Effects of obeying traditional rituals during postpartum period on depression in Taiwan—the role of male support and marital satisfaction

Background: Based upon traditional Chinese postpartum rituals, women should be confined to home and obey restrictive regimen (e.g., special diet, avoiding bath) for one month. Although some evidences suggested confinement practices reduced postpartum depression, there was little consensus. Almost none of these studies examined the impact of prenatal and partner's factors. Our study was thus aimed to investigate the effects of obeying traditional rituals during postpartum period on depression, with simultaneous consideration of impact from prenatal and partner's factors. Methods: A total of 335 pregnant women and their partners were recruited for participation during their first trimester prenatal visits in Taipei from 2011-2012. They were followed till six months postpartum. Self-reported data were collected, using the Edinburgh Postnatal Depression Scale and questions on prenatal and partner's factors (e.g., lifestyle, prenatal depression, partner's support and marital satisfaction). Multivariate regression models were used. Results: Lower depression scores were observed among women obeying postpartum rituals (6.74±3.79 vs. 8.79±4.66, p=0.04). Adherence to postpartum practice was negatively associated with depressive symptoms (OR = 0.92, 95% CI: 0.85-0.99) after adjustment for prenatal depression, social support, and marital adjustment. The protective effects were more prominent among women with partner's report of high support and marital satisfaction. More modifying effects from prenatal and partner's factors were found. Conclusions With the protective postpartum rituals on depression, the key element may be the presence of welcome support, especially from partners, rather than the specific ritual. Our findings may provide information for service planning to support postpartum care in the communities.