Postpartum psychosis and social support in Uganda : the effect of family psychoeducation

Abstract

Background: Postpartum psychosis is a rare but severe psychiatric condition that affects not only the mother but the whole family. The standard of care for this condition in Uganda is mainly medical treatment. The role of adjunctive psychosocial treatments for this condition on social support that is crucial when mothers develop psychosis is not well researched in Uganda.

Main objective: To investigate the effect of family psychoeducation (FPE) on perceived social support of mothers with postpartum psychosis (amakiro) in central Uganda.

Methods: Fourteen Focus Group Discussions (FGDs) and 30 in-depth interviews were conducted among mothers with and without psychosis, their caregivers, nurses and midwives, and Traditional Birth Attendants (TBAs) to explore existing knowledge on perceptions on postpartum psychosis in Uganda (Study I). In Study II, we adapted the Multidimensional Scale of Perceived Social Support (MSPSS) in a cross-sectional design with consecutive recruitment of 240 postpartum mothers. Analysis of reliability and validity using cronbach alpha and principal component analyses were performed. In Study III, a section of the Family Psychoeducation Implementation Resource Toolkit was adapted to incorporate Ganda cultural issues related to postpartum psychosis. Postpartum mothers with psychosis, their caregivers, psychiatric nurses, and psychologists were the participants. In-depth interviews, consultative meetings and a FGD were carried out together with observation. Through discussions and drawing consensus, FPE was adapted. In a Randomized Controlled Trial (RCT) of 104 postpartum mothers and their caregivers, FPE was carried out on the intervention group (n = 53) of mothers for 3 months on a weekly basis for 2 hour sessions (Study IV). Data about perceived social support at baseline and after intervention were collected. Intention to treat analysis using analysis of covariance and moderation analysis were used.

Results: Perceptions on postpartum psychosis that were documented in the 1970s are still prevalent in the setting (Study I). Using cronbach alpha, the MSPSS yielded internal consistency of .83. Principal component analysis generated high loadings on all subscales (Study II). Potential improvements in FPE were identified both in the process and the content of the program. Whereas the basic principles underlying the process of carrying out FPE remain the same, changes in the content were proposed and these reflected the social cultural and economic reality of the population (Study III). After adjusting for baseline perceived social support, postpartum mothers in the interventional group had higher levels of perceived social support than the control group (F = 6.31, p = .01) and a moderate effect of .35 (Study IV).

Conclusion: FPE has a positive impact on the perceived social support of mothers with postpartum psychosis in central Uganda and it might be one way by which cultural perceptions can be demystified.