Maternal mental health is increasingly recognized as a significant issue in Indonesia, where postpartum depression (PPD) among young mothers (ages 15-24) is reported to be 4.0%. Broader estimates for perinatal mental health disorders range from 15.19% to 26.15%, which is notably higher than in neighboring Malaysia and Singapore. Depression and anxiety in the perinatal period can negatively impact outcomes for both mothers and infants, with studies indicating that 15.5% to 23.0% of women in low- and middle-income countries (LMICs) experience perinatal depressive symptoms, especially among socioeconomically disadvantaged groups. Maternity blues have also been identified as a strong predictor of PPD.
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Despite increasing awareness, maternal mental health is often under-recognized in Indonesia. Screening typically utilizes self-report tools such as the Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9), which are favored for their cost-effectiveness and ease of use in primary health care settings. However, challenges remain in implementing these screenings effectively, due to barriers faced by healthcare workers.
To enhance maternal mental health assessments, biological markers may be integrated alongside self-report questionnaires. These biomarkers can provide objective insights into the physiological processes underlying maternal mental health, which may not be fully captured by self-reports due to the psychological changes that occur during and after pregnancy. For instance, biomarkers such as cytokines and C-reactive proteins can fluctuate during pregnancy and the postpartum period, indicating biological changes that relate to mental health.
In Indonesia, mental health issues during the perinatal period are often perceived through moral or spiritual lenses, complicating their interpretation. Local adaptations of the EPDS have demonstrated effective structural evaluation, but the socio-cultural stigma around mental health remains a significant barrier to diagnosis and treatment.
Challenges in biomarker research in low-resource settings include high costs of biomarker assays, variability in ethnic and demographic populations, as well as limited laboratory capacities. Biomarkers should complement rather than replace psychological assessments, serving as research tools that help clarify the biological pathways connecting psychosocial stressors to maternal mental health outcomes.
Pragmatic hybrid research approaches are proposed for integrating biomarkers into maternal mental health studies in Indonesia. This involves a limited selection of affordable and minimally invasive biological indicators, such as cortisol levels in hair and saliva, which may offer insights into stress dynamics and relate to maternal mental health outcomes.
Additionally, maximizing the feasibility of biomarker research could involve aligning sample collection with existing healthcare services and ensuring robust ethical governance. Future studies are encouraged to adopt longitudinal designs to account for the physiological variations throughout pregnancy.
In conclusion, while evidence on relevant biomarkers remains inconsistent, their potential to inform our understanding of the interplay between biological and psychosocial factors in maternal mental health is significant. This suggests an urgent need for further longitudinal studies focusing on integrating psychosocial assessments with biological markers, thus enhancing maternal mental health understanding within the Indonesian context.