Prematurity, maternal emotional distress, and infant social responsiveness among Arab-Bedouin families: The role of social support as a resilience factor

Development and psychometric properties of a perceived social support scale for nurses returning to work after childbirth

BACKGROUND

There has been an increase in the number of nurses returning to work after childbirth (NRWCs) in Chinese hospital. Social support is important for NRWCs.

OBJECTIVE

To develop and validate a perceived social support scale for NRWCs in China.

METHOD

The original items were based on a literature review, the social support theory, and semi-structured interviews. The Delphi technique was used to adjust further and screen the scale entries to form an initial draft of the scale. From February to October 2023, we recruited 627 NRWCs from hospitals in 12 provinces of China. The psychometric attributes of the scale were examined by construct validity, content validity, test-retest reliability, and internal consistency reliability. The STROBE checklist was used to guide the submission.

RESULTS

4 dimensions and 22 items compose the initial scale. Exploratory factor analysis verified a four-factor scale structure. The confirmatory factor analysis results showed that the four-factor structure model fitted well. The resulting scale contains 4 dimensions with 18 items. The item-level content validity index ranged from 0.83 to 1.00. The Cronbach's alpha coefficient of four dimensions and total scale were respectively 0.957, 0.899, 0.870, 0.945, 0.967. The reliability of the scale over time was further verified, with a coefficient of 0.809 for the overall scale and a range from 0.682 to 0.718 for each domain.

CONCLUSION

The perceived social support scale for NRWCs is a reliable and valid instrument. The application of the perceived social support scale for NRWCs would improve the assessment of social support among NRWCs.

Social Support and Spousal Relationship Quality Improves Responsiveness among Anxious Mothers

Maternal responsiveness, a mother's ability to consistently identify infant cues and then act on them, is critical for healthy child development. A woman's social support and spousal relationship may affect responsiveness to an infant, especially among mothers with anxiety. We assessed how social support and spousal relationship quality is associated with responsiveness among anxious mothers, and if postpartum depression (PPD) moderated these associations. Cross-sectional data were collected from 2019 to 2022 in a public hospital in Pakistan from 701 women at six-weeks postpartum. Eligible women had at least mild anxiety in early- to mid- pregnancy. Linear regression analyses assessed if spousal relationship quality and social support from family and friends were associated with maternal responsiveness, measured using the Maternal Infant Responsiveness Instrument. Interaction terms were used to examine if PPD moderated these associations. Spousal relationship quality (B = 2.49, 95% CI: 1.48, 3.50) and social support (B = 1.07, 95% CI: 0.31, 1.83) were positively related to maternal responsiveness to the infant. Emotional support from a spouse was positively associated with responsiveness (B = 1.08, 95% CI: 0.12, 2.03 depressed; B = 2.96, 95% CI: 1.34, 4.58 non-depressed), and conflict with the spouse was negatively associated with responsiveness (B=-1.02, 95% CI: -1.94, -0.09 depressed; B=-2.87, 95% CI: -4.36, -1.37 non-depressed). However, social support was related to responsiveness only in non-depressed women (B = 2.61, 95% CI: 1.14, 4.07). While spousal relationships and social support enhance maternal responsiveness, for depressed women, spousal relationships were particularly critical. In considering maternal-infant interventions to improve child development outcomes, our study indicates the importance of supportive relationships that foster effective responsiveness.

"I'll Be There": Informal and Formal Support Systems and Mothers' Psychological Distress during NICU Hospitalization

Mothers of infants hospitalized in the Neonatal Intensive Care Unit (NICU) are at a high risk for psychological distress, which is of concern to health and social professionals due to the negative implications for mothers and infants. A model for explaining maternal psychological distress, consisting of intolerance to uncertainty and support from informal (spouse, family, and friends) and formal (medical staff) systems was examined. Data was collected from one of the largest NICUs in Israel; 129 mothers of 215 preterm infants completed self-report questionnaires regarding their background variables, intolerance to uncertainty, perceived informal support and perceived medical staff support. The NICU's medical staff provided indicators for the infants of participating mothers. A hierarchical multiple regression analysis was conducted. The examined model explained 29.2% of the variance in maternal psychological distress. Intolerance of uncertainty positively predicted psychological distress. Informal support, and in particular, spousal support negatively predicted psychological distress above and beyond intolerance of uncertainty. Medical staff support negatively predicted psychological distress above and beyond intolerance to uncertainty and informal support. Our findings suggest that maternal psychological distress is reduced through a family-centered care approach in NICUs. Medical professionals and social services should develop further solutions for addressing preterm mothers' need for certainty and support.

Resilience in the Perinatal Period and Early Motherhood: A Principle-Based Concept Analysis

A context-specific delineation of research approaches to resilience in the perinatal and early motherhood literature is currently lacking. A principle-based concept analysis was used to establish a description of how women's resilience is currently conceptualised and operationalised within empirical research in the perinatal period and early motherhood (defined as up to five-years postpartum). CINAHL, Medline, PsychInfo, EMBASE, ASSIA, Web of Science, Scielo, Maternity and Infant Care, the Cochrane Library, and the World Health Organization were systematically searched (January/February 2020 and March 2022). Fifty-six studies met the inclusion criteria. Analysis demonstrated interchangeable use of associated concepts such as 'coping', 'coping strategies', and 'adaptation'. Resilience was frequently operationalised as the absence of illness symptomatology, rather than the presence of mental well-being. Investigations of positive areas of functioning were predominately related to the mother's family role. There was limited qualitative exploration of women's perspectives. Recommendations for the pragmatic application of resilience research were not well developed. The narrow operationalisation of resilience by mental ill-health and parental role, and the distinct absence of women's perspectives, restricts the logical maturity and pragmatic application of the concept. Future research may benefit from exploration of women's insights on indicators that might best reflect positive functioning and resilience in this period.