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

The effect of nurse support and social support on fatigue experienced by mothers whose children are hospitalized

The authors' aim in this study was carried out to determine the effect of social support and nurse support on fatigue experienced by mothers whose children were hospitalized. This is a descriptive, analytical and cross-sectional research study. Our study population consisted of all the mothers (n = 198) who had children hospitalized in the pediatric services of the public and training and research hospitals. Data were collected using a questionnaire, Nurse Parent Support Tool, Multidimensional Scale of Perceived Social Support and Brief Fatigue Inventory. Our finding the mothers accompanying their hospitalized children who received adequate nurse support were found to have less maternal fatigue.

Factors associated with maternal postpartum fatigue: an observationalstudy

OBJECTIVES

To assess the prevalence of postpartum fatigue at 10 days, 1 month and 3 months, and to describe the sociodemographic and clinical characteristics of women with fatigue and the associations with infant characteristics, maternal-infant attachment, and partner and midwifery support.

SETTING

Maternity care in England. Secondary analysis of 2014 National Maternity Survey.

PARTICIPANTS

Participants were a random sample of 10 000 women selected by the Office for National Statistics using birth registration records. Women aged less than 16 years or if their baby had died were excluded. Questionnaires were sent to women at 3 months post partum and asked about well-being and care during pregnancy, labour, birth and post partum. Specifically, women were asked whether they experienced fatigue/severe tiredness at 10 days, 1 month or 3 months post partum. Responses were received from 4578 women (47% response rate).

RESULTS

Decreasing but substantial proportions of women, 38.8%, 27.1% and 11.4%, experienced fatigue/severe tiredness at 10 days, 1 month and 3 months, respectively. These figures varied significantly by maternal age, level of deprivation, education and parity. Women reporting depression, anxiety, sleep problems and those breast feeding were at significantly increased risk (eg, OR for depression in women with fatigue at 3 months: 2.99 (95% CI 2.13 to 4.21)). Significantly more negative language was used by these women to describe their babies, and they perceived their baby as more difficult than average (eg, two or more negative adjectives used by women with fatigue at 3 months: OR 1.86 (95% CI 1.36 to 2.54)). Women with postpartum fatigue had greater partner support but were significantly less likely to report seeing the midwife as much as they wanted.

CONCLUSIONS

Postpartum fatigue is not inevitable or universal, although early in the postnatal period it affects a substantial proportion of women. Predictors include age and parity, but practical help and support from partners and midwives may be protective factors.

Postpartum fatigue and depression: A systematic review and meta-analysis

BACKGROUND

New parents are vulnerable to fatigue and depressive symptoms. Many studies have reported significant positive correlations between the two in postpartum parents, but the size of correlations varies considerably between studies. The relationship between postpartum fatigue and depression is yet to be systematically synthesized and meta-analyzed.

METHODS

A PROSPERO registered systematic review and meta-analysis (CRD42017065240) was conducted on the correlation between fatigue and depression within the first two years postpartum in parents. Moderation analysis was used to examine the influence of demographic and measurement factors on the effect sizes.

RESULTS

Thirty-five eligible papers were identified (34 on mothers, 1 on fathers). The meta-analytic summary effect size for simultaneously measured fatigue and depressive symptoms among women in the postpartum period was r = 0.52, 95% CI [0.45, 0.59], p < .001. There was a high degree of heterogeneity in the strength of the correlation between studies. This heterogeneity was not accounted for by demographic (e.g., infant age, maternal age, population type) or methodology (e.g., measurement) related moderators.

LIMITATIONS

Studies not reporting or providing correlation between fatigue and depression were not included. Unable to assess some moderators due to limited sample size.

CONCLUSIONS

There is a strong correlation between fatigue and depressive symptoms among women in the first two years after child-birth, but a high degree of heterogeneity in correlation strength exists between studies. Careful assessment of both fatigue and depression when either symptom is reported could facilitate accurate differential diagnosis and prioritizing treatment in postpartum women. Further implications for assessment, treatment, and future research are discussed.

Evaluation of Technology-Based Peer Support Intervention Program for Preventing Postnatal Depression: Protocol for a Randomized Controlled Trial

BACKGROUND

Multiple international agencies, including the World Health Organization and the International Monetary Fund, have emphasized the importance of maternal mental health for optimal child health and development. Adequate social support is vital for the most vulnerable to postpartum mood disorders. Hence, an urgent need for sustainable social support programs to aid mothers ease into their new parenting role exists.

OBJECTIVE

This study protocol aims to examine the effectiveness of a technology-based peer support intervention program among mothers at risk for postnatal depression in the early postpartum period.

METHODS

A randomized controlled 2-group pretest and repeated posttest experimental design will be used. The study will recruit 118 mothers from the postnatal wards of a tertiary public hospital in Singapore. Eligible mothers will be randomly allocated to receive either the peer support intervention program or routine perinatal care from the hospital. Peer volunteers will be mothers who have experienced self-reported depression and will be receiving face-to-face training to support new mothers at risk of depression. Outcome measures include postnatal depression, anxiety, loneliness, and social support. Data will be collected at immediate postnatal period (day of discharge from the hospital), at fourth week and twelfth week post childbirth.

RESULTS

The recruitment and training of peer support volunteers (N=20) ended in June 2017, whereas recruitment of study participants commenced in July 2017 and is still ongoing. The current recruitment for new mothers stands at 73, with 36 in the control group and 37 in the intervention group. Data collection is projected to be completed by May 2018.

CONCLUSIONS

This study will identify a potentially effective and clinically useful method to prevent postnatal depression in new mothers, which is the top cause of maternal morbidity. Receiving social support from others who share similar experiences may enhance the positive parenting experiences of mothers, which in turn can improve the psychosocial well-being of the mothers, tighten mother-child bond, and enhance overall family dynamics for mothers and infants.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number ISRCTN14864807; http://www.isrctn.com/ISRCTN14864807 (Archived by WebCite at http://www.webcitation.org/6xtBNvBTX).

A Postpartum Sleep and Fatigue Intervention Feasibility Pilot Study

The purpose of this pilot study was to evaluate the feasibility, acceptability, and cost of a self-management intervention for postpartum fatigue and sleep in socioeconomically disadvantaged urban women. Helping U Get Sleep (HUGS) is a theory-guided intervention developed from the Individual and Family Self-Management Theory. Medicaid-enrolled participants in the United States were recruited from an inpatient postpartum unit. Treatment and attention control interventions were delivered (15 HUGS, 12 comparison) at a week 3 postpartum home visit and 4 follow-up phone calls. Over the 9-week protocol, the HUGS group demonstrated significant improvements in subjective fatigue and subjective sleep disturbance relative to the comparison group. The HUGS intervention was feasible and acceptable, delivered on average, in 100 min and costing US$79 per participant.

Design and development of a stepped-care behavioral intervention to support parents of young children newly diagnosed with type 1 diabetes

One of the most common chronic conditions of childhood, the prevalence of type 1 diabetes (T1D) in young children is increasing. Early childhood development complicates optimal T1D management and glycemic outcomes. Parents are at risk for elevated psychological distress, especially immediately following diagnosis. Few empirically supported interventions are available to support parents and promote optimal T1D management during this vulnerable period. This paper reports on the development and study design of First STEPS: Study of Type 1 in Early childhood and Parenting Support. The aim of this trial is to evaluate the efficacy of a stepped care behavioral intervention for parents of young children over the first year following a new T1D diagnosis. The stepped care design provides participants with up to three intensity levels, or steps, of clinical behavioral intervention support based on need, compared to usual care. Intervention steps include peer parent coaching, telephone-based behavioral support, personalized psychological assessment and recommendations, and intensive assessment of T1D glycemic management with recommendations. Primary outcomes include children's glycemic control and parents' psychosocial functioning. Secondary outcomes include children's behavioral and psychosocial functioning. Exploratory analyses will evaluate demographic, disease-specific, and psychosocial factors related to progression in and response to each step of the intervention.

"I didn't know it was possible to feel that tired": exploring the complex bidirectional associations between maternal depressive symptoms and fatigue in a prospective pregnancy cohort study

Depressive and fatigue symptoms are common health concerns for women in the postnatal period. Few studies have sought to investigate the role of fatigue in the development and maintenance of depressive symptoms. The aim of this paper was to examine the relationship between depressive symptoms and fatigue over the course of the first 4 years postpartum, in particular focusing on the extent to which fatigue at earlier time points predicted later depressive symptoms and vice versa. Data from over 1000 women participating in a longitudinal study of Australian women's physical and psychological health and recovery after childbirth were used. An autoregressive cross-lagged panel model was tested to assess the mutual influences of fatigue and depressive symptoms across five time points at 3, 6, 12 and 18 months postpartum, and at 4 years postpartum. A complex bidirectional relationship between fatigue and depressive symptoms from 3 months to 4 years postpartum was observed, where fatigue at earlier time points predicted depressive symptoms at later time points, and vice versa. The findings of this study suggest interventions targeting the prevention and management of fatigue may also confer some benefit in improving or preventing the development of depression symptoms in the early parenting period.

Association of Parenting Stresses, Maternal Role Adjustment, and Types of Feeding during Hospital Stays at Birth to Breastfeeding Adaptation

PURPOSE

This study was to explore association of maternal role adjustments, parenting stresses, and demographic factors to breastfeeding adaptation.

METHODS

A correlational survey design was used to recruit 183 mothers who breastfeed or breastfed their babies. Participants' visited outpatient departments and were admitted to pediatric ward at 2 hospitals in metropolitan city of Korea. Inclusion criteria for subjects were mothers whose babies were from 1 month to 24 months old. Data were collected using a self-report questionnaire for mothers' and babies' demographic variables, maternal role adjustments, parenting stresses, and maternal breastfeeding adaptations.

RESULTS

Higher levels of maternal adaptations and low levels of parenting stresses were associated with greater maternal breastfeeding adaptations. Types of feeding during hospital stays and baby's health status at birth were also associated with maternal breastfeeding adaptation.

CONCLUSION

Results showed that a higher level of mothers' adjustment to breastfeeding; indicated lesser parenting stresses with higher levels of maternal adaptation. Nursing interventions for breastfeeding should be applied for appropriate breastfeeding adaptation during mothers' hospital stay. As baby's poor health status at birth medical team should provide a proper breastfeeding education.

Recommendations for peer-to-peer support for NICU parents

Peer-to-peer support provided by 'veteran' neonatal intensive care unit (NICU) parents to those with current NICU babies is a legitimate and unique form of support that can complement or supplement, but not replace, services provided by professional NICU staff. Peer support can be delivered through hospital- or community-based programs that offer one-to-one in-person or telephone matches, or support groups that meet in-person or via the Internet. Issues in program development, volunteer training and program operation are discussed. Recommendations for offering peer support to all NICU parents as an integral component of family-centered care and comprehensive family support are presented.

The relationship between parental fatigue, parenting self-efficacy and behaviour: implications for supporting parents in the early parenting period

BACKGROUND

Emerging evidence indicates that parental fatigue is associated with low warmth and increased hostility in parent-child interactions. One possible pathway by which fatigue may impact on parenting behaviour is via parental self-efficacy (PSE), whereby high fatigue may undermine PSE, which is often associated with suboptimal parenting behaviour. The current study sought to explore a model of the relationships between parental fatigue, parenting warmth and hostility, where PSE mediates these relationships and whether the nature of these relationships differ by social or family context.

METHODS

The current sample was drawn from a larger Australian community sample survey on parent well-being and parenting. It consisted of 1143 parents (mothers, n = 1003; fathers, n = 140) of children aged 0-4 years.

RESULTS

Path analysis revealed that the relationship between fatigue and parenting warmth and hostility was fully mediated by PSE.

CONCLUSIONS

These results indicate that fatigue has the potential to negatively influence parenting behaviours that are important for their children's well-being and development, and that fatigue plays a mediating role in this relationship. Implications of the study for psycho-education and interventions targeting the management of parental fatigue are discussed.

Translating research-based knowledge about infant sleep into practice

PURPOSE

Review infant sleep research with a focus on understanding the elements related to infant safety and infant and maternal well-being during nighttime care.

DATA SOURCES

This review summarizes current research and addresses the controversies and conflicting outcomes reported in infant nighttime care. This review addresses current literature on infant sleep patterns, as well as factors that influence infant sleep and are consequences of different care routines. Conversation points are provided to help nurse practitioners (NPs) address safety and practice concerns.

CONCLUSIONS

Shared information can help parents provide a safe and healthy environment for infants and help to facilitate communication ties between the healthcare providers and the families.

IMPLICATIONS FOR PRACTICE

NPs need to help parents understand infant sleep patterns norms, what is current knowledge about infant nightwakings and parental presence, as well as about approaches to altering infant sleep patterns. Integrating this knowledge with parent preferences that are influenced by cultural practices and individual differences is crucial in helping parents develop a strong sense of competence and comfort with their choices and behaviors.

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.

The effect of telephone-based interpersonal psychotherapy for the treatment of postpartum depression: study protocol for a randomized controlled trial

BACKGROUND

Substantial data indicate potential health consequences of untreated postpartum depression (PPD) on the mother, infant, and family. Studies have evaluated interpersonal psychotherapy (IPT) as treatment for PPD; however, the results are questionable due to methodological limitations. A comprehensive review of maternal treatment preferences suggests that mothers favor 'talking therapy' as a form of PPD treatment. Unfortunately, IPT is not widely available, especially in rural and remote areas. To improve access to care, telepsychiatry has been introduced, including the provision of therapy via the telephone.

METHODS/DESIGN

The purpose of this randomized controlled trial is to evaluate the effect of telephone-based IPT on the treatment of PPD. Stratification is based on self-reported history of depression and province. The target sample is 240 women. Currently, women from across Canada between 2 and 24 weeks postpartum are able to either self-identify as depressed and refer themselves to the trial or they may be referred by a health professional based on a score >12 on the Edinburgh Postnatal Depression Scale (EPDS). Following contact by the trial coordinator, a detailed study explanation is provided. Women who fulfill the eligibility criteria (including a positive diagnostic assessment for major depression) and consent to participate are randomized to either the control group (standard postpartum care) or intervention group (standard postpartum care plus 12 telephone-based IPT sessions within 12 to 16 weeks, provided by trained nurses). Blinded research nurses telephone participants at 12, 24, and 36 weeks post-randomization to assess for PPD and other outcomes including depressive symptomatology, anxiety, couple adjustment, attachment, and health service utilization. Results from this ongoing trial will: (1) develop the body of knowledge concerning the effect of telephone-based IPT as a treatment option for PPD; (2) advance our understanding of training nurses to deliver IPT; (3) provide an economic evaluation of an IPT intervention; (4) investigate the utility of the EPDS in general clinical practice to identify depressed mothers; and (5) present valuable information regarding PPD, along with associated couple adjustment, co-morbid anxiety and self-reported attachment among a mixed rural and urban Canadian population.

TRIAL REGISTRATION

Current Controlled Trials Ltd. ISRCTN88987377.

Evaluation of the clinical effect of an on-line course for community nurses on post-partum emotional distress: a community-based longitudinal time-series quasi-experiment

About 14% of Icelandic women suffer post-partum from frequent depressive symptoms, and of those, 12% also report a high degree of parenting stress. Education of nurses and midwives on post-partum distress is crucial in reducing its degree. The purpose of the study is to evaluate the clinical effect of an on-line course for community nurses on post-partum emotional distress. A community-based, longitudinal, time-series quasi-experiment was conducted in four stages from 2001 to 2005. Mothers attending 16 health centres throughout Iceland and scoring ≥ 12 on the Edinburgh Postnatal Depression Scale (EPDS) at the 9th week post-partum were eligible to participate. Health centres were divided into experimental (EHC) and control centres (CHC), and control centres were crossed over to experimental centres the following year and new control centres recruited. Nurses at EHC attended an on-line course on post-partum emotional distress. Participating mothers answered the EPDS; the Parenting Stress Index/Short form and the Fatigue Scale. Nursing diagnoses and interventions were recorded at all study centres. Of the women who were eligible (n = 163), 57% (n = 93) participated. At baseline, 9 weeks post-partum, there were no significant differences between groups of women in the rate of depressive symptoms, fatigue or parenting stress. Women in all groups improved on all distress indicators over time; however, those from the EHC improved statistically and clinically significantly more on depressive symptoms than those from the CHC. Documentation of particular nursing diagnoses and interventions was significantly more frequent at the EHC, but referrals to specialists were significantly less frequent. On-line education for nurses on post-partum emotional distress is feasible and is related to improvement in post-partum depressive symptoms.

Maternal distress: a concept analysis

AIM

This paper is a report of an analysis of the concept of maternal distress.

BACKGROUND

Although not well-developed, the concept of maternal distress has offered an important viewpoint in nursing and midwifery practice since the mid-1990s. Traditionally, understanding of maternal distress has been based on the medical model and dysfunction. The concept of maternal distress needs development so that it describes responses ranging from normal stress responses to those indicating mental health problem/s.

DATA SOURCES

The SCOPUS, CINAHL and Medline databases were searched for the period from 1995 to 2009 using the keywords 'psychological distress', 'emotional distress' and 'maternal distress'.

REVIEW METHODS

Steps from Rodgers' evolutionary concept analysis guided the conduct of this concept analysis.

RESULTS

Four attributes of maternal distress were identified as responses to the transition to motherhood, with the level of each response occurring along a continuum: stress, adapting, functioning and control, and connecting. Antecedents to maternal distress include becoming a mother, role changes, body changes and functioning, increased demands and challenges, losses and gains, birth experiences, and changes to relationships and social context. The consequences of maternal distress are compromised mental health status, maternal role development, quality of life, ability to function, quality of relationships and social engagement. The extent of the impact depends on the level of maternal distress.

CONCLUSION

Clearer interpretation of maternal distress offers a comprehensive approach to understanding maternal emotional health during the transition to motherhood. Acknowledging women's experiences and providing more appropriate support could alleviate some of the struggles and hardships experienced by mothers.

Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial

OBJECTIVE

To evaluate the effectiveness of telephone based peer support in the prevention of postnatal depression.

DESIGN

Multisite randomised controlled trial.

SETTING

Seven health regions across Ontario, Canada.

PARTICIPANTS

701 women in the first two weeks postpartum identified as high risk for postnatal depression with the Edinburgh postnatal depression scale and randomised with an internet based randomisation service.

INTERVENTION

Proactive individualised telephone based peer (mother to mother) support, initiated within 48-72 hours of randomisation, provided by a volunteer recruited from the community who had previously experienced and recovered from self reported postnatal depression and attended a four hour training session.

MAIN OUTCOME MEASURES

Edinburgh postnatal depression scale, structured clinical interview-depression, state-trait anxiety inventory, UCLA loneliness scale, and use of health services.

RESULTS

After web based screening of 21 470 women, 701 (72%) eligible mothers were recruited. A blinded research nurse followed up more than 85% by telephone, including 613 at 12 weeks and 600 at 24 weeks postpartum. At 12 weeks, 14% (40/297) of women in the intervention group and 25% (78/315) in the control group had an Edinburgh postnatal depression scale score >12 (chi(2)=12.5, P<0.001; number need to treat 8.8, 95% confidence interval 5.9 to 19.6; relative risk reduction 0.46, 95% confidence interval 0.24 to 0.62). There was a positive trend in favour of the intervention group for maternal anxiety but not loneliness or use of health services. For ethical reasons, participants identified with clinical depression at 12 weeks were referred for treatment, resulting in no differences between groups at 24 weeks. Of the 221 women in the intervention group who received and evaluated their experience of peer support, over 80% were satisfied and would recommend this support to a friend.

CONCLUSION

Telephone based peer support can be effective in preventing postnatal depression among women at high risk.

TRIAL REGISTRATION

ISRCTN 68337727.

The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures

Fatigue is a common symptom associated with a wide range of chronic diseases. A large number of instruments have been developed to measure fatigue. An assessment regarding the reliability, validity, and utility of fatigue measures is time-consuming for the clinician and researcher, and few reviews exist on which to draw such information. The aim of this article is to present a critical review of fatigue measures, the populations in which the scales have been used, and the extent to which the psychometric properties of each instrument have been evaluated to provide clinicians and researchers with information on which to base decisions. Seven databases were searched for all articles that measured fatigue and offered an insight into the psychometric properties of the scales used over the period 1980-2007. Criteria for judging the "ideal" measure were developed to encompass scale usability, clinical/research utility, and the robustness of psychometric properties. Twenty-two fatigue measures met the inclusion criteria and were evaluated. A further 17 measures met some of the criteria, but have not been tested beyond initial development, and are reviewed briefly at the end of the article. The review did not identify any instrument that met all the criteria of an ideal instrument. However, a small number of short instruments demonstrated good psychometric properties (Fatigue Severity Scale [FSS], Fatigue Impact Scale [FIS], and Brief Fatigue Inventory [BFI]), and three comprehensive instruments demonstrated the same (Fatigue Symptom Inventory [FSI], Multidimensional Assessment of Fatigue [MAF], and Multidimensional Fatigue Symptom Inventory [MFSI]). Only four measures (BFI, FSS, FSI, and MAF) demonstrated the ability to detect change over time. The clinician and researcher also should consider the populations in which the scale has been used previously to assess its validity with their own patient group, and assess the content of a scale to ensure that the key qualitative aspects of fatigue of the population of interest are covered.

Effects of maternal depressive symptoms and infant gender on the interactions between mothers and their medically at-risk infants

OBJECTIVE

To examine the effects of maternal depressive symptoms and infant gender on interactions between mothers and medically at-risk infants.

DESIGN

Longitudinal, descriptive secondary analysis.

SETTING

Neonatal intensive care unit, intermediate care unit, and infectious disease clinic of the tertiary medical centers in the Southeast and East.

PARTICIPANTS

One hundred and eight preterm infants and their mothers, 67 medically fragile infants and their mothers, and 83 infants seropositive for HIV and their primary caregivers were studied in their homes between 6 and 24 months.

MAIN OUTCOME MEASURES

Observation and the Home Observation for Measurement of the Environment Inventory were used to assess the interactions of mothers and their medically at-risk infants. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale.

RESULTS

The level of depressive symptoms did not differ between the mothers of boys and mothers of girls in the three groups. Mothers of medically fragile infants had higher levels of depressive symptoms than mothers of preterm infants at 6 months corrected age and similar levels of depressive symptoms as HIV-positive mothers at 12 months. Mothers of medically fragile infants with elevated depressive symptoms were less attentive and more restrictive to their infants. HIV-positive mothers with elevated depressive symptoms were less attentive to their infants. The effects of gender on mother-infant interactions were not moderated by maternal depressive symptoms.

CONCLUSION

Maternal depressive symptoms had a somewhat negative effect on the interactions of mothers and medically at-risk infants.

Evaluation of a web-based course for community nurses on postpartum emotional distress

The purpose of this multicentre and quasi-experimental study is to evaluate the effect of a web-based course for community nurses in Iceland with regard to outcome of postpartum emotional distress. A sample of six community health centres was selected and equally divided into an experimental and a control group. All nurses at the experimental centres attended a web-based course focusing on evidence-based interventions for postpartum emotional distress. All new mothers were screened 9 weeks postpartum using the Edinburgh Postpartum Depression Scale (EPDS). If they scored 12 points or more they were eligible for the study. Mothers answered the EPDS at three different points in time, (9, 15 and 24 weeks postpartum) and the Parent Stress Index: Short Form (PSI/SF) at two times (9 and 15 weeks). Results showed no significant difference in the rate of depressive symptoms between study centres at 9 weeks. At 15 and 24 weeks there was, however, a significant difference between mothers at the experimental and control centres. Nurses at the experimental centres documented significantly more evidence-based interventions than did nurses at the control centres, and they had more frequent contact with new mothers suffering from postpartum emotional distress. There was no significant variation in PSI scores between the groups at any time. More women at the experimental centres were on antidepressants compared to the control centres. Of the total of 32 women eligible for the study, 10 declined participation. The findings are limited by small sample size and a probable confounding effect of antidepressants with the nursing interventions. Findings indicate that the web-based transfer of knowledge to nurses on evidence-based interventions for postpartum emotional distress has a positive effect on distressed women in the postpartum period and warrants further study.

Telecare for women with postpartum depression

Data were collected to pilot test the feasibility and effects of telecare as an intervention for depression in a small group of mothers with postpartum depression. Treatment involved a 10-week telecare therapy consisting of three related aspects: cognitive-behavioral therapy, relaxation techniques, and problem-solving strategies. Beck Depression Inventory II scores were significantly lower after telecare treatment. Women identified psycho-education as the greatest help to them.

Changes in sleep problems, parents distress and impact of sleep problems from infancy to preschool age for referred and unreferred children

This article compares and describes changes in sleep problems in 3- to 5-year-old Icelandic children referred and unreferred for sleep problems in infancy and explores changes in parents' distress and the impact of children's sleep problems on families over time. The sample consisted of a clinical group (n = 31) that had been referred to a sleep-disorder clinic in infancy, and a comparative group (n = 150) of age-matched unreferred community children. Self-report scales assessed infant/child sleep pattern, the impact of the sleep problem on family life and parents' distress. Results showed that about half the children in the community group have had a sleep problem in infancy. Nightwakings improved in both the referred and unreferred group over time but remained more frequent in the unreferred group. The referred group had significantly more settling problems in infancy than the other group but settling improved markedly over time. Parents of referred children were more fatigued compared with others despite improvement of children's sleep problems over time. Mothers of referred children were however, less likely to perceive the sleep problem as troublesome for family life than the others. It is concluded that parents of referred children are more fatigued than parents of unreferred children and nightwakings are more likely to persist in children who had sleep problems in infancy than in those with no such problems.

Evaluating a family-centred intervention for infant sleep problems

AIM

This paper reports a study to describe changes in parents' distress after a family-centred intervention for sleep problems of infants.

BACKGROUND

Infant sleep problems are common and are related to depressive symptoms in mothers, but their impact on fathers has rarely been studied. Because childhood sleep problems and parental distress are associated, their interdependence should be recognized in research and in paediatric sleep practice.

METHODS

All children hospitalized for sleep problems in a hospital in Iceland in 1997-1998 and their parents were studied using a pre- and post-test quasi-experimental design. The sample consisted of 33 infants (6-23 months of age), 33 mothers and 30 fathers. Parents' distress was assessed before and after treatment with regard to: (1) fatigue and resulting symptom distress; (2) parenting stress; (3) state-anxiety; and (4) depressive symptoms. Infants were treated for a variety of sleep problems by a paediatric nurse. The parents were simultaneously treated for distress by either the paediatric nurse or a specialist, depending on the nature of their problems.

RESULTS

Mothers and fathers experienced a high degree of distress before the intervention, with no significant difference between them. Two months after the intervention both parents' distress had significantly improved. Parents' degree of distress was at a psychopathological level before the intervention but was reduced to population norms 2 months after the intervention. The paediatric nurse intervention was sufficient to reduce distress for 83% of parents.

CONCLUSIONS

Health care professionals who care for infants with sleep problems should pay attention to the distressed responses of parents and support their recovery. An intervention such as that described here could be used by nurses for this purpose.

A population-based study of exclusive breastfeeding in Icelandic women: is there a relationship with depressive symptoms and parenting stress?

This study investigated whether postpartum depressive symptoms and parenting stress are related to exclusive breastfeeding in mothers at 2-3 months postpartum. Data were collected from 734 Icelandic mothers postpartum. Parenting stress, depressive symptoms, feeding methods and demographical data were assessed by self-administered questionnaires. A high level of maternal education increased the likelihood of exclusive breastfeeding whereas lower maternal education, high levels of depressive symptoms, twins and single motherhood reduced the likelihood of exclusive breastfeeding. It is concluded that depressive symptoms are related to lower levels of exclusive breastfeeding and that exclusive breastfeeding becomes more likely with higher level of maternal education.

Systematic review of the literature on postpartum care: methodology and literature search results

BACKGROUND

The postpartum period is a time for multiple clinical interventions. To date, no critical review of these interventions exists. This systematic review examined evidence for the effectiveness of postpartum interventions that have been reported in the literature.

METHODS

MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women that were conducted in North America, Europe, Australia, or New Zealand. The initial literature search was done in 1999, using postpartum content search terms, and was enhanced in 2003. In both years, bibliographic databases were searched from their inception. Studies were categorized into key topic areas. Data extraction forms were developed and completed for each study, and the quality of each study was systematically reviewed. Groups of studies in a topic area were reviewed together, and clinically relevant questions emanating from the studies were identified to determine whether the studies, alone or together, provided evidence to support the clinical intervention.

RESULTS

In the 1999 search, of 671 studies identified, 140 studies were randomized controlled trials that met the selection criteria: 41 studies related to breastfeeding, 33 to postpartum perineal pain management, and 63 to 11 other key topic areas (Papanicolaou test, rubella immunization, contraception, postpartum support, early discharge, postpartum depression and anxiety, postpartum medical disorders, smoking cessation, nutrition supplements other than breastfeeding, effects of pelvic floor exercise, and effects of early newborn contact). The results of the systematic review of each topic will be summarized in separate papers as they are completed.

CONCLUSIONS

This systematic search has identified key topic areas in postpartum care for which randomized controlled trials have been conducted. Our ultimate goal is to provide evidence-based guidelines on the use of routine postpartum interventions.

A brief screening questionnaire for infant sleep problems: validation and findings for an Internet sample

OBJECTIVE

To develop and validate (using subjective and objective methods) a brief infant sleep questionnaire (BISQ) that would be appropriate for screening in pediatric settings.

DESIGN

Two studies were performed to assess the properties of the BISQ. Study I compared BISQ measures with sleep diary measures and objective actigraphic sleep measures for clinical (N = 43) and control (N = 57) groups of infants (5-29 months of age). The second study was based on an Internet survey of 1028 respondents who completed the BISQ posted on an infant sleep web site.

RESULTS

In study I, BISQ measures were found to be correlated significantly with sleep measures derived from actigraphy and sleep diaries. BISQ measures (number of night wakings and nocturnal sleep duration) were the best predictors for distinguishing between clinical and control samples. High test-retest correlations (r >.82) were demonstrated for BISQ measures for a subsample of 26 infants. Study II provided a developmental perspective on BISQ measures. The study demonstrated that BISQ measures derived from a large Internet survey provided developmental and sleep ecology-related findings that corresponded to the existing literature findings on sleep patterns in early childhood.

CONCLUSIONS

The findings provide psychometric, clinical, and ecologic support for the use of the BISQ as a brief infant sleep screening tool for clinical and research purposes. Potential clinical cutoff scores are provided.

The socio-economic impact of telehealth: a systematic review

We reviewed the socio-economic impact of telehealth, focusing on nine main areas: paediatrics, geriatrics, First Nations (i.e. indigenous peoples), home care, mental health, radiology, renal dialysis, rural/remote health services and rehabilitation. A systematic search led to the identification of 4646 citations or abstracts; from these, 306 sources were analysed. A central finding was that telehealth studies to date have not used socio-economic indicators consistently. However, specific telehealth applications have been shown to offer significant socio-economic benefit, to patients and families, health-care providers and the health-care system. The main benefits identified were: increased access to health services, cost-effectiveness, enhanced educational opportunities, improved health outcomes, better quality of care, better quality of life and enhanced social support. Although the review found a number of areas of socio-economic benefit, there is the continuing problem of limited generalizability.

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.

Tiredness and fatigue in the postnatal period

AIMS OF THE PAPER

This paper aims to analyse critically a selective review of the literature on tiredness and fatigue in health and illness. This analysis is then applied to the experience of the new mother in the postnatal period.

BACKGROUND AND RATIONALE

Although the twin concepts of tiredness and fatigue are well known in both sickness and health, our understanding of them is less complete. This paradox of familiarity and lack of understanding applies particularly to the postnatal period.

METHOD

A literature search was undertaken using MEDLINE, CINAHL and Web of Science. The search terms 'tiredness', 'fatigue' and 'post natal' were used.

FINDINGS

This search of the literature produced a small number of articles. Few of these, however, addressed the problem of tiredness or fatigue in the postnatal period, suggesting that this problem needs more research attention.

CONCLUSIONS

On the basis of this analysis, it is suggested that childbirth education could be extended to foster more realistic expectations and more effective coping skills to facilitate women's adjustment to motherhood. The possibility of midwives educating mothers about the need to access, recruit and delegate some household activities to willing helpers is addressed. We propose that midwives can help women to have more realistic expectations about life after the birth, by providing advice and legitimizing the need for support and the use of coping mechanisms to assist the transition to motherhood.

Severe postpartum distress in Icelandic mothers with difficult infants: a follow-up study on their health care

This article describes help seeking and health care of mothers with a difficult infant who suffered long-term depressive symptoms and a high degree of parenting stress. A subsample of severely distressed mothers (n = 37) was recruited from a cross-sectional national survey and followed up 2 months later by a semi-structured telephone interview. The survey included all Icelandic women who gave birth during a quarter of a year and had a live baby 2 months later (n = 1053). All distressed mothers with a difficult infant were selected from sample respondents on preset scores of two self-report distress measures. The study sample emerged during the selection process for an intervention study from which it was excluded on grounds of very high distress scores. Results showed that 5% of the surveyed population were postpartum severely distressed. Findings from this follow-up study revealed that only one woman of four received health care for severe distress by various professionals. One woman of six received help from others. Very few women utilized the services available at Health Care Centers. About half of the women held attitudes that hindered them in seeking help and health care. It is concluded that postpartum severely distressed women receive little primary health care for mental health problems and the majority of them show little initiative to seek out for help. More active outreach by health professionals is recommended.