Occupation of The Husband is a Risk Factor for Psychological Problems Among Pregnant Immigrant Women in East Belitung, Indonesia

Introduction: According to WHO, there are 970 million people in the world who had psychological problems. The prevalence of psychological problems is highest in women (34.5%), and pregnant women who had psychological problems, especially depression, were about 10%, and 13% occurred in postpartum mothers. Psychological disorders in pregnant women might be caused by various factors, including the husband’s occupation and residency status. In order to provide the necessary care to pregnant women, it is important to know whether there is a relationship between a husband’s occupation and demographic status with maternal psychological problems. With this study, the relationship between a husband’s occupation and demographic status with psychological problems of pregnant women in the work area of Manggar Health Center, East Belitung, Indonesia can be analyzed. Methods: The study design was cross-sectional and analytic observation. The study sample consisted of 90 pregnant women (45 primiparous and 45 multiparous), who were randomly selected. The instrument used to collect data was the SRQ. Data from this study were analyzed using the chi-square test. Results: The results showed that the psychological problems in pregnant women were associated with the husband’s occupation (p = 0.018) and demographic status (p = 0.014). Conclusion: There were significant findings on the relationship between a husband’s occupation, pregnant women’s demographic status, and psychological problems.

Introductions

An unresolved issue or challenge in both developed and developing countries to date is the issue of mental health. Data from the WHO showed that there were 970 million people in the world who had experienced psychological problems[1]. There were about 4.7 million people who attempted self-harm[1]. The prevalence of psychological problems was higher among women (34.5%), men (23.2%), and pregnant women who experienced psychological problems, especially depression, around 10%, and 13% occurred in postpartum women[2].

The mental health and well-being of pregnant women were impacted by their own lives and the lives of their unborn children[3]. One of the antenatal psychological problems was associated with an increased risk of postpartum depression and decreased breastfeeding[4]. Another impact on pregnant women was preterm births[4]. Preterm birth has been identified as a common indirect cause of increased morbidity and mortality[5]. One of the indicators of Sustainable Development Goals (SDGs) was to improve well-being and ensure healthy lives for all people of all ages, including pregnant women, newborns, and children under five. The SDGs stated that by 2030, a country's neonatal mortality and maternal mortality rates should be less than 12 and 70 per 100,000 live births, respectively. The 2020-2024 strategic plan was established through the Minister of Health Regulation (PMK) Number 21 in the year 2020 to prevent and control mental health disorders. Therefore, it would be expected that all districts and cities should prioritize mental health issues to reach national goals. The Minister of Health Regulation stated that Puskesmas and its network were the first lines to conduct mental health checks using a special tool, the Self-Reporting Questionnaire (SRQ). Screening using SRQ was tailored based on target groups, which included people of productive age as well as pregnant and lactating mothers. Pregnant women who had been screened and treated were expected to reduce maternal and neonatal mortality. Research finds that primigravida mothers have a higher likelihood of experiencing psychological problems (70.74%) than multigravida mothers (65.70%).[6]

The emotional states of pregnant women needed to be known because the phases of a woman's life—pregnancy, childbirth, postpartum period, and breastfeeding—were very important. The most common reasons for psychological problems faced by pregnant women include lack of material resources, unfavorable working conditions, the burden of heavy household and family responsibilities, dysfunctional family relationships, and pregnancy complications[7].

First-level health facilities had implemented SRQ screening according to the Ministry of Health guidelines as part of the mandatory program. One of the sub-districts in East Belitung Regency with the largest population, screening results showed that the community experienced psychological problems. However, women and pregnant women had never been specifically screened for emotional status, so the emotional state of pregnant women was unknown. Research on the relationship between a husband's occupation and psychological problems in pregnant women in the working area of First Level Health Facilities Manggar, East Belitung Regency, had never been investigated.

Methods

This study used a cross-sectional design and analytic observations. The population was all pregnant women in the working area of First Level Health Facilities Manggar. The research period began in November 2023 and ended in April 2024. The sample used amounted to 90 respondents and was divided into two groups, namely 45 primigravida mothers and 45 multigravida mothers, using random sampling techniques from the total population at the time of the study. The inclusion criteria were pregnant women, age >19 years, and gestational age >28 weeks. Data collection was carried out through the distribution of questionnaires to eligible respondents. After signing the research consent form, respondents filled out the questionnaire. The SRQ questionnaire consisted of 20 questions. Positive answer scores of 6-20 indicated the presence of psychological problems. Data were processed by using IBM SPSS 22 software and analyzed by univariate and bivariate analyses with a significance level of p < 0.05 by the Chi-Square test. This study received ethical approval No. 25/EC/KEPK/FKUA/2024 from the Faculty of Medicine, Universitas Airlangga Surabaya, Indonesia.

Results

The first-level health facility Manggar is an ambulatory care facility located in Kurnia Jaya Village, Manggar Sub-region, East Belitung Regency. Its working area consists of nine villages. The population of Kecamatan Manggar in 2022 was approximately 40,007 people. Most of the population were migrants, had a primary school education, and were freelancers/entrepreneurs. The first-level health facility in Manggar consisted of three sub-primary health centers, forty-two integrated health centers, and seven midwives' practices. The first-level health facility in Manggar has a total of four general practitioners, twenty-two midwives, twenty nurses, one pharmacist, two laboratory staff, and three nutrition staff.

Table 1. Distribution of Respondent Characteristics.Univariate Analysis

Characteristics		Primiparous n = 45	Multiparous n = 45
		N	%	N	%
Population	Immigrants	27	46.6​	31	53.4
	Native people	18	56.3	14	43.8
Husband’s Occupation	Freelancers	27	44.3	34	55.7
	Permanent staff	18	62.1	11	37.9

Table 2. Data analysis of population status with psychological problems in pregnant women.Analysis Bivariate

Variable	Pregnant Women n = 90	Total	Chi-Square nilaiP	PR (95% CI)
	Immigrants	Native people
	N	%	N	%	N	%	0,018	3.549 (1.194-10.551)
Psychological problems Score 6-20	23	82.1	5	17.9	28	100
No psychological problem Score 1-5	35	56.5	27	43.5	62	100

Variable	Pregnant Women n = 90	Total	Chi-Square nilaiP	PR (95% CI)
	Freelancers	Permanent Staff
	N	%	N	%	N	%	0,014	4.054 (1.253-13.112)
Psychological problems Score

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