HUBUNGAN DUKUNGAN SOSIAL DAN GANGGUAN JIWA RINGAN (COMMON MENTAL DISORDERS=CMDs) PADA IBU HAMIL DENGAN KEJADIAN PREEKLAMSIA/EKLAMSIA DI KABUPATEN SUKOHARJO JANUARI 2010-DESEMBER 2011

Yudhi Wibowo, Prof. dr. H. M. Hakimi, Sp.OG (K), Ph.D,

2012 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Tahun 2010, penyebab langsung kematian ibu tertinggi di Sukoharjo adalah preeklamsia/eklamsia (PE/E) (47,62%). Dukungan sosial mempengaruhi kesehatan mental ibu hamil yang berbeda menurut bentuk keluarga. Distres selama hamil kemungkinan mengarah kepada PE/E. Di Kabupaten Sukoharjo, kasus psikosis meningkat dari 1.387 (2008) menjadi 2.445 (proyeksi tahun 2010). Tujuan penelitian untuk menganalisis hubungan dukungan sosial dan gangguan jiwa ringan (CMDs) pada ibu hamil dengan kejadian PE/E. Metode Penelitian: Penelitian ini merupakan matched case-control study. Kasus adalah ibu hamil yang telah didiagnosis PE/E oleh dokter RS. Kontrol adalah ibu hamil normal atau tidak didiagnosis sebagai PE/E oleh tenaga kesehatan. Instrumen: kuesioner sosial demografi, SSQ-6 dan SRQ-20. Analisis menggunakan Chi Square, McNemar, uji stratifikasi dan kondisional regresi logistik multipel. Hasil: Responden penelitian 286 orang, 56,99% tinggal dalam keluarga inti (nuclear), 45,10% memiliki dukungan sosial rendah, dan 27,27% CMDs (+). Dukungan sosial rendah tidak berhubungan langsung dengan kejadian PE/E. Risiko CMDs (+) meningkat 26 kali lebih pada responden dengan dukungan sosial rendah dibandingkan responden dengan dukungan sosial tinggi (p<0,01; OR=26,4; 95% CI: 10,67-77,20). Beberapa variabel berhubungan bermakna dengan PE/E yaitu CMDs (+) (p<0,01; OR=6,11; 95% CI: 2,99-14,07), pendapatan keluarga rendah (p<0,01; OR=2,93; 95% CI: 1,56-5,82), riwayat hipertensi kronik (+) (p<0,01; OR=7,67; 95% CI: 2,32-39,89), riwayat PE/E sebelumnya (+) (p<0,01) dan riwayat keturunan PE/E (+) (p=0,01; OR=6; 95% CI: 1,34-55,20). Kesimpulan: Dukungan sosial rendah tidak berhubungan langsung dengan PE/E tetapi berhubungan dengan CMDs (+). CMDs (+), pendapatan keluarga rendah (+), riwayat HT kronik (+), riwayat PE/E (+) dan riwayat keturunan PE/E (+) berhubungan dengan PE/E. Perlu adanya pelayanan yang terpadu antara program KIA, program pencegahan penyakit tidak menular (PTM) dan kesehatan jiwa serta dukungan sosial dari keluarga. Penelitian ke depan perlu perbaikan metodologi dan menspesifikan dukungan sosial dalam dukungan emosional dan instrumental serta kualitas hubungan.

Background: In 2010, the highest direct cause of maternal mortality was preeclampsia/ eclampsia (PE/E) (47.62%). Social support influenced the mental health in pregnant women according to different family structure. The distress during pregnancy was likely to lead to PE/E. In Sukoharjo, there were increased psychosis cases from 1387 (2008) to 2445 (projected in 2010). The objective was to analyze the association of social support and common mental disorders (CMDs) in pregnant women with PE/E. Methods: This study was a matched case-control study. Cases were pregnant women who have been diagnosed with PE/E by a hospital specialist. Controls were pregnant women with normal pregnancies or not diagnosed as PE/E by health workers. Instruments: social demographic questionnaire, SSQ-6 and SRQ20. Analysis using Chi Square, McNemar, stratified analysis, and conditional logistic regression multiple. Results: Respondents were 286 people, 56.99% live in nuclear family, 45.10% had low social support, and 27.27% had CMDs (+). Low social support was not directly associated to PE/E. Compared with high social support, those with low social support had a 26 fold increased risk of CMDs (+) (p<0.01, OR=26.4, 95% CI: 10.67 to 77.20). Several variables significantly associated with PE/E were CMDs (+) (p<0.01, OR=6.11, 95% CI: 2.99 to 14.07), low family income (p<0.01, OR=2 , 93, 95% CI: 1.56 to 5.82), history of chronic hypertension (+) (p<0.01, OR=7.67, 95% CI: 2.32 to 39.89), history of PE/E (+) (p<0.01), and history of hereditary of PE/E (+) (p=0.01, OR=6, 95% CI: 1.34 to 55.20). Conclusion: Low social support was not directly associated to PE/E but it was associated to CMDs (+). CMDs (+), low family income, history of chronic HT (+), history of PE/E (+), and history of hereditary of PE/E (+) were associated to PE/E. There is need for an integrated service between the MCH program, noncommunicable diseases prevention program, and mental health, as well as social support from family. Future study should specify the methodology and the improvement of social support in the emotional and instrumental support as well as the quality of the relationship.

Kata Kunci : Dukungan sosial, gangguan jiwa ringan, PE/E.