 70 μg/l; nearly 83% had a UIC lower than the 150 μg/l recommended by the World Health Organization; only 73.6% reported using iodized salt in any form in their households. Iodized salt use was lower among nulliparous women (odds ratio, OR: 0.56; 95% confidence interval, CI: 0.32-0.96); less educated women (OR: 0.34; 95% CI: 0.16-0.71); factory workers or small-scale traders (OR: 0.52; 95% CI: 0.31-0.86), government workers (OR: 0.35; 95% CI: 0.13-0.89) and women with common mental disorders at recruitment (OR: 0.61; 95% CI: 0.38-0.98). Conclusion The decline in the use of iodized salt in Viet Nam since the National Iodine Deficiency Disorders Control Programme was suspended in 2005 has placed pregnant women and their infants in rural areas at risk of iodine deficiency disorders.


Rahman A.,University of Liverpool | Fisher J.,Monash University | Bower P.,University of Manchester | Luchters S.,Burnet Institute | And 4 more authors.
Bulletin of the World Health Organization | Year: 2013

Objective To assess the effectiveness of interventions to improve the mental health of women in the perinatal period and to evaluate any effect on the health, growth and development of their offspring, in low- and middle-income (LAMI) countries. Methods Seven electronic bibliographic databases were systematically searched for papers published up to May 2012 describing controlled trials of interventions designed to improve mental health outcomes in women who were pregnant or had recently given birth. The main outcomes of interest were rates of common perinatal mental disorders (CPMDs), primarily postpartum depression or anxiety; measures of the quality of the mother-infant relationship; and measures of infant or child health, growth and cognitive development. Meta-analysis was conducted to obtain a summary measure of the clinical effectiveness of the interventions. Findings Thirteen trials representing 20 092 participants were identified. In all studies, supervised, non-specialist health and community workers delivered the interventions, which proved more beneficial than routine care for both mothers and children. The pooled effect size for maternal depression was -0.38 (95% confidence interval: -0.56 to -0.21; I2 = 79.9%). Where assessed, benefits to the child included improved mother-infant interaction, better cognitive development and growth, reduced diarrhoeal episodes and increased immunization rates. Conclusion In LAMI countries, the burden of CPMDs can be reduced through mental health interventions delivered by supervised non-specialists. Such interventions benefit both women and their children, but further studies are needed to understand how they can be scaled up in the highly diverse settings that exist in LAMI countries.


Fisher J.,Monash University | de Mello M.C.,World Health Organization | Patel V.,London School of Hygiene and Tropical Medicine | Rahman A.,University of Liverpool | And 3 more authors.
Bulletin of the World Health Organization | Year: 2012

Objective To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low-and lower-middle-income countries. Methods Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. Findings Thirteen papers covering 17 lowand lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). Conclusion CPMDs are more prevalent in low-and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.


Fisher J.,University of Melbourne | Tran T.,Research and Training Center for Community Development | La B.T.,Research and Training Center for Community Development | Kriitmaa K.,University of Melbourne | Rosenthal D.,University of Melbourne
Bulletin of the World Health Organization | Year: 2010

Objective: To establish the prevalence of common perinatal mental disorders their determinants, and their association with preventive health care use among women in one rural and one urban province in northern Viet Nam. Methods: We conducted a cross-sectional survey of cohorts of pregnant women and mothers of infants recruited systematically in 10 randomly-selected communes. The women participated in psychiatrist-administered structured clinical interviews and separate structured interviews to assess sociodemographic factors, reproductive health, the intimate partner relationship, family violence and the use of preventive and psychiatric health care. Associations between these variables and perinatal mental disorders were explored through univariate analyses and multivariable logistic regression. Findings: Among women eligible for the study (392), 364 (93%) were recruited. Of these, 29.9% (95% confidence interval, CI: 25.20-34.70) were diagnosed with a common perinatal mental disorder (CPMD). The frequency of such disorders during pregnancy and in the postpartum period was the same. Their prevalence was higher among women in rural provinces (odds ratio, OR: 2.17; 95% CI: 1.19-3.93); exposed to intimate partner violence (OR: 2.11; 95% CI: 1.12-3.96); fearful of other family members (OR: 3.36; 95% CI: 1.05-10.71) or exposed to coincidental life adversity (OR: 4.40; 95% CI: 2.44-7.93). Fewer women with a CPMD used iron supplements than women without a CPMD, but the results were not statistically significant (P = 0.05). None of the women studied had ever received mental health care. Conclusion: Perinatal depression and anxiety are prevalent in women in northern Viet Nam. These conditions are predominantly determined by social factors, including rural residence, poverty and exposure to family violence. At present the needs of women with common perinatal mental disorders are unrecognized and not attended to and their participation in essential antenatal preventive care appears to be compromised.


Nguyen T.T.,Research and Training Center for Community Development | Tran T.D.,Monash University | Tran T.,Research and Training Center for Community Development | La B.,Research and Training Center for Community Development | And 2 more authors.
British Journal of Psychiatry | Year: 2015

Background: In low- and middle-income countries little is known about changes in women's mental health status from the perinatal period to 15 months postpartum or the factors associated with different trajectories. Aims: To determine the incidence and rates of recovery from common mental disorders (CMD) among rural Vietnamese women and the risk and protective factors associated with these outcomes from the perinatal period to 15 months after giving birth. Method: In a population-based prospective study, a systematically recruited cohort of women completed baseline assessments in either the last trimester of pregnancy or 4-6 weeks after giving birth and were followed up 15 months later. The common mental disorders of major depression, generalised anxiety and panic disorder were assessed by psychiatristadministered Structured Clinical Interview for DSM-IV Disorders at both baseline and follow-up. Results: A total of 211 women provided complete data in this study. The incidence rate of CMD in the first postpartum year was 13% (95% CI 8-19), and 70% (95% CI 59-80) of women who had perinatal CMD recovered within the first postpartum year. Incidence was associated with having experienced childhood maltreatment, experiencing the intimate partner as providing little care, sensitivity, kindness or affection, and the chronic stress of household poverty. Recovery was associated with higher quality of a woman's relationships with her intimate partner and her own mother, longer period of mandated rest following birth, and sharing of domestic tasks and infant care. Conclusions: Modifiable social factors, in particular the quality of a woman's closest relationships with her partner and her own mother, and participation by family members in domestic work and infant care, are closely related to women's mental health in the first year after giving birth in resource-constrained settings. © 2015, Royal College of Psychiatrists. All rights reserved.


Casey G.J.,Royal Melbourne Hospital | Jolley D.,Monash University | Phuc T.Q.,National Institute of Malariology | Tinh T.T.,National Institute of Malariology | And 3 more authors.
PLoS ONE | Year: 2010

Background: The prevalence of anaemia and iron deficiency in women remains high worldwide. WHO recommends weekly iron-folic acid supplementation where anaemia rates in non-pregnant women of reproductive age are higher than 20%. In 2006, a demonstration project consisting of weekly iron-folic acid supplementation and regular de-worming was set up in two districts in a northern province in Vietnam where anaemia and hookworm rates were 38% and 76% respectively. In 2008 the project was expanded to all districts in the province, targeting some 250,000 women. The objectives of this study were to: 1) examine changes in haemoglobin, iron stores and soil transmitted helminth infection prevalence over three years and 2) assess women's access to and compliance with the intervention. Methods and Findings: The study was a semi-cross-sectional, semi-longitudinal panel design with a baseline survey, three impact surveys at three-, twelve- and thirty months after commencement of the intervention, and three compliance surveys after ten weeks, eighteen and thirty six months. Results: After thirty months, mean haemoglobin stabilised at 130.3 g/L, an increase of 8.2 g/L from baseline, and mean serum ferritin rose from 23.9 μg/L to 52 μg/L. Hookworm prevalence fell from 76% to 22% over the same period. After thirty six months, 81% of the target population were receiving supplements and 87% were taking 75% or more of the supplements they received. Conclusions: Weekly iron-folic acid supplementation and regular de-worming was effective in significantly and sustainably reducing the prevalence of anaemia and soil transmitted helminth infections and high compliance rates were maintained over three years. © 2010 Casey et al.


Tran T.D.,Monash University | Tran T.D.,University of Melbourne | Tran T.,Research and Training Center for Community Development | La B.,Research and Training Center for Community Development | And 4 more authors.
Journal of Affective Disorders | Year: 2011

Background: There is increasing recognition that Perinatal Common Mental Disorders (CMDs) are a major public health problem for women in resource-constrained countries. There is an urgent need for screening tools suitable for use by community based health workers to assist in the identification of people with compromised mental health. The aim of this study was to establish the validity of three widely used psychometric screening instruments in detecting CMDs in women in northern Viet Nam. Methods: Translated and culturally verified versions of the Edinburgh Postnatal Depression Scale (EPDS), General Health Questionnaire 12 items (GHQ-12), Zung's Self-rated Anxiety Scale (Zung SAS) and a gold-standard diagnostic tool, the Structured Clinical Interview for DSM IV, were administered to a community-based representative cohort of 364 Vietnamese women in the perinatal period. Post-hoc analyses, Cronbach's alpha, and Receiver Operating Characteristic (ROC) analyses were performed to identify the optimal cut-off points and to compare the validity of three scales. Results: The Areas under the ROC Curve were: EPDS 0.77 (95%CI 0.72-0.82); Zung SAS 0.79 (95%CI 0.74-0.84) and GHQ-12 0.72 (95%CI 0.67-0.78). The optimal cut-off point for the EPDS was 3/4 (Se 69.7%; Sp 72.9%). The corresponding value for Zung SAS was 37/38 (Se 67.9%; Sp 75.3%) and for GHQ-12 was 0/1 (Se 77.1%; Sp 56.6%). The internal reliability Cronbach's alpha for EPDS was 0.75, for Zung SAS was 0.76, and for GHQ-12 was 0.64. Conclusions: These instruments are suitable for use as screening tools for CMDs in women in northern Viet Nam, but probably because of differences in emotional literacy, familiarity with test-taking and the effects of chronic social adversity require much lower cut off scores to detect clinically significant symptoms than in other settings. © 2011 Elsevier B.V. All rights reserved.

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