Measuring social support in pregnancy: can it be simple and meaningful?

Sociocultural factors associated with the development of postnatal anxiety symptoms

Background

Postnatal anxiety is relatively common when transitioning to parenthood; however, there are relatively few studies assessing postnatal anxiety in Middle Eastern women.

Aim

To identify the prevalence of postnatal anxiety among Jordanian women and associated sociocultural factors.

Method

A descriptive cross-sectional design was used with 324 women. Participants completed the Depression, Anxiety, and Stress Scale (DASS) and Maternity Social Support Scale at 6-8 weeks postpartum in addition to a sociodemographic data form.

Findings

Some 45.4% of women scored above ‘mild’ on the DASS scale. Postnatal anxiety was significantly associated with low levels of support, giving birth to a female baby, financial difficulties, and having four or more children. Findings revealed a high level of postnatal anxiety among Jordanian women.

Conclusion

There is a need for routine assessment, ongoing support, counselling and emotional care, which are important to enhance maternal satisfaction and psychological wellbeing.

Risk factors for miscarriage among women attending an early pregnancy assessment unit (EPAU): a prospective cohort study

BACKGROUND

Miscarriage is the most common adverse outcome in early pregnancy; however, high proportion of miscarriages are classified as unexplained. In addition, pregnant women attending early pregnancy assessment units might be more vulnerable.

AIMS

The purpose of this study was to explore the risk factors that might be associated with miscarriage among women attending an early pregnancy assessment unit (EPAU).

METHODS

A prospective cohort study was undertaken. The study was conducted on women attending an EPAU at a large, tertiary hospital. A detailed lifestyle questionnaire was completed. In addition, data from validated psychometric scales were collected. Participants were followed up to determine pregnancy outcome. The relative risk was calculated to estimate the probability of having a miscarriage for all independent variables.

RESULTS

A total sample of 293 women were included in this study. Well-established risk factors for miscarriage were found in this group including advanced maternal age and high-risk pregnancy (i.e. threatened miscarriage and recurrent miscarriage). In addition, lack of emotional wellbeing did contribute to an increased risk of miscarriage. Conversely, presenting with nausea or low-medium energy levels early in pregnancy were associated with a decreased risk of miscarriage. Finally, our results did not find any association between stressful life events, general health and lifestyle factors in this group.

CONCLUSIONS

Our findings indicated that maternal, psychological and obstetric factors may have an influence on miscarriage among women attending an EPAU. The insight of a relationship between emotional wellbeing and miscarriage opens a window for prevention in this area.

Facilitators and Barriers to Disclosure of Postpartum Mood Disorder Symptoms to a Healthcare Provider

Objectives This study explored perceived barriers and facilitators to disclosure of postpartum mood disorder (PPMD) symptoms to healthcare professionals among a community-based sample. Methods A sample of predominantly white, middle class, partnered, adult women from an urban area in the southeast United States (n = 211) within 3 years postpartum participated in an online survey including the Perceived Barriers to Treatment Scale, the Maternity Social Support Scale, the Depression, Anxiety and Stress Scales-21, and items querying PPMD disclosure. Perceived barriers were operationalized as factors, from the patient's perspective, that impede or reduce the likelihood of discussing her postpartum mood symptoms with a healthcare provider. Analyses examined: (1) characteristics associated with perceived barriers; (2) characteristics associated with perceived social support; and (3) characteristics, perceived barriers, and perceived social support as predictors of disclosure. Results Over half of the sample reported PPMD symptoms, but one in five did not disclose to a healthcare provider. Approximately half of women reported at least one barrier that made help-seeking "extremely difficult" or "impossible." Over one-third indicated they had less than adequate social support. Social support and stress, but not barriers, were associated with disclosure in multivariable models. Conclusions for Practice Many women experiencing clinically-significant levels of distress did not disclose their symptoms of PPMD. Beyond universal screening, efforts to promote PPMD disclosure and help-seeking should target mothers' social support networks.

Postpartum depression symptoms among Syrian refugee women living in Jordan

Postpartum depression (PPD) is recognized as a common maternal health problem, but few studies have investigated the postpartum mental health of refugee women. In this cross-sectional study, we investigated the prevalence of PPD symptoms and associated factors among Syrian refugee women living in north Jordan. Women (N = 365) were recruited from four health care centers in Ramtha and Jarash, cities in northern Jordan. Participants completed a demographic data form, the Edinburgh Postnatal Depression Scale (EPDS), and the Maternal Social Support Scale at 6-8 weeks postpartum. Half (49.6%; n = 181) of the Syrian refugee women scored >12 on the EPDS. PPD symptoms were significantly associated with low social support, low monthly income, and recent immigration (less than 2 years). There is a high level of PPD symptoms among Syrian refugee women, many of whom are living in poverty and with limited social support. The results highlight the need for immediate action by governments to support childbearing refugee women with early screening for psychosocial risk and respond to women's physical and mental health, and social needs through interservice collaboration. Social support programs would meet an important need for these women, as would ongoing assessment by health professionals and early intervention for women who screen positive for PPD.

Personal support and expressions of care for pregnant women in Soweto, South Africa

Background: Pregnancy is life changing, making great demands on women to adapt physically, psychologically, and socially. Social relationships and the support that flow from these provide a critical role in managing health problems in pregnancy. Isolation and lack of care, in contrast, may lead women to experience increased distress during this time.

Objective: This study aimed to explore South African women's perception and experience of care and support in pregnancy.

Methods: A life history approach was employed to explore women’s experiences of pregnancy and sexual behaviour, with each participant encouraged to narrate important life events from her own perspective. We drew on narrative interviews with 15 pregnant women, conducted between July and October 2015, in which we explored questions regarding pregnancy planning and the provision and receipt of care. A thematic approach was employed to code and analyse the data.

Results: Themes that emerged from the interviews showed that participants gained a sense of stability in their lives when they had support in their pregnancy, especially when dealing with challenging situations. This support came variously from family, friends, and social networks. Overall, those participants who mentioned the most support, and its diversity across different groups, reported a better experience of pregnancy.

Conclusions: Women emphasised the importance of social and emotional support in pregnancy. Understanding women’s experiences can assist in making pregnancy less overwhelming, and can add to a woman’s ability to deal with different challenges before and after the arrival of the new baby.

Domestic Violence as a Risk Factor for Postpartum Depression Among Ethiopian Women: Facility Based Study

BACKGROUND

Mental illness in women leads to an increased maternal morbidity and mortality. Postpartum depression accommodates various groups of depressive disorders and syndromes that occur within the first immediate year after delivery. Thus, this study aimed to assess the prevalence of postpartum depression symptoms and correlates among mothers attending public health centers of Addis Ababa, Ethiopia.

METHODS

Facility-based cross-sectional study was conducted on 618 women in their postpartum period. Simple random sampling technique was used to select three out of ten sub cities in Addis Ababa. Then, nine health centers were selected by lottery method from the three sub-cities. The number of women included from each health center was determined by proportional allocation. Study participants were enrolled by systematic random sampling. The Edinburgh Postnatal Depression Scale was used at a cutoff point >13 to detect depression. Descriptive statistics were done. The bivariate and multivariate analysis was also carried out to identify predictors of postpartum depression.

RESULTS

Significant proportion 144 (23.3%) of the women had the symptom of postpartum depression. Respondents who were the victims of domestic violence [AOR 3.1; 95% CI: 1.6-5.9], reported to have diagnosed with postpartum depression [AOR 4.41; 95% CI: 2.4-8.3], and dissatisfied with their marriage [AOR 2.9; 95% CI: 1.5-5.6] had higher odds of reporting postpartum depression symptoms.

CONCLUSION

Postpartum depression is a common mental health problem during the postnatal period. Domestic violence was positively and significantly associated with the symptom of postpartum depression. Maternity services shall consider a sector that provides health care for women who encounter violence and develop symptoms of postpartum depression.

A Mobile Health App-Based Postnatal Educational Program (Home-but not Alone): Descriptive Qualitative Study

Background

The postnatal period poses numerous challenges for new parents. Various educational programs are available to support new parents during this stressful period. However, the usefulness of educational programs must be evaluated to ascertain their credibility.

Objective

The aim of this descriptive, qualitative study was to explore the views of parents of newborns with regard to the content and delivery of a mobile health (mHealth) app–based postnatal educational program.

Methods

A qualitative semistructured interview guide was used to collect data from 17 participants who belonged to the intervention group of a randomized controlled trial. The intervention, a 4-week-long access to a mHealth app–based educational program, was evaluated. The interviews were conducted in English and at the participants’ homes. Thematic analysis was used to analyze the data. The Consolidated Criteria for Reporting Qualitative Research checklist was used to report the findings.

Results

The interviews revealed 4 main themes: (1) positive features of the mHealth app, (2) advice from midwives, (3) experiences gained from using the mHealth app, and (4) recommendations for the future. The participants evaluated the educational program to be a good source of information that was tailored to the local context. The different modes of delivery, including audio and video, accentuated the accessibility of information. The parents evaluated that the facilitator of the featured communication platform, a midwife, provided trustworthy advice. Belongingness to a virtual community beyond the hospital endowed the parents the confidence that they were not alone and were supported by other parents and health care professionals.

Conclusions

According to the parents, the mHealth app–based educational program was helpful in supporting a multi-ethnic sample of parents during the postnatal period. This insight indicates that the program could be implemented in a wide community of parents in the postnatal period. The helpfulness of the educational program is a testament of the potential benefits of using telemedicine among new parents postnatally. Resources can also be dedicated toward extending the duration of access to the app beyond 1 month and developing relevant content for parents across the perinatal period.

Prevalence of Antenatal Depression and Associated Factors among Pregnant Women Attending Antenatal Care at Dubti Hospital: A Case of Pastoralist Region in Northeast Ethiopia

BACKGROUND

Globally, depression affects an estimated 10 % to 20% of women during pregnancy. There is limited evidence on antenatal depression in Northeast Ethiopia. This study aimed to assess prevalence of antenatal depression and associated factors among Dubti Hospital Antenatal care attendants.

METHODS

Institution based cross-sectional study was conducted among 363 Antenatal care attendants at Dubti Hospital from March 07 to May 07, 2016. Beck's Depression Inventory tool was used to collect data. Data were entered into Epi-Data 3.1 and analyzed using SPSS 20. Bivariable and multivariable logistic regression analyses were fitted. Variables having p value < 0.05 were considered as statistically significant.

RESULTS

A total of 357 pregnant women were interviewed. The prevalence of antenatal depression was 17.9% [95% CI (14.0, 22.0%). Pregnancy planning [AOR: 0.04; 95% CI (0.014, 0.114), social support [AOR: 0.21; 95% CI (0.07, 0.66), and marital conflict [AOR: 6.45; 95% CI (2.1, 17.9)] were significantly associated with antenatal depression.

CONCLUSIONS

Nearly one in five pregnant women had depression. Marital conflict, pregnancy planning, and social support were significant predictors of antenatal depression. Dubti Hospital should strengthen its effort on prevention of unplanned pregnancy. Healthcare workers in antenatal care unit have to deal with marital conflict and social support as part of their routine investigation to avoid complications through early detection of antenatal depression.

Voces de la frontera/Voices from the Border: Using Case Studies of Pregnancy, Birth and Parenting along the U.S.-Mexico Border to Identify Shared Measures of Success

Purpose This research analyzes the cases of five women living along the U.S.-Mexico border who overcame challenges during pregnancy or parenting with the support of a federally funded Healthy Start program, designed to eliminate disparities in perinatal health in disadvantaged communities with the poorest birth outcomes. Study objectives were to: (1) identify common factors that affect healthy maternal and child outcomes for Healthy Start participants; and (2) identify a shared definition of what success looks like for Healthy Start participants and opportunities for further study. Description Five border Healthy Start sites (CA, AZ, NM, and TX) contributed case stories from participants who had overcome access barriers to achieve positive pregnancy, birth or parenting outcomes. Case studies were collected using review of successful participant cases and non-structured interviews by Healthy Start staff, and analyzed using participatory methods and thematic analysis. Assessment Common barriers were: lack of insurance; isolation or unsupportive family relationships; timidness and lack of self-advocacy. Healthy Start programs have been successful in securing supportive relationships through the community health worker model; reducing isolation; obtaining insurance access and a medical home; building self-advocacy skills; and supporting participants to pursue their goals. Conclusion Identified barriers are in line with available literature on health care access and provide a U.S.-Mexico border-specific view. The Healthy Start model is effective at helping women to overcome barriers. Learning from this research may contribute to development of shared measures for more impactful evaluation of Healthy Start and similar programs.

Prenatal care: associations with prenatal depressive symptoms and social support in low-income urban women

We examined associations of depressive symptoms and social support with late and inadequate prenatal care in a low-income urban population. The sample was prenatal care patients at five community health centers. Measures of depressive symptoms, social support, and covariates were collected at prenatal care entry. Prenatal care entry and adequacy came from birth certificates. We examined outcomes of late prenatal care and less than adequate care in multivariable models. Among 2341 study participants, 16% had elevated depressive symptoms, 70% had moderate/poor social support, 21% had no/low partner support, 37% had late prenatal care, and 29% had less than adequate prenatal care. Women with both no/low partner support and elevated depressive symptoms were at highest risk of late care (AOR 1.85, CI 1.31, 2.60, p < 0.001) compared to women with both good partner support and low depressive symptoms. Those with good partner support and elevated depressive symptoms were less likely to have late care (AOR 0.74, CI 0.54, 1.10, p = 0.051). Women with moderate/high depressive symptoms were less likely to experience less than adequate care compared to women with low symptoms (AOR 0.73, CI 0.56, 0.96, p = 0.022). Social support and partner support were negatively associated with indices of prenatal care use. Partner support was identified as protective for women with depressive symptoms with regard to late care. Study findings support public health initiatives focused on promoting models of care that address preconception and reproductive life planning. Practice-based implications include possible screening for social support and depression in preconception contexts.

Effects of frequent PATient moves on patient outcomes in a large tertiary Hospital (the PATH study): a prospective cohort study

Objective The aim of the present study was to investigate the incidence of and patient outcomes associated with frequent patient moves. Methods In a prospective cohort study, any bed move and the reason for the move were documented. Patients were assessed on admission for anxiety, social support and delirium. Adverse events, length of stay and satisfaction were recorded. Patients moved three or more times were compared with those moved less than three times. Results In all, 566 patients admitted to a tertiary referral hospital were included in the study. Of these, 156 patients (27.6%) were moved once, 46 (8.1%) were moved twice and 28 (4.9%) were moved at least three times. Those moved three or more times were almost threefold more likely to have an adverse event recorded compared with those moved fewer times (relative risk (RR) 2.75; 95% confidence interval (CI) 1.18, 6.42; P=0.02) and to have a hospital stay twice as long (RR 7.10; 95% CI 2.60, 11.60; P=0.002). Levels of satisfaction and anxiety were not affected by frequent moves and there was no effect on delirium. Conclusion Frequent bed moves affect patient safety and prolong length of stay. What is known about the topic? Retrospective and qualitative studies suggest that patient safety and costs may be affected by frequent patient moves. What does this paper add? The present study is the first prospective study to assess the negative effects of frequent patient moves on specific patient outcomes, such as adverse events, length of stay and satisfaction with care. What are the implications for practitioners? Within- and between-ward moves may affect patient safety. Patients should be moved only when there is a clear and unavoidable reason for doing so.

Promoting improved social support and quality of life with the CenteringPregnancy® group model of prenatal care

This prospective cohort study compared women participating in CenteringPregnancy® group prenatal care (N = 120) with those in standard individual care (N = 221) to determine if participation in Centering was associated with improvements in perceived social support and quality of life, with concomitant decreases in screens of postpartum depression and improvements in breastfeeding rates. Participants completed surveys at the onset of prenatal care, in the late third trimester and in the postpartum period. Centering participants had higher scores of perceived social support from friends after participating in group care (p < 0.05) with associated improvements in quality of life in the psychological and relational domains (p < 0.05) compared to standard care participants who showed higher scores of perceived support from family (p < 0.05) but did not show concomitant improvements in quality of life. This did not translate to any significant difference in scores on postpartum depression screens but was associated with improvements in breastfeeding continuation rates among Centering participants in the postpartum period. This study indicates that Centering care is associated with improved perceptions of peer social support with associated improvements in quality of life and higher rates of continued breastfeeding.

Effects of Group Prenatal Care on Food Insecurity during Late Pregnancy and Early Postpartum

OBJECTIVE

This study compared the effects of group to individual prenatal care in late pregnancy and early postpartum on (1) women's food security and (2) psychosocial outcomes among food-insecure women.

METHODS AND RESULTS

We recruited 248 racially diverse, low-income, pregnant women receiving CenteringPregnancy™ group prenatal care (N = 124) or individual prenatal care (N = 124) to complete surveys in early pregnancy, late pregnancy, and early postpartum, with 84 % completing three surveys. Twenty-six percent of group and 31 % of individual care participants reported food insecurity in early pregnancy (p = 0.493). In multiple logistic regression models, women choosing group versus individual care were more likely to report food security in late pregnancy (0.85 vs. 0.66 average predicted probability, p < 0.001) and postpartum (0.89 vs. 0.78 average predicted probability, p = 0.049). Among initially food-insecure women, group participants were more likely to become food-secure in late pregnancy (0.67 vs. 0.35 individual care average predicted probability, p < 0.001) and postpartum (0.76 vs. 0.57 individual care average predicted probability, p = 0.052) in intention-to-treat models. Group participants were more likely to change perceptions on affording healthy foods and stretching food resources. Group compared to individual care participants with early pregnancy food insecurity demonstrated higher maternal-infant attachment scale scores (89.8 vs. 86.2 points for individual care, p = 0.032).

CONCLUSIONS

Group prenatal care provides health education and the opportunity for women to share experiences and knowledge, which may improve food security through increasing confidence and skills in managing household food resources. Health sector interventions can complement food assistance programs in addressing food insecurity during pregnancy.

Suicidality in early pregnancy among antepartum mothers in urban India

This study assessed the prevalence and predictors of suicidality among 462 pregnant women in South India. Women in early pregnancy (<20 weeks) attending an urban public hospital antenatal center were assessed for suicidality using a modified version of the Suicide Behaviors Questionnaire-Revised (SBQR) and a single-item (item 10) from the Edinburgh Postnatal Depression Scale (EPDS). Severity of depressive symptoms, family violence, and perceived social support were also measured. The prevalence of suicidality in pregnancy was 7.6 % (35/462). Eleven women (2.4 %) reported having had suicidal plans, and 8 (1.7 %) had made a suicidal attempt during the current pregnancy. Younger age, belonging to a middle socioeconomic status, poor perceived support, domestic violence, depressive symptoms, and having a past history of suicidality predicted suicidal ideation during the current pregnancy. Multivariate analysis revealed depression severity and a life time history of suicidal ideation as being the strongest predictors. The findings underscore the need for assessment of psychiatric and psychosocial factors that confer risk among women in this vulnerable period. The results of the study however may be specific to low-income urban women from this geographical location limiting the external validity of our findings.

The comparative effects of group prenatal care on psychosocial outcomes

To compare the psychosocial outcomes of the CenteringPregnancy (CP) model of group prenatal care to individual prenatal care, we conducted a prospective cohort study of women who chose CP group (N = 124) or individual prenatal care (N = 124). Study participants completed the first survey at study recruitment (mean gestational age 12.5 weeks), with 89% completing the second survey (mean gestational age 32.7 weeks) and 84% completing the third survey (6 weeks' postpartum). Multiple linear regression models compared changes by prenatal care model in pregnancy-specific distress, prenatal planning-preparation and avoidance coping, perceived stress, affect and depressive symptoms, pregnancy-related empowerment, and postpartum maternal-infant attachment and maternal functioning. Using intention-to-treat models, group prenatal care participants demonstrated a 3.2 point greater increase (p < 0.05) in their use of prenatal planning-preparation coping strategies. While group participants did not demonstrate significantly greater positive outcomes in other measures, women who were at greater psychosocial risk benefitted from participation in group prenatal care. Among women reporting inadequate social support in early pregnancy, group participants demonstrated a 2.9 point greater decrease (p = 0.03) in pregnancy-specific distress in late pregnancy and 5.6 point higher mean maternal functioning scores postpartum (p = 0.03). Among women with high pregnancy-specific distress in early pregnancy, group participants had an 8.3 point greater increase (p < 0.01) in prenatal planning-preparation coping strategies in late pregnancy and a 4.9 point greater decrease (p = 0.02) in postpartum depressive symptom scores. This study provides further evidence that group prenatal care positively impacts the psychosocial well-being of women with greater stress or lower personal coping resources. Large randomized studies are needed to establish conclusively the biological and psychosocial benefits of group prenatal care for all women.

Influence of Perinatal Depression on Labor-Associated Fear and Emotional Attachment to the Child in High-Risk Pregnancies and the First Days After Delivery

BACKGROUND

The aim of this study was to analyze the influence of the level of perinatal depression on the labor-associated fear and emotional attachment of children born to women during high-risk pregnancies and in the first days after delivery.

MATERIAL/METHODS

133 women aged between 16 and 45 years took part in the study. The first group included 63 pregnant women (mean age=28.59, SD=5.578) with a high-risk pregnancy (of maternal origin, for example, cardiologic disorders and diabetes). The second group included 70 women (mean age=27.94, SD=5.164) who were in the first days post-partum. Research methods included: Analysis of medical documentation; Clinical interview; the Edinburgh Postnatal Depression Scale (EPDS); the Questionnaire of Labor-Associated Anxiety (KLP), the Maternal-Fetal Attachment Scale (MFAS).

RESULTS

Women after delivery displayed a higher level of concern for the child's health and life when compared to the high-risk pregnancy group. The results indicated the appearance of a postnatal fear, the level of which is connected with the perception of the role of the mother. This fear is lower in women prior to childbirth than it is after. There has also been noted a statistically significant relationship between the appearance of depression and attachment to the child. Those women with depression show less attachment to their child than is the case for those who do not suffer from depression.

CONCLUSIONS

The appearance of a high level of depression amongst women from the high-risk pregnancy group during the first days post childbirth was accompanied by perinatal depression and a weaker attachment to the child.

Deprivation and poor psychosocial support are key determinants of late antenatal presentation and poor fetal outcomes--a combined retrospective and prospective study

BACKGROUND

Published guidelines emphasise the need for early antenatal care to promote maternal and neonatal health. Inadequate engagement with antenatal care is associated with adverse pregnancy outcomes including maternal death. The factors that influence the uptake and utilisation of maternity care services are poorly understood. We retrospectively explore a large maternity database of births in a large referral UK hospital to capture the socio-demographic factors that influence late pregnancy booking, and then prospectively compare the stress and social support status of consenting early and late-booking women.

METHODS

Retrospective socio-demographic and clinical outcome data on 59,487 women were collected from the maternity database record of births between 2002 and 2010 at the Jessop Wing Hospital, Sheffield UK. In a follow-on prospective survey between October 2012 and May 2013 a convenience cohort of early and late bookers for antenatal care were then studied using validated scales for fetomaternal attachment, stress and anxiety, and social support.

RESULTS

In our retrospective study, pregnancy during the teenage years, higher parity, non-white ethnic background, unemployment and smoking were significantly associated with late access to antenatal services and poor fetal outcomes (P < 0.001). However, late booking per se did not predict adverse fetal outcomes, when socio-demographic factors were accounted for. A high index of multiple deprivation (IMD) score remained independently associated with late booking when confounding factors such as ethnicity and employment status were controlled for in the model (P = 0.03). Our prospective data demonstrated that women who book late were more likely to be unmarried (OR: 3.571, 95 % CI: 1.464-8.196, p =  .005), of high parity (OR: 1.759, 95 % CI: 1.154-2.684, P = 0.009), and have lower social support than early bookers (P = 0.047).

CONCLUSIONS

Of the many complex sociocultural factors that influence the timing of maternal engagement with antenatal care, multiple deprivation and poor social support remain key factors. Improving access to prenatal care requires in-depth exploration of the relationship between maternal psychosocial health indices, social support mechanisms and engagement with antenatal care. Findings from these studies should inform interventions aimed at improving access to care.

The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes

OBJECTIVE

this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors.

DESIGN

a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records.

SETTING

data were recruited from antenatal health-care clinics in Halland, Sweden.

PARTICIPANTS

a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42.

MEASUREMENTS

five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States.

FINDINGS

results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy.

KEY CONCLUSIONS

this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth.

The role of satisfaction with social support on the psychological health of primiparous mothers in the perinatal period

The aim of this study was to develop a satisfaction scale for social support and to investigate the relation of satisfaction with social support to the psychological health of primiparous mothers in terms of depressive symptoms, anxiety, and parental self-efficacy. We carried out a quantitative study during the last month of pregnancy (T1) and 6 weeks after birth (T2) including 235 mothers who were expecting their first child in Geneva (Switzerland) from September 2010 to April 2012. The satisfaction scale for social support revealed five sources of support (from the spouse, young woman's mother, family, friends, professionals), each associated with different types of support (i.e., emotional, esteem, material, and informative). This scale showed good internal consistency for each factor. Moreover, the results revealed a relationship between satisfaction with social support and the mental health of mothers, in particular in the postnatal period for depressive symptoms, anxiety, and self-efficacy. This study highlights the important role of social support and the scale specifically developed during this period is a useful tool to investigate this aspect.

Depressive symptoms in the second trimester relate to low oxytocin levels in African-American women: a pilot study

Low-income African-American women report elevated prenatal depressive symptoms more often (42 %) than the national average (20 %). In the USA in 2012, 16.5 % of African-American women experienced a premature birth (less than 36 completed gestational weeks) compared to 10.3 % of white women. In addition, 13 % of African-American women had a low-birth weight infant (less than 2,500 g) compared to 7 % of white women. Variation in the neuropeptide, oxytocin has been implicated in perinatal depression, maternal behavior, regulation of stress responses, and may be associated with this health disparity. The purpose of this investigation was to examine factors associated with prenatal depressive symptoms, including plasma oxytocin levels and birth weight, in a sample of urban African-American women. Pregnant African-American women (N = 57) completed surveys and had blood drawn twice during pregnancy at 15-22 weeks and 25-37 weeks. In addition, birth data were collected from medical records. A large number of participants reported elevated prenatal depressive symptoms at the first (n = 20, 35 %) and the second (n = 19, 33 %) data points. Depressive symptoms were higher in multigravidas (t(51) = -2.374, p = 0.02), women with higher anxiety (r(47) = 0.71, p = 0.001), women who delivered their infants at an earlier gestational age (r(51) = -0.285, p = 0.04), and those without the support of the infant's father (F(4, 48) = 2.676, p = 0.04). Depressive symptoms were also higher in women with low oxytocin levels than in women with high oxytocin levels (F(2, 47) = 3.3, p = 0.05). In addition, women who had low oxytocin tended to have infants with lower birth weights (F(2, 47) = 2.9, p = 0.06). Neither prenatal depressive symptoms nor prenatal oxytocin levels were associated with premature birth. Pregnant multigravida African-American women with increased levels of anxiety and lacking the baby's father's support during the pregnancy are at higher risk for prenatal depressive symptoms. Prenatal depressive symptoms are associated with low oxytocin levels and lower infant birth weights. Further research is needed to understand the mechanisms between prenatal depressive symptoms, oxytocin, and birth weight in order to better understand this health disparity.

Baseline characteristics of depressive disorders in Thai outpatients: findings from the Thai Study of Affective Disorders

BACKGROUND

The Thai Study of Affective Disorders was a tertiary hospital-based cohort study developed to identify treatment outcomes among depressed patients and the variables involved. In this study, we examined the baseline characteristics of these depressed patients.

METHODS

Patients were investigated at eleven psychiatric outpatient clinics at tertiary hospitals for the presence of unipolar depressive disorders, as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The severity of any depression found was measured using the Clinical Global Impression and 17-item Hamilton Depression Rating Scale (HAMD) clinician-rated tools, with the Thai Depression Inventory (a self-rated instrument) administered alongside them. Sociodemographic and psychosocial variables were collected, and quality of life was also captured using the health-related quality of life (SF-36v2), EuroQoL (EQ-5D), and visual analog scale (EQ VAS) tools.

RESULTS

A total of 371 outpatients suffering new or recurrent episodes were recruited. The mean age of the group was 45.7±15.9 (range 18-83) years, and 75% of the group was female. In terms of diagnosis, 88% had major depressive disorder, 12% had dysthymic disorder, and 50% had a combination of both major depressive disorder and dysthymic disorder. The mean (standard deviation) scores for the HAMD, Clinical Global Impression, and Thai Depression Inventory were 24.2±6.4, 4.47±1.1, and 51.51±0.2, respectively. Sixty-two percent had suicidal tendencies, while 11% had a family history of depression. Of the major depressive disorder cases, 61% had experienced a first episode. The SF-36v2 component scores ranged from 25 to 56, while the mean (standard deviation) of the EQ-5D was 0.50±0.22 and that of the EQ VAS was 53.79±21.3.

CONCLUSION

This study provides an overview of the sociodemographic and psychosocial characteristics of patients with new or recurrent episodes of unipolar depressive disorders.

Racial/Ethnic and nativity differences in birth outcomes among mothers in New York City: the role of social ties and social support

Immigrants have lower rates of low birth weight (LBW) and to some extent preterm birth (PTB), than their US-born counterparts. This pattern has been termed the 'immigrant health paradox'. Social ties and support are one proposed explanation for this phenomenon. We examined the contribution of social ties and social support to LBW and PTB by race/ethnicity and nativity among women in New York City (NYC). The NYC Pregnancy Risk Assessment Monitoring System survey (2004-2007) data, linked with the selected items from birth certificates, were used to examine LBW and PTB by race/ethnicity and nativity status and the role of social ties and social support to adverse birth outcomes using bivariate and multivariable analyses. SUDAAN software was used to adjust for complex survey design and sampling weights. US- and foreign-born Blacks had significantly increased odds of PTB [adjusted odds ratio (AOR) = 2.43, 95 % CI 1.56, 3.77 and AOR = 2.6, 95 % CI 1.66, 4.24, respectively] compared to US-born Whites. Odds of PTB among foreign-born Other Latinas, Island-born Puerto Ricans' and foreign-born Asians' were not significantly different from US-born Whites, while odds of PTB for foreign-born Whites were significantly lower (AOR = 0.47, 95 % CI 0.26, 0.84). US and foreign-born Blacks' odds of LBW were 2.5 fold that of US-born Whites. Fewer social ties were associated with 32-39 % lower odds of PTB. Lower social support was associated with decreased odds of LBW (AOR 0.69, 95 % CI 0.50, 0.96). We found stronger evidence of the immigrant health paradox across racial/ethnic groups for PTB than for LBW. Results also point to the importance of accurately assessing social ties and social support during pregnancy and to considering the potential downside of social ties.

Influence of health information levels on postpartum depression

While extensive research has been conducted on postpartum depression (PPD), the majority has been focused on psychological risk factors and treatments. There is limited research on the explicit relationship between the degree to which individuals are informed about relevant prenatal and postnatal health topics and whether this level of knowledge influences psychological outcome. This study assesses health information levels of new mothers and their influence on PPD as measured by Edinburgh Postnatal Depression Scale (EPDS) scores. Data from the 2006 Maternity Experiences Survey developed by the Canadian Perinatal Surveillance System (N = 6,421) were used. The study population included mothers ≥15 years of age at the time of the birth, who had a singleton live birth in Canada during a 3-month period preceding the 2006 Census and who lived with their infants at the time of the survey. Pre- and postnatal health information components were measured using latent variables constructed by structural equation modeling. EPDS score was added to the model, adjusting for known covariates to assess the effects of information levels on EPDS score. Pre- and postnatal health information levels are associated with decreased EPDS scores. More specifically, information on topics such as postnatal concerns and negative feelings was associated with the largest decrease in score for primiparous and multiparous women, respectively (p < 0.0001 for both). The pre-established predictors of PPD were confirmed for both samples, with life stress associated with the largest change in EPDS score for both samples (p < 0.0001 for both). This study demonstrates a distinct role for pre- and postnatal health information in influencing EPDS scores, supplementing previous literature. Primiparous and multiparous women benefited from different information content, with information on postnatal concerns had the largest effect on the primiparous group while information on negative feelings had the largest effect on the multiparous group. Therefore, information provision should be tailored to these two groups.

Prevalence of alcohol use before and during pregnancy and predictors of drinking during pregnancy: a cross sectional study in Sweden

BACKGROUND

There is a paucity of research on predictors for drinking during pregnancy among women in Sweden and reported prevalence rates differ considerably between studies conducted at different antenatal care centres. Since this knowledge is relevant for preventive work the aim of this study was to investigate these issues using a multicenter approach.

METHODS

The study was conducted at 30 antenatal care centers across Sweden from November 2009 to December 2010. All women in pregnancy week 18 or more with a scheduled visit were asked to participate in the study. The questionnaire included questions on sociodemographic data, alcohol consumption prior to and during the pregnancy, tobacco use before and during pregnancy, and social support.

RESULTS

Questionnaires from 1594 women were included in the study. A majority, 84%, of the women reported alcohol consumption the year prior to pregnancy; about 14% were categorized as having hazardous consumption, here defined as a weekly consumption of > 9 standard drinks containing 12 grams of pure alcohol or drinking more than 4 standard drinks at the same occasion. Approximately 6% of the women consumed alcohol at least once after pregnancy recognition, of which 92% never drank more than 1 standard drink at a time. Of the women who were hazardous drinkers before pregnancy, 19% reduced their alcohol consumption when planning their pregnancy compared with 33% of the women with moderate alcohol consumption prior to pregnancy. Factors predicting alcohol consumption during pregnancy were older age, living in a large city, using tobacco during pregnancy, lower score for social support, stronger alcohol habit before pregnancy and higher score for social drinking motives.

CONCLUSIONS

The prevalence of drinking during pregnancy is relatively low in Sweden. However, 84% of the women report drinking in the year preceding pregnancy and most of these women continue to drink until pregnancy recognition, which means that they might have consumed alcohol in early pregnancy. Six factors were found to predict alcohol consumption during pregnancy. These factors should be addressed in the work to prevent alcohol-exposed pregnancies.

The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: evidence from rural Southwestern Ethiopia

BACKGROUND

Depression in pregnancy has adverse health outcomes for mothers and children. The magnitude and risk factors of maternal depression during pregnancy is less known in developing countries. This study examines the association between pregnancy intention, social support and depressive symptoms in pregnancy in Ethiopia.

METHODS

Data for this study comes from a baseline survey conducted as part of a community- based cohort study that involved 627 pregnant women from a Demographic Surveillance Site (DSS) in Southwestern Ethiopia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms during pregnancy. Data on depressive symptoms, pregnancy intention, social support and other explanatory variables were gathered using an interviewer-administered structured questionnaire. The association between independent variables and depressive symptom during pregnancy was assessed using multivariable logistic regression.

RESULTS

The prevalence of depressive symptoms during pregnancy was 19.9% (95% CI, 16.8-23.1), using EPDS cut off point of 13 and above. The mean score on the EPDS was 8, ranging from 0 to 25 (SD ±5.4). Women reporting that the pregnancy was unwanted were almost twice as likely to experience depressive symptoms compared with women with a wanted pregnancy. (Adjusted Odds Ratio (AOR) = 1.96, 95% Confidence Interval (CI) 1.04-3.69) Women who reported moderate (AOR = 0.27; 95% CI 0.14-0.53) and high (AOR = 0.23, 95% CI 0.11-0.47) social support during pregnancy were significantly less likely to report depressive symptoms. Women who experienced household food insecurity and intimate partner physical violence during pregnancy were also more likely to report depressive symptoms.

CONCLUSION

About one in five pregnant women in the study area reported symptoms of depression. While unwanted pregnancy increases women's risk of depression, increased social support plays a buffering role from depression. Thus, identifying women's pregnancy intention and the extent of social support they receive during antenatal care visits is needed to provide appropriate counseling and improve women's mental health during pregnancy.

Maternal mental health: pathways of care for women experiencing mental health issues during pregnancy

Perinatal mental health has become the focus for policymakers, government, research, the acute health sector, and health practitioners. The aim of this clinical data-mining study ( Epstein, 2010 ) was to undertake a retrospective exploration into the primary mental health and psychosocial issues experienced by women who were pregnant and accessing obstetric care at one of the largest maternity hospitals in Australia. The study also investigated service pathways and gaps. Aboriginal women were overrepresented, demonstrating their ongoing disadvantage, whereas other linguistically and culturally diverse women were underrepresented, suggesting the existence of barriers to service. Although psychosocial factors tend to be underreported ( Buist et al., 2002 ), the findings highlighted the integral rather than peripheral nature of these factors during pregnancy ( Vilder, 2006 ) and suggest the need for change to systems that work to support women's perinatal mental health.

Pregnancy and after: what women want from their partners - listening to women in Uyo, Nigeria

BACKGROUND

A qualitative survey was conducted among childbearing women at three public health facilities in Uyo, Nigeria. We aimed to determine (i) women's expectations of partner support during pregnancy and the postpartum period; (ii) predictors of partner presence during childbirth.

METHODS

From May to mid-July 2011, 387 eligible women were recruited serially during visits to the child welfare clinic at each facility. Interviews were conducted using semistructured questionnaires. Responses were extracted and categorized into eight distinct themes with corresponding examples.

RESULTS AND DISCUSSION

The most desired form of partner support was assistance with domestic chores during and after pregnancy; followed by financial support during pregnancy and providing/caring for the baby in the postpartum period. Partner support during pregnancy was high 98.0% (351). While 73% of respondents expected partner presence during childbirth, 69.4% reported actual partner presence. Women with no experience of pregnancy before marriage, a husband in formal employment, and regular assistance at home had a two- to three-fold likelihood of expecting partner presence at childbirth compared to those without these attributes. Expecting partner presence increased the likelihood of partner presence at childbirth. Results suggest that women have specific expectations of partner involvement during and after pregnancy.

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.

Postpartum depression is a family affair: addressing the impact on mothers, fathers, and children

The purpose of this paper is to present research on the effects of postpartum depression (PPD) on mothers, fathers, and children that point to a re-conceptualization of PPD as a mental health condition that affects the whole family. As such, the objectives of this paper are to discuss: (1) the incidence and effects of PPD on mothers and fathers; (2) common predictors of PPD in mothers and fathers, and (3) the effects of PPD on parenting and parent-child relationships, and (4) the effects of PPD on children's health, and their cognitive and social-emotional development. Finally, the implications for screening and intervention if depression is re-conceptualized as a condition of the family are discussed.

Measuring perinatal mental health risk

The purpose of this review was to critically analyse existing tools to measure perinatal mental health risk and report on the psychometric properties of the various approaches using defined criteria. An initial literature search revealed 379 papers, from which 21 papers relating to ten instruments were included in the final review. A further four papers were identified from experts (one excluded) in the field. The psychometric properties of six multidimensional tools and/or criteria were assessed. None of the instruments met all of the requirements of the psychometric properties defined. Some had used large sample sizes but reported low positive predictive values (Antenatal Risk Questionnaire (ANRQ)) or insufficient information regarding their clinical performance (Antenatal Routine Psychosocial Assessment (ARPA)), while others had insufficient sample sizes (Antenatal Psychosocial Health Assessment Tool, Camberwell Assessment of Need-Mothers and Contextual Assessment of Maternity Experience). The ANRQ has fulfilled the requirements of this analysis more comprehensively than any other instrument examined based on the defined rating criteria. While it is desirable to recommend a tool for clinical practice, it is important that clinicians are made aware of their limitations. The ANRQ and ARPA represent multidimensional instruments commonly used within Australia, developed within large samples with either cutoff scores or numbers of risk factors related to service outcomes. Clinicians can use these tools, within the limitations presented here, to determine the need for further intervention or to refer women to mental health services. However, the effectiveness of routine perinatal psychosocial assessment continues to be debated, with further research required.

Timeliness of antenatal care for mothers of Aboriginal and non-Aboriginal infants in an urban setting

To compare the timing of first hospital antenatal care visit by mothers of Aboriginal and non-Aboriginal infants, and to identify the risk and protective factors associated with timeliness of accessing care, mothers who delivered at Campbelltown hospital between October 2005 and November 2006 were surveyed on the maternity ward. This survey was linked to hospital administrative data. Gestational age at first visit to a hospital-based antenatal clinic was compared for mothers of Aboriginal and non-Aboriginal infants. Risks and protective factors associated with timing of antenatal care were also examined using Cox regression and Kaplan–Meier survival curves. Data on 1520 deliveries were included in this study. Mothers of Aboriginal infants presented slightly later to hospital-based antenatal clinics than mothers of non-Aboriginal infants (median 15.6 weeks versus 14.0 weeks). This difference did not remain after adjustment for all risk and protective factors. The three significant factors remaining were: maternal smoking; not in paid employment; and residence in a disadvantaged suburb. The results may reflect the complex associations that exist between the clustering of disadvantage among families of Aboriginal infants. A multifaceted approach is required to improve the timeliness of hospital-based antenatal care for the mothers of Aboriginal infants.

Partner support and postpartum depressive symptoms

BACKGROUND

One out of eight women suffers an episode of depression following delivery. We explored the role of expectations of partner support in postpartum depressive symptoms in new mothers attending a regional public hospital in Italy.

METHODS

Seventy women participated in a two-stage (third trimester and 3 months postpartum) prospective study using self-report measures. At stage 1, they completed the Support Expectations Index to measure expectations for partner support and the Dyadic Adjustment Scale to measure conflicts in marital relationship, whereas socio-demographic (i.e. maternal age and education level) and clinical variables (i.e. previous miscarriages and depression episodes) were collected from medical reports. Depressive symptoms were evaluated at stage 2 with the Edinburgh Postnatal Depression Scale using a cut-off >9 and confirmation of marital support expectations was measured with the Expectancy Confirmation Scale. Stepwise logistic regression analysis was used to examine predictors of depressive symptoms at 3 months postpartum.

RESULTS AND DISCUSSION

As many as 55.7% (n = 39) of new mothers presented postpartum depressive symptoms, which were predicted by low expectancy confirmation concerning partner support [odds ratio (OR) 3.02; 95% confidence interval (CI) 1.25-8.10]. Therefore, clinicians should consider the possible role of partner support when treating women with postnatal depressive symptoms.

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.

Prenatal family support, postnatal family support and postpartum depression

BACKGROUND

Inadequate social support is an important determinant of postpartum depression (PPD). Social support for pregnant women consists of supports from various sources and can be measured at different gestation periods. Differentiating the effects of social support from different sources and measured at different gestation periods may have important implications in the prevention of PPD. In the family centred Chinese culture, family support is likely to be one of the most important components in social support.

AIMS

The aim of this study was to assess the association of prenatal family support and postnatal family support with PPD.

METHODS

A prospective cohort study was conducted between February and September 2007 in Hunan, China. Family support was measured with social support rating scale at 30-32 weeks of gestation (prenatal support) and again at 2 weeks of postpartum visit (postnatal support). PPD was defined as Edinburgh Postnatal Depression Scale (EPDS) score > or =13.

RESULTS

A total of 534 pregnant women were included, and among them, 103 (19.3%) scored 13 or more on the EPDS. PPD was 19.4% in the lowest tertile versus 18.4% in the highest quartile (adjusted odds ratio: 1.04, 95% confidence interval 0.60, 1.80) for prenatal support from all family members, and PPD was 39.8% in the lowest tertile versus 9.6% in the highest tertile (adjusted odds ratio: 4.4, 95% confidence interval 2.3, 8.4) for postnatal support from all family members. Among family members, support from husband had the largest impact on the risk of developing PPD.

CONCLUSIONS

Lack of postnatal family support, especially the support from husband, is an important risk factor of PPD.

Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women

OBJECTIVES

To investigate the prevalence of depression during pregnancy and postpartum period for Jordanian women and identify associated risk factors and maternity service delivery issues.

DESIGN

A prospective cross-sectional study. Participants were recruited during the last trimester of pregnancy, provided personal, social and obstetric information, and completed the Edinburgh Postnatal Depression Scale (EPDS), Depression Anxiety and Stress Scale (DASS-21), the Maternity Social Support Scale (MSSS), the Cambridge Worry Scale (CWS), Perceived Self-Efficacy Scale (PSES) and Perceived Knowledge Scale (PKS). All participants were contacted again at six-eight weeks and six months post partum to complete a telephone or face-to-face interview. The postnatal questionnaire included the EPDS, MSSS, and DASS-21.

SETTING

A teaching hospital and five health centres in Irbid city in northern Jordan.

PARTICIPANTS

Arabic speaking women (n = 353) between the ages of 18 and 45 years, in their last trimester of pregnancy, at low risk for obstetric complications and receiving antenatal care between November 2005 and August 2006.

FINDINGS

High rates of antenatal (19%) and postnatal depression (22%) were reported. A regression analysis revealed that stress, anxiety, financial problems, perceived lack of parenting knowledge, difficult relationship with the mother-in-law, unplanned pregnancy, and low self-efficacy were associated with antenatal depression. These seven factors accounted for 83% (r(2) = 0.834) of variance in the development of probable antenatal depression. At six-eight weeks post partum, a regression analysis revealed that antenatal depression, unplanned pregnancy, difficult relationship with mother-in-law, dissatisfaction with overall care, stress, lack of social support, giving birth to a female baby, feeling pressured to birth the baby quickly, and perceived low parenting knowledge were associated with postnatal depression. These nine variables accounted for 82% (r(2) = 0.819) of variance in the development of probable PND. Three intrapartum and postpartum variables associated with PND at six-eight weeks (postpartum haemorrhage, unhelpful doctors during labour and birth, and anxiety) were no longer associated with PND at six months.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Jordanian women need support to prepare for labour and birth. Postpartum emotional support and assessment of symptoms of depression needs to be incorporated into routine practice. The opportunity for open discussion along with increased awareness and clarification of common misconceptions about antenatal and postnatal depression are necessary. Quality assurance systems would help reduce the rate of invasive obstetric procedures, and give greater emphasis to emotional care provided to women during the perinatal period.

Management of post traumatic stress disorder after childbirth: a review

Prevalence and risk factors for the development of post traumatic stress disorder (PTSD) after childbirth is well described in the literature. However, its management and treatment has only begun to be investigated. The aim of this article is to describe the studies that examine the effects of interventions on PTSD after childbirth. MedLine, PILOTS, CINAHL and ISI Web of Science databases were systematically searched for randomised controlled trials, pilot studies and case studies using key words related to PTSD, childbirth, treatment and intervention. The reference lists of the retrieved articles were also used to supplement the search. A total of nine studies were retrieved. Seven studies that examined debriefing or counselling were identified; six randomised controlled trials and one pilot study. Also found were one case report describing the effects of cognitive behavioural therapy (CBT) on two women, and one pilot study of eye movement desensitisation and reprocessing (EMDR). Overall, there is limited evidence concerning the management of women with PTSD after childbirth. The results agree with the findings from the non-childbirth related literature: debriefing and counselling are inconclusively effective while CBT and EMDR may improve PTSD status but require investigation in controlled trials before conclusions could be drawn.

Stressful events, social support and coping strategies of primiparous women during the postpartum period: a qualitative study

OBJECTIVE

to identify problems and events perceived as stressful by primiparous mothers during the postpartum period, and to explore the social support and coping strategies they used to face these situations.

DESIGN

a qualitative study. Data were collected via semi-structured interviews and analysed using a content-analysis method.

SETTING

Geneva University Hospitals, Geneva, Switzerland from October 2006 to March 2007.

PARTICIPANTS

60 women interviewed six weeks after the birth at term of their first child.

FINDINGS

during the early postpartum period, interaction with caregivers was an important source of perceived stress. Upon returning home, the partner was considered as the primary source of social support, but the first need expressed was for material support. Breast feeding was perceived negatively by the new mothers, and this may be due to the difference between the actual problems encountered and the idealised expectations conveyed by prenatal information. Educational information dispensed by medical staff during the prenatal period was not put into practice during the postpartum period. Mothers expressed the need to be accompanied and counselled when problems arose and regretted the lack of long-term postpartum support.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

both the prenatal education and postpartum social support seem to mismatch women's needs and expectations. Concerted efforts are required by health professionals at the maternity unit and in the community to provide mothers with more adequate postpartum assistance.

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.

Evaluation of a social support measure that may indicate risk of depression during pregnancy

BACKGROUND

Strong social support has been linked with positive mental health and better birth outcomes for pregnant women. Our aim was to replicate the psychometric properties of the Kendler Social Support Interview modified for use in pregnant women and to establish the inventory's relationship to depression in pregnancy.

METHODS

The modified Kendler Social Support Interview (MKSSI) was evaluated using principal components analysis. The association with depression was used as an indicator of external validity and was assessed by logistic regression.

RESULTS

Data from 783 subjects were analyzed. One large principal component, termed "global support," (eigenvalue=6.086) represented 22.5% of the total variance. However, 6 of the 27 items (frequency of contact with spouse, siblings, other relatives, and friends, and attendance at church and clubs) had low levels of association (<0.4) and thus were excluded from suggested items for a total score. Varimax rotation of the remaining 21 items resulted in subscales that fell into expected groupings: mother, father, siblings, friends, etc. One unit and two unit increases in the global support score were associated with 58.3% (OR=0.417, 95% CI=0.284-0.612) and 82.6% (OR=0.174, 95% CI=0.081-0.374) reductions in odds for depression, respectively.

LIMITATIONS

The ability of this social support scale to predict future depression in pregnancy has not yet been established due to cross-sectional design.

CONCLUSION

The MKSSI is reliable and valid for use in evaluating social support and its relationship to depression in pregnant women.

The impact of maternal depression in pregnancy on early child development

OBJECTIVE

Postpartum depression in mothers is associated with developmental problems in their children. Many women who are depressed following childbirth are also depressed during pregnancy. The aim of this study was to examine the associations between maternal depressive symptoms during pregnancy and child development at 18 months of age.

DESIGN

A prospective cohort study, Avon Longitudinal Study of Parents and Children.

SETTING

The former county of Avon, southwest England.

POPULATION

All pregnant women in the defined area with delivery dates between April 1991 and December 1992, 9244 women and their children.

METHODS

Data were collected antenatally, at 18 and 32 weeks of gestation and at 8 weeks and 8 months postnatally, through postal questionnaires, including a self-report measure of depression (Edinburgh Postnatal Depression Scale [EPDS]). By the time their child was 18 months old, women completed five further questionnaires about their children's health and development.

MAIN OUTCOME MEASURE

Child development at 18 months using a modified Denver Developmental Screening Test (modified DDST).

RESULTS

Applying the standard 12/13 cutoff, 1565 (14%) women were depressed antenatally but not at either time-points postnatally. Employing the modified DDST, 893 (9%) children were developmentally delayed at 18 months of age. Persistent depression (EPDS > or = 10 at both time-points) is associated with developmental delay (adjusted OR 1.34, 95% CI 1.11-1.62). Applying the 12/13 and 14/15 cutoffs gave similar results. After further adjustment for postnatal depression, the effect sizes were slightly attenuated.

CONCLUSIONS

These findings highlight the importance of depression in pregnancy. Some effects on child development attributed to postpartum depression are caused in part by depressive symptoms during pregnancy.