Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.3
, Sep
t
em
b
e
r
20
14, pp
. 158
~162
I
S
SN
: 225
2-8
8
0
6
1
58
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Pari
ty E
a
rl
y St
age of M
a
rri
age with Incidence of P
o
stpartu
m
Depression
Eny
R
e
tna
Amba
rwat
i, R
i
a
List
i
y
ani
Midwifer
y
Acad
em
y
of
Yog
y
akarta, Yog
y
akar
ta,
Indonesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received April
02, 2014
Rev
i
sed
May 20
, 20
14
Accepted Aug 25, 2014
Postpartum depression is a condition th
at
may
be experienced b
y
women. If
it is
not
addres
sed properly
,
it will
have
a
ne
gativ
e im
pa
ct.
The r
e
s
ear
ch
aim
e
nd to det
e
r
m
ine the corre
la
tion betwe
e
n par
i
t
y
and the
earl
y
s
t
age of the
m
a
rriage
wi
th the incid
e
nc
e of
pos
tpartum
depres
s
i
on. Thi
s
res
earc
h
emplo
y
edanaly
t
ic observational
method
with
cr
oss sectional ap
proach. Th
e
population
in th
is research was
postpartum mo
thers in Matern
al Hospital
Leonis
a
. The re
s
u
lt s
howed that
there was
a cor
r
ela
tion betwe
e
n
parit
y
and
the
earl
y
s
t
ag
e o
f
the
m
a
rriag
e w
ith th
e
incid
e
nc
e
of pos
tpar
tum
d
e
pres
s
i
on.
Keyword:
Parity
Early
stage of marriage
Post
p
a
rt
um
de
pressi
o
n
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
En
y Retn
a
Amb
a
rwati,
M
i
dwi
f
e
r
y
Aca
d
em
y
of Y
o
gy
akart
a
,
Jl. Parang
tritis Km
6
,
Sewon
,
Ban
t
u
l
,
Yo
g
y
ak
arta.
Em
a
il: en
yretn
a
@g
m
a
il.co
m
1.
INTRODUCTION
Po
stpartu
m
d
e
p
r
essi
on
is a
co
nd
itio
n th
at
is p
o
s
sib
l
y ex
p
e
rien
ced
b
y
wo
m
e
n
in
the p
o
stp
a
rt
u
m
peri
od
. F
r
om
t
h
e
pre
v
i
o
us
re
search
, i
t
i
s
no
t
e
d t
h
at
i
n
We
st
ern c
o
unt
ri
es
, p
o
st
part
um
d
e
pres
si
o
n
i
n
ci
d
e
nces
ex
p
e
r
i
en
ced
by ap
pr
ox
im
ate
l
y 1
5
-
20
%
o
f
w
o
m
e
n
in
labo
ur
, either
for th
e fi
rst ti
m
e
o
r
fo
r t
h
e
n
e
x
t
. In
M
a
l
a
y
s
i
a
, i
t
i
s
not
e
d
t
h
at
m
o
thers e
xpe
ri
enc
i
ng p
o
st
part
um
dep
r
essi
o
n
i
s
3.
9%, m
eanwh
i
l
e
i
n
Si
ngap
o
r
e
t
h
e
num
ber of inci
dence is only 1%. T
h
e num
b
er of
postpa
rtum depressi
on i
n
cide
nce in
Indonesia only reaches
an
av
erage of 1
1
-3
0
%
. If it i
s
n
o
t
ad
dressed
prop
erly, it
will g
i
v
e
a n
e
g
a
tiv
e im
p
act
for th
e m
o
th
ers, the
infa
nts, a
n
d
the
fam
i
lies [1]
.
The ca
usat
i
v
e
fact
or
s
of
p
o
st
part
um
depres
s
i
on i
n
cl
u
d
e
bi
o
l
ogi
cal
,
psy
c
h
o
l
ogi
cal
, s
o
ci
o
-
c
u
l
t
u
ral
a
n
d
age
fact
or
s a
n
d m
a
ny
ot
he
r
fact
or
s t
h
at
ca
n l
ead
t
o
p
o
st
part
um
depres
si
on
. Ot
her
ca
uses
of
p
o
st
pa
rt
um
dep
r
essi
on i
n
cl
ude t
h
e m
o
t
h
er
s’ age w
h
i
c
h a
r
e t
oo y
o
u
n
g
o
r
t
oo ol
d, t
h
e h
i
st
ory
of m
i
scarri
age
,
t
h
e pari
t
y
or
th
e nu
m
b
er
o
f
t
h
e ch
ild
ren
,
sing
le m
o
th
ers and
b
i
rth trau
m
a
[2
].
Age i
s
one
of t
h
e causal
fact
o
r
s o
f
p
o
st
pa
rt
u
m
depressi
on
.
The m
a
jori
t
y
o
f
t
h
e com
m
uni
t
y
bel
i
e
ves
th
at th
e ap
propriate ti
me fo
r a wo
m
a
n
to
b
e
in
lab
o
u
r
is b
e
t
w
een
th
e ag
e of 2
0
an
d
3
0
year-o
ld
b
ecau
s
e
with
in
th
at ti
m
e
,
it
is
an
o
p
tim
al p
e
riod
to
p
e
rfo
rm in
fan
t
and
fa
m
i
ly caring.
The wom
e
n’s age factor duri
ng the
pre
g
nancy
a
n
d
t
h
e l
a
b
o
u
r
peri
od
i
s
oft
e
n
ass
o
ci
at
ed
w
ith
t
h
e wo
m
e
n
'
s
m
e
n
t
al read
in
ess
to
becom
e
a m
o
ther.
If i
t
see
n
vi
ew
ed
fr
om
t
h
e ps
y
c
hol
ogical
as
pect, wom
e
n between
t
h
e
ag
e 20
an
d 35
year
-o
ld
h
a
v
e
b
een m
a
tu
re in
m
a
k
i
n
g
th
e
d
ecision
, and
at th
is ag
e, t
h
e produ
ctiv
ity cap
ab
ility is sufficien
t
, in con
t
rast to
wo
m
e
n
you
nger th
an
20
year-o
ld
wh
o are
still to
o
you
ng
to
b
e
m
o
th
ers and
wo
m
e
n
old
e
r t
h
an 35
y
ear-o
ld
wh
o ha
ve
t
o
o m
a
ny
psy
c
h
o
s
o
ci
al
st
ress
ors
[3]
.
Accord
ing
to
th
e d
a
ta o
b
t
ai
n
e
d
fro
m th
e
Relig
io
u
s
Ministry o
f
Yog
y
ak
arta in
20
12
, it can
b
e
co
n
c
l
u
d
e
d
t
h
at th
e rate of
u
n
d
e
rag
e
m
a
rriages in
Yo
g
y
ak
arta Pro
v
i
n
ce is still relativ
ely
h
i
gh
.
Gunu
ngKidu
l
R
e
gency
ran
k
s
fi
rst
,
i
.
e
.
i
n
n
u
m
ber of
wom
e
n wi
t
h
earl
y
m
a
rri
age
w
h
i
c
h
i
s
am
ount
ed t
o
37
w
o
m
e
n, f
o
l
l
o
we
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Pari
t
y
E
a
rl
y
St
age
of
Mar
r
i
a
g
e
w
i
t
h
I
n
ci
de
nc
e of
P
o
st
p
a
rt
u
m
Depre
ssi
o
n
(
E
ny Ret
n
a
A
m
barw
a
t
i
)
15
9
by
B
a
nt
ul
R
e
gency
whi
c
h r
a
nk
s seco
n
d
, i
.
e. as m
a
ny
as 30
w
o
m
e
n, i
n
Y
o
gy
akart
a
C
i
t
y
as
m
a
ny
as 17
wom
e
n, i
n
Sl
e
m
an R
e
ge
ncy
as m
a
ny
as 1
2
wom
e
n, a
n
d
i
n
K
u
l
o
nPr
o
g
o
R
e
gency
as
m
a
ny
as 2
wo
m
e
n.
Th
erefo
r
e, th
e
writer sub
s
equen
tly p
e
rf
or
m
e
d
a pr
elimin
ary stu
d
y
in
Leon
isa Matern
ity Hosp
ital, lo
cated
in
W
ono
sar
i
, Gunu
ngK
idu
l
Reg
e
n
c
y.
The r
e
sul
t
s
f
r
o
m
prel
im
i
n
ary
st
udy
t
h
at
had
bee
n
c
o
n
duct
e
d i
n
L
e
oni
sa M
a
t
e
r
n
a
l
Hos
p
i
t
a
l
,
Wo
n
o
sari
,
G
u
nu
n
g
Ki
dul
i
n
Jan
u
ary
an
d F
e
br
uary
20
1
3
i
ndi
cat
ed t
h
at
fr
om
t
h
e sam
p
l
e
co
nsi
s
t
e
d
of
10
pat
i
e
nt
s w
ho
were
use
d
as t
h
e res
p
on
de
nt
s, aft
e
r a scree
n
i
n
g wi
t
h
E
d
i
n
b
u
r
g
h
P
o
st
na
t
a
l
Depressi
on
Scal
e
(EPDS) and
questionnaire
s
on the m
a
ternal age a
nd t
h
e
matern
al p
a
rit
y
, it was d
e
termin
ed
th
at 4 ou
t of
10
resp
o
nde
nt
s e
xpe
ri
ence
d de
pressi
o
n
sym
p
t
o
m
s
, 7 res
p
o
n
d
ent
s
e
x
p
e
ri
ence
d m
u
l
t
i
p
ara,
3 res
p
on
de
nt
s
expe
ri
ence
d pr
im
i
p
ara,
an
d 3 out
of
1
0
r
e
sp
on
de
nt
s’
a
g
e at thei
r m
a
rriage
s
were i
n
cluded in
unhealthy
r
e
pr
odu
ctiv
e ag
es, i.e.
w
e
r
e
yo
ung
er th
an
20
y
ear-
o
l
d
o
r
ol
der
t
h
a
n
35
y
ear-
o
l
d
.
2.
R
E
SEARC
H M
ETHOD
The t
y
pe of t
h
e researc
h
was
anal
y
t
i
c
obser
vat
i
onal
st
u
d
y
,
i
.
e. a research
m
e
t
hod t
h
at
d
e
scri
bes t
h
e
rel
a
t
i
ons
hi
p ex
i
s
t
i
ng bet
w
ee
n
-
va
ri
abl
e
s by
h
y
pot
he
si
s
t
e
st
i
n
g
[4]. Based
on the tim
e setting
of the
res
earch,
t
h
e desi
gn
of t
h
i
s
resea
r
ch
us
ed cr
oss
-
sect
i
o
nal
st
u
d
y
beca
use i
t
st
udi
e
d
t
h
e co
rrel
a
t
i
o
n
bet
w
ee
n t
h
e
ri
sk a
n
d
effect
fact
o
r
s
wi
t
h
"Poi
nt
Ti
m
e
App
r
oac
h
"
m
odel
whi
c
h
u
s
ed
on
e-tim
e
d
a
ta co
llectio
n q
u
i
ck
ly, as well as to
d
e
scri
b
e
ind
i
v
i
d
u
a
l
’
s d
e
v
e
lopmen
t in
o
r
d
e
r t
o
ob
tain
co
m
p
lete d
a
ta in
a relativ
ely sh
o
r
t time, i.e. to
d
e
term
in
e
th
e
d
e
gr
ee o
f
po
stp
a
r
t
u
m
d
e
pressio
n
in
Leon
i
s
a
Mater
n
ity
Ho
sp
ital, W
ono
sar
i
, G
unu
ng
K
i
d
u
l
[5
].
Pop
u
l
ation
is a g
e
n
e
ralized
reg
i
on
co
m
p
rises of
o
b
j
ects or su
bj
ects
po
ssessin
g certain qu
an
tities and
characte
r
istics establishe
d
by the resea
r
cher to
be st
u
d
i
e
d a
n
d
t
o
be
co
ncl
u
ded
su
bse
que
nt
l
y
[6]
.
Th
e
po
p
u
l
a
t
i
on i
n
t
h
i
s
re
searc
h
w
a
s al
l
p
o
st
pa
rt
um
m
o
t
h
ers i
n
l
a
bo
u
r
at
Le
o
n
i
s
a M
a
t
e
r
n
i
t
y
H
o
spi
t
a
l
am
ount
e
d
t
o
61
p
o
st
part
um
. The
sam
p
l
e
s were
t
a
ke
n
by
pu
r
posi
v
e sam
p
l
i
n
g
wi
t
h
i
n
cl
usi
o
n a
n
d e
x
cl
usi
o
n c
r
i
t
e
ri
a a
s
t
h
e
fo
llowing
:
1.
In
cl
u
s
ion
criteria in
t
h
is research
:
po
stp
a
rtum
fro
m
d
a
y 7
th
to
d
a
y 14
th
i
n
Leon
isa Matern
ity Ho
sp
ital,
Wono
sari, were willin
g
t
o
b
e
respon
d
e
n
t
s
and
were on
site
d
u
ring
t
h
e research.
2.
The e
x
clusi
on
criteria in this
researc
h
: post
partum
in
Leo
n
isa Matern
ity Ho
sp
ital, Wono
sari
su
ffering
fro
m
m
o
rb
id
ities o
r
co
m
p
li
catio
n
s
, su
ch
as b
l
eed
ing
,
hyp
erten
s
i
o
n, po
stp
a
rtu
m
wit
h
d
e
ad
in
fan
t
s,
post
p
art
u
m
wi
th
prem
at
ure i
n
fant
s.
Th
e i
n
d
e
p
e
n
d
en
t
v
a
riab
les in th
is
research
were
pa
rity and t
h
e a
g
e at t
h
e m
a
rriage. T
h
e de
pe
nde
nt
vari
a
b
l
e
s i
n
t
h
i
s
researc
h
w
e
re p
o
st
pa
rt
um
dep
r
essi
on
. Th
e dat
a
anal
y
s
i
s
was
per
f
o
r
m
e
d by
uni
vari
at
e and
bi
va
ri
at
e anal
y
s
i
s
. C
h
i
-
sq
uare
t
e
st
was
d
one
as bi
vari
at
e a
n
al
y
s
i
s
m
e
t
hod
[
7]
.
The res
earc
h
instrum
e
nt used to
e
x
am
ine the age a
n
d the
parity in
th
is
research
was qu
estion
n
a
ires
co
n
t
ain
i
n
g
th
e id
en
tity, ag
e, and
m
a
tern
al p
a
rity, m
ean
wh
ile t
h
e m
easu
r
i
n
g in
st
ru
m
e
n
t
to
ex
am
in
e
th
e
p
o
s
t
p
ar
t
u
m
d
e
p
r
essi
on
in
ci
den
ce
w
a
s
Ed
i
n
bur
gh
Po
st
n
a
tal D
e
pr
ession Scale (EPD
S)
ad
op
ted fr
om
Th
e
British
Journ
a
l
of Psych
i
atry [8
].
3.
R
E
SU
LTS AN
D ANA
LY
SIS
3.
1.
Uni
v
ari
a
te An
al
ysi
s
Un
i
v
ariate an
alysis in
clu
d
e
s
v
a
riab
le an
alysis in
th
e
research
, i.e.
p
a
rity v
a
riab
le, th
e ag
e at
t
h
e m
a
rri
age vari
a
b
l
e
an
d
p
o
st
pa
rt
um
dep
r
essi
o
n
i
n
ci
de
nce v
a
ri
abl
e
.
There
f
ore,
t
h
e
am
ount
or
t
h
e
fre
que
ncy
a
n
d
t
h
e
pe
rce
n
t
a
ge can be vi
ewe
d
.
Tabl
e 1.T
h
e fr
eque
ncy
di
st
ri
b
u
t
i
o
n
o
f
t
h
e
r
e
s
p
o
n
d
ent
s
base
d on the
pa
rity, the a
g
e at t
h
e marriage
,
an
d
po
st
part
u
m
depressi
o
n
i
n
ci
de
nce
No Variable
Frequen
c
y
%
1 P
a
rit
y
a.
P
r
im
i
p
ar
a 13
34
b.
Sekundipar
a
14
47
c.
Multipara
11
29
d.
Grande
m
u
ltipara
0
0
2
The Age at
the M
a
rriage
a.
Healthy
Repr
od
uctive Age
b.
Unhealthy
Reproductive Age
26
68
3
Postpar
t
u
m
Depr
es
sion I
n
cidence
a. Nor
m
al
b.
Depr
ession Sy
m
p
to
m
s
25
66
T
o
tal 38
100
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
58
–
16
2
16
0
Tabl
e
1 s
h
o
w
s
t
h
e f
r
e
que
ncy
di
st
ri
b
u
t
i
o
n
of
t
h
e re
sp
o
nde
n
t
s base
d
on t
h
e
pari
t
y
, t
h
e
ag
e at
t
h
e m
a
rri
age, and
po
st
part
um
dep
r
essi
o
n
i
n
ci
dence
in
Leon
isa Matern
al Ho
sp
ital,
Wo
no
sari. Th
e tab
l
e
in
fo
r
m
s th
at th
at th
e
m
a
j
o
r
ity o
f
th
e
r
e
sp
onden
t
s ar
e sek
und
ip
ar
a, i.e. as
man
y
as 1
4
p
e
o
p
l
e (47
%
), the
m
a
jori
t
y
of t
h
e resp
on
de
nt
s wh
o are i
n
he
al
t
h
y
re
produc
tive age at the
m
a
rriage are as
m
a
ny as 26
wom
e
n (
68%
)
,
m
eanwhi
l
e
t
h
e m
a
jori
t
y
of
resp
o
nde
nt
s t
h
at
i
s
2
5
w
o
m
e
n (6
6%
) d
o
not
e
x
peri
e
n
c
e
post
p
art
u
m
depressi
o
n
or n
o
r
m
al
.
3.
2.
B
i
vari
a
te An
a
l
ysi
s
Bivariate anal
ysis includes
varia
b
le analysis
in
th
e
research, i.e.
p
a
rity v
a
riab
le
with
post
p
art
u
m
depressi
o
n
i
n
ci
de
nce, a
n
d t
h
e
a
g
e at
t
h
e m
a
rri
age
wi
t
h
po
st
pa
rt
um
depre
ssi
o
n
i
n
ci
denc
e.
Tabl
e
2. T
h
e
re
l
a
t
i
onshi
p
bet
w
een
pari
t
y
an
d
post
p
art
u
m
depressi
o
n
i
n
ci
de
nce
Pa
rity
P
o
stpartum
depression incidence
Total
x
2
count
P value
Nor
m
al
Depr
ession
S
y
mp
t
o
ms
n %
n
%
n
%
Pr
im
ipar
a
2 5
11
29
13
34
22,
864
0,
00
Sekundipar
a
12
32
2
5
14
37
Multipara
11
29
0 0
11
29
Grande
m
u
ltipara
0
0
0
0
0
0
T
o
tal 25
66
13
34
38
100
Fro
m
Tab
l
e 2, it can
b
e
seen
th
at fro
m
3
8
resp
ond
en
t
s
, th
e resu
lt ob
tain
ed
is t
h
at th
e
m
a
jori
t
y
of t
h
e
resp
on
de
nt
s ar
e seku
n
d
i
p
a
r
a and
do
n
o
t
exp
e
ri
ence p
o
st
par
t
um
depre
ssi
o
n
sym
p
t
o
m
s
or
no
rm
al
,
i
.
e. as
m
a
ny
as 12 wom
e
n (3
2%)
,
m
eanwhi
l
e
t
hose ex
peri
e
n
ci
ng
dep
r
essi
o
n
sym
p
t
o
m
s
ar
e
maj
o
r
l
y
p
r
im
ip
ar
a, i.e. as m
a
ny as 11
w
o
m
e
n (2
9
%
)
.
After t
h
e d
a
ta
an
alysis was co
ndu
cted
,
x2
co
un
t is ob
tain
ed
b
y
22
.86
4
and
p
v
a
lu
e
0
.
0
0
with
2 d
f
si
gni
fi
can
ce l
e
vel
o
f
5
%
(0
.0
5)
x t
a
bl
e
of
5.
5
9
1
.
T
h
er
efo
r
e, i
t
can
be
co
ncl
u
ded t
h
a
t
t
h
e p
val
u
e i
s
less than 0.05 and
x2 c
o
unt is greater tha
n
x table,
thus
Ho is rejected a
n
d Ha is accepted, which m
e
a
n
s
t
h
at
t
h
ere
i
s
a
r
e
l
a
t
i
onshi
p
bet
w
een
t
h
e
pa
ri
t
y
an
d
post
p
art
u
m
depre
ssi
o
n
i
n
ci
denc
e i
n
L
e
oni
sa
M
a
t
e
rni
t
y
Ho
sp
ital, Wono
sari.
Parity is th
e n
u
m
b
e
r o
f
liv
e b
i
rth
s
wh
ich
are exp
e
rien
ced b
y
a wo
m
a
n
[9
]. Th
e p
a
rity will
affect
a w
o
m
a
n’s
psy
c
h
o
l
ogy
i
n
pe
rf
orm
i
ng
t
h
ei
r r
o
l
e
as a
m
o
ther. Howe
ver, how m
u
ch of t
h
e im
pact is
yet unknown
because of ea
ch
pers
on’s
psychol
ogy
is
dive
rse a
nd is
influe
nce
d
by
m
a
ny factors.
Postpartum
dis
o
rders are
ass
o
ciated
with
p
a
rity statu
s
, i.e.
th
e p
a
tien
t
s’
ob
stetric h
i
st
o
r
y
in
clud
ing
th
e
h
i
sto
r
y of pregn
a
n
c
y un
til th
e lab
o
u
r p
e
riod
as well as
wh
eth
e
r th
ere are co
m
p
licatio
n
s
o
f
th
e prev
iou
s
pre
g
nancy
an
d
t
h
e l
a
bou
r,
It
occu
rs m
o
re oft
e
n i
n
pri
m
ipara
wom
e
n. Pri
m
i
p
ara wo
m
e
n suf
f
er f
r
o
m
depressi
on m
o
re comm
only because in postnatal
pe
riod, prim
ipara
wom
e
n
are in the ada
p
tation
pr
ocess
10
.
P
h
y
s
i
cal
chan
ges
a
f
t
e
r t
h
e
l
a
b
o
u
r
pr
ocess
an
d t
h
e hei
g
ht
e
n
i
n
g
of
m
e
nt
al
di
so
rde
r
s
d
u
ri
n
g
t
h
e
first two
weeks indicates that physi
cal factors which are a
ssociated wi
t
h
th
e first lab
our, are i
m
p
o
r
tan
t
fact
or
s.
Ho
rm
onal
cha
n
ges
oc
cur
d
r
ast
i
cal
l
y
i
n
p
o
st
nat
a
l
pe
ri
o
d
an
d l
a
t
e
nc
y
peri
o
d
d
u
ri
n
g
t
h
e t
w
o
day
s
bet
w
ee
n t
h
e
l
a
bo
u
r
a
nd t
h
e
appea
r
a
n
ce
of
t
h
e sy
m
p
toms. T
h
ese c
h
a
n
ges
greatly affect the bala
nc
e,
especi
al
l
y
dras
t
i
c
changes i
n
pr
o
g
est
e
r
one a
nd est
r
o
g
en h
o
r
m
ones i
n
post
n
at
al
peri
o
d
. T
h
e pari
t
y
or t
h
e
num
ber
of the
childre
n als
o
a
ffects
on m
o
thers’ psyc
h
o
l
o
gy in
carryin
g ou
t th
eir ro
les as m
o
th
ers [10
]
.
A rap
i
d transitio
n fro
m
th
e state o
f
"t
wo
i
n
o
n
e
" at th
e en
d o
f
th
e
p
r
egn
a
n
c
y to
b
eco
m
e
two
i
ndi
vi
dual
s
, i
.
e
.
t
h
e m
o
t
h
ers
a
n
d
t
h
e c
h
i
l
d
ren
de
pen
d
o
n
t
h
e
i
ndi
vi
d
u
al
’s
p
s
y
c
hol
ogi
cal
a
d
j
u
st
m
e
nt
. Th
e
im
port
a
nce
of
l
ove i
n
p
r
e
v
e
n
t
i
ng t
h
i
s
t
r
an
si
t
i
on pe
ri
o
d
i
s
t
o
st
art
a goo
d rel
a
t
i
o
ns
h
i
p bet
w
ee
n t
h
e
m
o
th
ers and
child
ren.
Pari
t
y
has a
rel
a
t
i
ons
hi
p w
i
t
h
post
p
a
r
t
u
m
depressi
o
n
i
n
ci
dence.
O
n
e of t
h
e fa
ct
or
s
i
n
fl
ue
nci
n
g
p
o
s
t
p
art
u
m
dep
r
essi
on
i
s
pa
ri
t
y
. Pari
t
y
affe
ct
s on
p
o
st
pa
r
t
um
depressi
o
n
i
n
ci
dence
.
A
m
o
th
er who
on
ly h
a
s
on
e child
is certain
ly
less in
e
xpe
riences c
o
m
p
ared to a m
o
th
er
with
two or m
o
re
ch
ild
ren
.
Mo
t
h
ers who
on
ly hav
e
on
e ch
ild
are less lik
ely
t
o
kn
ow
ho
w
to car
e f
o
r th
e infan
t
s as well as
for th
em
selv
es
who
h
a
v
e
tran
sitio
n
e
d
t
h
eir
roles as m
o
th
ers.
The num
b
er of primipara at Leonisa Materni
t
y
Ho
sp
ital after th
e research
was con
d
u
c
ted; 1
1
resp
o
nde
nt
s e
xpe
ri
enci
ng
de
pressi
o
n
sy
m
p
t
o
m
s
co
m
p
ared t
o
se
ku
n
d
i
p
ara
t
h
at
onl
y
co
nsi
s
t
e
d
of
2
respon
d
e
n
t
s
(5%),
wh
ereas in
m
u
ltip
arou
s, no
n
e
h
a
d
d
e
pression
sym
p
to
m
s
. It prov
es th
at
p
r
im
ip
ara
indee
d
tends to be m
o
re susceptible to e
xpe
ri
ence
postpart
um
depres
sion sym
p
toms. The
recearc
h
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Pari
t
y
E
a
rl
y
St
age
of
Mar
r
i
a
g
e
w
i
t
h
I
n
ci
de
nc
e of
P
o
st
p
a
rt
u
m
Depre
ssi
o
n
(
E
ny Ret
n
a
A
m
barw
a
t
i
)
16
1
diffe
re
nt with recearc
h
from
janica
wi
sart,
2005 em
ployment, pa
rity did
not seem
to have any effect in
pr
o
duci
n
g
de
pr
essi
on
[
1
1]
.
Tabl
e
3. T
h
e
re
l
a
t
i
onshi
p
bet
w
een t
h
e
ag
e at
t
h
e m
a
rri
age a
n
d
post
p
art
u
m
depres
si
o
n
i
n
ci
d
e
nce
The Age at
the
Marriage
P
o
stpartum
depression incidence
Total
x
2
count
P value
Nor
m
al
Depr
ession
S
y
mp
t
o
ms
n %
n
%
N
%
Healthy
Rep
r
oductive Age
22
58
4
10
26
68
12,
965
0,
00
Unhealthy
r
e
pr
oductive age
3
8
9
24
12
32
Total
25
66
13
34
38
100
From
Tabl
e 3, i
t
can be seen t
h
at
t
h
e m
a
jo
ri
t
y
of res
p
on
de
nt
s get
m
a
rri
ed at
hea
l
t
hy
rep
r
o
d
u
ct
i
v
e a
g
e a
nd t
h
ey
d
o
n
o
t
ex
peri
e
n
c
e
p
o
st
pa
rt
um
depres
si
o
n
sy
m
p
t
o
m
s
(n
orm
a
l), i
.
e.
as m
a
ny
as
22
res
p
o
n
d
ent
s
(5
8%
),
whe
r
e
a
s t
hose e
x
per
i
enci
ng
p
o
st
pa
rt
um
depressi
o
n
sy
m
p
t
o
m
s
are
m
a
jori
t
y
g
o
t
mar
r
i
ed
at
un
health
y r
e
pr
oductio
n
ag
e, i
.
e. s m
a
n
y
as 9
r
e
sp
ond
en
ts (2
4
%)
.
Aft
e
r
bei
n
g a
n
al
y
zed, x
2
i
s
o
b
t
a
i
n
ed
at
1
2
.
9
65 a
n
d p
val
u
e
at
0.
00
wi
t
h
si
gni
fi
cance l
e
ve
l
df
1 at
5% an
d x
t
a
bl
e at
3.48
1
.
There
f
ore
,
i
t
can be c
oncl
u
ded t
h
at
t
h
e
p val
u
e i
s
l
e
ss t
h
an 0.
0
5
an
d x
2
count is great
er than
x table, t
hus
, Ho is rejected a
nd
Ha is accep
ted, which m
eans that there i
s
a
relations
hip
be
tween the a
g
e
at the
m
a
rriage with
t
h
e
p
o
st
pa
rt
um
dep
r
essi
o
n
i
n
ci
de
nce i
n
Le
oni
s
a
Matern
ity Hosp
ital,
Wo
no
sari.
The age at the
m
a
rriage highly affects a woma
n’s psy
c
hol
ogy
.
If a w
o
m
a
n get
s
m
a
rri
ed at
th
e ag
e youn
ger
th
an
20
year
-o
ld
, t
h
e exp
e
r
i
en
ce is cer
tai
n
ly in
suf
f
i
cient an
d
h
e
r
p
s
ych
e
is less th
an
matu
re. If th
e
co
nd
itio
n is cou
p
l
ed
with
th
e
p
r
egn
a
n
c
y and lab
o
u
r
cond
itio
n th
at au
to
m
a
tically ch
an
g
e
s
th
e ro
le to b
e
a wife and
a m
o
th
er, it certain
l
y
n
eeds a
fast
process
of a
d
a
p
tation
or a
d
justm
e
nt.
Th
is co
nd
itio
n is in
con
t
rast t
o
wo
m
e
n
wh
o
g
e
t m
a
rried
b
e
tween
t
h
e ages o
f
20
year-o
l
d
to
35 year-ol
d
. If being seen from the
psychological aspect, wom
e
n at
the
age of 20-35 year-ol
d
are m
a
ture
en
oug
h in
tak
i
n
g
d
ecision
and
wit
h
in
th
is ag
e, t
h
e pr
o
d
u
c
t
i
v
ity cap
ab
iliti
es are su
fficien
t
. In
con
t
rast
to
w
o
m
e
n
yo
unger th
an
20
year-o
ld
w
h
o
are
still to
o
yo
un
g an
d
wo
m
e
n
o
l
d
e
r th
an
3
5
y
ear-o
ld
w
h
o
too
m
a
ny
psy
c
h
o
s
o
ci
al
st
ress
ors
[8]
.
The age at the
marriage is the
age when a
wom
a
n gets
m
a
rried
and it
m
e
a
n
s that she is ready
t
o
ex
peri
e
n
ce
pre
g
nancy
a
n
d
l
a
bo
ur
peri
od
. The
best
t
i
m
e
fo
r a w
o
m
a
n t
o
get
pre
g
n
a
nt
an
d g
o
i
n
t
o
l
a
bo
ur
ra
nge
s i
s
fr
om
t
h
e age
of
2
0
t
o
35
y
ear-
o
l
d
.
Hi
gh
-ri
s
k
pre
g
nancy
e
m
erges i
n
w
o
m
e
n w
h
o
bec
o
m
e
pre
g
nant
at
t
h
e
age y
o
u
n
g
er t
h
an
2
0
y
ear
-
o
l
d
or
ol
de
r t
h
an
3
5
y
ear
-ol
d
,
h
a
ve
del
i
v
ere
d
f
o
u
r
c
h
i
l
d
re
n
or
m
o
re, and
th
e in
terv
al or the
distan
ce is less t
h
an two years
[10],[14].
The effects of psychos
o
cial factors, s
o
cio
econom
i
c factors
,
relevant de
m
ogra
p
hical data
(num
ber of
fa
mily
m
e
m
b
ers, age
)
beca
use
these
f
actors are lik
ely t
o
in
fl
u
e
n
c
e th
e resu
lts d
e
presi
post
p
art
u
m
.
Such
cha
n
ges
coul
d
pre
d
i
s
p
o
se
wom
e
n t
o
devel
o
p
de
pressi
o
n
t
o
a
cert
a
i
n
de
gr
ee,
sug
g
est
i
n
g a t
i
m
e
-speci
fi
c t
h
r
e
sh
ol
d m
i
ght
b
e
app
r
op
ri
at
e [
12]
-
[
14]
. T
h
e
WH
O
has a
dvi
sed t
h
at
heal
t
h
policy integrat
e m
e
ntal health care
in
to primary h
ealth
care settin
g
s
[15]. A
lth
oug
h fur
t
h
e
r r
e
sear
ch
is
n
eed
ed
t
o
est
a
b
lish
t
h
e scalab
ility an
d
effectiv
en
ess
o
f
in
terv
en
tion
s
fo
r
d
e
p
r
ession
in co
mm
u
n
i
ty
co
n
t
ex
ts, t
h
is
stu
d
y
p
r
ov
id
es an
im
p
o
r
tan
t
step
in do
cu
men
tin
g th
e n
e
ed
for an
ten
a
tal
screen
ing
for
dep
r
essi
on
[
1
6
]
.
4.
CO
NCL
USI
O
N
Th
e m
a
j
o
rity o
f
respo
n
d
e
n
t: was sek
und
ipara
(47
%
); got m
a
rriag
e in
h
ealth
y reprodu
ctiv
e age
(6
8%
);
di
d n
o
t
experi
e
n
ce p
ops
pa
rt
um
depressi
o
n
sy
m
p
tom
s
(66%)
.
There wa
s a si
gni
fi
cant
rel
a
t
i
ons
hi
p
betwee
n the
parity and the a
g
e at
the m
a
rriage with
postpartum
depre
ssi
o
n
i
n
cid
e
n
ce in
Leon
isa Matern
ity
Ho
sp
ital, Wono
sari.
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