Background: Postnatal depression (PND) is one of the most common maternal mental health problems for women worldwide. Yet the wide range of reported rates of PND in different countries raises questions about how PND is experienced by women in different cultures and whether interventions developed in western cultures are appropriate in very different settings. It is important to establish how PND is defined, experienced and managed in different cultures in order to create culturally relevant interventions. No previous studies of experience of PND and its management have been conducted in Malaysia. The aim of this study was to explore women’s experiences and healthcare practitioners’ (HCPs) perspectives of PND in a multicultural country, Malaysia. Methods: This was a qualitative study informed by a critical realist approach. Semi-structured interviews were carried out with 33 women (from three different cultural backgrounds) attending for child or postnatal care and 18 HCPs in six purposively selected maternal and child health (MCH) clinics and a female psychiatric ward in Kuala Lumpur, Malaysia. Data were analysed using framework analysis. Findings: There were some differences in the women’s perceptions of PND experience across three different cultural backgrounds in Malaysia. Malay women were more likely to describe the symptoms of PND based on a combination of emotional and behavioural changes, whereas Chinese and Indian women talked more about emotional changes. Traditional postnatal practices were described as contributing to PND by some Malay women but were accepted as promoting maternal and infant well-being by the majority of Indian women. Religious activities were reported as an effective strategy for the Malay women but were not seen as helpful by the majority of Chinese women. Considering HCPs, it appeared that the absence of a clear and specific policy and guideline in the management of PND within the Malaysian healthcare system has resulted in a lack of professional ownership in the management of PND, especially among HCPs in MCH clinics. Conclusion: The women and the HCPs had distinct ways of conceptualising PND experiences, although they agreed on several symptoms and causal explanations. This study calls for a system-based enhanced PND care with an initiation of culturally appropriate care for PND within the healthcare system.

Un corpus de recherches en sciences sociales et en santé publique menées principalement en Amérique du Nord depuis les années 1980 montre que l'absence de logement personnel a un effet délétère sur l'état de santé, physique et psychique des familles sans logement. En France, les études quantitatives sur la santé des femmes sans-domicile restaient exceptionnelles avant la réalisation de l'enquête ENFAMS conduite en Ile-de-France en 2013. A partir des données de cette enquête, nous avons montré que, bien qu’elles soient plus jeunes que les femmes en population générale, la santé des femmes sans logement est plus mauvaise, en particulier en ce qui concerne leur santé mentale et leur santé nutritionnelle. Malgré un état de santé plus mauvais, les femmes sans logement ont moins recours aux soins que les femmes en population générale. Cette thèse a permis de souligner l’importance du suivi gynécologique dans l’accès au dépistage des cancers féminins puisque la proportion de femmes dépistées du cancer du col de l’utérus est deux fois plus élevée chez les femmes avec un suivi que chez celles sans suivi. Nous avons aussi montré que dans le contexte français d’une couverture maladie universelle et de l’existence de filets de protection sociale, nous ne retrouvons pas les associations classiquement observées entre renoncement aux soins et ressources financières ou assurance maladie. Les professionnels en soins primaires doivent s’appuyer sur les fenêtres d’opportunité de dépistage qu’offre chacun de leur contact avec les services de soins. Les stratégies d’amélioration à l’accès aux soins de ces femmes ne doivent pas seulement viser à lever les obstacles financiers. / Social sciences and public health research conducted mainly in North America, since the 1980s, have shown that homelessness has a significant impact on health, physical conditions and psychological health of families without housing. In France, quantitative studies on homeless women were scarce until the realization of the ENFAMS survey in Paris region in 2013.Based on data from this survey, we showed that, although younger than women in the general population, the health of homeless women is worse, especially with regards to their mental health and nutritional status. Despite their poor health, homeless women have less access to health care than women in the general population. Our research has highlighted the importance of gynecological follow-up in accessing women's cancer screening since the proportion of women who were screened for cervical cancer was twice as high among women with follow-up than among women without follow-up. We have also shown that in the French context of universal health coverage and numerous social safety nets, we do not find the classic associations between unmet health care needs and financial resources or health insurance status.Primary care professionals need to rely on windows of opportunity provided by each of their contact with health care services to make them benefit from cancer screening. Strategies to improve the access to health care of these women must not only aim to remove financial barriers.