Prenatal Social Support, Postnatal Social Support, and Postpartum Depression

New mothers and postpartum depression: a narrative review of peer support intervention studies

Postpartum depression (PPD) is a serious maternal mental health issue that negatively impacts new mothers and their infants. Various interventions have been studied and one that has shown promise is social support delivered by peers. Understanding what previous studies on peer support interventions have found will contribute to the development and implementation of future peer support interventions for women with PPD. To this end, a systematic search and narrative review of studies that investigated peer support interventions for PPD was conducted. Relevant studies were identified using CINAHL, Medline, PsychINFO and the Cochrane Library published between 2000 and 2010. Six studies matching inclusion criteria were reviewed. Each of the studies had specific selection criteria and some used screening tools for recruitment. There were differences regarding the criteria for volunteers. All volunteers participated in some form of training and had support from a co-ordinator. Interventions varied in terms of length and nature of support offered, frequency and mode of delivery. Volunteers reported positively on their experience, although there were some challenges in providing support. Overall findings suggest that interventions should be targeted and take into consideration the age of the mother, any cultural and linguistic differences, the mother's circumstances and her needs. All volunteers should receive training before providing support and be screened for their ability to commit their time. Although the results were mixed, they provide insights into how peer support volunteers can be an innovative part of a team approach to PPD intervention.

The Role of Emotional Intelligence in Predicting Postpartum Depression

This study examines the direct and moderating effects of emotional intelligence on postpartum depression (PPD), while taking into account social support and stressful life events. Using a prospective cohort design, 165 women were surveyed in their third trimester and again at 9 weeks postpartum. Results support the direct effects of emotional intelligence (β = -.20, p = .01), social support (β = -.17, p = .04), and stressful life events (β = .17, p = .04) on PPD. Moderating effects are also supported with significant effects on PPD: stressful life events × emotional intelligence (β = -.17, p = .04) and stressful life events × social support (β = -.21, p = .01).

Relationship between social support during pregnancy and postpartum depressive state: a prospective cohort study

Although the association between social support and postpartum depression has been previously investigated, its causal relationship remains unclear. Therefore, we examined prospectively whether social support during pregnancy affected postpartum depression. Social support and depressive symptoms were assessed by Japanese version of Social Support Questionnaire (J-SSQ) and Edinburgh Postnatal Depression Scale (EPDS), among 877 pregnant women in early pregnancy and at one month postpartum. First, J-SSQ was standardized among peripartum women. The J-SSQ was found to have a two-factor structure, with Number and Satisfaction subscales, by exploratory and confirmatory factor analyses. Analysis of covariance was performed to examine how EPDS and J-SSQ scores during pregnancy affected the EPDS score at postpartum. Significant associations were found between postpartum EPDS score and both EPDS and total scores on the Number subscales during pregnancy (β = 0.488 and -0.054, ps < 0.001). Specifically, this negative correlation was stronger in depressive than non-depressive groups. Meanwhile, total score on Satisfaction subscales was not significantly associated with postpartum EPDS score. These results suggest that having a larger number of supportive persons during pregnancy helps protect against postpartum depression, and that this effect is greater in depressive than non-depressive pregnant women. This finding is expected to be vitally important in preventive interventions.

Trajectories of depressive symptoms over 2 years postpartum among overweight or obese women

BACKGROUND

Although depressive symptoms are common postpartum, few studies have followed women beyond 12 months postpartum to investigate changes in the number and severity of these symptoms over time, especially in overweight and obese women. Using two complementary analytical methods, this study aims to identify trajectories of depressive symptoms over 2 years postpartum among overweight or obese mothers, and assess the demographic, socioeconomic, and health covariates for these trajectories.

METHODS

Using longitudinal data from two behavioral intervention studies (Kids and Adults Now!-Defeat Obesity [KAN-DO] and Active Mothers Postpartum (AMP); n = 844), we used latent growth modeling to identify the overall trajectory of depressive symptoms and how it was related to key covariates. Next, we used latent class growth analysis to assess the heterogeneity in the depressive symptom trajectories over time, and thereby, identify subgroups of women with distinct trajectories.

FINDINGS

The overall trajectory of depressive symptoms over 2 years postpartum was relatively stable in our sample. However, the presence of three distinct latent class trajectories (stable-low [82.5%], decreasing symptoms [7.3%], and increasing symptoms [10.2%]), identified based on trajectory shape and mean depressive symptom score, supported heterogeneity in depressive symptom trajectories over time. Lower maternal education was related to a higher symptom score, and poorer subjective health status at baseline predicted inclusion in the increasing symptoms trajectory.

CONCLUSIONS

In some overweight or obese mothers, postpartum depressive symptoms do not resolve quickly. Practitioners should be aware of this phenomenon and continue to screen for depression for longer periods of time postpartum.

Social support and the incidence and persistence of depression between antenatal and postnatal examinations in Turkey: a cohort study

OBJECTIVES

This study aims to measure incidence and persistence of depression and to investigate the influence of self-reported antenatal social support and traditional/nuclear family structure on incidence and persistence of depression between the third trimester of pregnancy and following childbirth. We hypothesised that lower antenatal social support would be associated with incidence and persistence of case-level depressive symptoms and the family structure would have an effect on the incidence and persistence of depressive symptoms.

SETTINGS

The cohort study described here was carried out in and around Ankara the capital of Turkey, because of the considerable heterogeneity of the population in terms of traditional Middle Eastern and 'modern' Western lifestyle and social environment. Samples were drawn from 20 urban and rural antenatal clinics (mainly primary care settings) within the geographic catchment.

PARTICIPANTS

Of 730 women recruited in their third trimester, 578 (79.2%) were re-examined between 2 and 6 months after childbirth. Exclusion criteria were as follows: aged younger than 18 years, illiteracy, significant health problems and refusal to participate.

PRIMARY AND SECONDARY OUTCOME MEASURES

Close Persons Questionnaire items enquired about relationships with the husband, mother and mother-in-law and depression was ascertained using the Edinburgh Postnatal Depression Scale at the each assessments.

RESULTS

In those followed, onset of postnatal depression occurred in 13.9% and persistence of antenatal depression in 49.7%. After adjustment, worse emotional support from the mother-in-law was significantly associated with postnatal depression incidence (OR=0.93, 95% CI 0.87 to 0.99) and worse emotional support from the husband with postnatal persistence (OR=0.89, 95% CI 0.83 to 0.96) of antenatal depression. Family structure was not a risk or modifying factor.

CONCLUSIONS

The incidence and persistence of postnatal depression in this Middle Eastern cohort were comparable to international findings. Certain family relationships predicted incidence and persistence of postnatal depression but no role of traditional/nuclear family structure was found.

Quasi-experimental evaluation of a telephone-based peer support intervention for maternal depression

AIMS

To evaluate the effect of telephone-based peer support on maternal depression and social support

BACKGROUND

Postpartum depression is a global health concern and lack of treatment options mean many mothers are depressed beyond the first year after birth. Strong evidence has shown telephone-based peer support, provided by a mother recovered from depression, effectively improves depression outcomes. This model has not been tested with mothers with depression any time up to two years postpartum.

DESIGN

Quasi-experimental, one group pre-test, posttest.

METHOD

The study population was mothers in New Brunswick, Canada with depression up to 24 months after delivery. The sample (N = 64) was recruited between May 2011-October 2013. Peer volunteers recovered from postpartum depression were trained and delivered an average of 8·84 (Range 1-13) support telephone calls. Depression and social support outcomes were assessed at intervention mid-point (average 7·43 weeks, n = 37) and end (average 13·9 weeks, n = 34).

RESULTS

Mean depression significantly declined from baseline, 15·4 (N = 49), to mid-point, 8·30 and end of the study, 6·26. At mid-point 8·1% (n = 3/37) of mothers were depressed and at endpoint 11·8% (4/34) were depressed suggesting some relapse. Perceptions of social support significantly improved and higher support was significantly related with lower depression symptoms.

CONCLUSION

Findings offer promise that telephone-based peer support is effective for both early postpartum depression and maternal depression up to two years after delivery.

Predictors of maternal and paternal depressive symptoms at postpartum

OBJECTIVES

Postnatal depression has emerged as a major public health concern, which has deleterious effects on the well-being of the entire family. The aim of this study was to examine the predictive role of prenatal family sense of coherence, stress, social support and family, and marital functioning; the effect that any changes in these factors from pregnancy to postpartum; and partner's depressive symptoms on depressive symptoms at 6 months postpartum.

METHODS

This study used a longitudinal design. A convenience sample of 200 childbearing couples in Hong Kong completed assessments of family sense of coherence, stress, social support, family, and marital functioning and depressive symptoms during pregnancy and at 6 months postpartum. Multiple regression analyses were employed.

RESULTS

The results showed that a low level of family sense of coherence and a high level of depressive symptoms during pregnancy and partner's depressive symptoms were significantly associated with an increase in depressive symptoms for both mothers and fathers at 6 months postpartum. A lack of social support was significantly associated with increased risk of depressive symptoms for mothers, but not for fathers.

CONCLUSION

The results suggest that couple-based interventions that foster a sense of family coherence may be helpful in promoting parental well-being. Well-designed trials to test the effects of such interventions are recommended for future research.

Family functioning, marital quality and social support in Chinese patients with epilepsy

Background

The purpose of this study was to examine family functioning, marital quality, social support, and anxiety and depression in Chinese patients with Epilepsy (PWE) in comparison with healthy people.

Methods

This case–control study included 42 PWE and 42 healthy controls. Participants completed the Zung’s self-rating depression scale, the Zung’s self-rating anxiety scale, the Chinese version of family cohesion and flexibility evaluation scales, the Chinese version of the marital inventory ENRICH, and the Chinese versions of the social support rating scale and perceived social support scale.

Results

PWE reported higher levels of anxiety and depression, and lower levels of family cohesion, marriage quality and social support compared with controls. Support within and outside the family was negatively associated with depression, however social support did not significantly predict depression in PWE. In patients, support within the family and emotional support predicted family cohesion and marriage quality. Instrumental support was negatively associated with anxiety in patients but positively associated with depression in healthy controls. Support within the family predicted family cohesion and marriage quality in both the control group and patient group, depression predicted family adaptation in both the control group and patient group, while support outside the family predicted marriage quality only in the patient group. Both emotional and instrumental support predicted family adaptation in the control group, and emotional support predicted family cohesion in patients.

Conclusions

PWE in China had higher levels of anxiety and depression, dissatisfaction with family functioning and marital life, and less social support compared with healthy controls. Emotional support within and outside families promoted family cohesion and marriage quality, depression decreased family adaptation, and instrumental support decreased anxiety of PWE. These findings suggest that enhancing family and emotional supports and decreasing depression could promote the family functioning and marital quality of PWE, and instrumental support may play a role in decreasing anxiety.

The roles of social support in helping chinese women with antenatal depressive and anxiety symptoms cope with perceived stress

A community-based sample of 755 pregnant Chinese women were recruited to test the direct and moderating effects of social support in mitigating perceived stress associated with antenatal depressive or anxiety symptoms. The Social Support Rating Scale, the Perceived Stress Scale, the Edinburgh Depressive Postnatal Scale and the Zung Self-Rating Anxiety Scale were used. Social support was found to have direct effects and moderating effects on the women's perceived stress on antenatal depressive and anxiety symptoms in multiple linear regression models. This knowledge of the separate effects of social support on behavioral health is important to psychiatric nurse in planning preventive interventions.

The relationship between glucocorticoid receptor polymorphisms, stressful life events, social support, and post-traumatic stress disorder

BACKGROUND

It is debatable whether or not glucocorticoid receptor (GR) polymorphisms moderate susceptibility to PTSD. Our objective was to examine the effects of stressful life events, social support, GR genotypes, and gene-environment interactions on the etiology of PTSD.

METHODS

Three tag single nucleotide polymorphisms, trauma events, stressful life events, and social support were assessed in 460 patients with PTSD and 1158 control subjects from a Chinese Han population. Gene-environment interactions were analyzed by generalized multifactor dimensionality reduction (GMDR).

RESULTS

Variation in GR at rs41423247 and rs258747, stressful life events, social support, and the number of traumatic events were each separately associated with the risk for PTSD. A gene-environment interaction among the polymorphisms, rs41423247 and rs258747, the number of traumatic events, stressful life events, and social support resulted in an increased risk for PTSD. High-risk individuals (a large number of traumatic events, G allele of rs258747 and rs41423247, high level stressful life events, and low social support) had a 3.26-fold increased risk of developing PTSD compared to low-risk individuals. The association was statistically significant in the sub-groups with and without childhood trauma.

CONCLUSIONS

Our data support the notion that stressful life events, the number of trauma events, and social support may play a contributing role in the risk for PTSD by interacting with GR gene polymorphisms.

Mental disorders of pregnant and postpartum women after earthquakes: a systematic review

OBJECTIVE

The aim of this review was to systematically search and critique relevant literature on the potential psychological impact of earthquakes on peripartum women to synthesize existing knowledge for further action.

METHODS

A search through 5 databases was conducted for relevant publications in English, and the results were screened through a set of inclusion and exclusion processes.

RESULTS

Eight articles were included. Depression and posttraumatic stress disorder were the most often reported mental disorders. Some factors (eg, family relationships and social support) were associated with mental disorders suffered by peripartum women after earthquakes. An assessment of the quality of the studies showed that most did not have high levels of evidence because of their cross-sectional design and limitations.

CONCLUSIONS

Among the factors that influenced the mental health of pregnant and postpartum women after earthquakes, family function appears to be one of the most important and deserves further exploration. Other mental health conditions such as minor psychiatric disorders should also be studied for their relationship with disasters and pregnancy. Well-designed studies are needed to enable a better understanding of the relationship between earthquakes and the mental disorders of peripartum women so that the most appropriate interventions can be proposed.

Internet therapy for postpartum depression: a case illustration of emailed therapeutic assistance

Postpartum depression (PPD) afflicts up to 15% of Canadian women following childbirth. Minimal research has focused on therapist-assisted internet-delivered cognitive behavior therapy (ICBT) for PPD. The purpose of this paper was to illustrate this novel treatment approach that was offered to a woman afflicted with PPD. A first-time mother participated in therapist-assisted ICBT for PPD. She completed the seven-module intervention in 12 weeks, sent seven emails to her therapist, and received 13 therapeutic emails. Therapeutic exchanges are presented. Treatment progress, therapeutic alliance, and treatment satisfaction were assessed. Symptom reduction was observed on all measures at post-treatment. Treatment satisfaction and a strong therapeutic alliance were also reported. The case will expand clinician understanding in therapist-assisted ICBT for PPD and may serve to stimulate clinician interest. Future research directions stemming from this case are presented.

Rates and predictors of postpartum depression by race and ethnicity: results from the 2004 to 2007 New York City PRAMS survey (Pregnancy Risk Assessment Monitoring System)

The objective of this study was to examine racial/ethnic disparities in the diagnosis of postpartum depression (PPD) by: (1) identifying predictors that account for prevalence rate differences across groups, and (2) comparing the strength of predictors across groups. 3,732 White, African American, Hispanic, and Asian/Pacific Islander women from the New York City area completed the Pregnancy Risk Assessment Monitoring System from 2004 to 2007, a population-based survey that assessed sociodemographic risk factors, maternal stressors, psycho-education provided regarding depression, and prenatal and postpartum depression diagnoses. Sociodemographic and maternal stressors accounted for increased rates in PPD among Blacks and Hispanics compared to Whites, whereas Asian/Pacific Islander women were still 3.2 times more likely to receive a diagnosis after controlling for these variables. Asian/Pacific Islanders were more likely to receive a diagnosis after their providers talked to them about depressed mood, but were less likely than other groups to have had this conversation. Prenatal depression diagnoses increased the likelihood for PPD diagnoses for women across groups. Gestational diabetes decreased the likelihood for a PPD diagnosis for African Americans; a trend was observed in the association between having given birth to a female infant and increased rates of PPD diagnosis for Asian/Pacific Islanders and Whites. The risk factors that account for prevalence rate differences in postpartum diagnoses depend on the race/ethnic groups being compared. Prenatal depression is confirmed to be a major predictor for postpartum depression diagnosis for all groups studied; however, the associations between other postpartum depression risk factors and diagnosis vary by race/ethnic group.

Perceived stress and emotional social support among women who are denied or receive abortions in the United States: a prospective cohort study

BACKGROUND

Examining women's stress and social support following denial and receipt of abortion furthers understanding of the effects of unwanted childbearing and abortion on women's well-being. This study investigated perceived stress and emotional social support over time among women who were denied wanted abortions and who received abortions, and compared outcomes between the groups.

METHODS

The Turnaway Study is a prospective cohort study of women who sought abortions at 30 abortion facilities across the United States, and follows women via semiannual phone interviews for five years. Participants include 956 English or Spanish speaking women aged 15 and over who sought abortions between 2008 and 2010 and whose gestation in pregnancy fit one of three groups: women who presented up to three weeks beyond a facility's gestational age limit and were denied an abortion; women presenting within two weeks below the limit who received an abortion; and women who received a first trimester abortion. The outcomes were modified versions of the Perceived Stress Scale and the Multidimensional Scale of Perceived Social Support. Longitudinal mixed effects models were used to assess differences in outcomes between study groups over 30 months.

RESULTS

Women denied abortions initially had higher perceived stress than women receiving abortions near gestational age limits (1.0 unit difference on 0-16 scale, P = 0.003). Women receiving first-trimester abortions initially had lower perceived stress than women receiving abortions near gestational age limits (0.6 difference, P = 0.045). By six months, all groups' levels of perceived stress were similar, and levels remained similar through 30 months. Emotional social support scores did not differ among women receiving abortions near gestational limits versus women denied abortions or women having first trimester abortions initially or over time.

CONCLUSIONS

Soon after being denied abortions, women experienced higher perceived stress than women who received abortions. The study found no longer-term differences in perceived stress or emotional social support between women who received versus were denied abortions.

Prevalence and predictors of maternal postpartum depressed mood and anhedonia by race and ethnicity

Aims. Depression requires the presence of either depressed mood or anhedonia, yet little research attention has been focused on distinguishing these two symptoms. This study aimed to obtain the prevalence rates of these two core depression symptoms and to explore the risk factors for each symptom by race/ethnicity. Methods. 2423 White, African American, Hispanic and Asian/Pacific Islander (API) women from the Massachusetts area completed the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2007 to 2008. Results. Socioeconomic variables (SES) accounted for increased rates in depressed mood and anhedonia among African Americans and Hispanics compared with Whites. API women were still 2.1 times more likely to report anhedonia after controlling for SES. Stressors were associated with depressed mood across groups and associated with anhedonia for Whites and Hispanics. Having a female infant was associated with depressed mood for APIs. Being non-US born was associated with anhedonia for Whites, APIs and African Americans, but not Hispanics. Conclusions. Prevalence rates for depressed mood and anhedonia differ across race/ethnic groups and risks associated with depressed mood and anhedonia depend on the race/ethnic group, suggesting the importance of distinguishing depressed mood from anhedonia in depression assessment and careful inquiry regarding symptom experiences with a diverse patient population.

The role of intimate partner violence and other health-related social factors on postpartum common mental disorders: a survey-based structural equation modeling analysis

BACKGROUND

Although studies suggest the relevance of intimate partner violence (IPV) and other health-related social characteristics as risk factors for postpartum mental health, literature lacks evidence about how these are effectively connected. This study thus aims to explore how socio-economic position, maternal age, household and marital arrangements, general stressors, alcohol misuse and illicit drug abuse, and especially psychological and physical IPV relate in a framework leading to postpartum common mental disorder (CMD).

METHODS

The study was carried out in five primary health care units of Rio de Janeiro, Brazil, and included 810 randomly selected mothers of children up to five postpartum months waiting for pediatric visits. The postulated pathways between exposures and outcome were based on literature evidence and were further examined using structural equation models.

RESULTS

Direct pathways to postpartum CMD arose from a latent variable depicting socio-economic position, a general stressors score, and both IPV variables. Notably, the effect of psychological IPV on postpartum CMD ran partly through physical IPV. The effect of teenage pregnancy, conjugal instability and maternal burden apparently happens solely through substance use, be it alcohol misuse, illicit drug abuse or both in tandem. Moreover, the effect of the latter on CMD seems to be entirely mediated through both types of IPV.

CONCLUSION

Although the theoretical model underlying the analysis still requires in-depth detailing, results of this study may have shed some light on the role of both psychological and physical IPV as part of an intricate network of events leading to postpartum CMD. Health initiatives may want to make use of this knowledge when designing preventive and intervention approaches.

Social support communication in unplanned pregnancy: support types, messages, sources, and timing

Pregnancy is a time of uncertainty and stress for many women, and these aspects are compounded for those facing unplanned pregnancies. Social support communication is considered a vital part of healthy outcomes in pregnancy but is largely unexplored in the unplanned pregnancy context, particularly for college-aged young women. The present study aimed to identify various dimensions of social support in unplanned pregnancy for this population, including support types desired and enacted, sources of support, support types helpful in various stages of this health experience, and message strategies used in helpful support communication. Results of an online semi-structured survey exploring message content and these other elements were analyzed through qualitative and quantitative content analysis as well as statistical analysis. Nurturing support, specifically network support, was found to be most desired in this health context, and the message strategies found in the most helpful support messages differed according to support type. Source and timing of support were also factors in the most helpful types of support in this context. Implications of these results will be discussed in terms of future research in social support in the unplanned pregnancy context.

Effects of a Brief, Prevention-Focused Parenting Education Program for New Mothers

We evaluated the effects of a parenting program, Baby and You, on parenting knowledge, parenting morale, and social support using a single-group, pre-test, and post-test design with 159 Canadian mothers of infants aged 2 to 9 months old. Baby and You is a prevention-focused parenting program (PFPP) to improve maternal and infant health through education and social support. The 4-week curriculum focuses on infant development and safety, parent–child relationships, maternal self-care, and community resources. We computed repeated-measures ANOVAs separately for scores on Parenting Knowledge Scale, Parenting Moral Index, and Family Support Scale. We found a significant increase between pre-test and post-test on parenting knowledge, but not parenting morale or social support. Parenting morale may be a stable construct that shows little change over time. It may take more than 4 weeks of programming for mothers to identify and integrate new sources of social support.

Maternal depressive symptoms, employment, and social support

OBJECTIVE

The purpose of this study was to characterize the relationship between maternal depressive symptoms and employment and whether it is mediated by social support.

METHODS

We used data from a nationally representative sample of 700 US women who gave birth in 2005 and completed 2 surveys in the Listening to Mothers series, the first in early 2006, an average of 7.3 months postpartum, and the second an average of 13.4 months postpartum. A dichotomous measure of depressive symptoms was calculated from the 2-item Patient Health Questionnaire, and women reported their employment status and levels of social support from partners and others. We modeled the association between maternal employment and depressive symptoms using multivariate logistic regression, including social support and other control variables.

RESULTS

Maternal employment and high support from a nonpartner source were both independently associated with significantly lower odds of depressive symptoms (adjusted odds ratio [AOR], 0.35 and P = .011, and AOR, 0.40, P = .011, respectively). These relationships remained significant after controlling for mothers' baseline mental and physical health, babies' health, and demographic characteristics (AOR, 0.326 and P = .015, and AOR, 0.267 and P = .025, respectively).

CONCLUSIONS

Maternal employment and strong social support, particularly nonpartner support, were independently associated with fewer depressive symptoms. Clinicians should encourage mothers of young children who are at risk for depression to consider ways to optimize their employment circumstances and "other" social support.

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.

Social relationships and postpartum depression in South Asia: a systematic review

BACKGROUND

Evidence suggests a much higher prevalence of postpartum depression in South Asia than in 'western' contexts.

AIM

To conduct a rapid systematic review of evidence on the association between social relationships and postpartum depression in South Asia.

METHODS

Five databases were searched to identify relevant studies. Studies meeting the selection and quality criteria were analysed and integrated in a narrative review.

RESULTS

Nine mostly quantitative studies were included in the review. Low support and poor relationships with the husband and parents-in-law were associated with postpartum depression, although associations were weakened in multivariate analyses. The different dimensions of support have not yet been systematically investigated and the likely complex interrelationships between social relationship risk factors are not yet well understood.

CONCLUSIONS

Findings mirror those from 'western' contexts, showing the key role of social relationships in the aetiology of postpartum depression. Yet, they also reinforce the hypothesis that the social and cultural context influences the association. The importance of relationships with the extended family, as well as the husband, in South Asia is highlighted. Further research is recommended to develop an understanding of these relationships to better inform interventions.

Job satisfaction and work related variables in Chinese cardiac critical care nurses

AIM

To explore critical care nurses' views of their job satisfaction and the relationship with job burnout, practice environment, coping style, social support, intention to stay in current employment and other work-related variables.

BACKGROUND

Nurse shortage is a global issue, especially in critical care. Job satisfaction is the most frequently cited factor linked to nurses' turnover.

METHOD

A convenience sample of cardiac critical care nurses (n = 215; 97.7% response rate) from 12 large general hospitals in Shanghai was surveyed from December 2010 to March 2011.

RESULT

Over half of the sample reported satisfaction with their jobs. Nurses with 10-20 years of professional experience and those who had taken all their holiday entitlement reported higher levels of job satisfaction. The independent variables of practice environment, intention to stay, emotional exhaustion, personal accomplishment and positive coping style explained about 55% of the variance in job satisfaction.

CONCLUSION

Chinese cardiac critical care nurses' job satisfaction was related to work related variables, which are amenable to managerial action.

IMPLICATIONS FOR NURSING MANAGEMENT

Our findings highlight the imperative of improving intrinsic and extrinsic rewards, together with the flexibility of work schedules to promote job satisfaction and staff retention. A clinical ladder system is needed to provide promotion opportunities for Chinese nurses.

Social support and parenting self-efficacy among Chinese women in the perinatal period

OBJECTIVE

to examine the changes in and relationship between perceived social support and parenting self-efficacy in the perinatal period among pregnant women in mainland China.

DESIGN AND SETTING

this was a secondary analysis with data from part of an experimental study of the effects of an interpersonal-psychotherapy-oriented childbirth psychoeducation programme on maternal adaptation. A longitudinal design was employed in the present study. The study was carried out from July 2008 to May 2009 in one general hospital in Guangzhou, China.

PARTICIPANTS

a convenience sample of 68 first-time mothers in mainland China completed measurement of social support and parenting self-efficacy during pregnancy and at six weeks and three months post partum.

FINDINGS

perceived social support and parenting self-efficacy declined during early motherhood. Parenting self-efficacy increased from six weeks post partum to three months post partum. Perceived social support positively correlated with parenting self-efficacy.

CONCLUSION

culturally competent health-care intervention should be developed during early motherhood to promote perceived social support and parenting self-efficacy for the new mothers.

Impact of a preventive intervention for perinatal depression on mood regulation, social support, and coping

Perinatal depression prevention trials have rarely examined proximal outcomes that may be relevant for understanding long-term risk for depression. The Mothers and Babies (MB) Course is a cognitive-behavioral depression prevention intervention, which has been shown to prevent depressive symptoms among at-risk perinatal women of color. This study examined intervention impact on three proximal outcomes that are theoretically linked with the intervention's model of change and have been empirically linked with risk for depression: mood regulation expectancies, perceived social support, and coping. The study used data from a randomized intervention trial of the MB Course with 78 low-income, predominantly African-American perinatal women enrolled at one of four home visitation programs in Baltimore City. Mood regulation expectancies, perceived social support, and coping were assessed with self-report instruments at baseline, post-intervention, and 3- and 6-month follow-ups. The intervention group experienced 16 % greater growth in mood regulation from baseline to 6-month follow-up compared to the usual care group, suggesting a prevention effect. The pattern of findings was similar, although not statistically significant, for social support. Contrary to prediction, the control group experienced less growth in avoidant coping than the intervention group. Findings indicate the MB Course enhances mood regulation, which may facilitate prevention of depression over time. Assessment of intervention effects on proximal outcomes is beneficial for understanding how interventions may enhance protective factors relevant to successful long-term outcomes.

The effect of telephone support on postpartum depression: a randomized controlled trial

INTRODUCTION

Postpartum depression is a common disorder. Systematic reviews emphasized the need to conduct more trials about interventions to prevent postpartum depression. The aim of this study was to determine the effect of postpartum telephone support on maternal depression.

METHODS

366 postpartum women with no history of known depression were randomly assigned into control (244 subjects) and intervention (122 subjects) groups. The control group received only routine postpartum care. In the intervention group, telephone support was provided twice in the first week and once a week during the second to sixth week of postpartum by a trained midwife in addition to the routine care. In order to meet their unpredicted needs, the mothers could contact the consultant 24 hours a day. Postpartum depression was assessed using the self-administered Edinburgh Depression Scale at 60 to 65 days of postpartum. Mothers with scores of 13 and above were considered to have depression. Logistic regression and Student's t-test were used for the data analysis.

RESULTS

There was no significant difference regarding frequency of depression between the intervention and control groups (29.9% vs. 31.6%; Odds ratio 0.91, 95% CI 0.56 to 1.49). Mean of depression score was not significantly different between the groups [9.2 (6.1) vs. 10.4 (5.8); mean difference -1.19, 95%CI -2.5 to 0.13].

CONCLUSION

This study did not provide evidence to show that telephone support of a midwife during postpartum period have a preventive effect on postpartum depression.

Antenatal depressive symptoms among Canadian-born and immigrant women in Quebec: differential exposure and vulnerability to contextual risk factors

PURPOSE

To examine the distribution of contextual risk factors for antenatal depression according to immigrant status and the length of stay in Canada, to assess the association between these risk factors and antenatal depression (AD) for Canadian-born and immigrant women, and to compare the vulnerability of Canadian-born and immigrant women to risk factors in relation to antenatal depression.

METHODS

Women were recruited at routine ultrasound examinations (16-20 weeks), at antenatal blood sampling (8-12 weeks), or in antenatal care clinics. Cross-sectional analysis was performed on the baseline sample consisting of 5,162 pregnant women. CES-D scale was used to investigate depression. Levels of exposure to the selected risk factors according to immigrant status and length of stay were assessed using Chi-square-test or the t test. All measures of association were assessed using logistic regression. Multiplicative interaction terms were constructed between each of the risk factors and immigrant status to reveal differential vulnerability between Canadian-born and immigrant women.

RESULTS

Prevalence of AD (CES-D ≥16 points) was higher in immigrants (32% [29.6-34.4]) than in Canadian-born women (22.8% IC 95% [21.4-24.1]). Immigrant women were significantly more exposed than Canadian-born women to adverse contextual risk factors such as high marital strain, lack of social support, poverty, and crowding. At the same level of exposure to risk factors, Canadian-born women presented higher vulnerability to AD when lacking social support (OR = 4.14 IC 95% [2.69; 6.37]) while immigrant women presented higher vulnerability to AD when lacking money for basic needs (OR = 2.98 IC 95% [2.06; 4.32]).

CONCLUSIONS

Important risk factor exposure inequalities exist between Canadian-born and immigrant pregnant women. Interventions should target poverty and social isolation. The observed high frequency of AD highlights the need to evaluate the effectiveness of preventive interventions of antenatal depression.

No relationship between maternal iron status and postpartum depression in two samples in China

Maternal iron status is thought to be related to postpartum depressive symptoms. The purpose of the present study was to evaluate the relationship between pre- and postnatal maternal iron status and depressive symptoms in pilot (n = 137) and confirmatory (n = 567) samples of Chinese women. Iron status was evaluated at mid- and late pregnancy and 3 days postpartum. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess maternal postpartum depression 24–48 hours after delivery and 6 weeks later. In the pilot sample, correlations between early- and late-pregnancy maternal Hb and EPDS scores at 6 weeks were r = 0.07 and −0.01, respectively (nonsignificant). In the confirmatory sample, the correlations between maternal iron measures (Hb, MCV, ZPP, ferritin, sTfR, and sTfR Index) in mid- or late pregnancy or 3 days postpartum and EPDS scores shortly after delivery or at 6 weeks were also low (r values < 0.10). EPDS scores in anemic and nonanemic mothers did not differ, regardless of sample or timing of maternal iron status assessment. In addition, women with or without possible PPD were similar in iron status in both samples. Thus, there was no relationship between maternal iron status and postpartum depression in these samples.

Postpartum Doula and Peer Telephone Support for Postpartum Depression

Objectives: This research provides the first test of feasibility of recruiting postpartum doulas and depressed mothers for a peer support intervention study and begins to evaluate the benefit of postpartum doula support and peer telephone support for at-risk mothers. Methods: The authors recruited postpartum doulas from national doula organizations, peer telephone supporters from nursing referrals, and mothers with depressive symptoms from 3 local hospitals, local medical practices, Web sites, and community organizations. Participating mothers were randomized to 3 groups—postpartum doula, peer telephone support, and control group. Surveys were completed at 0, 3, and 6 months postenrollment. Results: Thirty-nine mothers with depressive symptoms, 6 postpartum doulas, and 6 peer telephone supporters participated. The postpartum doula group, compared with the other 2 groups, had a higher proportion of women with a previous history of depression, and similarly, a higher proportion of women who were depressed and receiving depression treatment at the 6-month follow-up. Satisfaction with study-sponsored support was greater in the postpartum doula group than in the telephone support group. Conclusions: It is feasible to recruit postpartum doulas, peer telephone supporters, and mothers with depressive symptoms for a peer support intervention trial. Mothers were more satisfied with postpartum doulas than peer telephone support. The authors recommend further research to assess the benefit of postpartum doula support for postpartum depression as adjunctive or alternative therapy.

Social support and online postpartum depression discussion groups: a content analysis

OBJECTIVE

Social support has a positive influence on women's childbearing experience and is shown to be a preventive factor in postpartum depression. This study examined the perceived value and types of social supports that characterize the discussions of women who participate in postpartum depression online discussion groups.

METHODS

A directed content analysis was used to examine 512 messages posted on a postpartum depression online support group over six months.

RESULTS

The majority of the women's postings illustrated emotional support followed by informational and instrumental support.

CONCLUSIONS

Online support groups provide women experiencing postpartum depression a safe place to connect with others and receive information, encouragement and hope.

PRACTICE IMPLICATIONS

Education strategies are needed to address the many questions regarding PPD medical treatment. Recommending vetted links to PPD online support groups will create opportunities for women to share their experiences and obtain support.

Group treatment for postpartum depression: a systematic review

Postpartum depression (PPD) is a serious public health problem affecting 10% to 15% of women during the first year after delivery with negative consequences for both mother and infant. There is a need for evidence-based interventions to treat this disorder. Thus, the purpose of this study was to systematically review the literature regarding group treatment for PPD to determine the current state of knowledge regarding the efficacy of this treatment modality for reducing depressive symptoms in postpartum women. A systematic search of published and unpublished literature using the electronic databases Medline, CINAHL, PsycINFO, Cochrane Database, Cochrane Central Register of Controlled Trials, Current Controlled Trials, and Dissertation Abstracts through March 2011, supplemented by hand searches, identified 11 studies which met inclusion criteria: six were randomized controlled trials and five were non-randomized trials which utilized non-equivalent control or comparison groups. All but one study showed statistically significant improvement in depression scores from pretreatment to post-treatment, suggesting that group treatment is effective in reducing PPD symptoms. The review provides initial support for the role of group therapy in the treatment of PPD; however, caution is advised in making generalized interpretations of the findings as there was considerable heterogeneity of the studies included and the quality of the studies was mixed. Overall, the review reveals significant gaps in the current evidence base for group treatment for PPD and recommendations for further research is discussed.

Anxiety and depression symptoms in women and men from early pregnancy to 3-months postpartum: parity differences and effects

This study aimed to investigate both anxiety and depression symptoms from early pregnancy to 3-months postpartum, comparing women and men and first and second-time parents.

METHODS

A sample of 260 Portuguese couples (N=520), first or second-time parents, recruited in an Obstetrics Out-patients Unit, filled in the State-Anxiety Inventory (STAI-S) and the Edinburgh Post-Natal Depression Scale (EPDS) at the 1st, 2nd and 3rd pregnancy trimesters, childbirth, and 3-months postpartum.

RESULTS

A decrease in anxiety and depression symptoms from early pregnancy to 3-months postpartum was found in both women and men, as well as in first and second-time parents. Men presented less anxiety and depression symptoms than women, but the same pattern of symptoms over time. Second-time parents showed more anxiety and depression symptoms than first-time parents and a different pattern of symptoms over time: an increase in anxiety and depression symptoms from the 3rd trimester to childbirth was observed in first-time parents versus a decrease in second-time parents.

LIMITATIONS

The voluntary nature of the participation may have lead to a selection bias; women and men who agreed to participate could be those who presented fewer anxiety and depression symptoms. Moreover, the use of self-report symptom measures does not give us the level of possible disorder in participants.

CONCLUSIONS

Anxiety and depression symptoms diminish from pregnancy to the postpartum period in all parents. Patterns of anxiety and depression symptoms from early pregnancy to 3-months postpartum are similar in women and men, but somewhat different in first and second-time parents. Second-time parents should also be considered while studying and intervening during pregnancy and the postpartum.

Treatment of postpartum depression: clinical, psychological and pharmacological options

Postpartum depression (PPD) is a common complication of childbearing, and has increasingly been identified as a major public health problem. Untreated maternal depression has multiple potential negative effects on maternal-infant attachment and child development. Screening for depression in the perinatal period is feasible in multiple primary care or obstetric settings, and can help identify depressed mothers earlier. However, there are multiple barriers to appropriate treatment, including concerns about medication effects in breastfeeding infants. This article reviews the literature and recommendations for the treatment of postpartum depression, with a focus on the range of pharmacological, psychotherapeutic, and other nonpharmacologic interventions.

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.

Social support and Quality of Life: a cross-sectional study on survivors eight months after the 2008 Wenchuan earthquake

Background

The 2008 Wenchuan earthquake resulted in extensive loss of life and physical and psychological injuries for survivors. This research examines the relationship between social support and health-related quality of life for the earthquake survivors.

Methods

A multistage cluster sampling strategy was employed to select participants from 11 shelters in nine counties exposed to different degrees of earthquake damage, for a questionnaire survey. The participants were asked to complete the Short Form 36 and the Social Support Rating Scale eight months after the earthquake struck. A total of 1617 participants returned the questionnaires. The quality of life of the survivors (in the four weeks preceding the survey) was compared with that of the general population in the region. Multivariate logistic regression analysis and canonical correlation analysis were performed to determine the association between social support and quality of life.

Results

The earthquake survivors reported poorer quality of life than the general population, with an average of 4.8% to 19.62% reduction in scores of the SF-36 (p < 0.001). The multivariate logistic regression analysis showed that those with stronger social support were more likely to have better quality of life. The canonical correlation analysis found that there was a discrepancy between actual social support received and perceived social support available, and the magnitude of this discrepancy was inversely related to perceived general health (rs = 0.467), and positively related to mental health (rs = 0.395).

Conclusion

Social support is associated with quality of life in the survivors of the earthquake. More attention needs to be paid to increasing social support for those with poorer mental health.