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

Exploring mothers' perspectives on the early mother-infant relationship to inform midwifery practice: A qualitative study

BACKGROUND

The mother-infant relationship plays a crucial role in individual and community health. The nature of the mother-infant relationship can influence the social and emotional development of the infant, impacting their lifelong health. Midwives are key in providing health promotion for women and babies and are ideally placed to support women during the early development of the mother-infant relationship.

AIMS

This study aimed to explore new mothers' perspectives on developing the early mother-infant relationship to inform midwifery practice.

METHODS

This study is phase one of a mixed-method, exploratory sequential design project. In this phase, 14 women were interviewed within six weeks of birth to explore experiences that influenced the developing relationship with their baby. To support reflection women were provided with a visual prompt activity. These interviews informed the co-design workshops to develop an intervention to support midwives to promote the early mother infant relationship. A research protocol was published prior to undertaking the study, however as this research did not seek to modify or measure any heath related outcomes it was not registered as a clinical trial.

RESULTS

Key themes from the interviews included: making moments that matter; the role of the village; feeling like I'm winning; supportive health professionals, and forming a new family. These themes underpinned strategies to support the mother-infant relationship.

CONCLUSION

The findings from this study offer ways for midwives to support the emerging mother-infant relationship during the early postnatal period. Facilitating mothers to engage with their baby as well as integrating key people is important. Midwives also play a key role in building maternal confidence and competence. Further research is needed to embed and evaluate strategies in midwifery practice.

The role of lack of grandparental support in perinatal depression

BACKGROUND

Low social support has been identified as a risk factor for perinatal mental health problems. However, previous studies mainly focused on partner support or general social support and neglected the roles of grandparents. Here, we examine whether a lack of grandparental support is related to increased risk of a diagnosis of perinatal depression. In addition, we examine whether poor grandparental support is related to more depressive symptoms in mothers with and without previously diagnosed perinatal depression and whether perceived grandparental support buffers against parenting difficulties in mothers with perinatal depression.

METHODS

The sample was drawn from an Australian pregnancy cohort study and consisted of 725 women, including 230 women who met criteria for Major Depression. At 12 months postpartum, women reported on grandparental geographical proximity and hours of grandparental childcare support. Perceived grandparental support was assessed with the Postpartum Social Support Questionnaire and parenting difficulties and depressive symptoms with the Parenting Stress Index and the Edinburgh Postnatal Depression Scale.

RESULTS

Perceived grandparental support was related to fewer depressive symptoms among mothers with perinatal depression. In addition, higher levels of perceived grandparental support were related to lower parenting stress in mothers with and without perinatal depression.

LIMITATIONS

Intergenerational conflicts and quality of grandparenting were not assessed.

CONCLUSIONS

Our findings indicate that supportive grandparents may prevent the development of more severe perinatal depression in mothers experiencing perinatal mental health problems. Future studies should examine whether involving grandparents in treatment may add to the effectiveness of existing perinatal mental health interventions.

Transition to Motherhood: Adverse Childhood Experiences, and Support from Partner, Family and Friends

BACKGROUND

The complex identity changes women have to go through to become mothers makes it a challenging transitional period. Especially, mothers who have experienced childhood adversity (ACEs) may be vulnerable to poor adjustment to motherhood. However, support from a partner, family and friends can act as a buffer to cope with this challenging transitional period. Therefore, the aim was to study whether ACEs and experienced social support (partners, family, and friends) were related to the adjustment to motherhood or 'motherhood constellation' of women after the birth of their first child.

METHOD

Data were collected via an online questionnaire among first-time mothers from June-September 2020. Motherhood constellation was measured with four items based on the descriptions by (Stern, 1995) about the motherhood constellation, i.e. worries about Life/Growth, Emotional Engagement, Support Systems, Identity Organisation. Multiple regression analyses with pairwise deletion were conducted.

RESULTS

ACEs were related to all four themes of motherhood constellation, indicating that the more frequent these adverse experiences occurred in the past the more concerns, both about the child and herself, the mother had. Moreover, after controlling for ACEs and other forms of support, only support from friends was related to the use of support systems and identity organisation. Finally, statistically significant interactions were found between ACES and support from friends with life/growth and between ACES and support from family with identity organisation. These interactions indicated that contrary to the expectation the positive association between mother's ACEs and worries was stronger for mothers who experienced more support.

CONCLUSION

The consequences of ACEs seemed to show up in the transition to motherhood, indicating that interventions targeting first-time mothers should address the motherhood constellation that may arise from earlier adverse life experiences. Moreover, especially support from friends seemed to be associated with less worries among mothers. Social support has no buffering effect for the negative consequences of ACEs on the themes of motherhood constellation. Further research is clearly needed to get more insight into these themes and to understand the meaning of different types of social support during the transition to motherhood.

Postpartum depression and partner support during the period of lactation: Correlation research and its influencing factors

BACKGROUND

Postpartum depression (PPD) not only affects the psychological and physiological aspects of maternal health but can also affect neonatal growth and development. Partners who are in close contact with parturient women play a key role in communication and emotional support. This study explores the PPD support relationship with partners and its influencing factors, which is believed to establish psychological well-being and improve maternal partner support.

AIM

To explore the correlation between PPD and partner support during breastfeeding and its influencing factors.

METHODS

Convenience sampling was used to select lactating women (200 women) who underwent postpartum examinations at the Huzhou Maternity and Child Health Care Hospital from July 2022 to December 2022. A cross-sectional survey was conducted on the basic information (general information questionnaire), depression level [edinburgh postnatal depression scale (EPDS)], and partner support score [dyadic coping inventory (DCI)] of the selected subjects. Pearson's correlation analysis was used to analyze the correlation between PPD and DCI in lactating women. Factors affecting PPD levels during lactation were analyzed using multiple linear regression.

RESULTS

The total average score of EPDS in 200 lactating women was (9.52 ± 1.53), and the total average score of DCI was (115.78 ± 14.90). Dividing the EPDS, the dimension scores were: emotional loss (1.91 ± 0.52), anxiety (3.84 ± 1.05), and depression (3.76 ± 0.96). Each dimension of the DCI was subdivided into: Pressure communication (26.79±6.71), mutual support (39.76 ± 9.63), negative support (24.97 ± 6.68), agent support (6.87 ± 1.92), and joint support (17.39 ± 4.19). Pearson's correlation analysis demonstrated that the total mean score and individual dimension scores of EPDS during breastfeeding were inversely correlated with the total score of partner support, stress communication, mutual support, and co-support (P < 0.05). The total mean score of the EPDS and its dimensions were positively correlated with negative support (P < 0.05). Multiple linear regression analysis showed that the main factors affecting PPD during breastfeeding were marital harmony, newborn health, stress communication, mutual support, negative support, co-support, and the total score of partner support (P < 0.05).

CONCLUSION

PPD during breastfeeding was associated with marital harmony, newborn health, stress communication, mutual support, negative support, joint support, and the total DCI score.

The impact of New Families home visiting program on first-time mothers' quality of life and its association with social support: a non-randomized controlled study

BACKGROUND

The transition to motherhood is characterized by physical, psychological, social, and relational changes. Quality of life (QoL) changes substantially during this transition. Higher QoL is associated with social support, essential for coping with the challenges and changes of becoming a mother. An early universal home visiting program (New Families) is developed to strengthen and support families. The study aims to evaluate the impact of New Families on first-time mothers' QoL and to investigate the association between their QoL, social support, and selected possible predictive factors.

METHODS

A prospective non-randomized controlled study with parallel group design. Child Health Services in five city districts of Oslo were matched in intervention and control groups. First-time mothers were allocated based on the residential area and assessed at pregnancy week 28 (N = 228), six weeks postpartum (N = 184), and three months postpartum (N = 167). Measures of the World Health Organization Quality of Life brief, Perinatal Infant Care Social Support Scale, and background variables were collected from October 2018 to June 2020. Multivariate linear regression models were applied to examine intervention impact and assess associations.

RESULTS

Our data did not reveal a significant association between New Families intervention and the QoL levels of first-time mothers at three months postpartum. Thus, we analyzed the whole sample together. Emotional support was significantly associated with higher QoL levels in the physical health (B = 0.19, 95%CI [0.04 to 0.34]) and social relationships (B = 0.40, 95%CI [0.20 to 0.60]) domains. Appraisal support was significantly associated with higher QoL levels in the psychological (B = 0.34, 95%CI [0.18 to 0.50]) and environment (B = 0.33, 95%CI [0.19 to 0.48]) domains. QoL levels in pregnancy were significantly associated with QoL levels postpartum, showing small to medium effect size (ES = 0.30 to 0.55), depending on the domain.

CONCLUSIONS

Further research, including qualitative interviews, could provide more insights into the impact of New Families on QoL. A positive association between QoL levels in pregnancy and postpartum suggests that postnatal interventions targeting improved QoL could potentially improve postpartum QoL. Emotional and appraisal support seems beneficial for first-time mothers' QoL and could be provided and facilitated by public health nurses.

TRIAL REGISTRATION

clinicaltrial.gov NCT04162626.

How Exposure to Online Parenting Content Relates to Mothers' Self-Discrepancy and Postpartum Mental Health

Postpartum mental health problems are common and have deleterious effects on new mothers and their babies. This study developed a theoretically informed model of the relationship between exposure to images of motherhood in online parenting content and mothers' postpartum mental health. The model was tested using survey data collected from 509 Chinese mothers during their 12-month postpartum period. The results revealed that greater exposure to online public parenting content was indirectly related to lower levels of shame among new mothers via two mediators: the presumed influence of parenting media content on their partners, and the mothers' perceptions of the discrepancy between their actual selves as mothers and their partners' expectations of an ideal mother (i.e. actual/own - ideal/partner self-discrepancy). In contrast, increased exposure to online private parenting content shared by peers was indirectly related to increased levels of shame among new mothers via the mediation of social comparison with parenting media images, and of the mothers' perceptions of the discrepancy between their actual selves as mothers and their own expectations of an ideal mother (i.e. actual/own - ideal/own self-discrepancy). Additionally, new mothers were more likely to experience depressive symptoms and shame if they felt that they fell short of their partners' expectations of an ideal mother. However, increased social support reduced the anxiety and shame that stemmed from this belief.

The effect of spousal support on distress experienced during pregnancy in COVID-19 pandemic: Sample of Türkiye

We conducted this study with 147 volunteer pregnant women to determine the effect of spousal support on the stress experienced during pregnancy during the COVID-19 pandemic period. We determined that the prenatal stress level of the pregnant women was low (15.34 ± 7.07), they were not at risk for distress, and the spousal support level was high (74.58 ± 8.78). We found that the rate of spousal support was 0.897 times higher for women who did not experience distress. Due to the stay-at-home rule during the pandemic, couples had to be together at home, which caused high spousal support, and we found that women's stress levels were lower.

Psychometric properties of the difficulties in emotion regulation Scale in a perinatal sample

BACKGROUND

One in five pregnant and postpartum individuals experience an anxiety, depressive, and/or trauma-related disorder. Emotion dysregulation (ED) underlies the development and maintenance of various mental health disorders. The Difficulties in Emotion Regulation Scale (DERS) is the most comprehensive and commonly used measure of emotion dysregulation, yet limited evidence supports its use in the perinatal population. The present study aims to evaluate the validity of the DERS and its six subscales in a perinatal sample and to assess its predictive utility in identifying perinatal individuals with a disorder characterised by emotion dysregulation.

METHODS

Pregnant and postpartum individuals (N = 237) completed a diagnostic clinical interview and self-report measures of anxiety, depression, and perceived social support.

RESULTS

The DERS subscales demonstrated good internal consistency and construct validity, as it strongly correlated with measures of anxiety and depression and failed to correlate with a measure of perceived social support. Results from an exploratory factor analysis supported a 6-factor solution, suggesting structural validity. An ROC analysis revealed good to excellent discriminative ability for the DERS full scale and four of the subscales. Finally, an optimal clinical cut-off score of 87 or greater was established with a sensitivity of 81% for detecting a current anxiety, depressive, and/or trauma-related disorder.

CONCLUSIONS

This study provides evidence for the validity and clinical utility of the DERS in a treatment-seeking and community sample of pregnant and postpartum individuals.

Grandparental Support and Maternal Postpartum Mental Health : A Review and Meta-Analysis

Support from grandparents plays a role in mothers' perinatal mental health. However, previous research on maternal mental health has mainly focused on influences of partner support or general social support and neglected the roles of grandparents. In this narrative review and meta-analysis, the scientific evidence on the association between grandparental support and maternal perinatal mental health is reviewed. Searches in PubMed, EMBASE, MEDLINE, Scopus, and PsycINFO yielded 11 empirical studies on N = 3381 participants, reporting on 35 effect sizes. A multilevel approach to meta-analysis was applied to test the association between grandparental support and maternal mental health. The results showed a small, statistically significant association (r = .16; 95% CI: 0.09-0.25). A moderator test indicated that the association was stronger for studies reporting on support from the maternal grandmother in particular (r = .23; 95% CI: 0.06-0.29). Our findings suggest that involved grandparents, in particular mother's own mother, constitute a protective factor for the development of maternal postpartum mental health problems. These findings have clear implications for interventions. Future studies should examine whether stimulating high-quality support from grandparents is a fruitful avenue for enhancing maternal postpartum mental health.

Social connectedness as a determinant of mental health: A scoping review

Public health and epidemiologic research have established that social connectedness promotes overall health. Yet there have been no recent reviews of findings from research examining social connectedness as a determinant of mental health. The goal of this review was to evaluate recent longitudinal research probing the effects of social connectedness on depression and anxiety symptoms and diagnoses in the general population. A scoping review was performed of PubMed and PsychInfo databases from January 2015 to December 2021 following PRISMA-ScR guidelines using a defined search strategy. The search yielded 66 unique studies. In research with other than pregnant women, 83% (19 of 23) studies reported that social support benefited symptoms of depression with the remaining 17% (5 of 23) reporting minimal or no evidence that lower levels of social support predict depression at follow-up. In research with pregnant women, 83% (24 of 29 studies) found that low social support increased postpartum depressive symptoms. Among 8 of 9 studies that focused on loneliness, feeling lonely at baseline was related to adverse outcomes at follow-up including higher risks of major depressive disorder, depressive symptom severity, generalized anxiety disorder, and lower levels of physical activity. In 5 of 8 reports, smaller social network size predicted depressive symptoms or disorder at follow-up. In summary, most recent relevant longitudinal studies have demonstrated that social connectedness protects adults in the general population from depressive symptoms and disorders. The results, which were largely consistent across settings, exposure measures, and populations, support efforts to improve clinical detection of high-risk patients, including adults with low social support and elevated loneliness.

Apoyo social percibido por mujeres gestantes de Santa Marta, Colombia: un análisis comparativo

Introducción: El apoyo social percibido durante la gestación es importante para la salud mental perinatal. Sin embargo, poco se conoce sobre estas variables en la población colombiana. Objetivo: Comparar el apoyo social percibido según variables sociodemográficas, ginecobstétricas y afecto positivo en mujeres gestantes de Santa Marta, Colombia. Materiales y métodos: Participaron 40 mujeres entre 19 y 41 años (M=26.48; DE=5.03), que se encontraban en su tercer trimestre de embarazo, beneficiarias de un programa de promoción de la lactancia materna exclusiva. Las participantes diligenciaron una ficha de información sociodemográfica y ginecobstétrica, la Escala Multidimensional de Apoyo Social Percibido (α=0.88) y una subescala de la Escala de Afectos Positivos y Negativos (α=0.82). Se aplicó la prueba U de Mann-Whitney para los análisis estadísticos comparativos y se siguieron los lineamientos éticos en investigación con humanos. Resultados: 67% de las participantes fueron de estrato socioeconómico bajo, 87.5% tenía pareja, 67.5% contaba con estudios superiores, 42.5% tenía trabajo y 47.5% eran madres primerizas. Las mujeres de estrato socioeconómico alto percibieron mayor apoyo social por parte de sus amigos (p=0.01). El apoyo social familiar fue significativamente más alto en las madres primerizas (p=0.01) y en las que reportaron mayor afecto positivo (p=0.03). Por último, el apoyo social por parte de personas significativas fue mayor cuando era el primer embarazo de la mujer (p=0.02). Conclusión: Se encontraron diferencias significativas en algunas dimensiones del apoyo social percibido según el estrato socioeconómico, ser madre primeriza y el afecto positivo. Se recomienda realizar otros estudios con mayor tamaño muestral. Como citar este artículo: Thomas-Hilarión Whitne Dayana, Fuentes-Vanegas Laura Vanessa, Gallo-Barrera Yeison David, Ramos-De la Cruz Ediltrudis. Apoyo social percibido por mujeres gestantes de Santa Marta, Colombia: un análisis comparativo. Revista Cuidarte. 2022;13(3):e2448. http://dx.doi.org/10.15649/cuidarte.2448      

Social support needs of first-time parents in the early-postpartum period: A qualitative study

Background

The early postpartum period is a critical time for first-time parents as they adapt to their new role. Perceived lack of social support is a risk factor for developing mental health problems. Insufficient or inappropriate professional support for both parents has been reported by many studies. Social support that appropriately meets parents' needs is an important protective factor for parents' wellbeing; however, little is known about the social support needs of both first-time parents.

Aims and objectives

To describe both first-time parents' formal social support needs in the early postpartum period.

Method

Individual semi-structured interviews were conducted with first-time parents recruited on the postpartum ward of a Swiss university hospital. Thematic analysis was used to identify themes and sub-themes.

Results

Fifteen mothers and eleven fathers were interviewed. Twelve themes were identified. Mothers' themes were "experiencing postpartum changes," "creation of a family unit," "self-esteem," "emotional needs," "difficulty in communicating their needs," and "the postpartum stay." Fathers' themes were "to be included in care procedures on the postpartum ward," "to be reassured," "to anticipate their postpartum stay" and "to consider their need as non-priority." Parental shared needs were: "to care for their newborn," and "returning home."

Conclusion

Mothers' and fathers' needs differed. Mothers needed more emotional support than fathers and fathers considered themselves as the main support for their partner. Fathers wanted to be integrated in the care of their newborn.

When the Bough Breaks: A systematic review and meta-analysis of mental health symptoms in mothers of young children during the COVID-19 pandemic

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: (1) the prevalence of depression and anxiety in parents of young children ( Collapse

Key Words

• Angs
• COVID-19
• Depression
• Mütter
• ansiedad
• anxiety
• anxiété
• depresión
• depression
• dépression
• madres
• maternal mental health
• mères
• psychische Gesundheit
• salud mental
• santé mentale
• young children
• الكلمات الأساسية: كوفيد-19، الصحة النفسية ، الأمهات ، الاكتئاب ، القلق
• キーワード:COVID-19、メンタルヘルス、母親、抑うつ、不安
• 关键词:2019冠状病毒病
• 心理健康
• 抑郁
• 母亲
• 焦虑

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MESH Headings

• Anxiety/epidemiology
• COVID-19
• Child
• Child, Preschool
• Depression/epidemiology
• Female
• Humans
• Mental Health
• Mothers
• Pandemics
• Prevalence
• SARS-CoV-2

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Grants Collapse

Affiliation(s)

Nicole Racine Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Rachel Eirich Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Jessica Cooke Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Jenney Zhu Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada
Paolo Pador Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
Nicole Dunnewold Health Sciences LibraryLibraries and Cultural ResourcesUniversity of CalgaryCalgaryAlbertaCanada
Sheri Madigan Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada Alberta Children's Hospital Research InstituteCalgaryAlbertaCanada

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Association Between Perceived Stress and Prenatal Depressive Symptoms: Moderating Effect of Social Support

Purpose

Prenatal depressive symptoms are an important mental health problem during pregnancy. We aimed to explore the moderating role of social support on the association between perceived stress and prenatal depressive symptoms.

Materials and Methods

A cross-sectional study was conducted at an obstetrics clinic. A total of 1846 women completed a self-administered questionnaire, with a response rate of 91.8%.

Results

Of the 1846 participants, 28.2% reported prenatal depressive symptoms (Edinburgh postnatal depression scale score ≥ 9). After adjusting for demographic characteristics, gestational age, exercise, and passive smoking, both perceived stress (adjusted odds ratio (AOR): 1.210, 95% confidence interval (CI): 1.178–1.242) and social support (AOR: 0.950, 95% CI: 0.932–0.968) were associated with prenatal depressive symptoms. Moreover, social support had a moderating effect on the association between perceived stress and prenatal depressive symptoms (p < 0.001), and pregnant women with low social support were more likely to be affected by stress and experience prenatal depressive symptoms.

Conclusion

Our study suggests that higher social support reduces the impact of stress on pregnant women, which in turn, decreases the risk of prenatal depressive symptoms. Therefore, interventions aimed at improving social support should be considered for the prevention and treatment of prenatal depressive symptoms.

The Impact of Perceived Social Support During Pregnancy on Postpartum Infant-Focused Anxieties: A Prospective Cohort Study of Mothers in Northern Jordan

Objective

This study aimed to evaluate the association between perceived social support during pregnancy and levels of anxiety among postpartum women using an anxiety-specific screening instrument.

Methods

Using a prospective cohort design, a two-stage methodology was conducted to collect data from women seeking maternal care at the King Abdullah University Hospital in northern Jordan. In the first stage, perceived social support was assessed among pregnant women using the Medical Outcomes Study Social Support Survey. During the first six months after childbirth, postpartum women were contacted to complete the second stage, wherein their perceptions of infant-focused anxieties were assessed using the Postpartum Specific Anxiety Scale. In our study, two types of infant-focused anxieties were investigated among a final sample of 419 mothers: infant safety and welfare anxieties and practical infant care anxieties.

Results

The results of multivariate linear regression analysis indicated that providing pregnant women with high levels of emotional support from close social networks (β= −0.08, p= 0.01) and perceiving informational support from health care providers (β= −0.71, p< 0.01) were protective factors for reducing the levels of postpartum anxiety concerning infant safety and welfare. Our findings also demonstrated that pregnant mothers who perceived high informational support from health care providers had a lower level of postpartum anxiety about practical infant care (β= −0.20, p< 0.01). In contrast, mothers who reported receiving high tangible support from close social networks during pregnancy had a significantly higher level of perceived anxiety concerning practical infant care after delivery (β= 0.13, p= 0.02).

Conclusion

Our study suggests that postpartum anxiety would be reduced if effective informational support were readily available for pregnant women. There is a clear need for building bridges between women, their families, and providers to distinguish the specific type and amount of support that should be provided to mothers during pregnancy.

Association between postpartum depression and social support satisfaction levels at four months after childbirth

This study clarifies the association between postpartum depression (PPD) and satisfaction with social support after childbirth through an anonymous survey of 427 postpartum mothers. Mothers' PPD was found to be significantly associated with satisfaction levels regarding formal-instrumental support (OR: 0.32, 95% CI: 0.162-0.632), informal-instrumental support (OR: 0.547, 95% CI: 0.313-0.955), and informal-psychological support (OR: 0.591, 95% CI: 0.384-0.912) in a multivariate logistic regression analysis. To prevent PPD, specialists as formal support providers must provide qualified care based on comprehensive judgments, and families as informal support providers should help with childcare, housework, and mental support.

Companionship as a method to reduce anxiety in pregnant women hospitalized during their third trimester

OBJECTIVE

The aim of this study was to study the association between pregnancy-related anxiety in women, screened during the third trimester, and companionship during their hospitalization.

METHOD

A case-control study was conducted in which 80 pregnant women over the age of 18 years, at 28 weeks and beyond, and without any diagnosed physical and/or health conditions took part. They were divided into 20 cases and 60 controls. Anxiety was measured using State-Trait Anxiety Inventory (STAI) and specific variables were recorded. A descriptive bivariate analysis was performed to compare the chosen variables by means of the chi-squared, Kruskal-Wallis H and Mann-Whitney U tests.

RESULTS

Companionship was associated with a reduction in state and trait anxiety ( p = 0.038 in both dimensions) during hospitalization. Women of the Roma (Gitano) ethnicity developed the most anxiety ( p = 0.019) and primiparous women were at four times greater risk.

CONCLUSION

The absence of support from a person of trust during hospitalization, together with ethnicity and primiparity, contributed to increased symptoms of anxiety in pregnant women hospitalized during their third trimester. Therefore, involvement by their close social circle is essential for the prevention and/or reduction of anxiety in this population.

'She come like a sister to me': a qualitative study of volunteer social support for disadvantaged women in the transition to motherhood in England

This qualitative study explores the ways in which disadvantaged women benefit from social support from a trained volunteer during pregnancy and the postnatal period, using the theoretical frameworks of stress and coping and a multi-dimensional model of social support. Forty-seven mothers took part in semi-structured interviews. The mothers, who had received social support through nine volunteer projects in England, faced many potentially stressful challenges besides having a baby (such as poverty, poor housing, histories of abuse, motherhood at a young age, living with physical or mental health difficulties, migration and insecure immigration status). Analysis was in two distinct stages: first, an inductive thematic analysis of mothers' experiences, and second, mapping of the results onto the theoretical frameworks chosen. Volunteers built relationships of trust with mothers and gave skilled emotional support, positive appraisal support, informational support and practical support according to mothers' individual needs, thereby assisting mothers exposed to multiple stressors with problem-focused, emotion-focused and perception-focused coping. This helped to reduce social isolation, increase effective access to services and community resources, and build mothers' confidence, self-esteem and self-efficacy. Volunteer social support may have particular salience for mothers who lack structural support and need skilled functional support. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Perinatal Anxiety Symptoms: Rates and Risk Factors in Mexican Women

Anxiety during pregnancy and after childbirth can have negative consequences for a woman and her baby. Despite growing interest in the perinatal mental health of Mexican women living in the U.S., perinatal anxiety symptom (PAS) rates and risk factors have yet to be established for women in Mexico. We sought to determine PAS rates and identify risk factors, including the traditional female role (TFR) in a sample of Mexican women. This secondary data analysis is based on 234 Mexican women who participated in a longitudinal study on perinatal depression in Mexico. Anxiety symptoms were assessed in pregnancy and at six weeks postpartum. Rates were determined through frequencies, and multiple logistics regressions were conducted to identify risk factors in the sample. The PAS rate was 21% in pregnancy and 18% postpartum. Stressful life events and depressive symptoms were associated with a higher probability of PAS. Adherence to TFR increased the probability of prenatal anxiety; lower educational attainment and low social support during pregnancy increased the probability of postpartum anxiety. The PAS rates were within the range reported in the literature. The TFR was only associated with anxiety in gestation, highlighting the role of this culturally relevant risk factor. Culturally responsive early interventions are therefore required.

Social Support and Perinatal Depression: The Perspectives of Mexican-American Adolescent Mothers

Perinatal depression is estimated to affect one in seven pregnant women. As such, social support has been shown to impact the mental health of women during the perinatal period. The purpose of this qualitative descriptive study was to examine the types of social support received by pregnant and parenting Mexican-American adolescent mothers and their perceptions of how it can influence perinatal mental health. Deductive content analysis was used to analyze the data using emotional, instrumental, and informational support as primary categories. Positive and negative aspects of the adolescent's social network were also included to understand how individuals impact their mental health. A convenience sample of 20 perinatal Mexican-American adolescents were interviewed. Emotional support, such as encouragement and affirmation, as well as instrumental support, via financial assistance and help with infant care, were primarily sought from significant others, which consisted of family members and their partner. Having strained relationships with their significant others primarily contributed to emotional distress. Health care providers were often sought out for informational support concerning perinatal depression. However, some adolescents were unable to establish rapport with their health care provider, making it difficult to inquire about pertinent mental health information. Study findings suggest that identifying support needs and expectations is an important component of facilitating positive mental health outcomes for Mexican-American adolescent mothers. Future efforts to promote mental health and prevent perinatal depression among Mexican-American adolescent mothers should consider integrating a strong focus on social support.

Association of Pregnancy Contexts with Depression and Low Social Support in Early Pregnancy

CONTEXT

Research into the relationship between pregnancy intention and perinatal depression or low social support is limited. Women's perspectives on pregnancy and their associations with perinatal depression could help in developing targeted efforts for screening and intervention.

METHODS

In 2014-2015, 161 women seeking pregnancy testing or abortion care at clinics in New Haven, Connecticut, were surveyed. They were asked about pregnancy context (intentions, planning, wantedness, desirability, timing and happiness), and the Edinburgh Depression Screen (EDS) and the Modified Kendler Social Support Index (MKSSI) were used to identify possible antenatal depression and low social support, respectively. Multivariable logistic regression analysis was employed to examine associations between pregnancy context and these outcomes.

RESULTS

On average, participants were 27 years old and at nine weeks' gestation. One-fifth reported a previous diagnosis of depression or anxiety, and 22% and 33% screened positive for depression (EDS scores of 13 or higher and 10 or higher, respectively); 52% received low social support (MKSSI score of 3.2 or less). Regression analysis found that pregnancies described as unintended, poorly timed or undesired were associated with depression at the higher cutoff (odds ratios, 3.2-4.5); all unfavorable pregnancy measures were associated with depression at the lower cutoff. Ambivalence regarding pregnancy timing, intention, wantedness and desirability was associated with increased odds of depression by either EDS score. Unplanned pregnancies and those about which the woman was ambivalent were associated with low social support.

CONCLUSIONS

Findings support the need to screen women for depression early in pregnancy and to integrate assessments of pregnancy context into the evaluation of potential risk factors.

Prenatal distress levels of pregnant women in Turkey and affecting factors: a multicentre study

This study was conducted to determine prenatal distress levels of pregnant women from seven provinces of Turkey and factors affecting prenatal distress levels. The multicentre descriptive study included 2365 pregnant women who were in the twentieth gestational week and above. The data were collected using the pregnancy information form, prenatal distress questionnaire and spousal support scale. Descriptive statistics, Student's t-test, ANOVA and logistic regression were used to evaluate the data. The results of this study demonstrated that pregnant women's prenatal distress levels are affected by such factors as the region lived in, lack of spousal support and being a primary school graduate. Nurses should develop intervention strategies that involve the pregnant woman's spouse to reduce prenatal distress and the factors affecting prenatal distress.Impact statementWhat is already known on this subject? Prenatal distress can have significant effects on pregnancy, maternal health and human development across the lifespan.What the results of this study add? Spousal support could also have an effect on the psychological health of mothers.What the implications are of these findings for clinical practice and/or further research? Nurses and midwives monitor the pregnant women, and therefore, they should evaluate the prenatal distress levels in the prenatal period, plan intervention strategies for pregnant women with high stress levels and include the pregnant women's spouses in these intervention strategies.

First-time mothers' perceptions of social support: Recommendations for best practice

Research indicates social support is imperative for postpartum well-being. The types of social support and access to preferred supports are less understood. This article considers first-time mothers' perceptions of the effectiveness of social supports and perceived barriers to accessing support and provides recommendations for best practice. A search of the literature for terms related to postpartum social support was conducted. Major themes were identified and synthesised. A critique and analysis of the literature is presented with recommendations for best practice. Much of the research around postnatal support fails to distinguish the specific type of support, meaning creating support solutions for the postpartum period may not be effectively targeted. Recommendations for individualised support are made.

The development and psychometric testing of the Perinatal Infant Care Social Support (PICSS) instrument

BACKGROUND

Social support facilitates a woman's transition to motherhood. This major developmental transition can be stressful as it includes adaptation of self as well as learning new infant care practice skills. Although a number of instruments have been developed to measure social support, none have been developed or underpinned by theory in the context of perinatal infant care practices.

AIM

To develop a reliable and valid instrument to measure social support for new mothers in the perinatal period.

METHODS

Phase 1 involved the development of instrument structure and content. Constructs to be measured were defined through an analysis of relevant theoretical and empirical literature. Phase 2 established the psychometric properties of the functional domain of the PICSS. Exploratory factor analyses and principal Component Analyses were undertaken with a sample of first-time mothers (n = 371) from postnatal wards of a large maternity hospital. Item reduction and Cronbach's alpha reliability tests were performed. The structural social support domain was not amenable to psychometric testing.

RESULTS

Exploratory Factor Analyses and Principal Component Analyses of the functional domain resulted in a logically coherent 19-item, two-factor solution. The first factor 'Supporting Presence' has nine items (Cronbach's alpha = 0.90) and the second factor 'Practical Support' has ten items (Cronbach's alpha = 0.86).

CONCLUSIONS

The PICSS is a coherent and valid measure of social support for new mothers in the postnatal period in the context of infant care practices.

The Relationship Between Assistance Satisfaction and Negative Affect in Long-Term Social Assistance Recipients in China: The Moderating Role of Self-Acceptance

Public welfare in China is less universal, comprehensive, and generous when compared with other welfare regimes, especially for individuals with occupational disease. The assistance satisfaction of Chinese pneumoconiosis patients, a typical group of long-term social assistance recipients, has been linked to diminished health and psychological well-being. Self-acceptance is theorized to promote well-being, which may buffer the negative consequences of negative emotion on assistance satisfaction. This research was conducted based on the survey data of 1,345 patients in typical mining areas of China. In addition to single-factor analysis of variance, descriptive analysis, and correlation analysis, a cluster analysis was performed to explore the profiles of participants' ratings of assistance satisfaction with five governing subjects: government, employing unit, medical institution, welfare organization, and laborer themselves. The results were as follows: (1) Social assistance satisfaction perceived by Chinese long-term social assistance recipients was at an average level, wherein self-assistance satisfaction perception was the lowest among five dimensions. (2) The overall perception of assistance satisfaction of Chinese long-term social assistance recipients was significantly correlated with educational background and household monthly income; specifically, the participants with higher levels of education and lower levels of income were more likely to have higher assistance satisfaction perception. (3) Cross analysis showed that participants with higher assistance satisfaction were mainly from the low-high group, having a lower level of negative affect, and higher level of self-acceptance. (4) The average negative affect level was above the scale midpoint (3.65) and negatively associated with each of the assistance satisfaction ratings. (5) The analysis yielded three distinct profiles—medium (19.26%), high (40%), and low (40.74%)—according to their degree of assistance satisfaction. Relative to the other profiles, low assistance satisfaction participants reported greater levels of negative affect in their daily life. However, self-acceptance moderated these effects, but no moderating effect was detected for individuals reporting greater levels of assistance satisfactory. Purpose is proved empirically a positive asset for promoting psychological adjustment in the period of receiving social assistance for Chinese long-term social assistance recipients.

"To Suffer in Paradise": Feelings Mothers Share on Portuguese Facebook Sites

Background: Motherhood is an emotional rollercoaster. This is overlooked by most literature, which tends to refer mothers’ pathological states of postpartum depression and anxiety, mainly seeking to understand their causes or predicting factors, and consequences on children’s development.

Objective: In this study, we aim to observe the diversity of mothers’ emotional states, and to analyze both positive and negative feelings they disclose on specific public and closed motherhood sites on Facebook. We hypothesize that the intensive motherhood model is prevalent in Portuguese society, thus influencing the type of feelings and circumstances in which mothers disclose them.

Methods: We collected posts and comments from the four most popular Portuguese Facebook motherhood sites during 2015 and, then, conducted a quantitative and content analysis to identify the expressed range of feelings concerning motherhood.

Results: Mothers preferably share their positive feelings on public pages, whereas negative feelings are shared more in closed groups (CGs). Expressed positive and negative feelings were significantly different whether we look at normative or non-normative, public or closed sites.

Discussion: We assume that motherhood sites on Portuguese Facebook reflect an intensive motherhood model that is normative in Portuguese society. Positive feelings toward children are promoted and openly shared in public normative sites, while negative feelings concerning motherhood are dealt with in the privacy of CGs. We propose an extensive motherhood model to overcome this duality and to allow women to pursue several different social roles simultaneously in an equally rewarding way.

Social media as social support in pregnancy and the postpartum

Based on the rapidly growing use of social media and its influence on society an online survey to explore social media use and perceptions of social support was developed. A survey link or QR, quick read code was provided to new mothers in the postpartum setting of an academic medical center, posted on the hospital hosted website for new mothers and shared with Centering Pregnancy groups at the research hospital. The survey link was available for 4 weeks and 117 mothers from 64 different zip codes across the United States completed the survey. The majority of respondents indicated the main source of social support came from their current partner (92%). In addition, 43% used blogs to communicate with other mothers, 99% used the internet for answers to parenting questions, 89% used social media sites for questions and advice related to pregnancy and/or their role as a parent, and 84% considered social media friends a form of social support. These results demonstrate social media plays a substantial role in the lives of mothers today. Providers of healthcare should become familiar and comfortable with social media resources to support mothers of young children.

Changes in mood after screening for antenatal anxiety and depression

BACKGROUND

Screening programmes with referral are a valuable strategy for mitigating consequences of perinatal depression on mothers and their families. The effectiveness of these screening programmes needs to be measured. One potential problem in assessing outcomes is measurement reactivity where the actual measure results in changes in the people being measured.

AIM

The aim of this article is to explain the mechanisms and circumstances by which measurement reactivity occurred in a sample of antenatal women who participated in a screening interview.

METHODS

Fifty-five women who participated in an antenatal screening interview in their second trimester were re-interviewed in their third trimester. These qualitative interviews were conducted between September 2015 and April 2016.

RESULTS

The qualitative data suggested that measurement reactivity occurred through mechanisms such as the disclosure, gaining self-knowledge, validation of experiences, and personal agency which resulted in them seeking out support from others.

CONCLUSION

Although the screening interview appeared to improve women's outcomes, this may have occurred through measurement reactivity. This needs to be considered when designing studies that aim to assess the effectiveness of screening with intervention for antenatal depression.

The prevalence of antenatal and postnatal co-morbid anxiety and depression: a meta-analysis

To date, the precise prevalence of co-morbidity of anxiety and depression in the perinatal period is not well known. We aimed to estimate the prevalence of co-morbid anxiety and depression in the antenatal and postnatal periods. Systematic searches of multiple electronic databases were conducted for studies published between January 1950 and January 2016. We included 66 (24 published and 42 unpublished) studies incorporating 162 120 women from 30 countries. Prevalence of self-reported antenatal anxiety symptoms and mild to severe depressive symptoms was 9.5% [95% confidence interval (CI) 7.8-11.2, 17 studies, n = 25 592] and of co-morbid anxiety symptoms and moderate/severe depressive symptoms was 6.3% (95% CI 4.8-7.7, 17 studies, n = 27 270). Prevalence of a clinical diagnosis of any antenatal anxiety disorder and depression was 9.3% (95% CI 4.0-14.7, 10 studies, n = 3918) and of co-morbid generalized anxiety disorder and depression was 1.7% (95% CI 0.2-3.1, three studies, n = 3085). Postnatally between 1 and 24 weeks postpartum, the prevalence of co-morbid anxiety symptoms and mild to severe depressive symptoms was 8.2% (95% CI 6.5-9.9, 15 studies, n = 14 731), while co-morbid anxiety symptoms and moderate/severe depressive symptoms was 5.7% (95% CI 4.3-7.1, 13 studies, n = 20 849). The prevalence of a clinical diagnosis of co-morbid anxiety and depression was 4.2% (95% CI 1.9-6.6, eight studies, n = 3251). Prevalence rates did not differ with regard to year of publication, country income, selection bias and attrition bias. The results suggest that co-morbid perinatal anxiety and depression are prevalent and warrant clinical attention given the potential negative child developmental consequences if left untreated. Further research is warranted to develop evidence-based interventions for prevention, identification and treatment of this co-morbidity.

Social support and depression across the perinatal period: A longitudinal study

AIMS AND OBJECTIVES

To report changes in the prevalence of depression and the level of social support at three different time points in the perinatal period (late pregnancy, 1 week postpartum and 4 weeks postpartum) and to examine the relationship between depression and social support at these points in time.

BACKGROUND

Social support is a modifiable factor for depression. Existing research is limited to examining social support at a single time point in relation to antepartum or postpartum depression.

DESIGN

A longitudinal study.

METHODS

In total, 240 pregnant women were recruited from the prenatal clinic at a general hospital in China between June-September 2013. The Edinburgh Postnatal Depression Scale and Perceived Social Support Scale were used to measure the risk of depression and perceived social support at late pregnancy, within the first week postpartum, and at 4 weeks postpartum.

RESULTS

The Perceived Social Support Scale scores within the first week after birth were higher than scores at the late pregnancy and postpartum week 4, while the Edinburgh Postnatal Depression Scale scores at late pregnancy were higher than scores at the two postpartum times. Women who had higher Perceived Social Support Scale scores at late pregnancy had less likelihood of developing antepartum depression, and women with higher Perceived Social Support Scale scores at postpartum week 4 were less likely to have postpartum depression. However, the Perceived Social Support Scale scores at late pregnancy did not predict the risk of postpartum depression.

CONCLUSION

The study revealed that social support perceived by women changed over the perinatal period. Social support at each stage of the perinatal period was an important buffer against depression at this stage.

RELEVANCE TO CLINICAL PRACTICE

An increased focus on the relationship between social support and depression at each stage of the perinatal period is necessary for future research and practice.

Childhood maltreatment, postnatal distress and the protective role of social support

The postpartum period is a vulnerable period for women with a history of childhood maltreatment. This study investigated the association between childhood maltreatment and postnatal distress three months postpartum and examined the role of social support provided by different sources (intimate partner, parents, parents-in-law, and friends). Analyses are based on N=66 women, who were screened for maltreatment experiences shortly after parturition with the Childhood Trauma Questionnaire. Their levels of postnatal distress (symptoms of depression, anxiety, and stress; assessed with the Hospital Anxiety and Depression Scale and the 4-Item version of the Perceived Stress Scale) and postpartum social support (measured with the Postpartum Social Support Questionnaire) were assessed three months postpartum. Adjusting for educational level and the experience of a recent stressful event, childhood maltreatment was directly associated with higher levels of postnatal distress. Social support provided by friends moderated this association in a heteroscedastic regression analysis. No moderating effect was observed for support provided by the own parents, the intimate partner, or parents-in-law. The association between childhood maltreatment and postnatal distress was not mediated by social support. Additional analyses revealed no main, moderating, or mediating effects of satisfaction with support. Results suggest that support provided by friends may promote resilience during the postpartum period in women with a history of childhood maltreatment. Efforts to better understand the role of postpartum support and mechanisms that may enhance a mother's ability to develop and maintain supportive friendships may be promising for guiding preventive interventions.

Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis

BackgroundMaternal anxiety negatively influences child outcomes. Reliable estimates have not been established because of varying published prevalence rates.AimsTo establish summary estimates for the prevalence of maternal anxiety in the antenatal and postnatal periods.MethodWe searched multiple databases including MEDLINE, Embase, and PsycINFO to identify studies published up to January 2016 with data on the prevalence of antenatal or postnatal anxiety. Data were extracted from published reports and any missing information was requested from investigators. Estimates were pooled using random-effects meta-analyses.ResultsWe reviewed 23 468 abstracts, retrieved 783 articles and included 102 studies incorporating 221 974 women from 34 countries. The prevalence for self-reported anxiety symptoms was 18.2% (95% CI 13.6-22.8) in the first trimester, 19.1% (95% CI 15.9-22.4) in the second trimester and 24.6% (95% CI 21.2-28.0) in the third trimester. The overall prevalence for a clinical diagnosis of any anxiety disorder was 15.2% (95% CI 9.0-21.4) and 4.1% (95% CI 1.9-6.2) for a generalised anxiety disorder. Postnatally, the prevalence for anxiety symptoms overall at 1-24 weeks was 15.0% (95% CI 13.7-16.4). The prevalence for any anxiety disorder over the same period was 9.9% (95% CI 6.1-13.8), and 5.7% (95% CI 2.3-9.2) for a generalised anxiety disorder. Rates were higher in low- to middle-income countries.ConclusionsResults suggest perinatal anxiety is highly prevalent and merits clinical attention. Research is warranted to develop evidence-based interventions.

Identifying and Exploring the Informational and Emotional Support Needs of Primipara Women: A Focus on Supportive Communication

Primipara women may require greater informational and emotional support than multipara women. Supportive communication, including informational and emotional support, can help to build a strong caregiver-patient relationship and can alleviate the difficulties associated with first-time birth. The objective of this study was to explore first-time mothers' experiences of labor and birth. Three hundred primipara women completed self-report questionnaires. Qualitative analysis of one open-ended question about the women's experience was conducted. Nine themes emerged from the data. Eight themes reflected informational and emotional support needs, whereas the final theme reflected instrumental support needs. The study concluded that informational and emotional supports are important factors of supportive communication and influence the birthing experience of primipara women.