Are concern for face and willingness to seek help correlated to early postnatal depressive symptoms among Hong Kong Chinese women? A cross-sectional questionnaire survey

Abstract

Background: Face (lian) is a pervasive phenomenon in Chinese culture, exerting an immense and subtle influence on the behavior of people. Coupled with the inherent stigma of mental illness, concern for face may lead women to deny having early postnatal depressive symptoms and to refrain from seeking help from others. Objective: The aim of the study was to explore how the traditional Chinese value of face and their willingness to seek help is associated with early postnatal depressive symptoms in Hong Kong. Design: A cross-sectional comparative study design was adopted. Settings: The samples were taken from three postnatal wards in a university-affiliated regional hospital. Participants: One thousand four hundred and sixty-five women who had given birth on 2-5 days postpartum were invited to participate in this study and 1200 women (81.9%) completed the questionnaires. Women with a history or family history of depression were excluded. Methods: Multivariate logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the relationships among concern for face, willingness to seek help, and early postnatal depressive symptoms. Results: The results indicated that 413 (34.4%) of the participants had early postnatal depressive symptoms. Women with high protective face, who "keep a low profile to avoid attention" (p < 0.01), and women with high acquisitive face, who "get ahead through social achievement" (GAT) (p < 0.05), were found to be more likely to show early postnatal depressive symptoms after adjusting for demo-socio-economic, obstetric, and neonatal variables. Women with high GAT were found to be 1.36 times less likely to seek help during early postnatal period (p < 0.05). Depressed women were found to be less likely to seek help (p < 0.05). Conclusions: Concern for face and willingness to seek help were important correlates associated with postnatal depressive symptoms. Health care professionals should make extensive efforts and provide more health education to reach out to these women and their families. © 2006 Elsevier Ltd. All rights reserved.