An Exploration of Perinatal Distress in Pakistan: A Mixed Methods Study

Abstract

Objectives: To develop an indigenous perinatal distress model (PDM) for couples, measured with the indigenously developed Perinatal Distress Inventory (PDI), and verified via statistical regression analysis. 

Methodology: An exploratory sequential mixed method research design was used. In Phase-I, an item pool of 209 items was generated by reviewing the literature and conducting semi-structured interviews with experts and perinatal couples at high risk of distress. Reflexive thematic analysis and interpretative phenomenological analysis were used to construct the PDM.  In Phase II, the face and content validation of 209 items in the PDI was carried out and 200 items were finalized. The try-out (50 couples) and pilot study (2080 participants) was carried out via purposive sampling technique, from hospitals.  Exploratory factor analysis yielded 194 items in PDI with Parental Perinatal Distress Scale (PPDS), Parental Perinatal Distress Expression Scale (PPDES), and Parental Perinatal Distress Aetiology Scale (PPDAS), with acceptable Cronbach’s alpha reliability coefficients 0.90, 0.97, and 0.91 respectively.

Results: PDM showed reciprocal interactions between assessments of distress in terms of depression, anxiety, mania, and psychosis and cultural expressions of emotions, somatization, maladaptive coping, and beliefs in religious and supernatural cognitions, and between the cultural aetiology of stressful and traumatic events; gender roles, mental health stigma, mental health illiteracy, family support, perinatal cognitions, emotional attachment, and bonding, all of which contributed to perinatal distress in couples. The regression analysis revealed that cultural expression and cultural aetiology significantly predicted perinatal distress in couples.

Conclusion: Indigenous PDM was developed, measured with PDI, and verified via regression analysis in couples.