The Effect of Family Support on Postpartum Depression: Scoping Review

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INTRODUCTION
A mother with a postpartum depressive disorder usually has a depressed mood and suicidal ideation.During the first six weeks after delivery, postpartum depression occurs (Nakamura et al., 2020).PPD (Postpartum Depression) is a psychological illness among postpartum women.Psychosomatic complaints and irritability, frequent lamentation, irrationality and hopelessness, low energy and drive, low sexual attention, loss of appetite and lack of sleep, and unable to experience the current situation are indications (Asaye et al., 2020).
Mothers and their children also suffer from postpartum depression.Cognitive impairment, emotional distress, and behavioral problems are risk factors for PPD (Reis et al., 2022).Problems in parenting and breastfeeding, and obstacles to children's development in the future such as attitude, anger, cognitive, and interpersonal problems will become more chronic in children of mothers experiencing psychological stress (Pratiwi et al., 2022).
The World Health Organization (WHO) reports that the number of individuals suffering from mental disorders worldwide is growing and that more than 300 million people-or 4.4% of the world's population-are affected by depression, making it the fourth most prevalent disease in the world (WHO, 2017).According to the usual Basic Health Research (referred to as Riskesdas) 2018, the prevalence of mental disorders of mood illnesses in Indonesia reached 9.8 (Kementerian Kesehatan RI, 2018).
Postpartum depression was 17.7% more prevalent in 291 studies sampled out from 56 countries, according to a systematic review study (Hahn-Holbrook et al., 2017).Another significant finding is that half of primiparous women with postpartum mental distress (PPD) were declared because of personal problems and preferred not to tell their families (Iyer, 2022).The occurrence of postpartum depression in Asia is quite high and varies between 26-85%.Meanwhile, the incidence rate in Indonesia ranges from 50 to 70% of postpartum women (Sari, 2020).On this ground, the period of pregnancy and childbirth has a greater potential for stress than other conditions.During pregnancy and childbirth (postpartum), mothers appear to experience great stress.This happens due to the limited physical condition of the mother, thereby limiting physical activity in the process of psychological adaptation (Arimurti et al., 2020).
According to a study in Indonesia, the number of attending relatives during the postpartum period will reduce the burden on the mothers and the family support factor given to mothers affects the incidence of postpartum depression.The number of relatives or family assisting physically and psychologically during puerperium will reduce the burden on the mother, and the social support factors received by the mother affect the occurrence of postpartum depression (Ariyanti, 2020).Research in Poland likewise showed results that support from family members drastically improved the likelihood of postpartum depression among postpartum mothers.Mothers with no support from a loved one (family support) scored significantly higher on the Edinburgh Postnatal Depression Scale (EPDS) (Gałęziowska et al., 2021).Another study in Canada revealed that early family history of abuse and neglect, lack of family support, and current partner violence during the postpartum period are additional psychosocial risk factors for high postpartum anxiety (Pawluski et al., 2017).
Not only does postpartum depression affect a woman's life not only her family, but also the development of the child.In some cases, depression can develop into postpartum psychosis (Janouskova, 2021).Therefore, the influence of the family is significant in the occurrence of postpartum depression among mothers.
Given the current state of the literature, scoping reviews are required to identify existing abstract and factual gaps in the research methodology.As a result, this method can be implemented by policy activists, teachers, researchers, and inventors.The goal of this research is to recognize the reality regarding the effect of family support on postpartum depression.Research question is: How does the evidence reassure the effect of family support on postpartum depression?

METHOD
The Scoping Review research design was utilized by the author for their study.An analytical study is channeled through a scoping review, which identifies the characteristics or important aspects, provides an overview of how the research is carried out in specific points or aspects, and identifies the kinds of data corresponding to the reviewed points that are linked to the concept of analytical research and explaining the systematic review (Munn et al., 2018).This scoping review was written by one lecturer and one student from a similar educational institution.The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scoping review extension checklist serves as the basis for the preparation of this scoping review (Arksey & O'Malley, 2005) and directs to arranging this checking survey.The modified reviews consist of the following steps: 1) finding documents using a systematic search; 2) screening articles based on titles and abstracts; 3) determining if the article may be read in full text; 4) critical appraisal; and 5) inserting pertinent articles.
Finding documents using a systematic search Researchers managed and solved the review focus using the Population, Exposure, and Outcome (PEO) Framework to design a review focus and search strategy.Using PEO helped with defining inclusion and exclusion criteria, creating relevant search phrases to characterize the issue, and choosing essential themes to concentrate on throughout the review.
PEO is deemed acceptable for usage as the article search focuses on quantitative research.This study's framework is Population: Family, Exposure: Postpartum Depression, Outcome: Support.Medical subject headings (MesH) and the Boolean operators OR and AND were considered as search terms in this study.The steps for searching for information sources, search strategies, and sorting objective facts acted as discourse material for authors related to posting searches.The number of studies on postpartum mental distress in postpartum mothers has increased in recent years.Posts about family support and postpartum mental stress in postpartum mothers, conclusions regarding family support ties with postpartum mental pressure in postpartum mothers, and important posts and posts published in English are the benchmarks used.Exclusion criteria are opinionated articles, SOPs, research designs using systematic reviews or scoping reviews, and articles on postpartum maternal mental health without inferences about family relationships.
The data sets utilized in this exploration comprise; Science Direct, ResearchGate, and PubMed.The authors used the Pubmed database because of its free access, which already has 32 million citations and offers links to the National Center for Biotechnology Information (NCBI) and other relevant websites.The basis for high-quality comprehensive reading posting information that has been peer-reviewed is Elsevier's ScienceDirect.ResearchGate (RG) is an academic social networking program that currently serves more than 20 million clients.(Muscanell & Utz, 2017) claims that the mission of RG is to provide academic ties, share knowledge and skills, and raise a fair reputation The authors began searching the three chosen databases, namely Pubmed, Science Direct, and Researchgate.The PRISMA Flowchart describes the article's findings.The Mendeley reference management tool was used to download and enter all article results, which then looked for duplicates and removed those that were found.

Screening articles based on titles and abstracts
The author went over the screening procedure and ensured that selected articles qualified the criteria for this study.Of 669 articles were discovered from 3 database's search results.There are 252 PubMed articles, 347 Science Direct articles, and 70 ResearchGate articles.The next step was to input articles into the Mendeley Reference Management Tool.The articles were removed as 87 were duplicates, narrowing down the total to 582 articles.Subsequently, the publications were chosen for screening based on their titles and abstracts, which related to "The Effect of Family Support on Postpartum Depression in Postpartum Mothers."As many as 25 articles were eligible after 557 completely unrelated ones were eliminated.The data graphing table (Table 2), which was adapted from the Joana Briggs Institute (JBI), lists the 10 papers that were included in this scoping review research (Moola et al., 2016).The Joana Briggs Institute (JBI) technique was used to perform a critical assessment since it is comprehensive for evaluating all studies and simple to use.All articles used under consideration employ a cross-sectional research design.They were divided into evaluations with a scoring score assigned to each number on the critical appraisal question; 0 for "no", 1 for "not applicable," 2 for "unclear," and 3 for "yes".There were 10 quality A articles, according to the findings of the article quality evaluation in Table 3 (A1, A2, A3, A4, A5, A6, A7, A8, A9, A10).Articles A5, A6, and A8 are more valuable because they provide a thorough explanation of the process.
The critical appraisal applied Joana Briggs Institute (JBI) Appraisal Tool as described in Table 3.
Were the environment and research participants thoroughly described?
Was the exposure measurement accurate and valid?
Were objective and standard criteria used for measurement of the condition?
Were confounding variables found?
Were there any methods mentioned for handling confounding variables?
Were the results accurately and validly measured?Inserting pertinent articles was applied in the result and discussion session as the result of this study.

RESULTS AND DISCUSSION
Out of 669 potential articles for use, 10 are eligible.These selected articles are written in English and were published between 2019 and 2023.The characteristics of articles and theme analysis are described in this section.Figure 2 shows the characteristics of articles by country.(1 article), and China (1 article).Figure 3 presents the article's characteristics based on the research design.Ten research papers were chosen using a quantitative study design and questionnaire-based data-gathering techniques.

Theme Analysis
Following are the data extraction analysis and assessment of the research posts' quality.Also, the research post themes were introduced.

Relationship Satisfaction With Family
Relationship Satisfaction With Husband.The EPDS ratio was applied to measure signs of postpartum mental distress as an outcome elastic.According to this study, postpartum mothers' emotional well-being was impacted by their husbands' involvement, their companionship, and their views on maternal health.EPDS score was 11, PPD habits was 27.6%, and suicidal ideation was indicated by 46 points (18.4%).Factors that were significantly related to PPD in the univariate analysis included: marriage to an aggressive employee, serious problems from the husband, marital conflict induced by the husband's alcoholism, low self-evaluation of marriage, and lack of physical assistance at home in the postpartum era.According to the findings, there was a strong and statistically important association between postpartum mental distress and co-existing violence distress and co-existing violence (Nhi et al., 2019).From previous research, mothers experiencing intimate partner violence during pregnancy have a greater level of postpartum mental distress (Ashenafi et al., 2021).
Relationship Satisfaction With Mother-in-Law.As most women live in families with in-laws, lack of support from mother-in-law as a risk factor has practical significance A8.Research conducted in China indicates that a negative relationship between a mother-in-law and a daughter-in-law is a risk factor for postpartum depression (OR= 2.89; 95% CI= 2.12-3.95).These findings suggest that cultural factors, such as attending mother-in-law as a caregiver and a negative relationship between a mother-in-law and her daughter-in-law are associated with postpartum depression risk (Qi et al., 2021).Disputes due to differences in background, values, identity, and logic or ideas in carrying out baby care will affect this issue (Siu et al., 2012).

Family Support
Husband Support.Spousal support has a direct effect on postpartum depression.Need of approval (NoP) suggests a profoundly positive immediate impact on postpartum depression (p<0.05).The connection between postpartum depression and partner support had a correlation value of -0.231**, indicating a link between postpartum depression and spouse support.This reinforces the notion that the quality of the husband-wife relationship will determine the husband's involvement during pregnancy, childbirth, and the puerperium (y= 0.60, p<0.001).Higher perceived stress [0.755; CI 95% = (0.470; 0.615)] is the consequence of lower partner support [-0.154; 95% CI= -0.115; -0.025].The strongest indicator of a reduction in postpartum depression symptoms is perceived stress.
According to American studies, perceived stress is adversely correlated with a wife's satisfaction with her husband's support.These results are consistent with those of several studies that a supportive spouse may greatly diminish stress experienced by mothers of all ages and be a key source of support (Luthar & Ciciolla, 2015).The other study indicates that good support from the partner during pregnancy and the postpartum period has a true protective impact, lowering the likelihood of a rise in EPDS rates following delivery (Dadi et al., 2020).
Parental Support.The findings reveal a connection between postpartum depression and family support (p= 0.000; r= -0.364), as well as a connection between postpartum depression incidence and self-efficacy (p= 0.000; r = -0.355).Parental support and postpartum depression had a correlation value of -0.178, indicating that the two conditions are not positively correlated.Lack of support from mother-in-law affected the incidence of postpartum depression (OR= 0.32, 95% CI= 0.15-0.68,p= 0.002).
Research conducted in Pakistan suggests that the sex of the first baby, level of family support, and family characteristics have a profound effect on the rate of maternal postpartum depression.These findings give insight into cultural risk factors modifying postpartum maternal mental health (Tarar et al., 2021).Tani and Castagna (2017) found that a low degree of perceived parental support is a powerful predictor of postpartum depression, and it has been discovered that in collectivistic societies, perceptions of parental support have the greatest effect on postpartum depression.
Social Support.Postpartum depression was more prevalent in women of little or moderate social support (OR= 1.78,OR= 2.76,.Those who had multiple pregnancies, lost pregnancies, had an obese body image and were working women all exhibited this pattern.Many family members, close friends, and other social supports are important for new mothers.Unexpectedly, subgroup research found that women with multiple pregnancies were five times more likely to have depression if their social support was insufficient. Postpartum depression affected 43.5% of new mothers.When compared to those who were Muliyani & Suryaningsih | 347 not depressed (1.78 0.87 vs. 2.33 1.00, respectively, p<0.001), depressive mothers' social support network scores were lower on average (Standard Deviation) at 2.09 0.99.Mothers with members of bigger social networks are less likely to have postpartum depression.The family must be informed of the crucial role that social support plays in healthcare and to be reinforced in every area to prevent postpartum depression.The findings showed that in terms of social support, there was a substantial difference between those who had postpartum depression (parents, husband, and close relatives) and those who were not depressed with a value (p= 0.03).The amount of social support is inversely correlated with both PSOC (parenting sense of competence) and PPD (postpartum depression) (p< 0.01).Higher levels of personal resilience are correlated with higher levels of social support.People may receive information, emotional support, and material help through their social networks and resilience is increased by facilitating individuals dealing with hardship and failures.
This research explains that PPD plays an intermediary role in social support and PSOC for postpartum women.Pain, lack of sleep, and hormonal imbalances hamper mothers from caring for newborns in the early postpartum period.Finally, social support from family, friends, and others is necessary.Women are more likely to develop PPD if they do not have sufficient social support (Dekel et al., 2017).A further study (Parsa et al., 2019) proves that the high incidence of postpartum mental distress is related to the severity of mental distress, and factors such as poor sleep quality, stress on life's perceptions, and lack of social support.

CONCLUSION
Based on the 10 publications examined, it was discovered that support from husbands, parents, and mother-in-law had a significant impact on postpartum women's mental health.Postpartum mental distress correlated significantly with low family support.Postpartum mothers with strong family support might be shielded against postpartum depression.Furthermore, postpartum mental stress was influenced by domestic intimacy, including the relationship between husband and mother-in-law, therefore, it is important to focus more on the mother's support during the postpartum period.To avoid postpartum depression in postpartum women, health policymakers and healthcare professionals in public and private health institutions should develop family-focused health programs.In the selected articles, the researchers explored the significance of family support and its impact on the mother's mental wellbeing.Therefore, future researchers should be taking these into account to explore social support for the baby's growth and development.

Figure 2 .
Figure 2. Characteristics of Articles by Country

Table 1 .
Table 1 lists the aforementioned terms in further detail.Keywords