Pre-term delivery, optimism and initial personal growth as predictors of mothers' long-term personal growth

Postpartum acute stress disorder symptoms, social support, and quality of couple's relationship associations with childbirth PTSD

Background

We aimed to examine the hypothesized negative associations between childbirth post-traumatic stress disorder (PTSD) symptoms (using the two-factor model of birth-related and general symptoms), social support, and a couple's relationship quality at 8-12 weeks postpartum. This analysis considered the longitudinal positive shared variance with acute stress disorder (ASD) symptoms measured shortly after birth, while accounting for obstetric and demographic variables.

Methods

Participants included 246 mothers who gave birth at the maternity ward of a tertiary healthcare center. Self-report questionnaires were used 1-4 days postpartum (T1): Demographic information, the Birth Satisfaction Scale-Revised (BSS-R), and the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS). At T2 (8-12 weeks postpartum), the Multidimensional Scale of Perceived Social Support (MSPSS), the Dyadic Adjustment Scale (DAS-7), and the City Birth Trauma Scale (BiTS).

Results

In partial support of our hypotheses, three hierarchical regression analyses revealed a significant positive contribution of ASD symptoms to childbirth PTSD general symptoms (β = .33, p <.001) and the total score (β = .29, p <.001), but not to birth-related symptoms. Social support (β = -.21, p = .003) and the quality of the couple's relationship (β=-.20, p = .003) showed negative associations with the BiTS general symptoms.

Conclusion

Our study enhances understanding of the shared variance between childbirth ASD and PTSD, supporting the factor structure of general and birth-related symptoms as different aspects of childbirth PTSD and highlighting the negative association of social support and the quality of a couple's relationship with PTSD general symptoms, suggesting potential avenues for targeted interventions.

The experience of mothering a preterm: a prolonged crisis with the potential for personal growth

OBJECTIVE AND BACKGROUND

The nine months of pregnancy allow mothers to plan for the birth of their child practically and emotionally. A very preterm birth, which is generally unexpected and requires the infant's stay in the Neonatal Intensive Care Unit (NICU), is perceived as a crisis by most mothers. This study sought to investigate the significance for the mother of the combined experience of a very preterm birth and the infant's stay in the NICU two-three years after the birth.

METHODS

Using qualitative methodology, semi-structured in-depth interviews were conducted with 13 mothers (age 26-44) whose infants were born at 24-32 weeks. The analysis adopted the approach of multi-level listening to the diverse voices of the interviewees.

RESULTS

Four core themes emerged: negative feelings about the preterm birth; the NICU experience as a crisis; long-term effects of the very preterm birth and NICU experience; personal growth following the preterm birth and NICU.

DISCUSSION

In view of the findings, we discuss the meaning of the circumstances surrounding preterm birth on motherhood, and offer recommendations for practitioners.

Resilience, optimism and posttraumatic growth in first-time mothers

This study examines the association between posttraumatic growth (PTG) and two psychological attributes, resilience and optimism, in first-time mothers, after controlling for demographic and motherhood-related characteristics. PTG, the self-examination triggered by life-changing events, contains five factors: (1) relating to others, (2) new possibilities, (3) personal strength, (4) spiritual change, and (5) appreciation of life. Outcomes from studies conflict on whether PTG is associated with the two psychological attributes of resilience (the ability to resume one's life after adversity) and optimism (viewing life in a positive light). This study used a cross-sectional design. A convenience sample of first-time mothers whose infants were between 3 months and 1 year (N = 415) completed questionnaires containing several standardized and reliable instruments including those measuring the independent variables of resilience and optimism, and the dependent variable of PTG. A STROBE checklist guided the reporting of this study. Resilience was associated with overall PTG and four of its five factors. Optimism also was associated with overall PTG but only associated with two of its five factors. PTG profiles and squared semipartial correlations indicated that resilience had the stronger association, compared to optimism, with PTG and most of its factors. Our study's findings on the strong link between resilience and PTG suggest the need for research examining the impact of specific psychosocial nursing activities (e.g., providing emotional support; assisting others to identify their own strengths; encouraging the mobilization of one's internal resources; furnishing needed resources and referrals; and supplying health education and information), as these activities may not only promote resilience but also may contribute to PTG.

The personal growth resources of the adult population following the first months of the war in Ukraine

We aimed to determine the peculiarities of personal growth resources among the adult population following the first months of the war in Ukraine. The study, which included 1257 respondents (32.3% male and 67.7% female, aged 18-61+ years), used the Posttraumatic Growth Inventory-Expanded, the Brief Resilience Scale, the Professional Hardiness Questionnaire and the General Self-Efficacy Scale. We found the following descending sequence of expression of the components of personal growth: appreciation of life, spiritual and existential changes, relations to others, new possibilities and personal strengths. Personal resources included resilience, professional commitment, professional control, professional challenge acceptance and self-efficacy, of which the last two were the most important. All indicators of personal growth were significantly higher in women but were more closely related to personal resources in men. Our findings suggest directions interventions should take to promote the Ukrainian adult population's personal growth and prevent negative mental health consequences.

The contribution of adverse childhood experiences to postpartum maternal reflective functioning: A prospective examination of the role of maternal disintegrative responses and personal growth

BACKGROUND

Adverse childhood experiences (ACE) may negatively impact a mother's parental reflective functioning. However, if coping with this difficulty generates personal growth, it may help her to function in a positive reflective manner with her child.

OBJECTIVE

In a two-phase prospective study, we examined a mediation model and a moderated mediation model depicting the contribution of ACE (Phase 1), maternal disintegrative responses (intrusive thoughts and dissociative experiences; Phase 1), and personal growth (Phase 2) to maternal reflective functioning (Phase 2) as expressed in three dimensions: Pre-mentalizing Modes (PM), Certainty about Mental States (CMS), and Interest and Curiosity (IC).

METHOD

Three hundred and eighty-five Israeli women participated in the study 16 weeks after childbirth (Phase 1) and again 6-10 months postpartum (Phase 2).

FINDINGS

The mediation model revealed that maternal dissociative experiences fully mediated the relationship between ACE and PM, and maternal intrusive thoughts fully mediated the relationship between ACE and CMS. However, the moderated mediation model showed that these mediation relationships were dependent on the level of personal growth reported by the mother.

CONCLUSIONS

The findings highlight the vulnerability of mothers with ACE to function in a less reflective manner, as well as the effect of personal growth on their maternal functioning.

Optimism as a mediator of the association between social support and peripartum depression among mothers of neonatal intensive care unit hospitalized preterm infants

The birth of a preterm infant and the hospitalization in a neonatal intensive care unit (NICU) add extra functional and emotional demands to the typical transition to motherhood. Therefore, the prevalence of peripartum depression (PPD) among preterm mothers is especially high. As optimism was found to be a mediator of the association between social support and depression, the current study aimed to test this mediation in the population of NICU mothers. A sample of 128 Israeli mothers of 214 NICU hospitalized infants filled out self-report questionnaires regarding background variables, social support, optimism, and PPD symptoms. As hypothesized, optimism was found to partially mediate the association between social support and PPD symptoms among mother of preterm infants. The higher the perceived social support reported, the higher maternal optimism reported, and in turn, the lower PPD symptoms reported. In accordance with the Transactional Stress Theory, social support and optimism reflect maternal secondary appraisals that impact the way mothers of preterm infants cope with the challenging situation of a preterm birth and NICU hospitalization. Healthcare professionals should encourage preterm mothers' use of social support to increase optimism and reduce the risk of developing PPD.

Maternal psychological growth following childbirth

Although maternal postpartum mental health has been extensively studied, rather little is known regarding the factors that may facilitate psychological growth following childbirth. The present study set forth to examine various pre-birth, birth, and post-birth correlates of overall psychological growth and growth domains in postpartum women, assessed within the first months following childbirth. A sample of 428 women completed self-report measures pertaining to psychological growth, mental health, maternal attachment, and childbirth characteristics. We found that the majority of women reported psychological growth following childbirth, with those experiencing stressors in childbirth reporting the highest levels of appreciation for life. In regression analyses, postpartum factors were significantly associated with overall growth and growth domains, taking into account other factors. The more the childbirth was perceived as central to the mothers' identity and the better the maternal attachment was to the child, the higher levels of growth. Growth was also negatively related to endorsement of childbirth PTSD. Background factors, such as maternal age, education, and prior mental health, were associated with specific growth domains, although the association was small and there was no association with overall growth. Post-birth factors are important in ensuing psychological growth in the first months following birth. Attention to opportunities of growth following childbirth is warranted in clinical care, in particular following traumatic childbirth.

Risk factors for developing posttraumatic stress disorder following childbirth

Women can develop childbirth-related posttraumatic stress disorder (CB-PTSD) in at-term delivery with healthy baby outcome as well as following pre-term delivery and neonatal complications, a potential added stressor. No study compares risk factors of CB-PTSD associated with different infant outcomes. We investigated CB-PTSD risk factors by comparing women with or without neonatal complications. Analysis reveals the importance of antepartum and birth-related risk factors in CB-PTSD above and beyond child outcomes, suggesting childbirth is an independent stressor capable of evoking CB-PTSD.