Quantitative study—other

Women’s health locus of controlduring pregnancy may predict riskfor postpartum depression10.1136/ebnurs-2014-101985

Elizabeth Mollard

University of Nebraska Medical Center, UNMC College of Nursing,Lincoln, Nebraska, USA

Correspondence to: Elizabeth Mollard, University of Nebraska MedicalCenter, UNMC College of Nursing, 1230 O Street, Ste 131, Lincoln, NE68588, USA; Elizabeth.Mollard@UNMC.EDU

Commentary on: Moshki M, Baloochi Beydokhti T, Cheravi K. The effectof educational intervention on prevention of postpartum depression: anapplication of health locus of control. J Clin Nurs 2014;23:2256–63.

Implications for practice and researchA woman’s belief about health control (HLC including internal HLC(IHLC) and chance HLC (CHLC)) may identify her risk for postpartumdepression (PPD).▪ Healthcare providers should consider assessing HLC to predict thosewomen who will be at greater risk for PPD.

▪ Researchers should develop educational interventions targetinginternal and chance HLC that may have the potential to prevent PPD.

ContextPPD is a serious concern for women and their babies, yet there are fewways to predict or prevent it. This study evaluated whether there was acorrelation between HLC and PPD and whether a HLC focused educa-tional intervention could prevent PPD. HLC determines how much anindividual believes their health is controlled by internal or externalfactors.1 With internal health locus of control (IHLC) the individual seestheir health as a result of their behaviours. An individual with externalbeliefs would see their health as under control of chance (CHLC) or undercontrol of powerful others (PHLC) such as a healthcare provider.1

MethodsThe purpose of the study was to test the relationship between HLC andPPD and to test the efficacy of an educational intervention based on HLCto prevent PPD. The study used a pre/post-test experimental design. Twohundred and thirty pregnant women in Iran were given theMultidimensional Health Locus of Control Scale (MHLCS) and randomly

divided into the control group or the experimental group. The experimen-tal group received an educational intervention about pregnancy, child-birth and the postpartum period targeted to HLC. At 4 weeks postpartum,participants were retested with the MHLCS and given the EdinburghPostnatal Depression Scale. Multiple statistical methods were applied.

FindingsIn this sample, the prevalence of depression was 21.5%, which is higherthan the generally accepted 10–15% prevalence rate, but lower thansome estimates of PPD prevalence in Iran.2 Women with a higher level ofIHLC had lower levels of PPD. Women with a higher level of CHLC hadhigher rates of PPD. The intervention was shown to reduce PHLC,although PHLC was not significantly associated with PPD.

CommentaryPrevious studies have shown that those with a high IHLC are more likelyto make positive health choices, including seeking care when needed.3

This study showed that those who have a higher IHLC are less likely tohave PPD and those with a high CHLC have higher levels of PPD.Although PHLC was unrelated to PPD, the educational intervention didreduce this type of HLC.

The importance of this study is twofold. First, healthcare providersmay be able to screen a woman using HLC during pregnancy to deter-mine her risk of PPD. Second, although the intervention did not affectPPD in this study, the intervention did lower levels of PHLC. If research-ers were able to develop an intervention in pregnancy that could increaselevels of IHLC and decrease levels of CHLC, they might be able to preventPPD.

Although the Diagnostic and Statistical Manual of Mental Disorders(Fifth Edition) supports the onset of PPD in the first 4 weeks postpartum,clinicians generally accept an onset of PPD within the first 6 months ormore.4 The authors may have found an increased prevalence rate of PPDor a change in HLC if they had conducted their post-test at 6 weeks post-partum or greater. The time frame for post-test should potentially belengthened in future studies. The use of control groups and randomisa-tion increase validity in this study. Further studies with larger, diversesamples are required to increase generalisability of results.

Competing interests None.

References1. Wallston K, Strudler Wallston B, DeVellis R. Development of the multidimensional

health locus of control (MHLC) scales. Health Educ Behav 1978;6:160–70.2. Shobeiri F, Farhadi Nasab A, Nazari M. Detecting postpartum depression in referents

to medical and health centers in Hamadan city. J Hamadan Univ Med Sci2007;3:24–8.

3. Wang R, Aldridge A, Malcarne V, et al. Health locus of control and assimilation ofcervical cancer information in deaf women. J Canc Educ 2010;25:354–9.

4. O’Hara M, McCabe J. Postpartum depression: current status and future directions.Annu Rev Clin Psychol 2013;9:379–407.

Evid Based Nurs Month 2015 | volume 0 | number 0 | 1

Midwifery Evidence-Based Nursing Online First, published on February 27, 2015 as 10.1136/ebnurs-2014-101985

Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd (& BCS) under licence.