The effects of postpartum stress and social support on postpartum women's health status

Interpersonal psychotherapy-oriented program for Chinese pregnant women: delivery, content, and personal impact

The interpersonal psychotherapy-oriented childbirth education program has the potential to promote social support and maternal role competence and prevent postpartum depression in Chinese women. The present study explored the perceptions of Chinese women about the delivery, content, and personal impact of the interpersonal psychotherapy-oriented childbirth education program. The study was conducted in a regional teaching hospital in China. The intervention was based on the principles of interpersonal psychotherapy, and consisted of two 90 min antenatal classes and a telephone follow up within 2 weeks after delivery. Ninety two women, pregnant for the first time, completed the program. The Program Satisfaction Questionnaires, with five open-ended questions, was used for the process evaluation (n = 83), and a one-on-one, in-depth interview was used for the outcome evaluation (n = 20). The findings suggested that the program could facilitate the participants' adjustment to motherhood, help to establish or improve their relationships, and enhance their perceived social support and maternal role competence. Future programs could be strengthened by lengthening the program and adding more interactive learning.

The association of neighbourhood and individual social capital with consistent self-rated health: a longitudinal study in Brazilian pregnant and postpartum women

BACKGROUND

Social conditions, social relationships and neighbourhood environment, the components of social capital, are important determinants of health. The objective of this study was to investigate the association of neighbourhood and individual social capital with consistent self-rated health in women between the first trimester of pregnancy and six months postpartum.

METHODS

A multilevel cohort study in 34 neighbourhoods was performed on 685 Brazilian women recruited at antenatal units in two cities in the State of Rio de Janeiro, Brazil. Self-rated health (SRH) was assessed in the 1st trimester of pregnancy (baseline) and six months after childbirth (follow-up). The participants were divided into two groups: 1. Good SRH--good SRH at baseline and follow-up, and, 2. Poor SRH--poor SRH at baseline and follow-up. Exploratory variables collected at baseline included neighbourhood social capital (neighbourhood-level variable), individual social capital (social support and social networks), demographic and socioeconomic characteristics, health-related behaviours and self-reported diseases. A hierarchical binomial multilevel analysis was performed to test the association between neighbourhood and individual social capital and SRH, adjusted for covariates.

RESULTS

The Good SRH group reported higher scores of social support and social networks than the Poor SRH group. Although low neighbourhood social capital was associated with poor SRH in crude analysis, the association was not significant when individual socio-demographic variables were included in the model. In the final model, women reporting poor SRH both at baseline and follow-up had lower levels of social support (positive social interaction) [OR 0.82 (95% CI: 0.73-0.90)] and a lower likelihood of friendship social networks [OR 0.61 (95% CI: 0.37-0.99)] than the Good SRH group. The characteristics that remained associated with poor SRH were low level of schooling, Black and Brown ethnicity, more children, urinary infection and water plumbing outside the house.

CONCLUSIONS

Low individual social capital during pregnancy, considered here as social support and social network, was independently associated with poor SRH in women whereas neighbourhood social capital did not affect women's SRH during pregnancy and the months thereafter. From pregnancy and up to six months postpartum, the effect of individual social capital explained better the consistency of SRH over time than neighbourhood social capital.

Relationship between social support and quality of life in childbearing women during the perinatal period

OBJECTIVE

To explore demographic and social support predictors of health-related quality of life (HRQoL) (mental and physical) for childbearing women in the perinatal period.

DESIGN

Longitudinal.

SAMPLE

Three public hospitals in metropolitan Brisbane, Australia.

PARTICIPANTS

Four hundred seventy-three (473) women recruited at 36 weeks of pregnancy, and 6 and 12 weeks following childbirth.

METHODS

The Short Form-12 (SF-12) Version 2 Health Survey was used to measure the mental and physical domains of HRQoL. Social support was measured using the Maternal Social Support Scale (MSSS).

RESULTS

Mean scores for the mental and physical domains of HRQoL were lower than population norms. Social support was found to be a significant and consistent predictor of higher HRQoL scores, particularly in the physical domain at 12 weeks following child birth and mental domain during the perinatal period. The relationship between social support and HRQoL was found to be independent of other factors including education, length of relationship with partner, age, parity, and antenatal visit. The only other significant predictor was length of relationship with partner in the mental domain at 36 weeks of pregnancy.

CONCLUSION

Social support is a significant and consistent predictor of a mother's HRQoL during the perinatal period. Nurses and midwives need to assess social support, rather than making assumptions based on demographic factors.

The place of proximity: social support in mother-adult daughter relationships

The mother-adult daughter relationship has been highlighted in both the social sciences and the public health literature as an important facet of social support networks, particularly as they pertain to maternal and child health. Evolutionary anthropologists also have shown positive associations between support from maternal grandmothers and various outcomes related to reproductive success; however, many of these studies rely on proximity as a surrogate measure of support. Here I present data from the Puerto Rican Maternal and Infant Health Survey (PRMIHS) comparing geographic proximity of mother and daughter with a self-reported measure of mother-to-daughter support. These two measures were used to predict infant health outcomes as well as various measures of instrumental and emotional aid provided during pregnancy and after birth. Primary support was shown to have a positive effect across the analyses, whereas geographic proximity was associated with an increased risk of infant mortality and low birth weight as well as reduced odds of receiving support. This paradox was then examined using a combination variable that teased out the interactions of maternal support and proximity. Women who were geographically close to their mothers but who did not consider them a primary source of support had increased odds of infant death and low birth weight, and were less likely to receive either tangible or intangible forms of aid, while women whose mothers were both close and primary showed uniformly positive outcomes. These results place the role of propinquity within the larger context of social support and highlight the need for more detailed studies of social support within evolutionary anthropology.

Development, validity and reliability of the Turkish version of the Hung Postpartum Stress Scale

AIM

The aim of the current study was to translate the Hung Postpartum Stress Scale into Turkish and test the reliability and validity of the Turkish version of the scale.

METHODS

The translation process of the Hung Postpartum Stress Scale into Turkish and the testing of reliability and validity of the newly developed scale on postpartum stress in women are described. The questionnaire was translated using a back-translation technique. Expert review of internal consistency reliability, content validity, factor analysis of construct validity and criterion-related validity were examined.

RESULTS

Cronbach's alpha for the Turkish version of the Hung Postpartum Stress Scale was 0.931, indicating very good reliability. Factor analyses resulted in a two factor scale structure: maternal concerns and acceptability of the newborn by the family. Analyses also indicated good test-re-test reliability for the Turkish version of the Hung Postpartum Stress Scale (P < 0.01).

CONCLUSIONS

The present study describes the design of a Turkish version of the Hung Postpartum Stress Scale. The newly developed scale proved to be reliable and valid and will be a valuable instrument for women's healthcare professionals.

Predictors of postpartum stress

AIM

To predict important factors in women's postpartum stress.

BACKGROUND

The transition to motherhood is often accompanied by stress, but research on predictors of postpartum stress is scant.

DESIGN

A cross-sectional survey was used in the study.

METHODS

Proportional stratified quota sampling based on births at 11 registered general hospitals and seven specialty clinics in the Kaohsiung area of southern Taiwan was used to obtain a high degree of representation. Eight hundred and fifty-nine women participated in the study within six weeks postpartum. The Hung postpartum stress scale, the social support scale and the 12-item Chinese Health Questionnaire were used in this study.

RESULTS

Women with minor psychiatric morbidity, one or two children, junior college educational level, formula feeding for their infants, preference for an infant boy and a low level of social support were important predictors for women's postpartum stress.

CONCLUSION

Our findings provide information and data for service planning and community care for the prevention and amelioration of postpartum stress.

RELEVANCE TO CLINICAL PRACTICE

Postpartum women face a constellation of factors that could put them at risk for high levels of postpartum stress. Postpartum stress could significantly negatively impact women's health status. Nursing interventions should be tailored to decrease women's postpartum stress as a means of promoting postpartum women's pursuit of well-being.

A longitudinal study of family conflicts, social support, and antenatal depressive symptoms among Chinese women

Little is known about the causal factors of antenatal depressive symptomatology in the Chinese population. A total of 1,527 pregnant women were recruited to investigate the predictors of antenatal depressive symptoms using a stress process model in a prospective longitudinal study. The Edinburgh Postnatal Depression Scale, the Dyadic Adjustment Scale, the Stryker Adjustment Checklist, and the Interpersonal Support Evaluation List were used. Multiple linear regression analysis revealed that marital conflict, parent-in-law conflict, and social support predicted antenatal depressive symptoms. Psychiatric nurses can identify predictors to help initiate preventive intervention.

Postpartum psychosocial changes among experienced and inexperienced mothers in Taiwan

PURPOSE

To compare differences in psychosocial changes among experienced and first-time mothers over 6 postpartum weeks.

DESIGN

A trend research study design.

METHOD

A cohort of 439 first-time mothers and 420 experienced mothers during the 6 postpartum weeks was recruited in southern Taiwan. Each participant was interviewed over the phone to complete the Hung Postpartum Stress Scale, the Social Support Scale, and the Chinese Health Questionnaire.

FINDINGS

Concern about lack of social support was significantly higher in first-time mothers in the third week than in the first week.

CONCLUSIONS

Postpartum stressors are different for inexperienced and experienced mothers, and these stressors vary in their importance over the 6 postpartum weeks, suggesting that the postpartum nursing needs of the two groups in 6 postpartum weeks may be different.

IMPLICATION FOR PRACTICE

Knowledge and skills in mothering capability should be emphasized for first-time mothers, and physical exercises are needed for both groups of mothers.

Empirical test of an explanatory theory of postpartum fatigue in Korea

AIM

This paper is a report of a study designed to test an explanatory theory of postpartum fatigue.

BACKGROUND

Postpartum fatigue is influenced by various factors and affects a mother's performance. A full understanding of postpartum fatigue is very important for developing effective nursing strategies to reduce postpartum fatigue and enhance mothers' performance.

METHODS

Healthy postpartum women were recruited from five medical centers and one midwifery office in urban area in Korea (n = 291) by convenience sampling. Data were collected at 4- to 8-week follow-up visits after childbirth in 2006, using a self-report questionnaire. The proposed fatigue theory incorporated postpartum fatigue, postpartum depression, sleep quality, childcare stress, unsatisfactory feeding, social support, infant difficulty and satisfaction with Sanhujori, the Korean traditional postpartum care provided for 3 weeks following delivery by non-professional caregivers. Structural equation modelling was used to test the explanatory theory of postpartum fatigue.

RESULTS

The modified fatigue theory showed good fit and high compatibility with the empirical data. In the final explanatory theory, postpartum depression and sleep quality directly affected postpartum fatigue, while childcare stress and the cultural phenomenon of Sanhujori had indirect effects on postpartum fatigue, via postpartum depression and sleep quality respectively.

CONCLUSION

These findings suggest the potential role of comprehensive nursing focused on decreasing postpartum depression and improving sleep quality as a way to decrease postpartum fatigue. Also, nursing strategies for decreasing childcare stress and enhancing Sanhujori satisfaction may be helpful in reducing postpartum fatigue in Korean mothers.

The role of family and friends in providing social support towards enhancing the wellbeing of postpartum women: a comprehensive systematic review

BACKGROUND

Maternal postpartum health is a neglected area both in research and practice. This aspect warrants more attention as the health of postpartum mothers has a considerable influence on her infant and also other family members. Social support provided by family and friends has been identified as a buffer against the many stressors faced by the women. Outcomes such as self-esteem, stress, postnatal depression, breastfeeding levels, infant care, and maternal adaptation have been studied and found to be significantly related to social support. The need to understand the role of social support provided by family and friends provide the impetus for conducting this review.

OBJECTIVES

The objective of this systematic review was to appraise and synthesise the best available evidence which discusses the impact of social support from family and friends on enhancing the wellbeing of postpartum women.

INCLUSION CRITERIA

This review includes women who were within their first year postpartum period, with any number of children, and had given birth to healthy infants. Mothers who had co-existing morbidities such as depression were excluded. Mothers from low socio-economic groups were excluded.This review considered any study that involved the provision of social support by family and/or friends. Interventions provided by peer counsellors were also considered.The six outcomes were stress, self esteem, breastfeeding levels, mental health in relation to postnatal depression, infant care and maternal adaptation.Quantitative This review considered any randomised controlled trials that examined the effectiveness of social support from family and friends on the well being of the postpartum women. As it was not likely to find RCTs on this topic, this review also considered observational studies (cohort, case control, quantitative descriptive studies such as surveys).Qualitative This review considered any interpretive studies that drew on the experiences of social support from family and friends in postpartum women including, but not limited to, designs such as phenomenology, grounded theory and ethnography.The search was conducted only in published literature in English. A search was conducted in the following databases: PsycINFO, MEDLINE, CINAHL, SCOPUS, THE COCHRANE LIBRARY, BMJ Clinical Evidence, Wiley Interscience, ScienceDirect and MEDNAR.Each paper was assessed independently by two reviewers prior to critical appraisal using Joanna Briggs Institute-System for the Unified Management, Assessment and Review of Information (JBI-SUMARI) developed by Joanna Briggs Institute (JBI).

DATA COLLECTION/EXTRACTION

Qualitative and quantitative data were extracted using the tools from the JBI-SUMARI DATA SYNTHESIS: Qualitative data was synthesised using QARI (Qualitative Assessment and Review Instrument). Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form.

RESULTS

This review included 24 quantitative articles, comprising of two RCTs and 22 descriptive studies. From these studies, social support was shown to have a significant positive correlation with outcomes such as breastfeeding, infant care, maternal adaptation, and self esteem. In addition, social support was shown to have a negative correlation with the levels of stress and postnatal depression. This indicated that increasing the social support of postpartum women will promote breastfeeding, infant care, maternal adaptation and self esteem. Rendering social support also aids in buffering their levels of stress and postnatal depression.Three qualitative articles were included in this review. Meta-synthesis of the qualitative findings yielded 17 findings which were grouped into seven categories and then further categorised into one synthesised finding which was, "Motherhood as a period of learning, adjustment, seeking positive social support whilst buffering against stressors'. This synthesised finding suggested that social support offered by family and friends has both positive and negative effects with which the postpartum mothers have to learn to cope.

CONCLUSIONS

Family members such as the partners and grandmothers should be involved in the provision of care towards the postpartum women. The support from peer volunteers may also contribute to the desired health outcomes. Healthcare professionals ought to be equipped with the knowledge on social support so that they can better assess the needs of the postpartum women and develop a support plan.Further research is necessary to better understand the negative effects of social support and to test interventions to buffer them. The effectiveness of the various types of social support interventions should be subject to further testing in future research. Further research may help to identify which support provider is more effective in enhancing a particular health outcome.

Validation of the Arabic version of the Cohen Perceived Stress Scale (PSS-10) among pregnant and postpartum women

BACKGROUND

This study was conducted to evaluate the validity of the Arabic translation of the Cohen Perceived Stress Scale (PSS-10) in pregnant and postpartum women.

METHODS

A sample of 268 women participated. These included 113 women in their third trimester of pregnancy, 97 in the postpartum period and 58 healthy female university students. GHQ-12 and EPDS were also administered to the participants. Internal consistency reliability, assessed using Cronbach's α, was 0.74.

RESULTS

PSS-10 significantly correlated with both EPDS and GHQ12 (ρ = 0.58 and ρ = 0.48 respectively), and significantly increased with higher scores on stressful life events. PSS-10 scores were higher among university students who also recorded higher stressful life events scores.

CONCLUSION

The Arabic translated version of the PSS-10 showed reasonably adequate psychometric properties.

Maternal role development: the impact of maternal distress and social support following childbirth

OBJECTIVE

to explore the relationship between maternal role development (MRD), maternal distress (MD) and social support following childbirth.

DESIGN

prospective longitudinal survey.

SETTING

three public hospital maternity units in Brisbane, Australia.

PARTICIPANTS

630 pregnant women were invited to participate in the study, with a 77% (n=473) completion rate.

MEASUREMENTS

to measure MRD, the Prenatal Maternal Expectation Scale was used at 36 weeks of pregnancy, and the revised What Being the Parent of a New Baby is Like (with subscales of evaluation, centrality and life change) was used at six and 12 weeks post partum. At all three data collection points, the Edinburgh Postnatal Depression Scale was used to measure MD, and the Maternal Social Support Scale was used to measure social support.

FINDINGS

at 36 weeks of gestation, optimal scaling for MRD produced a parsimonious model with MD providing 39% of predictive power. At six weeks post partum, similar models predicting MRD were found (evaluation: r(2)=0.14, MD providing 64% of predictive power; centrality: r(2)=0.07, MD providing 11% of predictive power; life change: r(2)=0.26, MD providing 59% of predictive power). At 12 weeks post partum, MD was a predictor for evaluation (r(2)=0.11) and life change (r(2)=0.26, 54% of predictive power).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

there is a statistically significant but moderate correlation between MRD and MD. The transition to motherhood can be stressful, but may be facilitated by appropriate acknowledgement and support with an emphasis on MRD.

The role of traditional confinement practices in determining postpartum depression in women in Chinese cultures: a systematic review of the English language evidence

BACKGROUND

The Chinese postpartum custom of "confinement" or "doing-the-month" involves formalised social support and recognition of the status of motherhood and has been presumed in anthropological literature to protect mothers of newborns from postpartum depression. The aim of this review was to examine systematically the evidence about the relationship between confinement practices and postpartum depression in Chinese cultures.

METHODS

A systematic search of the English-language literature.

RESULTS

Sixteen studies met inclusion criteria. It was found that the role of confinement in postpartum depression is complex: eight studies concluded that it had a protective role; four that it increased risk of postpartum mood disturbance and four studies had inconclusive findings. Aspects of the confinement practice that could contribute to or fail to protect against postpartum depression include the generally diminished social support in contemporary society, conflict with a mother-in-law and the tension experienced by modern women as they work to balance traditional with contemporary values.

LIMITATIONS

Methodological differences limit meaningful comparisons between the reviewed studies and generalizations from them.

CONCLUSIONS

There is little consistent evidence that confinement practices reduce postpartum depression in Chinese cultures. Specific components of confinement practices might reduce psychological distress in Chinese mothers of newborns, but these cannot be discerned from the existing evidence. Confinement cannot be presumed to be available to, welcomed by or effective for all Chinese women or to be a substitute for health service provision.

The experiences of socioeconomically disadvantaged postpartum women in the first 4 weeks at home

We used a qualitative descriptive approach to explore and describe the situated experiences of socioeconomically disadvantaged (SED) postpartum women in the first 4 weeks after hospital discharge. Qualitative content analysis was used to analyze the data from in-depth interviews with 24 SED postpartum women. Two intertwining, overarching themes emerged: (a) the ongoing burden of their day-to-day lives, with subthemes of poverty and material deprivation, stigmatization through living publicly examined lives, and precarious social support; and (b) the ongoing struggles to adjust to changes that came with the baby's arrival, with subthemes of "the first weeks were hard," "feeling out of control," "absence of help at home," "complex relationship with the baby's father," and "health and well-being." Knowledge of SED women's situated experiences is vital to the development of health policies and services that will truly meet their needs.

Taiwanese women's experiences of becoming a mother to a very-low-birth-weight preterm infant: a grounded theory study

BACKGROUND

Significant improvements have occurred in the survival rates of small preterm infants. As more infants survive their preterm birth, the number of parents associated with this experience has also increased. Clearly, the birth of very-low-birth-weight (VLBW) preterm infants poses considerable challenges for all mothers. These challenges are further compounded in Taiwan, where women are traditionally required to practise the cultural ritual (Zuo Yue Zi) which includes confinement to the house with a special balanced diet for the first month postnatally. Moreover, there is a deficit of information on mothers' experiences when their preterm infants are in neonatal intensive care units (NICUs).

AIMS

The aim of this study was to explore Taiwanese mothers' (n=26) parenting experiences when their preterm infants were in NICUs.

DESIGN

A qualitative research approach, grounded theory, was used to explore the mothers' lived reality of these experiences.

METHODS

In-depth interviews and participant observations were conducted to gain insight into the experience of parenting.

FINDINGS

A theoretical model was formulated from the findings delineating Taiwanese mothers' parenting experiences during their preterm infants stay in hospital. The findings indicated that the preterm birth, together with the admission of their infants to a NICU, presented mothers with an unexpected crisis. The particular cultural postnatal ritual posed this group of Taiwanese mothers with an additional difficulty in establishing physical interactions. However, the Taiwanese mothers created alternative channels of contact with their hospitalised infants using emotional connections, while the physical interactions were certainly limited. Despite all the difficulties this group of Taiwanese mothers faced and resolved, they all gradually captured and embraced the parenting role. The finding of this study further indicated that the support the mothers received from the healthcare professionals and the social networks the mothers made helped to create the connections that developed between the mothers and infants, making their journey towards parenthood possible.

CONCLUSION

The theoretical model developed in this study is the first of its kind to contribute to the field of neonatal nursing in Taiwan. This would help Taiwanese women come to terms with becoming mothers of VLBW infants and subsequently enhance their parenting role.

Postpartum depression and traditional postpartum care in China: role of zuoyuezi

OBJECTIVE

To determine the relationship between the traditional Chinese practice of postpartum care, known as zuoyuezi, and postpartum depression (PPD) in China.

METHODS

A total of 342 Chinese women were surveyed 6- to 8-weeks post partum using the Edinburgh Postnatal Depression Scale (EPDS) and items assessing sociodemographics, health history, peripartum experiences, zuoyuezi, and social support.

RESULTS

Prevalence of PPD was 15.5% (EPDS cutoff >or=13). PPD was associated with lower income, difficult pregnancy experience, poor infant health status, not attending childbirth classes, and low spousal involvement before and after delivery. Among the 96% of women who practiced zuoyuezi, those for whom the caregiver was her mother-in-law or who perceived zuoyuezi as unhelpful had twice the odds of PPD.

CONCLUSION

These data highlight the importance of the peripartum experience in assessing PPD risk. Zuoyuezi is still commonly practiced in urban China, and further research is needed to explore its role in the potential prevention of PPD.

Shifting landscapes: immigrant women and postpartum depression

Utilizing an ethnographic narrative approach, we explored in the Canadian context the experiences of three groups of first-generation Punjabi-speaking, Cantonese-speaking, and Mandarin-speaking immigrant women with depression after childbirth. The information emerging from women's narratives of their experiences reveals the critical importance of the sociocultural context of childbirth in understanding postpartum depression. We suggest that an examination of women's narratives about their experiences of postpartum depression can broaden the understanding of the kinds of perinatal supports women need beyond health care provision and yet can also usefully inform the practice of health care professionals.

Continuity in self-report measures of maternal anxiety, stress, and depressive symptoms from pregnancy through two years postpartum

This study examined stability and change in maternal anxiety, stress and depression both during the second half of pregnancy and from pregnancy to six weeks and two years postpartum. Self-report measures included those designed to measure mood and state as well as more persistent attributes. Longitudinal data were collected from 137 women during pregnancy, 120 at six weeks, and 97 at two years. There was significant individual stability in scores on specific measures during pregnancy (range in Pearson rs=0.30-0.86) and from pregnancy through two years postpartum (rs=0.30-0.74). Comparable levels of convergence among measures of different constructs both within pregnancy and over time were also demonstrated, suggesting lack of precision in measurement instruments designed for specific constructs. Despite intra-individual stability, changes in mean levels were also observed over time with somewhat different patters for each variable. However, maternal parity was an important contributor to both level and trajectory. A summary composite score showed an elevated level of psychological distress during pregnancy in multiparous women, followed by a decline through two years postpartum; primiparous women displayed a gradual increase in distress [main effect F (1,87)=3.97, p < 0.05; time interaction F (2,174)= 7.15, p < 0.001] to multiparous levels by two years. Results are discussed in terms of a "motherhood" effect on psychological distress.

Effectiveness of an exercise support program in reducing the severity of postnatal depression in Taiwanese women

BACKGROUND

Depression during the perinatal period should be identified as early as possible to avoid negative effects on the new family. The purpose of this study was to examine the effectiveness of an exercise support program on reducing psychological morbidity after childbirth.

METHODS

A controlled trial was conducted in a regional hospital in Taipei, Taiwan. Eighty primiparas with an Edinburgh Postnatal Depression Scale (EPDS) score above 10 at 4 weeks postpartum agreed to participate. They were allocated alternately to an intervention (to receive exercise support) and control group (to receive standard care) at 6 weeks postpartum. The exercise support consisted of 1 hour per week at the hospital and two sessions at home for 3 months. Sixty-three primiparas finished the exercise support program. The main outcome measure was the EPDS score at 5 months postpartum.

RESULTS

Women who received the exercise support program were less likely to have high depression scores after childbirth when compared with the control group.

CONCLUSIONS

The exercise support program given to postpartum women appeared to benefit their psychological well-being. This promising finding should be tested in a well-designed randomized controlled trial.

Are concern for face and willingness to seek help correlated to early postnatal depressive symptoms among Hong Kong Chinese women? A cross-sectional questionnaire survey

BACKGROUND

Face (lian) is a pervasive phenomenon in Chinese culture, exerting an immense and subtle influence on the behavior of people. Coupled with the inherent stigma of mental illness, concern for face may lead women to deny having early postnatal depressive symptoms and to refrain from seeking help from others.

OBJECTIVE

The aim of the study was to explore how the traditional Chinese value of face and their willingness to seek help is associated with early postnatal depressive symptoms in Hong Kong.

DESIGN

A cross-sectional comparative study design was adopted.

SETTINGS

The samples were taken from three postnatal wards in a university-affiliated regional hospital.

PARTICIPANTS

One thousand four hundred and sixty-five women who had given birth on 2-5 days postpartum were invited to participate in this study and 1200 women (81.9%) completed the questionnaires. Women with a history or family history of depression were excluded.

METHODS

Multivariate logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) to estimate the relationships among concern for face, willingness to seek help, and early postnatal depressive symptoms.

RESULTS

The results indicated that 413 (34.4%) of the participants had early postnatal depressive symptoms. Women with high protective face, who "keep a low profile to avoid attention" (p<0.01), and women with high acquisitive face, who "get ahead through social achievement" (GAT) (p<0.05), were found to be more likely to show early postnatal depressive symptoms after adjusting for demo-socio-economic, obstetric, and neonatal variables. Women with high GAT were found to be 1.36 times less likely to seek help during early postnatal period (p<0.05). Depressed women were found to be less likely to seek help (p<0.05).

CONCLUSIONS

Concern for face and willingness to seek help were important correlates associated with postnatal depressive symptoms. Health care professionals should make extensive efforts and provide more health education to reach out to these women and their families.

Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles

BACKGROUND

To reach the Millennium Development Goals, maternal health-promoting behaviours need to be encouraged after childbirth; little is known about the health-promoting behaviour among first-time mothers during their postpartum period.

AIM

To examine levels of engagement in health-promoting behaviours and related factors among postpartum women in Taiwan.

METHODS

This cross-sectional study was conducted through a convenience sample of 122 qualified women. Participants self-completed a questionnaire and mailed it back using a stamped, self-addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert-type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self-developed social support scale.

RESULTS

The average overall Health Promotion Lifestyle Profile score was low (mean, 2.83 SD 1.35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers-in-law, mothers and husbands. An astonishing 42.6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health-promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self-actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model.

CONCLUSIONS

This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles.

RELEVANCE TO CLINICAL PRACTICE

This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.

Anglo-American mothers and the prevention of postpartum depression

The purpose of this study was to assess for postpartum depression prevention activities of a group of 20 Anglo-American mothers who had given birth within the last year and who denied having postpartum depression. Results of open-ended interviewing and qualitative analysis indicated that in addition to the women being able to articulate a prescribed postpartum period, they also were the beneficiaries of protective measures and rituals, some degree of social seclusion, rest, assistance with tasks, and social recognition of their new social status as a mother. These results underscore the importance of social support for the prevention of postpartum depression and the need to educate mothers, families, and health care workers on their use and value.

Traditional beliefs and practices in the postpartum period in Fujian Province, China: a qualitative study

BACKGROUND

Zuo yuezi is the month postpartum in China associated with a variety of traditional beliefs and practices. We explored the current status of zuo yuezi from social, cultural and western medical perspectives.

METHODS

We interviewed family members (36) and health workers (8) in Fujian Province, selecting one rural and one rapidly developing urban county. We asked about their traditional beliefs and their behaviour postpartum. We used a framework approach to identify main themes. We categorised reported behaviour against their probable effects on health, drawing on Western standards.

RESULTS

Respondents reported that zuo yuezi was commonly practiced in urban and rural families to help the mother regain her strength and protect her future health. Zuo yuezi included: dietary precautions, such as eating more food and avoiding cold food; behavioural precautions, such as staying inside the home, avoiding housework and limiting visitors; hygiene precautions, such as restricting bathing and dental hygiene; and practices associated with infant feeding, including supplementary feeding and giving honeysuckle herb to the infant. Respondents reported that the main reasons for adhering to these practices were respect for tradition, and following the advice of elders. Categorised against Western medical standards, several zuo yuezi practices are beneficial, including eating more, eating protein rich food, avoiding housework, and daily vulval and perineal hygiene. A few are potentially harmful, including giving honeysuckle herb, and avoiding dental hygiene. Some women reported giving infants supplementary feeds, although zuo yuezi emphasises breast feeding.

CONCLUSION

Zuo yuezi is an important ritual in Fujian. In medical terms, most practices are beneficial, and could be used by health staff to promote health in this period. Further research on reported potentially harmful practices, such as supplements to breast feeding, is needed.

When giving life starts to take the life out of you: women's experiences of depression after childbirth

OBJECTIVE

To capture the missing voices of mothers who are suffering postnatal depression.

DESIGN

Qualitative methodology using in-depth interviews.

SETTING

Melbourne, Victoria, Australia.

PARTICIPANTS

10 women who had been clinically diagnosed and admitted to a large hospital mother and baby unit in Australia.

FINDINGS

Stigma is frequently attached to women who are unhappy after the birth of their child, because they are not coping with the demands of motherhood or do not instantly bond with, and love, their baby. As a result, postnatal depression can be a terrifying and isolating experience for women. It is also a complex illness with varying degrees, reasons for onset and medical treatments.

IMPLICATIONS FOR PRACTICE

In this study, we have captured the emotions and feelings of women first hand, allowing us and health-care practitioners who are treating women to truly understand this debilitating illness. It is hoped that, in making the wider community aware of depression after childbirth, fewer women will suffer in silence.

Postpartum stress as a predictor of women's minor psychiatric morbidity

The purpose of this study was to predict women's minor psychiatric morbidity after they had childbirth as measured repeatedly at the first, the third, and the fifth weeks of the postpartum period. The Chinese Health Questionnaire, the Postpartum Stress Scale, the Zung's Self-rating Depression Scale and Anxiety Scale, and the Social Support Scale were used at the three points of time. A total of 526 women in Taiwan participated in the study. The results indicated that postpartum stress and anxiety are important predictors for postpartum women's minor psychiatric morbidity at three points in time.

Psychosocial Features at Different Periods after Childbirth

The purpose of this study was to examine and compare first-time mothers' postpartum stress, depression, social support, and health status over the first 6 weeks following discharge from hospital after childbirth. Four hundred and thirty-five women were enrolled from clinics and hospitals in Kaohsiung City, southern Taiwan. The study showed that three items - "the baby getting sick suddenly", "the unpredictability of the baby's schedule", and "the flabby flesh of my belly" - were consistently perceived to be among the top five postpartum stressors by women, regardless of which postpartum week it was. Most women had minimal depression with 71.83% in the sixth week to 81.58% in the first week. Women perceived a high level of social support and their greatest amount of support was from family. A range of women from 25.71% in the fifth week to 32.39% in the second week of postpartum was categorized as having minor psychiatric morbidity. However, the results indicated that the mean scores for postpartum stress and social support did not differ significantly for the women over the 6 postpartum weeks. Women with different depression levels and health status over the 6 postpartum weeks had no significant differences either. Insight into the results of this study provides a framework for additional research that a longitudinal design is needed from immediate childbirth to 1 year postpartum in order to explore the fluctuations of women's psychosocial factors.

Use of factor analysis in Journal of Advanced Nursing: literature review

AIM

This paper reports a review analysing the use of factor analysis in papers in Journal of Advanced Nursing.

BACKGROUND

Factor analysis is a multivariate statistical method for reducing large numbers of variables to fewer underlying dimensions. There are several methods of factor analysis with principal components analysis being the most commonly applied. Factor analysis has been used by researchers in nursing for many years but the standards for use and reporting are variable.

METHOD

Papers using factor analysis in Journal of Advanced Nursing were retrieved from 1982 to the end of 2004. The search term 'factor analysis' was used in the CINAHL database and applied specifically to Journal of Advanced Nursing in December 2004. Retrieved papers were included in the review if they came from Journal of Advanced Nursing and used factor analysis as part of the method of the reported study.

RESULTS

One hundred and twenty-four papers were retrieved as a result of the initial search criteria of which 116 were from Journal of Advanced Nursing. Screening of papers for the use of factor analysis left 100 papers for review. Principal components analysis was the most commonly used method of factor analysis; Eigenvalues greater than one was the most commonly applied criterion for selecting the number of factors followed by orthogonal rotation to achieve simple structure. The majority of papers did not report the whole factor solution and there were papers that did not specify anything beyond the fact that they carried out factor analysis. Confirmatory factor analysis was rarely used and exploratory methods other than principal components analysis were also rarely used.

CONCLUSIONS

Factor analysis is quite commonly used in nursing research reported in Journal of Advanced Nursing. While some papers are exemplary there is room for improvement in the reporting of all aspects of factor analysis.

Revalidation of the postpartum stress scale

AIMS AND OBJECTIVES

The purpose of this study was to test further and validate the postpartum stress scale developed for Taiwanese women.

BACKGROUND

The postpartum stress scale was developed to measure postpartum stress in Taiwanese women. However, over the last decade, the social context in Taiwan has changed and several items in the scale needed to be re-examined.

DESIGN

Non-experimental quantitative research with repeated measures at the first and fifth week of the postpartum period was conducted for this study.

METHODS

A proportional stratified quota was used to sample from the 10 hospitals and six clinics with the highest birth rates in Kaohsiung, Taiwan. Participants were 505 and 518 postpartum women at each time point, respectively.

RESULTS

Factor analysis at two points in time identified three attributes of postpartum stress: (a) maternal role attainment, (b) lack of social support, and (c) negative body changes. The Cronbach's alphas at each time point were 0.94 and 0.92, respectively.

CONCLUSIONS

The results support the postpartum stress scale as a validated instrument that has been conceptualized, created, and tested with Taiwanese postpartum women.

RELEVANCE TO CLINICAL PRACTICE

This study was done in the hope that women experiencing specific postpartum stressors would be detected and subsequently helped by supportive nursing intervention that provides stressor-specific coping resources.

Stress in women with postpartum depression: a phenomenological study

AIM

The aim of this paper is to report a study of the lived experience of postpartum stress among depressed Hong Kong Chinese mothers.

BACKGROUND

Research consistently relates postpartum stress to the mood and well-being of mothers during the postpartum period. While several studies have used questionnaires to assess the stress levels of mothers or have identified stressors by asking them to list stressful events, the existing literature lacks in-depth information on the lived experience of postpartum stress from the perspective of the depressed mother.

METHODS

The study adopted a phenomenological approach with a purposive sample of 11 depressed Hong Kong Chinese mothers at around the sixth postpartum month. In-depth interviews were conducted in Cantonese and focused on the stress the mothers experienced during the postpartum period up to the time of the interview. The data were collected in 2000.

RESULTS

Living in a metropolitan city under the mixed and sometimes conflicting influences of cultures from the East and the West, Hong Kong Chinese mothers face a unique set of challenges which, if not properly managed, may cause stress and/or depression in the postpartum period. We identified five major postpartum stress themes amongst this group of women: parenting competence, the expectation-experience gap, baby-minder arrangements, childcare demands, and conflict with culture and tradition.

CONCLUSIONS

Health care staff should give anticipatory guidance to mothers and their spouses about the culturally prescribed set of rules that proved stressful. Antenatal education classes need to enhanced, and support is needed to help this population of women manage and overcome the challenges in the postpartum period.

Measuring postpartum stress

AIMS

This paper reports a study whose purpose was to revalidate the Hung Postpartum Stress Scale by expanding and revising its contexts to reflect the social changes that have occurred in Taiwan over the last two decades.

BACKGROUND

Existing measures of general stress, which have also been used to assess postpartum stress, fail to measure women's specific childbearing stressors during the postpartum period. The Hung Postpartum Stress Scale was initially developed 11 years ago by Hung and associates to measure stress in the early postpartum period as it occurred in the Taiwanese social milieu of the time. However, revalidation was needed because of rapid changes in the Taiwanese social system.

METHODS

Employing a non-experimental, quantitative research design and a proportional stratified quota sampling of hospitals by birth rate, the revised instrument was completed by 861 postpartum women selected from clinics and hospitals in Taiwan.

RESULTS

An exploratory common factor analysis indicated the structure validity of three dimensions of postpartum stress: concerns about maternity role attainment, concerns about negative body changes, and concerns about lack of social support. With regard to generalizability of the factors across delivery type, education level, and income status subgroups within the population, high coefficients of congruence were shown. Moreover, the internal consistency reliabilities for the total Hung Postpartum Stress Scale and its three dimensions across the full sample and within pertinent sub-samples showed that it is a reliable tool for measuring postpartum stress.

CONCLUSIONS

A series of analyses supported the validity and reliability of the revised Hung Postpartum Stress Scale. Additional research is recommended using confirmatory factor analysis to determine the stability of the factor structure identified in the present study.