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Cukurova Medical Journal

Pengaruh Pijatan Endorphin pada level -endorphin dan Sekor Edinburgh Postnatal Depression Scale (EPDS) pada Perempuan dengan Postpartum Blues

Hidayati Hidayati1, Wisnu Barlianto2, SitiCandraWindu Baktiyani3

1Brawijaya University,, Faculty of Medicine,Midwifery Master Study Programme, 2Pediatric Laboratory, Saiful Anwar General Hospital, 3Division of
Social Obstetric and Ginaecology, Obstetric and Ginaecology Laboratory, Malang, East Java, INDONESIA
CukurovaMedicalJournal 2014; 39 (3):512-516.

ABSTRACT
Tujuan: Penelitian ini bertujuan untuk menginvestigasi dampak pijat endorphin pada tingkat -endorphin dan skor EPDS pada wanita dengan postpartum
blues.
Purpose: This study aimed to investigate the effects of endorphin massage on -endorphin level and EPDS score in women with postpartum blues.

Material dan Metode: Ada dua puluh relawan prempuan postpartum (prempuan melahirkan saat muda) untuk penelitian. Semua dari mereka memberi
persetujuan tertulis mengenai partisipasi mereka. Kriteria inklusi adalah ibu dengan postpartum blues di hari ketiga pasca persalinan dan EPDS skor> 9,
sedangkan kriteria eksklusi adalah ibu dengan riwayat depresi postpartum. Pengukuran penanda (-endorphin) dan skor EPDS dilakukan sebelum dan
setelah pelayanan pijat. Pijat Endorphin dilakukan oleh suaminya atau peneliti sesuai instruksi yang diberikan, 4 kali seminggu, sekali di waktu pagi selama
20 menit termasuk lengan kanan, kiri lengan, leher, dan punggung bawah (masing-masing 5 menit).
Material and Methods: Twenty postpartum women volunteered for the study. All of them gave written consent regarding their participation. The
inclusion criteria were mother with post partum blues at third day post partum and EPDS score > 9, while the exclusion criteria were mother with history
of depression post partum. The measurement of marker (-endorphin) and EPDS scoring was done prior and after massage treatment. Endorphin
massage was done by her husband or researcher according instruction that provided, 4 times a week, once in morning for 20 minutes including right
arm, left arm, neck, and lower back (5 minutes each).

Hasil: Perawatan Pijat Endorphin secara signifikan meningkatkan -endorphin dibandingkan dengan sebelum perawatan (P <0,05). Tingkat EPDS secara
signifikan berkurang setelah perawatan dari pada sebelum perawatan (P <0,05). Ada korelasi negatif yang signifikan antara tingkat -endorphin dan
skor EPDS (r = -0.517; P <0,05).
Results: Endorphin massage treatment significantly increase the -endorphin level compared to before treatment (P < 0.05). The level of EPDS
significantly decrease after treatment than that before treatment (P < 0.05). There is significantly negative correlation between -endorphin level and
EPDS score (r = -0,517; P < 0.05).

Kesimpulan: Pijat Endorphin adalah perawatan alternatif yang baik untuk meningkatkan tingkat -endorphin dan menurunkan skor EPDS pada ibu yang
postpartum blues.
Conclusion: Endorphin massage is good alternative treatment to increase -endorphin level and decresae EPDS score among mother with postpartum
blues.

Key Words: Endorphin massage; minor depression; scoring; hormonal.


Kata Konci: Pijat Endorphin ; depresi ringan; skoring; hormonal.

PENGANTAR
Puerperium (Masa nifas) adalah masa kerentanan terbesar untuk wanita 1-3. Maternity blues (MB), juga dikenal dengan postpartum blues dengan
digejalai mudah marah, sedih, dan kecenderungan untuk menangis dalam sepuluh hari pertama setelah melahirkan 4-7. Menurut beberapa
diagnostik
kriteria, prevalensi 15% sampai 80% dari ibu nifas yang diakui 1.8,9. MB adalah berasosiasi dengan
risiko depresi yang lebih besar pada awal atau akhir masa nifas 10,11.
INTRODUCTION

Puerperium is the period of greatest vulnerability for the woman1-3. Maternity blues (MB), also known post-partum blues is characterized by
symptoms of irritability, sadness, and a tendency to cry within the tent first days after giving birth 4-7. According to the various diagnostic
criteria, a prevalence of 15% to 80% of puerperal women are admitted1,8,9. MB is associate it with
greater risk for depression in early or late puerperium10,11.

Keselamatan terhadap antidepresan selama menyusui ada tetapi dampak jangka panjang dari pembukaan antidepresan selama menyusui
pada berkembang otak bayi tidak diketahui. Selain itu, resep untuk wanita menyusui memerlukan kasus khusus putusan risiko-manfaat keputusan
12,13. Bahkan, mengingat bahwa sebagian besar ibu baru lebih memilih untuk menghindari obat-obatan, terutama jika menyusui, penting bahwa

intervensi alternatif dievaluasi untuk pencegahan dan pengobatan depresi post-partum14,15 ..


The safety of antidepressants during lactation exis but the long-term effects of antidepressant exposure through breast-feeding on the
infant's developing brain are unknown. In addition, the prescription to breast-feeding women requires a case-specific risk-benefit decision12,13.
Moreover, given that most new mothers prefer to avoid medication, particularly if breast-feeding, it is important that alternative interventions be
evaluated for prevention and treatment of post-partum depression14,15
muscles16,17.
Pijat secara umum seharusnya memberikan relaksasi pada otot-otot. Pijat dapat meningkatkan pelepasan oksitosin dan endorfin dan
penurunan tingkat hormon stres dalam darah setelah perawatan pijat. Pijat dianggap untuk mengubah phisiologis dan manfaat psikologis kerena
penurunan tekanan darah, sirkulasi limfatik ditingkatkan, dan meningkatkan ambang untuk nyeri . Selanjutnya, pijat seharusnya untuk
meningkatkan
kesadaran subyek 'dari keadaan otot 16,17.
Massage in general is supposed to cause relaxation of the muscles. Massage able to increased release of oxytocin and endorphins and
decreased stress hormone level in the blood after massage treatment.Massage is considered to change physiological and psychological benefits
due to lowered blood pressure, improved lymphatic circulation, and increase threshold for pain. Furthermore, massage is supposed to improve
subjects awareness of the state of the muscles16,17.

-Endorphin adalah komponen dari sumbu hipotalamus-hipofisis-adrenal, dilepaskan ke dalam darah perifer selama stres, cedera, ketegangan mental,
dan olahraga sebagai regulator positif kekebalan tubuh manusia18. . EPDS adalah 10 jenis kuesioner yang dirancang untuk layar untuk depresi
postpartum, ia memiliki validitas yang kuat dan kehandalan dalam
survei besar di masyarakat dan telah diterjemahkan dan divalidasi di Perancis 19,20.

-Endorphin is a component of the hypothalamic-pituitary-adrenal axis, it is released into the peripheral blood during stress, injury, mental strain, and
exercise as positive human immune regulator18.The EPDS is a 10-item questionnaire designed to screen for post-partum depression, it has strong
validity and reliability in large community surveys and has been translated and validated in French19,20
Sebuah korelasi positif yang sangat signifikan telah dicatat antara skor EPDS pada 5 hari dan 6 minggu postpartum, ambang batas 10 menjadi prediksi
depresi postpartum 21. Penelitian ini bertujuan untuk menyelidiki dampak pijat endorphin pada tingkat -endorphin dan skor EPDS pada wanita dengan
postpartum blues.
A highly significant positive correlation has been noted between EPDS scores at 5 days and 6 weeks post-partum, a threshold of 10 being predictive of
post-partum depression21.This study aimed to investigate the effects of endorphin massage on -endorphin level and EPDS score in women with
postpartum blues

MATERIAL DAN METODE


Subyek
Dua puluh relawan perempuan postpartum untuk penelitian. Semua dari mereka memberi persetujuan tertulis mengenai partisipasi mereka. Seorang
dokter meninjau sejarah medis mereka. Sampel adalah kelompok pijat perawatan. Kriteria inklusi adalah ibu dengan postpartum blues di hari ketiga
nifas dan skor EPDS > 9, sedangkan kriteria eksklusi adalah ibu dengan riwayat depresi post partum.
Pengukuran penanda (-endorphin) dan skor EPDS dilakukan sebelum dan setelah perawatan pijat.
Subjects
Twenty postpartum women volunteered for the study. All of them gave written consent regarding their participation. A physician reviewed their
medical histories. The sample was massage-treatment group. The inclusion criteria were mother with post partum blues at third day post partum and
EPDS score > 9, while the exclusion criteria were mother with history of depression post partum. The measurement of marker (-endorphin) and EPDS
scoring was done prior and after massage treatment.

EPDS Scoring
Pada hari ketiga, skala Edinburgh Postnatal Depression juga selesai. Edinburgh Postnatal Depression Scale adalah 10-item laporan sel kuesioner. Setiap
pertanyaan memiliki empat batang pertanyaan dengan skor 0-3 (dihasilkan kisaran 0-30) [22].
On the third day, the Edinburgh Postnatal Depression Scale was also completed. The Edinburgh Postnatal Depression Scale is a 10-item sel report
questionnaire. Each question has four syem questions that are scores 0-3 (resulting range 0-30) [22].

Endorphin Massage
Pijat Endorphin dilakukan oleh suami atau peneliti sesuai instruksi yang diberikan. Pijat dilakukan 4 kali seminggu, sekali di pagi selama 20 menit termasuk
lengan kanan, lengan kiri, leher, dan punggung bawah (masing-masing 5 menit).
Endorphinmassage was done by her husband or researcher according instruction that provided. Massage was done 4 times a week, once in
morning for 20 minutes including right arm, left arm, neck, and lower back (5 minutes each).

Sampel Darah
Darah diambil dari pembuluh darah antecubital ke dalam 10-ml tabung serum Vacutainer, 5-ml tabung Vacutainer heparin dan 3 ml tabung Vacutainer
ethylenedi- Deppression Scale aminetetraacetic acid (EDTA). Tabung-tabung Heparin dan EDTA kemudian disimpan dalam es dan disentrifugasi dalam
waktu 30 menit pada 3000 rpm (5000 g) selama 10 menit pada 4 C. Setelah sekitar 45 menit, tabung serum disentrifugasi pada 3000 rpm (5000 g)
selama 10 menit pada suhu kamar. Serum dan plasma dipisahkan dari sel-sel darah dan disimpan pada suhu -20 C sampai dianalisis.
Blood Samples
Blood was drawn from an antecubital vein into 10-ml serum Vacutainer tubes, 5-ml heparin Vacutainer tubes and 3-ml ethylenedi- Deppression Scale
aminetetraacetic acid (EDTA) Vacutainer tubes. The heparin and EDTA tubes were then stored on ice and centrifuged within 30 min at 3000 rpm (5000
g) for 10 min at 4 C. After approximately 45 min, serum tubes were centrifuged at 3000 rpm (5000 g) for 10 min at room temperature. Serum and
plasma were separated from blood cells and stored at -20C until analyzed.

Analisis -endorphin
-endorphin dalam serum diukur sebelum dan setelah pijat-perawatan dengan immunoenzymatically menggunakan metode ELISA ( Manusia -..
Endorphin ELISA Kit, REF DZE30867, LOT 201.306, diproduksi by Asmausco Pharma, Co, Ltd,) dengan kisaran assay 75 ng / L - 2400 ng / L.
-endorphin Analysis
-endorphin in serum was measured before and after massage-treatment by immunoenzymatically using an ELISA method (Human - Endorphin ELISA
Kit, REF. DZE30867, LOT. 201306, produced byAsmausco Pharma, Co.,Ltd,) with assay range 75 ng/L 2400 ng/L.
Etika
Penelitian ini telah disetujui oleh komite kode etik penelitian Fakultas Kedoktaran Universitas Brawijaya, Malang, Indonesia
This research has been approved by research ethics committee Faculty of Medicine University of Brawijaya, Malang, Indonesia

Analisis Statistik
Data disajikan sebagai tujuan SD dan perbedaan antara kelompok dianalisis menggunakan uji t-student dengan SPSS 15.0 paket statistik. korelasi
Pearson juga dilakukan untuk menganalisis hubungan antara tingkat -endorphin dan skor EPDS.
Statistical analysis
Data are presented as mean SD and differences between groups were analyzed using t-student test with SPSS 15.0 statistical package. Pearson
correlation was also conducted to analyze the association between -endorphin level and EPDS score.

HASIL
Tabel 1 menunjukkan tingkat -endorphin dan EPDS sebelum dan setelah perawatan pijat endorphin. Perawatan Pijat Endorphin secara signifikan
meningkatkan tingkat -endorphin dibandingkan dengan sebelum pengobatan (P <0,05). Tingkat EPDS secara signifikan berkurang setelah pperawatan
daripada sebelum perawatan (P <0,05). Ada signifikan korelasi negatif antara tingkat -endorphin dan skor EPDS (r = -0.517; P <0,05).
RESULTS

Table 1 shows the levels of -endorphin and EPDS before and after endorphin massage treatment. Endorphin massage treatment significantly increase
the -endorphin level compared to before treatment (P< 0.05). The level of EPDS significantly decrease after treatment than that before treatment (P<
0.05). There is significantly negative correlation between -endorphin level and EPDS score (r = -0,517; P< 0.05)

Tabel 1. -endorphin dan EPDS sebelum dan sesudah endorphin perawatan pijat
Sebelum Perawatan Setelah Perawatan
(N = 20) (N = 23)

-endorphin (ng/l) 1241.47 1701.91 1929.96 2617.93a


EPDS (unit) 14.60 3.79 9.15 4.16a
Nilai dinyatakan sebagai maksud SD. aP <0,05; dibandingkan dengan sebelum perawatan; EPDS: Edinburgh Postnatal Depression Scale; ng / l:
nanogram per liter.
DISKUSI
Pijat adalah pengobatan yang umum digunakan, tetapi sedikit bukti ilmiah yang ada untuk mendukung penggunaannya, terutama untuk ibu dengan
postpartum blues. Dalam penelitian ini kami menemukan bahwa pijat endorfin merubah phisiologis dan manfaat psikologis pada ibu dengan postpartum
blues. Tingkat EPDS secara signifikan berkurang setelah perawatan pijat endorphin (9.15 4.16) dibandingkan sebelum perawatan (14,60 3,79) (P
<0,05). Temuan ini menunjukkan bahwa pijat endorfin memiliki danpak manfaat karena perubahan depresi besar menjadi depresi ringan pada ibu
postpartum. Di Nigeria, memisahkan dari 9 dan 13 telah direkomendasikan untuk gejala-gejala depresi ringan atau depresi berat, berturut-turut. 23.
Massage is a commonly used treatment, but little scientific evidence exists to support its use, especially for mother with postpartum blues. In this study
we found that endorphin massage change physiological and psychological benefits in mother with postpartum blues.The level of EPDS significantly
decrease after endorphin massage treatment (9.15 4.16) than that before treatment (14.60 3.79) (P< 0.05). This finding indicate that endorphin
massage have benefits effects due to changes major depression into minor depression in postpartum mother. In Nigerian, cutoff of 9 and 13 have been
recommended for symptoms of minor depression or major depression, respectively 23

Terapi pijat mempengaruhi permukaan kulit, jaringan lunak, otot, tendon, ligamen dan fasia oleh
teknik sistematis manual. Menggunakan mekanisme endorphin-release, mengendalikan gerbang saraf dan merangsang saraf simpatik, terapi pijat bisa
menyebabkan relaksasi otot. Dalam penelitian ini kami menemukan bahwa endorfin perawatan pijat secara signifikan meningkatkan tingkat -endorphin
dibandingkan dengan sebelum perawatan (P <0,05) .Corticotropin mengeluarkan hormone (CRH), sebagai mediator utama stres, bertanggung jawab
untuk plasma pusat -endorphin meningkat. Studi sebelumnya menunjukkan bahwa peningkatan kadar -endorphin pada pasien dengan gangguan
depresi setelah 2 minggu perawatan adalah tanda-tanda perombakan adaptif dan aktivasi pembatasan sistem stres pada tubuh 25,26. Dampak psikologis
ini menunjukkan perubahan sanogenetic sistemik. Meningkatkan plasma -endorphin yang ditemukan pada akhir periode akut pada gangguan traumatis.
Selain itu, temuan ini juga mendukung peningkatan tingkat peptida pada pasien dengan depresi setelah aksi sengatan listrik, sebagai "respon
hipotalamus" 27.
Massage therapy affects surface skin, soft tissues, muscles, tendons, ligaments and fascia by manual systematic techniques. Using an endorphin-
release mechanism, controlling nerve gates and stimulating sympathetic nerves, massage therapy could lead to muscular relaxation. In this study we
found that endorphin massage treatment significantly increase the -endorphin level compared to before treatment (P < 0.05).Corticotrophin releasing
hormone (CRH), as the main stress mediator, is responsible for the central plasma -endorphin level increase. CRH may directly stimulate plasma -
endorphin level production24. Previous studies showed that elevated levels of -endorphin in patients with depressive disorders after 2 weeks of
treatment were the signs of readaptive remodeling and activation of the stress-limiting systems of the body25,26. This psychologic effects indicated the
systemic sanogenetic changes. Increased plasma -endorphin levels were found by the end of the acute period of traumatic disorders. Besides, this
finding also supported for increased peptide level in patients with depression after the action of electric shock, as the hypothalamic response27
Kesimpulannya, data kami menunjukkan bahwa perawatan pijat endorfin alternatif yang baik untuk meningkatkan tingkat -endorphin dan menurunkan skor EPDS
antara ibu dengan postpartum blues.
In conclusion, our data suggested that endorphin massage is good alternative treatment to increase -endorphin level and decresae EPDS score among mother
with postpartum blues.

Pernyataan Kepentingan
Penulis menyatakan bahwa tidak ada konflik kepentingan mengenai publikasi artikel ini.
REFERENCES/ REFRENSI-REFRENSI

1. Adewuya AO. The maternity blues in Western Nigerian women: prevalence and risk factors. Am J Obstet Gynecol. 2005;193:1522-5.

2. Gale S, Harlow BL. Postpartum mood disorders: A review of clinical and epidemiological factors. J PsychosomObstet Gynecol. 2003;24:257-66.

3. Seyfried LS, Marcus SM. Postpartum mood disorders. Int Rev Psych. 2003;15:231-42.

4. Kennerly H, Gath D. Maternity blues: I. Detection and measurement by questionnaire. Br J Psychiatry. 1989;155:356-62.

5. Rhode LAP, Busnello E, Wolf A, Zomer A, Shansis F, Martins S, et al. Maternity blues in Brazilian women. ActaPsychiatr Scand. 1997;95:231-5.

6. Pitt B. Maternity blues. Br J Psychiatry. 1973;22:431-3.

7. Stein GS. The pattern of mental changes and body weight change in the first post-partum week. J Psychosom Res 1980; 24:165-71.

8. Gonidakis F, Rabavilas AD, Varsou E, Kreatsas G, Christodoulou GN. (2007). Maternity blues in Athens
Greece: A study during the first 3 days after delivery. J Affect Disord. 2007;99:107-15.

9. Murata A, Nadaoka T, Morioka Y, Oiji A, Saito H. Prevalence and background factors of maternity blues. GynecolObstet Invest. 1998;46:99-104.

10. Fossey L, Papiernik E, Bydlowski M. Postpartum blues: A clinical syndrome and predictor of postnataldepression?.J PsychosomObstet Gynecol. 1997;18:17-21.

11. Henshaw C. Mood disturbance in the early puerperium: A review. Arch Womens Mental Health. 2003;6:33-42.

12. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996;153:1132-7.
13. Stowe ZN, Cohen LS, Hostetter A, Ritchie JC, Owens MJ, Nemeroff CB.. Paroxetine in human breast milk and nursing infants. Am J Psychiatry. 2000;157:185-9.

14. O'Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry. 2000;57:1039-45.

15. Appleby L, Warner R, Whitton A, Faragher B. A controlled study of Fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. Br
Med J. 1997;314:932-36.

16. Laukkanen AM, Leppanen K, Tyrmi J. Vilkman E. Immediate effects of voice massage treatment on the speaking voice of helathy subjects. Folia PhoniatrLogop.
2005;57:163-72.

17. Wright A, Sluka KA. Nonpharmacological treatments for musculoskeletal pain. The Clinical Journal of Pain. 2001;17:3346.

18. Gein SV, Baeva TA, Nebogatikov VO, Tendrykova SP. -endorphin effcets on antibody production, proliferation, and secretion of Th1/Th2 cytokines in vivo. Bull
ExpBiol Med. 2012;152:595-9.

19. Nonacs R, Cohen LS. Post-partum mood disorder: diagnosis and treatment guidelines. J Clin Psychiatry. 1998;59:34-40.

20. Guedeney N, Fermanian J. Validation study of the French version of the Edinburgh Post-natal Depression Scale (EPDS): new results about use and
psychometric properties. Eur Psychiatry. 1998;13:83-9.

21. Hannah P, Adams D, Lee A, Glover V, Sandler M. Links between early post-partum mood and post-natal depression. Br J Psychiatry. 1992;154:777-80.

22. Cox Jl, Holden JM. Sagovsky RV. Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry.
1987;150:782-6.

23. Uwakwe R, Okonwo JE. Affective (depressive) morbidity in puerperal Nigerian women: validation of the Edinburgh Postnatal Depression Scale. ActaPsychiatr Scand.
2003;107:251-9.

24. Meczekalski B, Podfigurna-Stopa A, Warenik-Szymankiewicz, Genazzani AR. Functional hypothalamic amenorrheaL current view on
neuroendocrine aberrations. GynecolEndocrinol. 2008;24:4-11.

25. Kubyrak OV, Umriukhin AE, Emeljanova IN, Antipova OS, Guseva AL, Pertsov SS, Sudakov SK. Increased -endorphin level in blood plasma as an indicator of positive
response to depression treatment. Bull ExpBiol Med. 2012;153:758-60.

26. Gappoeva ET, Karsanova DB. Characteristics of the acoustic analyzer trauma in blast trauma due to mine explosion. VestnOtorinolangol. 2006;1:51-4.
27. Alexopoulos GS, Inturrisi CE, Lipman R, Frances R, Haycox J, Dougherty Jr JH, Rossier J. Plasma immunoreactive -endorphin levels in depression: effect of
electroconvulsive therapy. Arch Gen Psychiatry.1983;40:181-3

YazmaAdresi / Address for Correspondence:


Dr.HidayatiHidayati
Midwifery Master Study Programme,
Faculty of Medicine, Brawijaya University,
Jl. Veteran, Malang, East Java
INDONESIA
Email: hidayatikhalik@gmail.com

Geli tarihi/Received on: 03.02.2014


Kabul tarihi/Accepted on:04.03.2014