Patterns of fatigue during childbearing

Factors associated with postpartum fatigue: an exploration of the moderating role of resilience

Background

Postpartum fatigue (PPF) can impair the physical and mental well-being of women. The aims of this study were to assess the associations between fatigue and maternal health-related variables, specifically, sleep quality, depression symptoms, and resilience, and to explore the moderating role of resilience in the relationships between sleep quality, depression symptoms, and fatigue.

Methods

This cross-sectional study used data collected from mothers during the postpartum period via an online platform. PPF was assessed using the Fatigue Severity Scale, whereas sleep quality and depression symptoms were assessed using the Pittsburgh Sleep Quality Index and Edinburgh Postnatal Depression Scale, respectively. The Brief Resilience Scale was used to assess resilience. Simple and multiple binary logistic regression analyses were performed to examine the association of each independent variable with PPF and to determine the most significant predictors of PFF. The data were analyzed using SPSS, and structural equation modeling was performed using AMOS 23. A moderation analysis was performed to explore the moderating role of resilience using the Hayes PROCESS macro.

Results

A total of 1,443 postpartum mothers were included in the analysis. The simple binary logistic regression analysis showed that having chronic disease (odds: 1.52; p = 0.02), mother's age (odds: 0.97; p = 0.03), mother's body mass index (BMI; odds: 1.03; p = 0.01), depression symptoms (odds: 1.09; p ≤ 0.0001), sleep quality (odds: 1.17; p ≤ 0.0001), and resilience (odds: 0.42; p ≤ 0.0001) all contributed to fatigue during postpartum. Multivariate logistic regression showed that the mother's BMI, sleep quality, depression symptoms, and resilience were significant predictors of PPF. Moderation analyses showed that resilience was not a significant moderator between the main effects of sleep quality and fatigue (interaction effect: β = 0.01, p = 0.31, 95% CI: -0.01 to 0.04) or between the main effects of depression symptoms and fatigue during postpartum (interaction effect: β = 0.01, p = 0.82, 95% CI: -0.01 to 0.02).

Conclusion

Given the deleterious effects of PPF on maternal health outcomes, factors associated with PPF should be assessed regularly. In addition to mothers' BMI, sleep quality, and depression symptoms, resilience could also be a crucial factor in predicting fatigue severity during this critical time for mothers even though it was not a significant moderator among this sample.

The relationship between fatigue, sleep quality, resilience, and the risk of postpartum depression: an emphasis on maternal mental health

BACKGROUND

Several factors can contribute to the development of postpartum depression (PPD) and negatively affect mothers' mental and physical well-being. The objective of this study was to determine the relationship between fatigue, sleep quality, resilience, and the risk of PPD development.

METHODS

A cross-sectional study was conducted using an online questionnaire distributed to mothers during their postpartum period. The risk of PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS), postpartum fatigue (PPF) was assessed using the Fatigue Severity Scale (FSS), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and resilience was assessed using the Brief Resilience Scale (BRS). The Pearson correlation coefficient was calculated to determine the relationship between the study variables. Simple and multiple linear regression analyses were performed to explain the contributions of PPF, sleep quality, and resilience as independent predictors of PPD development.

RESULTS

A total of 1409 postpartum women were included in the analysis, with 75% of the participants reporting a risk of PPD, 61% reporting PPF, 97% reporting having sleep problems, and 36% being in the "low resilience level" category. In terms of correlations, the scores of FSS and the PSQI showed moderate positive relationships with the EPDS scores (r = 0.344 and r = 0.447, respectively, p = .000). The BRS scores were negatively associated with the EPDS scores (r = -0.530, p = 0.000). Fatigue, sleep quality, and resilience were predictors of depressive symptoms (β = 0.127, β = 0.262, and β = -0.393, respectively, R² = 0.37, p = 0.000). The association remained significant in the regression model after adjusting for mother's age, mother's BMI, child's age, smoking status, full-term pregnancy, having a chronic disease, and taking anti-depressant.

CONCLUSIONS

Mothers with higher levels of fatigue, poor sleep quality, and low resilience levels were at high risk of developing PPD. Healthcare providers should identify these factors and thus set better rehabilitation goals to improve overall maternal health.

The relationship of maternal anxiety, positive and negative affect schedule, and fatigue with neonatal psychological health upon childbirth

BACKGROUND

Exposure of mothers to negative moods and stress before childbirth leads to negative consequences for the infants. Given the importance of psychological health, this study aimed to examine the effect of these factors on the infants' psychological health.

METHOD

This cross-sectional study was conducted in Shiraz hospitals on 110 pregnant women selected with multistage random sampling. Research tools included The McGill Pain Questionnaire (MPQ) to measure fatigue with three criteria; The Positive and Negative Emotion Schedule (PANAS); and The Spielberger State-Trait Anxiety Inventory (STAI) were used to measure maternal mood and anxiety level. Also, neonatal psychological health was assessed by a checklist. Neonatal psychological health's correlation with maternal anxiety, fatigue, and mental state was assessed. Data were analyzed by SPSS-19 software using Pearson correlation coefficient and statistical regression at the significance level of 0.05.

RESULT

Although there was no significant relationship between maternal anxiety score and neonatal psychological health after birth (p = 0.231; r=-0.343), the relationship was significant immediately after birth with positive (P < 0.001; r = 0.343) and negative affect scores (P < 0.001; r=-0.357).

CONCLUSIONS

There was a statistically significant relationship between the neonatal psychological health and maternal fatigue (p ≤ 0.001; r = -0.357) and PANAS (p ≤ 0.001) of the mother; however, it had no significant relationship with maternal anxiety (p = 0.231; r=- 0.343). Therefore, nurses and midwives can reduce maternal anxiety and improve neonatal mental health by supporting mothers.

Sleep quality in women with nausea and vomiting of pregnancy: a cross-sectional study

BACKGROUND

Nausea and vomiting of pregnancy (NVP) deteriorates many aspects of daily lives of women. However, little is known about associations between NVP and sleep quality.

METHODS

Women attending to routine mid-pregnancy visits in maternity health care clinics in Turku city area and surrounding municipalities, Finland, during 2011-2014, were invited to participate. A cohort of 1203 volunteers (mean age 30 years, mean gestational week 16.6, mean BMI 24.4 kg/m2, nulliparous 46%) was recruited. The severity of NVP in the worst 12-h period of current pregnancy was assessed with Pregnancy Unique Quantification of Emesis Questionnaire (PUQE) and categorized accordingly into no/mild/moderate and severe NVP. Sleep disturbances during the past 3 months were assessed with selected questions (difficulty falling asleep, night awakenings, too early morning awakenings and sleepiness during the day) from Basic Nordic Sleep Questionnaire (BNSQ). In addition, general sleep quality, as well as physical and mental quality of life (QoL) were rated with three visual analog scales (VAS). Associations between PUQE categories (severity of NVP) and sleep disturbances, general sleep quality, physical QoL and mental QoL were evaluated with multinomial regression analysis.

RESULTS

According to PUQE, NVP was most frequently moderate (n = 629, 52.3%), followed by mild (n = 361, 30.0%) and severe (n = 77, 6.4%). Only 11.3% had no NVP (n = 136). The most frequent sleep disturbance was night awakenings (69.9%, n = 837), followed by sleepiness during the day (35.7%, n = 427), too early morning awakenings (12.0%, n = 143) and difficulty falling asleep (7.1%, n = 81). In adjusted analysis (age, parity, body mass index, smoking, employment), more severe NVP was associated with night awakenings (AOR 3.9, 95% CI 1.79-8.47, P < 0.0001) and sleepiness during the day (AOR 4.7, 95% CI 2.20-9.94, P < 0.0001). In VAS, women with more severe NVP rated worse general sleep quality and worse physical and mental QoL. However, in multivariable analysis, the association between the severity of NVP and physical and mental QoL was stronger than that of sleep .

CONCLUSIONS

More severe NVP is associated with sleep disturbances and in close relation to lower physical and mental QoL. Thus, in comprehensive care of women with NVP, also sleep quality should be evaluated.

Associations between Nausea, Vomiting, Fatigue and Health-Related Quality of Life of Women in Early Pregnancy: The Generation R Study

The objective of this study was to evaluate the independent associations between nausea, vomiting, fatigue and health-related quality of life of women in early pregnancy in the Generation R study, which is a prospective mother and child cohort. Analyses were based on 5079 women in early pregnancy in the Rotterdam area, the Netherlands. The information on nausea, vomiting and fatigue in the previous three months was measured in the questionnaire at enrollment, as well as potential confounders (i.e., maternal/gestational age, ethnic background, educational level, parity, marital status, body mass index, tobacco and alcohol use, chronic/infectious conditions, uro-genital conditions/symptoms, sleep quality, headache, anxiety, and depression). Health-related quality of life was assessed by the 12-item Short Form Health Survey and physical and mental component summary scores were calculated. Multivariate regression models were performed to evaluate the independent associations of the presence of nausea, vomiting and fatigue with health-related quality of life, adjusting for potential confounders. 33.6% of women experienced daily presence of nausea, 9.6% for vomiting and 44.4% for fatigue. Comparing with women who never reported nausea, vomiting and fatigue, women with daily presence of at least one of these symptoms had significantly lower scores of physical component summary and mental component summary, after adjusting for potential confounders. Our study shows how common nausea, vomiting and fatigue are among women in early pregnancy and how much each of these symptoms negatively impact on health-related quality of life. We call for awareness of this issue from health care professionals, pregnant women and their families.

Psychological Distress and Milk Volume in Lactating Mothers

The purpose of this article is twofold: (a) to compare psychological distress as measured via self-reported perceived stress, sleep, and fatigue levels in lactating mothers of a term infant and mothers of a preterm infant and(b) to determine whether the addition of psychological distress to a previous model predicts milk volume at Postpartum Week 6 by gestation group. The convenience sample of 95 mothers of a preterm infant (31 weeks) and 98 mothers of a term infant completed the Perceived Stress Visual Analogue Scale, Richards-Campbell Sleep Questionnaire, and the Fatigue Visual Analog Scale. Stress, sleep difficulty, and fatigue levels decreased during the 6-week study period for mothers of a term but not for mothers of a preterm infant. Perceived stress, sleep difficulty, and fatigue during the first 6 weeks postpartum were not related to milk volume; thus, the mother’s perceived psychological distress had no apparent effect on lactation.

Recovery Symptoms and Mood States in Thai CABG patients

Recovery symptoms and related mood states during early recovery after coronary artery bypass graft surgery (CABG) have never been assessed in Thailand. This cross-sectional descriptive correlational study was to identify the relationships between frequency of recovery symptoms and mood states of a convenience sample of 91 Thai CABG patients during 2 weeks after discharge. Standardized tools/procedures were used to measure the variables of interest. The most common recovery symptoms were chest and leg incision pain, having trouble sleeping, and neck and shoulder or back discomfort. The most common mood states were confusion, anxiety, and anger, respectively. In addition, Thai CABG patients who had more frequent recovery symptoms also had greater negative mood disturbance. These findings provide a beginning explanation about the phenomena of recovery symptoms and mood states in a specific culture, Thai CABG patients.

Differentiating maternal fatigue and depressive symptoms at six months and four years post partum: Considerations for assessment, diagnosis and intervention

OBJECTIVE

fatigue and depressive symptoms are common among women in the postpartum period, and it has been proposed that fatigue is a risk factor for later depression. To progress this research, there is a need to clarify the conceptual and measurement issue of whether these two sets of symptoms are distinct constructs. There is also a need to determine whether they are distinct constructs beyond the postnatal period. The aim of the study was to assess the construct and discriminant validity of fatigue and depressive symptoms as measured by the SF-36 Vitality subscale (SF-36) and the Edinburgh Postnatal Depression Scale (EPDS) at six months and at four years post partum.

DESIGN, SETTING AND PARTICIPANTS

data from over 1000 women participating in the Maternal Health Study, a longitudinal study of women׳s physical and psychological health and recovery after childbirth were used.

FINDINGS

confirmatory factor analysis revealed a two-factor model of fatigue and depressive symptoms represented as distinct but related constructs was a better fit to the data than a one-factor model of fatigue and depression sharing the same underlying construct at both six months and four years post partum.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

this study provides empirical evidence that maternal fatigue and depression in the first year after having a baby and at four years post partum are best understood as separate psychological constructs or experiences. The findings have important implications for clinical practice, in particular underlining the importance of differentiating tiredness from depression.

Perinatal stress, fatigue, depressive symptoms, and immune modulation in late pregnancy and one month postpartum

Stress and fatigue are common complaints of pregnant and postpartum women as is depression. These symptoms may be related to immunomodulation. However, few studies have examined these relationships. The aim of this study was to examine the relationships among stress, fatigue, depression, and cytokines as markers of immune modulation in prenatal and postpartum women. Women completed questionnaires and gave blood samples during late pregnancy and again at 4–6 weeks postpartum. Blood was analyzed for cytokines as measures of immune modulation. Stress, fatigue, and depression were experienced at moderately high levels, with higher levels of fatigue and depression in the postpartum but higher stress in the prenatal period. Levels of several cytokines were increased in the postpartum over the prenatal period. Stress and depression were related in the prenatal period and stress, depression, and fatigue were related in the postpartum. While various cytokines were related to each other in both periods, only stress was related to MIP-1β, a cytokine that may be important for childbirth processes. More studies, especially longitudinal and interventional studies, are needed to increase our knowledge about etiology, patterns, symptoms, factors, and management of maternal distress. The search for reliable biomarkers for at-risk mothers remains a priority.

Fatigue, stress and coping in mothers of children with an autism spectrum disorder

Raising a child with an autism spectrum disorder (ASD) can be exhausting, which has the potential to impact on parental health and wellbeing. The current study investigated the influence of maternal fatigue and coping on the relationship between children's problematic behaviours and maternal stress for 65 mothers of young children (aged 2-5 years) with ASDs. Results showed that maternal fatigue but not maladaptive coping mediated the relationship between problematic child behaviours and maternal stress. These findings suggest child behaviour difficulties may contribute to parental fatigue, which in turn may influence use of ineffective coping strategies and increased stress. The significance of fatigue on maternal wellbeing was highlighted as an important area for consideration in families of children with an ASD.

Wide Awake Parenting: study protocol for a randomised controlled trial of a parenting program for the management of post-partum fatigue

BACKGROUND

Exhaustion and fatigue are commonly experienced by parents during the post-partum period, and can have implications for daily functioning, mental health and parenting practices. There is a need for the development of effective interventions to assist parents with the management of fatigue. This paper outlines the procedure for a randomised controlled study which aims to test the efficacy of Wide Awake Parenting, a program for the management of fatigue in the postnatal period.

METHODS/DESIGN

Parents with an infant less than 6 months of age, and from seven Local Government Areas in Melbourne, Australia were invited to participate in this study. Parents were randomised to receive the Wide Awake Parenting program (intervention groups) or usual care (control group) offered by health services. The Wide Awake Parenting program provides parents with psycho-education and information about fatigue, and strategies to reduce its effects either via a self-directed method, or professionally led with a home visit and telephone support. Baseline data will be collected prior to randomisation, and further data will be collected at 2- and 6-weeks post intervention.

DISCUSSION

To our knowledge this is the first randomised controlled trial of a program which compares the efficacy of a self-management approach and health professional assistance for the management of fatigue in the early post-partum period. If effective, it could offer an important, universal public health management approach to this common health concern.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry, ACTRN12611000133932.

Primigravid and multigravid women: prenatal perspectives

A paucity of prenatal data is available concerning prenatal experiences of primigravid women compared with those of multigravid women. Therefore, the objectives of this study were twofold: to compare prenatal personal (demographic and other descriptive elements, including self-esteem) and psychosocial variables (maternal-fetal attachment, marital satisfaction) and to describe perceived pregnancy experiences for both primigravid and multigravid women. Both quantitative and qualitative data were collected using a descriptive mixed-methods design. The data were part of a larger, longitudinal study focused on adjustment to parenthood in military and civilian couples. Married pregnant women who resided on the east and west coasts of the United States were recruited from prenatal care facilities. Participants included 50 pregnant primigravid and 50 multigravid married women recruited during the last trimester of a healthy, uncomplicated pregnancy. The main outcome measures included personal and psychosocial variables (demographics, self-esteem, maternal-fetal attachment, marital satisfaction) and perceived pregnancy experiences. Multigravid women had significantly lower levels of maternal-fetal attachment (p < .00) and marital satisfaction (p < .00) than did primigravid women during their third trimester of pregnancy. The pregnant women's responses clearly reveal that unique and distinct differences exist between the needs of primigravid women and those of multigravid women. Innovative prenatal educational interventions tailored to meet the distinct needs of primigravid and multigravid women are suggested.

Parental fatigue and parenting practices during early childhood: an Australian community survey

BACKGROUND

Parenting behaviours are influenced by a range of factors, including parental functioning. Although common, the influence of parental fatigue on parenting practices is not known. The first aim of this study was to investigate the relationship between fatigue and parenting practices. The second aim was to identify parental psychosocial factors significantly associated with fatigue.

METHODS

A sample of 1276 Australian parents, of at least one child aged 0-5 years, completed a survey. Demographic, psychosocial (social support, coping responses) and parental sleep and self-care information was collected. Hierarchical regression was performed to assess the contribution of fatigue (modified Fatigue Assessment Scale) to parental practices (warmth, irritability and involvement), and parenting experiences (Parenting Stress Index, Parenting Sense of Competence Scale). Hierarchical multiple regression assessed the contribution of a range of parental sleep, psychosocial (social support, coping responses) and self-care variables to fatigue when demographic characteristics were held constant.

RESULTS

Higher fatigue was significantly associated with lower parental competence (β=-0.17, P < 0.005), greater parenting stress (β= 0.21, P < 0.005) and more irritability in parent-child interactions (β= 0.11, P < 0.005). Several psychosocial characteristics were associated with higher parental fatigue, including inadequate social support, poorer diet, poorer sleep quality and ineffective coping styles including self-blame and behaviour disengagement.

CONCLUSIONS

Fatigue is common, and results suggest that fatigue contributes to adverse parental practices and experiences. However, possible risk factors for higher fatigue were identified in this study, indicating opportunities for intervention, management and support for parents.

Study of correlation between maternal fatigue and uterine contraction pattern in the active phase of labour

AIMS AND OBJECTIVES

To evaluate the correlation between maternal fatigue and uterine contraction pattern at the beginning of the active phase of labour.

BACKGROUND

Fatigue is one of the most common complaints in pregnant women that often continues until delivery. Maternal fatigue prolongs the labour process and increases the rate of cesarian section. Studies on the pattern of uterine contractions have shown that the length of the fall time is longer in prolonged labours than in normal deliveries.

DESIGN

A cross-sectional study.

METHODS

This study was conducted on 100 primiparous women who were referred to Ommolbanin Hospital (Mashhad, Iran) in 2011. Maternal fatigue was assessed at the beginning of the active phase of labour. Then, the pattern of uterine contractions was monitored for 30 minutes by an external tocodynamometer. The F/R ratio was determined by measuring the time for a contraction to return to its baseline from its peak and the time for a contraction to rise to its peak. The data were analysed by chi-square and anova tests.

RESULTS

The results showed that there was a significant relationship between maternal fatigue and uterine contraction pattern. The F/R ratio was increased with increase in fatigue severity.

CONCLUSIONS

Fatigue causes changes in the pattern of uterine contractions. The return time of a contraction from its peak to its baseline (fall) is increased with increase in fatigue severity.

RELEVANCE TO CLINICAL PRACTICE

Offering strategies to prevent tiredness and reduce the related fatigue complications.

Empirical test of an explanatory theory of postpartum fatigue in Korea

AIM

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

A Review of Physical Activity Patterns in Pregnant Women and Their Relationship to Psychological Health

Regular physical activity contributes positively to physical and psychological health. Adverse consequences of inactivity may be an especially important problem among pregnant women. Up to 60% are inactive during pregnancy. This review found consistent evidence that physical activity is reduced during pregnancy; however, few investigators have sought to quantify physical activity patterns among pregnant women using well validated measures. Some of the barriers to physical activity during pregnancy, such as depression, anxiety and fatigue, have been shown to be attenuated by regular exercise performed by non-pregnant samples. There is a need to better understand the relationships between these factors and physical activity during pregnancy. Available retrospective and prospective results suggest that both leisure time and work-related physical activities are decreased across pregnancy. Intensity and duration decrease both during pregnancy compared with pre-pregnancy and in the third trimester compared with the first. There is a need for well designed longitudinal investigations that document pregnancy-related changes in physical activity at frequent intervals during pregnancy using validated and more precise measures of physical activity. Reductions in physical activity and a worsening mood are common during pregnancy. If the relationship between physical inactivity and mood disturbances is indeed observed and maintained during pregnancy, then decreases in physical activity in the third trimester would be expected to result in a worsening mood. In recent years, increased attention has been paid to antenatal mood disturbances, and this research has yielded a host of important findings. Prior correlational and experimental research with non-pregnant samples has demonstrated a consistent relationship between physical inactivity and mood disturbances. Whether this relationship occurs among pregnant women and/or is maintained as women progress during pregnancy is uncertain. Prior investigations have revealed that there is higher rate of mood disturbance during pregnancy than following pregnancy but little is known about the mechanisms that cause these mood disturbances. It is important to better understand changes in mood with pregnancy because mood disturbances can have major negative consequences for a pregnant woman. The major adverse consequences of depression among pregnant women are largely the same as those of non-pregnant individuals. Only six investigations have quantified the relationship between changes in physical activity and changes in mood during pregnancy. The available evidence suggests that inactivity is associated with worse mood. Additional research into this topic is warranted due to the limited number of published papers and the design and methodology limitations of these investigations.

Fatigue during pregnancy predicts caesarean deliveries

BACKGROUND

Previous studies on fatigue and pregnancy outcomes were confined to women with occupational fatigue and did not include women who did not work outside the home. Fatigue during mid- and late pregnancy has rarely been studied.

AIMS

This paper reports a study examining the associations between work factors, household factors, and fatigue among low-risk pregnant women in Taiwan and links the effects of fatigue to preterm births and caesarean deliveries.

METHODS

The participants were 633 women who were 20-36 weeks pregnant without evidence of obstetrical complications at the time of interview. Pregnancy outcomes were abstracted from the hospital records after delivery. Fatigue was measured using the Fatigue Symptom Checklist. Women were categorized into three groups according to their work status: non-working, sedentary work, and active work. Other work factors included hours worked and exposure to adverse work environments. Household factors included household work and childcare responsibilities. Multiple linear regression and logistic regression were used for the analysis.

RESULTS

The factors significantly associated with fatigue in the regression model were age, infection during pregnancy, bleeding after 12 weeks of pregnancy, and work status. Women who did not work outside of the home had significantly higher fatigue scores than those who did sedentary work outside the home. Younger women had higher fatigue scores than older women. Fatigue scores during pregnancy predicted caesarean deliveries, given that age and obstetrical risks were controlled in the model.

CONCLUSIONS

Fatigue is a significant problem for pregnant women. Fatigue assessments should include morbidities during pregnancy as well as household and work-related factors. Special attention should be paid to women who do not work outside the home. Staff should elicit information about fatigue and intervene early, as this may help decrease the number of caesarean deliveries.

Symptoms experience: a concept analysis

PURPOSE/OBJECTIVES

To provide a clearly constructed definition of the concept of symptoms experience.

DATA SOURCES

Articles and book chapters.

DATA SYNTHESIS

Symptoms experience has not been explored previously. Several approaches to the concept of symptoms have been addressed, including symptom occurrence, symptom distress, and unpleasant symptoms. Limitations of these approaches may include the lack of focus on symptoms as occurring concurrently or in clusters or the multiplicative nature of symptoms. In addition, situational and existential meaning often is not explored.

CONCLUSIONS

Symptoms experience is the perception of the frequency, intensity, distress, and meaning of symptoms as they are produced and expressed. Symptoms are multiplicative in nature and may act as catalysts for the occurrence of other symptoms. Antecedents to the symptoms experience include demographic, disease, and individual factors. Consequences include the impact on mood state, psychological status, functional status, quality of life, disease progression, and survival.

IMPLICATIONS FOR NURSING

Evaluation of symptoms in patients with cancer should include a meaning-centered approach, in which symptoms are evaluated not only for occurrence characteristics and perceived distress but also for the meaning of the symptoms experience to individuals.

Fatigue as a predictor of postpartum depression

BACKGROUND

The postpartum is a time when women commonly report increased fatigue that may contribute to depression. Studies have not examined fatigue alone as a predictor of postpartum depression.

OBJECTIVE

To examine whether and when fatigue in the early postpartum is predictive of postpartum depression.

DESIGN

Correlational, longitudinal study.

SETTING

Two hospitals and participants' homes in central Pennsylvania.

PARTICIPANTS

Convenience sample of 38 healthy women recruited from hospital maternity units within 24 hours after an uncomplicated birth.

MAIN OUTCOME MEASURES

Fatigue was measured using the Modified Fatigue Symptom Checklist (MFSC) on Days 0, 7, 14, and 28 after childbirth. Depression was assessed using the Center for Epidemiological Studies-Depressive Symptomatology Scale (CES-D) on Day 28.

RESULTS

After adjustments for multiple comparisons, a significant correlation was obtained between fatigue as measured by the MFSC and postpartum depression on Day 7 (r = .46; p < .05), Day 14 (r = .57), and Day 28 (r = .70). Fatigue on Day 0 was correlated with fatigue on Day 7 (r = .45), Day 14 (r= .58), and Day 28 (r = .34).

CONCLUSIONS

Fatigue as early as 7 days postpartum is predictive of depression at Day 28 postpartum.

The breastfeeding support team for low-income, predominantly-minority women: a pilot intervention study

This quasiexperimental pilot study explored whether a focused breastfeeding intervention had potential to improve outcomes in low-income breastfeeding women. Twenty breastfeeding women (10 in intervention and 10 in usual care) were matched on type of delivery, previous breastfeeding experience, and race. Women were low-income, young, 65% high school graduates, and 40% minority. For this intervention, the BST, a breastfeeding support team (community health nurse and peer counselor) provided hospital and home visits and telephone support. Outcomes were measured weekly for the first month, and monthly through month five. At all time periods, more women who received the intervention were breastfeeding. Further, they had less nipple discomfort in the first month; significantly less fatigue in month four and at three and five months reported less fatigue, depression, and anxiety.

Fatigue and work in pregnancy

Fatigue is a common complaint among women throughout pregnancy and during the postpartum period. It is suggested that there are physical, psychological, and situational factors predisposing a woman to fatigue during pregnancy. Several studies have attempted to correlate levels of fatigue with other variables. While many of these studies have noted an association between stress and fatigue related to work or home environment and the increased risk of antenatal morbidity, the mechanism of these effects is unclear. It is important for health care professionals, family members, and employers to recognize fatigue as a real problem during pregnancy and the potential negative impact of adverse working conditions on pregnancy outcome.

Longitudinal changes in fatigue and energy during pregnancy and the postpartum period

OBJECTIVE

To describe perceived levels of fatigue and energy before, during, and after pregnancy in a group of healthy women experiencing uncomplicated pregnancies; and to examine relationships between their perception of fatigue and energy, parity, and physiologic indicators of sleep disturbances, thyroid function, and iron deficiency.

DESIGN

Prospective, longitudinal.

SETTING

Participants' homes.

PARTICIPANTS

Convenience sample of 24 primiparous and 1 8 multiparous women.

MAIN OUTCOME MEASURES

Change in fatigue and energy over time. Measures were obtained at follicular and luteal phases of the menstrual cycle before pregnancy, at each trimester, and at 1 and 3 months after delivery.

RESULTS

Younger age and lower prepregnancy levels of iron, ferritin, and hemoglobin explained 1st trimester fatigue. Less total sleep was related to fatigue in the 3rd trimester. Postpartum fatigue was related to reduced amounts of sleep and low levels of ferritin and hemoglobin.

CONCLUSIONS

With the exception of premenstrual (luteal) fatigue, progesterone levels were unrelated to fatigue. Neither paid employment nor family variables influenced perception of fatigue. Nurses working with childbearing populations should counsel women about significant 1st trimester fatigue so they can prepare their work and home environments in an attempt to achieve adequate rest.

Clinical approaches in the assessment of childbearing fatigue

Modifications of the Fatigue Symptoms Checklist can be used clinically to assess fatigue during the childbearing year. Data from a series of studies provide beginning norms that can be used to interpret clinical scores and point to the potential importance of assessments to pregnancy complications and maternal performance. Consistent with North American Nursing Diagnosis Association (NANDA) definition of fatigue and the theory of unpleasant symptoms, fatigue and performance are important phenomena critical to the experience of pregnancy and assumption of the maternal role.

A telephone intervention to reduce fatigue and symptom distress in mothers with difficult infants in the community

The purpose of this study was to test the effectiveness of a telephone intervention to reduce fatigue and the resulting symptom distress of mothers in Iceland who reported having a behaviourally difficult infant of 2-3 months of age. A sample of 78 mothers who reached distress criteria of depressive symptoms and parental stress was selected and randomly allocated in a controlled experimental study. In a brief intervention both maternal distress and infant difficulty were discussed. Results indicate a significant (P < 0.001) intervention effect on fatigue and its side-effects. It is concluded that intervention by telephone can be effective with fatigued mothers caring for a difficult infant.

The 'worn-out athlete': a clinical approach to chronic fatigue in athletes

Chronic fatigue in the athletic population is a common but difficult diagnostic challenge for the sports physician. While a degree of fatigue may be normal for any athlete during periods of high-volume training, the clinician must be able to differentiate between this physiological fatigue and more prolonged, severe fatigue which may be due to a pathological condition. As chronic fatigue can be the presenting symptom of many curable and harmful diseases, medical conditions which cause chronic fatigue have to be excluded. The clinician must then be able to differentiate between chronic fatigue associated with training or chronic fatigue from other medical causes, and also between the chronic fatigue syndrome and the overtraining syndrome. Once the clinician has excluded all of the above medical conditions which cause chronic fatigue in athletes, a significant proportion of fatigued athletes remain without a diagnosis. Novel data indicate that skeletal muscle disorders may play a role in the development of symptoms experienced by the athlete with chronic fatigue. The histological findings from muscle biopsies of athletes suffering from the 'fatigued athlete myopathic syndrome' are presented. We have designed a clinical approach to the diagnosis and work-up of the athlete presenting with chronic fatigue. The strength of this approach is that it hinges on the participation of a multidisciplinary team in the diagnosis and management of the athlete with chronic fatigue. The athlete, coach, dietician, exercise physiologist and sport psychologist all play an important role in enabling the physician to make the correct diagnosis.

The natural evolution of postpartum fatigue among a group of primiparous women

A prospective, longitudinal study was conducted to examine the natural evolution of levels of fatigue, as measured by the Visual Analogue Scale-F, among a group of 36 primiparous women during the first 6 weeks postpartum. The results revealed that this group of women experienced higher levels of morning fatigue across the 6 weeks than had previously been reported. Their morning fatigue peaked at 4 weeks and then slowly decreased. At the 6th week, the group mean for morning fatigue was 1.42 points (on a 100-point scale) lower than at the 1st week postpartum, suggesting women do not completely recover from the effects of pregnancy, childbirth, and transition to parenthood by 6 weeks postpartum. Maternal age and length of labor were found to be significantly related to the levels of fatigue and energy at various times during the 6 week postpartum period.

The middle-range theory of unpleasant symptoms: an update

A detailed description of the newly revised and updated theory of unpleasant symptoms is provided. Revisions have resulted in a more accurate representation of the complexity and interactive nature of the symptom experience. Examples are provided to demonstrate the implications of the revised theory for measurement and research, and its application in practice. A detailed exemplar describes how it guided the design of a multifaceted intervention to encourage successful breastfeeding.