BACKGROUND Traditional postpartum practices are intended to provide care to mothers, but there is mixed evidence concerning their impact on postpartum depression (PPD). It remains unknown if there is a unique impact of postpartum practices on PPD separately from other types of social support, or if practices differentially affect those with existing prenatal depression. In Pakistan, chilla (چله) is a traditional postpartum practice in which women receive relief from household work, additional familial support, and supplemental food for up to 40 days postpartum. This study aims to understand if chilla protects against PPD independent of other support and whether this relationship varies by prenatal depression status. METHODS Data come from the Bachpan cohort study in rural Pakistan. Chilla participation and social support (Multidimensional Scale of Perceived Social Support) were assessed at 3 months postpartum. Women were assessed for major depressive episodes (MDE) with the Structured Clinical Interview, DSM-IV and for depression symptom severity with the Patient Health Questionnaire (PHQ-9) in their third trimester and at 6 months postpartum. Adjusted linear mixed models were used to assess the relationship between chilla participation and PPD. RESULTS Eighty-nine percent of women (N = 786) participated in chilla and almost 70% of those that participated took part in all of chilla's aspects. In adjusted models, chilla participation was inversely related to MDE (OR = 0.56;95%CI = 0.31,1.03) and symptom severity (Mean Difference (MD) = - 1.54;95%CI: - 2.94,-0.14). Chilla participation was associated with lower odds of MDE (OR = 0.44;95%CI = 0.20,0.97) among those not prenatally depressed and with lower symptom severity among those prenatally depressed (MD = -2.05;95%CI:-3.81,-0.49). CONCLUSIONS Chilla is inversely associated with both MDE and symptom severity at 6 months postpartum above and beyond social support. Specifically, chilla is inversely associated with MDE among those not prenatally depressed and with lower symptom severity among those prenatally depressed. This relationship signals an opportunity for interventions aimed at preventing and treating PPD in this region to draw upon chilla and similar traditional postpartum practices in creating community-based, low-cost, sustainable interventions for maternal mental health. TRIAL REGISTRATION NCT02111915. Registered 18 September 2015. NCT02658994. Registered 22 January 2016. Both trials were prospectively registered.

中文翻译：

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巴基斯坦农村地区的产妇抑郁症：与产后文化习俗的保护性联系。

背景技术传统的产后习俗旨在为母亲提供护理，但是关于其对产后抑郁症（PPD）的影响的证据不一。产后习俗对PPD的独特影响是否与其他类型的社会支持分开存在，或者习俗对患有现存产前抑郁症的人的影响不同，这仍是未知的。在巴基斯坦，chilla（چله）是一种传统的产后习俗，在这种习俗中，妇女在产后长达40天的时间里从家庭工作，额外的家庭支持和补充食品中获得救济。这项研究旨在了解，chilla是否能独立于其他支持而预防PPD，以及这种关系是否因产前抑郁状态而异。方法数据来自巴基斯坦农村地区的Bachpan队列研究。在产后3个月，评估孩子的参与和社会支持（感知社会支持的多维量表）。通过结构性临床访谈，DSM-IV对妇女的重度抑郁发作（MDE）进行评估，并在妊娠中期和产后6个月通过《患者健康问卷》（PHQ-9）对妇女的抑郁症状严重程度进行评估。调整后的线性混合模型用于评估辣椒参与与PPD之间的关系。结果有百分之八十九的妇女（N = 786）参加了奇克拉，参与其中的妇女中有近70％参与了奇克拉的所有方面。在调整后的模型中，chilla的参与与MDE（OR = 0.56; 95％CI = 0.31,1.03）和症状严重程度（均值差（MD）=-1.54; 95％CI：-2.94，-0.14）成反比。未产前抑郁者中的Chilla参与与MDE发生机率较低（OR = 0.44; 95％CI = 0.20,0.97）以及产前抑郁者中症状严重程度较低（MD = -2.05; 95％CI：-3.81，- 0.49）。结论产后6个月以上的社交支持与超出的MDE和症状严重程度呈负相关。特别是，在非产前抑郁的人群中，chilla与MDE呈负相关，而在产前抑郁的人群中，症状严重程度较低。这种关系为旨在预防和治疗该地区PPD的干预措施提供了机会，可以借鉴子和类似的传统产后做法，为社区建立产妇心理健康的，低成本，可持续的干预措施。试用注册NCT02111915。2015年9月18日注册。NCT02658994。