Stress in women with postpartum depression: a phenomenological study

"It Slowly Drained the Life Out of Me, Leaving Me Dead Inside": Coping and Response Patterns Among Chinese Women Experiencing Postpartum Depression

The prevalence of postpartum depression (PPD) exceeds 20% in China. In this article, we unpack the coping strategies and involuntary responses to PPD among Chinese women and how such patterns are shaped by family communication dynamics and reflect distinct social, structural, and cultural contexts. Drawing upon the communication accommodation theory and the generic stress and coping model, we analyzed 661 posts collected under the hashtag #PPD (chanhou yiyuzheng) on Zhihu using the phronetic iterative approach. The analysis reveals that women self-identifying as having PPD often find themselves situated within a family environment marked by non-adaptive communication, culminating in insufficient support from their social circles. Furthermore, a significant number of these women lack effective coping mechanisms to manage PPD. Instead, they tend to stifle their expressions and needs through automatic responses, dedicating themselves to constant self-monitoring without practicing self-care. Our findings contribute to informed policymaking for postpartum support, addressing nuanced challenges encountered by new mothers in China.

Maternal postnatal confinement practices and postpartum depression in Chinese populations: A systematic review

BACKGROUND

The postpartum period is critical for maternal health status after childbirth. The traditional Chinese postpartum confinement practice, "doing-the-month", is considered especially effective in helping mothers recover during the postpartum period. However, research has not provided evidence to confirm its benefits. Postpartum depression is a common postpartum disease that seriously threatens maternal health. The systematic review aims to explore the association between "doing-the-month" and postpartum depression in the Chinese female population and to provide a scientific foundation for evidence-based postpartum maternal care.

METHODS

Five databases (PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, and Web of Science) were searched according to the protocol (INPALSY202320102). The JBI assessment tool was used to assess the quality of the included studies.

RESULTS

Sixteen quantitative studies from China and Chinese female immigrants in other countries, including 15 cross-sectional studies and 1 randomized controlled study, were identified. Four studies indicated that "doing-the-month" rituals reduced postpartum depression risk while 2 studies showed opposite results; 10 studies did not show a significant association between "doing-the-month" practices and postpartum depression.

CONCLUSION

There is conflicting evidence regarding the association between "doing-the-month" and the likelihood of developing postpartum depression. Some studies have explored the impact of family ties, particular rituals, and specific stressors during the postpartum period on the occurrence of postpartum depression in Chinese women. According to current research, "doing-the-month" practice failed to show a significant protective effect on postpartum depression in the Chinese maternal population. Evidence-based medical health education for the Chinese postpartum female community is urgently needed.

Experience of postpartum depression among Chinese women: A meta-synthesis of qualitative research

Postpartum depression (PPD) is associated with various adverse health outcomes among mothers and babies. Meta-synthesis can improve our understanding of postpartum women's experiences. However, the meta-analysis of PPD among Chinese women is limited. Therefore, a meta-analysis was conducted to evaluate the prevalence of PPD among Chinese women and if and how traditional culture may exacerbate PPD. Qualitative studies on the experiences of Chinese women with PPD were searched from database establishment until May 2022 in ten databases. The meta-ethnography reporting guidelines and framework was applied to the writing and reporting of this review. The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42022323388). 2321 studies were retrieved, and 11 studies qualified for the meta-synthesis. The final five themes extracted and re-conceptualized from these studies were as follows: the gap between expectation and reality, conflicts with family, physical and mental frustrations, critical needs for coping with changes, and measures against PPD. Chinese women with PPD frequently feel vulnerable physically, mentally, or both after childbirth and often have conflicts with their families due to the influence of traditional Chinese culture. Family relationships and social support often are factors preventing women from seeking help.

Parenting experiences of Chinese mothers living with a mental illness

BACKGROUND

Although the experiences of mothers with mental illness are well researched in Western countries, little is known about the experiences of Chinese mothers. This study aims to explore the experiences of family life and parenting of Chinese mothers, in the context of their mental illness.

METHODS

Fourteen Chinese mothers with mental illness undertook in-depth, semi-structured interviews. Interpretative Phenomenological Analysis was employed to guide the data analysis.

RESULTS

Seven themes were identified: motherhood as a central identity, the stigma associated with being a mother with mental illness, participants' perceptions about the impact of mental illness on parenting and their children, experiences of talking to children about mental illness, how having children impacts mothers' illness and recovery, and support obtained and needed. Similar to Western mothers, Chinese mothers experienced stigma and fluctuating mental illness symptoms which impacted on parenting. Unlike mothers based in Western countries, the mothers interviewed in this study highlighted complicated co-caring relationships with parents-in-law and did not raise child custody concerns.

CONCLUSIONS

Mental health professionals need to have the skills to identify and recognize the mothering role of their clients. Culturally sensitive interventions are required to assist Chinese families where mothers have a mental illness. Future research is required to investigate family experiences of parental mental illness from the perspectives of children, partners, and mental health professionals.

Prevalence of postpartum depression and associated factors among women in Mbarara and Rwampara districts of south-western Uganda

BACKGROUND

Postpartum depression (PPD) is a significant cause of maternal morbidity and has severe consequences on the well-being of mothers, new-borns, families, and communities. PPD reduces the mother's response to the child's needs. In severe cases, mothers suffering from PPD are prone to postpartum psychosis, commit suicide and, in rare cases, infanticide. We aimed to determine the prevalence and understand the factors associated with PPD among mothers in southwestern Uganda.

METHODS

This was a cross-sectional study between November 2019 and June 2020 among 292 mothers, 6 to 8 weeks' postpartum. Mothers were selected from three health facilities in southwestern Uganda and enrolled using stratified consecutive sampling. Postpartum depression was clinically diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V. The factors associated with PPD were assessed by using a structured interviewer administered questionnaire. The factors were analyzed using bivariate chi square analyses and multivariate logistic regression.

RESULTS

Overall prevalence of PPD was 27.1% (95% CI: 22.2-32.5). This did not vary by the number of previous births or mode of birth. Five factors associated with PPD were low perceived social support, HIV positive status, rural residence, obstetrical complications and the baby crying excessively.

CONCLUSION AND RECOMMENDATIONS

Prevalence of PPD in Mbarara and Rwampara districts is higher than what has previously been reported in Uganda indicating an urgent need to identify pregnant women who are at increased risk of PPD to mitigate their risk or implement therapies to manage the condition. Midwives who attend to these mothers need to be empowered with available methods of mitigating prevalence and consequences of PPD. Women who are HIV positive, residing in rural settings, whose babies cry excessively, having low social support systems and who have birth complications may be a particularly important focus for Ugandan intervention strategies to prevent and reduce the prevalence of PPD.

Chinese mothers' experiences of family life when they have a mental illness: A qualitative systematic review

The challenges experienced by families in western countries, where a parent has a mental illness, are well established. However, research documenting the experiences of Chinese families with parental mental illness appears limited. This study aimed to systematically review qualitative research about the experiences of families, living in mainland China, Hong Kong, Macao, and Taiwan, where parents have a mental illness. Eight databases were comprehensively searched, along with manual search of reference lists. The identified studies were critically appraised and analysed using a thematic synthesis approach. Ten papers were identified, with nine investigating mothers' experiences, one focusing on children's experiences, and none reporting on fathers' experiences. Subsequently, only papers presenting mothers' experiences were included for thematic synthesis. Five primary themes were identified including managing parenting in the context of mental illness; failure to meet one's expectations of motherhood; being burdened by others' expectations; stigma from self, others and service providers; and support obtained and needed. Similar to western mothers, Chinese mothers struggled to balance the demands of parenting and their illness, and experienced stigma associated with being a parent with a mental illness. Western and Chinese mothers' experiences differ in regard to the influence of parents-in-law and the division of domestic labour. Future research might investigate Chinese mothers with various mental health diagnoses, the perspectives of Chinese fathers with a mental illness, and the children in these families.

New parents' experiences of postpartum depression: a systematic review of qualitative evidence

OBJECTIVES

The objective of the review was to synthesize the evidence on new mothers' and fathers' experiences of postpartum depression (PPD).

INTRODUCTION

Postpartum depression is a form of clinical depression that affects women and, less frequently, men, typically during the first months after childbirth. It has been estimated that 10% to 20% of women and 10% of men suffer from PPD and it may have serious consequences for mothers, fathers and their children. Therefore, this review covers the experiences of both mothers and fathers.

INCLUSION CRITERIA

This qualitative review considered studies that included new mothers and fathers who had any number of children and who experienced PPD within a one-year postpartum period. The phenomenon of interest was the lived experience of new mothers and fathers with PPD. Qualitative studies including, but not limited to, phenomenology, grounded theory, ethnography, action research and feminist research were considered.

METHODS

The review systematically searched the following databases: MEDLINE, CINAHL, PsycINFO, Scopus and the Finnish database MEDIC. In addition, the search for unpublished articles included ProQuest Dissertations and Theses. The methodological quality of the included studies was assessed independently by two reviewers, and qualitative data were extracted from papers by two independent reviewers using a standardized data extraction tool. Qualitative research findings were pooled using the JBI methodology.

RESULTS

Thirteen papers that considered mothers' (n = 199) experiences of PPD were included in the review. A total of 98 findings were extracted and aggregated into 14 categories, and from them, four synthesized findings were developed: i) Depressed mothers feel unable to control their own lives due to low resilience; ii) The ambivalent feelings depressed mothers experience towards their babies, partners and in-laws cause distress and suffering; iii) Depressed mothers experience anger and despair if they perceive imbalances between their support needs and the support they get from healthcare providers and significant others; and iv) Depressed mothers experience hopelessness and helplessness resulting from their new-found motherhood and financial worries. Two papers that considered fathers' (n = 20) experiences of PPD were included in the review. A total of 19 findings were extracted and aggregated into six categories, and from them, two synthesized findings were developed: i) Depressed fathers experience disappointment arising from perceived imbalances between their support needs and the support they get from their partner and significant others; and ii) Depressed fathers are more imbalanced after childbirth than fathers who are not suffering from PPD, so they feel unable to control their own lives due to low resilience.

CONCLUSIONS

The qualitative studies concerning new parents' experiences of PPD have focused on the mother's perspective, and studies of the father's perspective, especially of the father's own experiences of PPD, are scarce. Both mothers and fathers do not receive enough support from their significant others. In addition, mothers want more support from health professionals. Because PPD has a great influence on the well-being of mothers and fathers, as well as children, it is important to understand what parents undergo after childbirth.

Pain, stress, analgesia and postpartum depression: Revisiting the controversy with a randomized controlled trial

BACKGROUND

Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed.

MATERIALS AND METHODS

Parturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery (n = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 μg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD.

RESULTS

Incidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact P = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86-43.55; P = 0.001).

CONCLUSION

CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.

The Lived Experience of Postpartum Depression: A Review of the Literature

Postpartum depression has been studied from a variety of perspectives and by many disciplines. The aim of this article is to review qualitative literature exploring the first-person accounts of women diagnosed with postpartum depression and highlight the absence of work in madness discourse. Searches of multiple databases (Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Sociology Database, Web of Science, Genderwatch, PILOTS, MedLine from PubMed, PsycINFO) were undertaken. There is a significant gap in literature that exists in relation to the lived experience of women diagnosed with postpartum depression who do not identify as mentally ill.

Evaluation of a Technology-Based Peer-Support Intervention Program for Preventing Postnatal Depression (Part 1): Randomized Controlled Trial

Background

The frenzy of postbirth events often takes a toll on mothers’ mental well-being, leaving them susceptible to postpartum psychological disorders such as postnatal depression (PND). Social support has been found to be effective in restoring the emotional well-being of new mothers. Therefore, mothers need to be supported during the crucial postpartum period to buffer the negative after effects of childbirth and to promote healthier maternal well-being.

Objective

This study aimed to evaluate the effectiveness of a technology-based peer-support intervention program (PIP) on maternal outcomes during the early postpartum period.

Methods

A randomized, parallel-armed controlled trial was conducted. The study recruited 138 mothers (69 in intervention group, 69 in control group) at risk of PND from a tertiary hospital in Singapore. To support these mothers, 20 peer volunteers were recruited by word of mouth and trained by a psychiatrist in social support skills before the intervention commenced. The 4-week–long intervention included a weekly follow-up with a peer volunteer through phone calls or text messages. The intervention group received peer support in addition to the standard care offered by the hospital. The control group only received postnatal standard care. Maternal outcomes (PND, postnatal anxiety [PNA], loneliness, and perceived social support) were measured with reliable and valid instruments. Data were collected immediately postpartum, at 1 month postpartum and at 3 months postpartum. The general linear model was used to compare the groups for postpartum percentage changes in the outcome variables at first and third months, and the linear mixed model was used to compare the trend over the study period.

Results

There was a statistically significant difference in Edinburgh Postnatal Depression Scale scores (d=–2.11; 95% CI −4.0 to −0.3; P=.03) between the intervention and control groups at 3 months postpartum after adjusting for covariates. The intervention group had a significant change over time compared with the control group.

Conclusions

The technology-based PIP was found to be effective in reducing the risk of PND among new mothers and showed a generally positive trend in reducing PNA and loneliness and increasing perceived social support. This study highlights the importance of training paraprofessionals to provide needed support for new mothers postpartum. A further long-term evaluation of the PIP on maternal and family outcomes and its cost-effectiveness is needed to inform clinical practices.

Trial Registration

ISRCTN Registry ISRCTN14864807; https://www.isrctn.com/ISRCTN14864807

International Registered Report Identifier (IRRID)

RR2-10.2196/resprot.9416

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).

Perinatal depression in Asian women: prevalence, associated factors, and cultural aspects

Background and Objective: Although perinatal depression is a worldwide problem, most of the studies related to this issue have been conducted in Western countries. This paper summarizes the literature on the prevalence as well as associated factors among Asian countries where the cultural attitudes, customs, and norms are considerably different from those in Western countries.

Methods: We conducted a literature search using MEDLINE (PubMed) from 1968, PsychINFO from 1970, and SCOPUS database from 1982 using keywords “depression”, “antenatal”, “antepartum”, “pregnancy”, “postnatal”, “postpartum”, “perinatal”, “after childbirth” and “Asia”. Only the articles published in English were included.

Results: The overall prevalence of depression during pregnancy and postnatal period are about 20% and 21.8%, respectively. The factors related to perinatal depression can be grouped into the following categories, individual characteristics, husband/marital relationship, pregnancy-related, infant-related, and other psychosocial issues. While there is considerable overlap between Asian and Western countries with respect to risk factors for perinatal depression, premarital pregnancy, conflict with mother in-law, and dissatisfaction with infant’s gender are more specific to Asian cultures.

Conclusions: Studies conducted in Asian countries suggest that the prevalence of perinatal depression is slightly higher than in Western countries. There are several unique culturally related issues that clinicians treating pregnant and postpartum Asian women should be aware as they contribute to an increased risk of depression in these women.

Stability of depressive symptoms over 3 months post-partum

AIM

Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum.

METHODS

From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models.

RESULTS

The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression.

CONCLUSION

Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.

Postpartum Mental Health in First-Time Mothers: A Cohort Study

Background

Post-partum depression (PPD) can produce adverse symptoms that make motherhood one of the most tumultuous events in a female’s life. First-time mothers who have problems adapting themselves to the mother’s role are more vulnerable to PPD.

Objectives

The current study aimed to explore the extent of social support and parental self-efficacy on PPD, this study was conducted among the first-time pregnant women.

Patients and Methods

A prospective cohort study assessed the depressive symptoms and related factors among 838 first-time not depressed pregnant women from third trimester of pregnancy to 12 weeks postpartum who attended primary health centers (Jan to July 2009). The study employed Edinburgh postnatal depression scale, social support appraisals scale, network orientation scale, marital inventory, parental expectation survey and socio-demographic questionnaires. Logistic regression was used for data analysis.

Results

The incidence of depression was 10.7% at three months post-partum. The adjusted odds ratio showed the PPD was associated with perceived social isolation (OR = 1.06; 95% CI = 1.01 - 1.12), lack of marital satisfaction (OR = 0.91; 95% CI = 0.86 - 0.97) and low parental self-efficacy (OR = 0.74; 95% CI = 0.65 - 0.85).

Conclusions

A high incidence of PPD was identified among the first-time mothers which makes PPD one of the major health problems in females. The important effects of perceived social isolation, maternal parental self-efficacy, and marital satisfaction on reducing the risk of PPD should be considered.

"I can't stop worrying about everything"—experiences of rural Bangladeshi women during the first postpartum months

Over recent years, researchers have found evidence which indicates that the prevalence of postpartum depressive symptoms crosses cultural boundaries and is reported to be at least as high in non-Western countries as in Western countries. However, qualitative studies about new mothers’ experiences from non-Western countries, such as Bangladesh, are rare, particularly in rural areas. This study aims to describe the experiences and concerns of rural Bangladeshi mothers with postpartum depressive symptoms. Open narrative interviews were conducted with 21 mothers with depressive symptoms 2–3 months postpartum, consecutively selected from a longitudinal study about prevalence and risk factors of perinatal depressive symptoms. Inductive content analysis was used to analyse data and three themes emerged: family dynamics, living at the limits of survival, and role of the cultural context after childbirth. These themes were based on six categories and 15 subcategories. The findings show that troublesome family relationships, including intimate partner violence and violence in the family, influenced the mothers’ mental well-being. They and their families lived at the limit of survival and the mothers expressed fear and worries about their insecure situation regarding economic difficulties and health problems. They felt sorry for being unable to give their infants a good start in life and sad because they could not always follow the traditional norms related to childbirth. Thus, it is important to focus on the depressive symptoms among new mothers and offer counselling to those showing depressive symptoms, as the cultural traditions do not always alleviate these symptoms in the changing Bangladeshi society today.

Predictors and incidence of post-partum depression: a longitudinal cohort study

AIM

This study was designed to identify the incidence and the related factors contributing to post-partum depression (PPD) in women in Iran for the first time.

MATERIAL AND METHODS

A total of 2279 eligible pregnant women from 32-42 weeks of pregnancy to 12 weeks post-partum (2009) who attended primary health centers in Mazandaran province were screened for depression using the Iranian version of the Edinburgh Postnatal Depression Scale. Pregnant women free from depression were assessed using validated questionnaires, including the Premenstrual Syndrome Questionnaire, Social Support Appraisal Scale, Network Orientation Scale, General Health Questionnaire, Marital Inventory, Life Events Rating Scale and Parental Expectation Survey. Logistic regression analysis was used to determine the risk factors of PPD.

RESULTS

Of 1801 women who screened negative for depression at 32-42 weeks' gestation, cumulative incidence proportions were 6.7%, 4.3% and 4.5% during 0-2, >2-8 and >8-12 weeks post-partum, respectively. The factors predictive of PPD were: history of depression during the first two trimesters of pregnancy (odds ratio [OR] = 2.55, 95% confidence interval [CI] = 1.59-4.1); psychiatric disorder during pregnancy (OR = 1.08, 95%CI = 1.06-1.11); gestational diabetes (OR = 2.93, 95%CI = 1.46-5.88); recurrent urinary infection (OR = 2.25, 95%CI = 1.44-3.52); unwanted pregnancy (OR = 2.5, 95%CI = 1.69-3.7) and low household income (OR = 3.57, 95%CI = 1.49-8.5). The risk was decreased with increasing age (OR = 0.88, 95%CI = 0.84-0.92) and those with high self-efficacy for mothering (OR = 0.7, 95%CI = 0.62-0.78).

CONCLUSION

A high rate of new cases of PPD was identified in Iranian women. A combination of psychological, sociological, obstetric and sociodemographic factors can render mothers vulnerable to post-partum depression.

An Overview of Risk Factors Associated to Post-partum Depression in Asia

Post partum depression (PPD) is an important complication of child-bearing. It requires urgent interventions as it can have long-term adverse consequences if ignored, for both mother and child. If PPD has to be prevented by a public health intervention, the recognition and timely identification of its risk factors is must. We in this review have tried to synthesize the results of Asian studies examining the risk factors of PPD. Some risk factors, which are unique to Asian culture, have also been identified and discussed. We emphasize on early identification of these risk factors as most of these are modifiable and this can have significant implications in prevention of emergence of post partum depression, a serious health issue of Asian women.

Effects of a mindfulness-based intervention on psychological distress, well-being, and maternal self-efficacy in breast-feeding mothers: results of a pilot study

Several pilot studies have provided evidence that mindfulness-based intervention is beneficial during pregnancy, yet its effects in mothers during the early parenting period are unknown. The purpose of the present pilot study was to examine the effectiveness of a mindfulness-based intervention in breast-feeding mothers. We developed and tested an 8-week mindfulness-based intervention aimed at improving maternal self-efficacy, mindfulness, self-compassion, satisfaction with life, and subjective happiness, and at reducing psychological distress. A randomized controlled, between-groups design was used with treatment and control groups (n = 26) and pretest and posttest measures. ANCOVA results indicated that, compared to the control group, mothers in the treatment group scored significantly higher on maternal self-efficacy, some dimensions of mindfulness (observing, acting with awareness, non-judging, and non-reactivity), and self-compassion (self-kindness, mindfulness, over-identification, and total self-compassion). In addition, mothers who received the treatment exhibited significantly less anxiety, stress, and psychological distress. The results supported previous research findings about the benefits of mindfulness-based intervention in women from the perinatal and postpartum periods through the early parenting period. Additional research is needed to validate our findings in non-breast-feeding mothers and to examine the intervention's indirect benefits in terms of family relationships and child development.

Chinese primiparous women's experiences of early motherhood: factors affecting maternal role competence

AIM

The aim of this study was to explore Chinese women's perceptions of maternal role competence and factors contributing to maternal role competence during early motherhood.

BACKGROUND

Developing a sense of competence and satisfaction in the maternal role are considered critical components in maternal adaptation, which have a significant impact on parenting behaviours and the psychosocial development of the child. However, qualitative studies that address maternal role competence are limited in the Chinese population.

DESIGN

This was an exploratory descriptive study.

METHOD

A purposive sample of 26 Chinese primiparous mothers participated in a childbirth psychoeducation programme and was interviewed at six weeks postpartum. Data were analysed using content analysis.

RESULTS

Women perceived a competent mother as being able to make a commitment to caring for the physical and emotional well-being of child, while cultivating appropriate values for childhood. Personal knowledge and experience of infant care, success in breastfeeding, infant's well-being, availability of social support and contradictory information from various sources were major factors affecting maternal role competency.

CONCLUSION

The findings highlight the importance of understanding Chinese cultural attitudes to childrearing and maternal role competence. New Chinese mothers need information on child care, positive experiences of infant care, social support and consistent information to enhance their maternal role competency. Recommendations are made for Chinese culturally specific guidelines and healthcare delivery interventions to enhance maternal role competence in early motherhood.

RELEVANCE TO CLINICAL PRACTICE

Nursing and midwifery care should always take into account the cultural beliefs and enable adaptation of traditional postpartum practices. Providing consistent information and positive experience on parenting skills and infant behaviour as well as enhancing effective coping strategies could strengthen Chinese women's maternal role competency.

Depressão pós-parto em puérperas: conhecendo interações entre mãe, filho e família

OBJETIVO: Conhecer a interação de puérperas, que apresentam depressão pós-parto, com seus filhos e compreender a percepção de familiares sobre a doença e cuidados maternos prestados por essas puérperas. MÉTODOS: Estudo qualitativo de caráter exploratório que teve como sujeitos do estudo quatro puérperas com depressão pós-parto, acompanhadas em um Centro de Atenção Psicossocial do município de Quixadá - CE e quatro familiares. Foram realizadas visitas domiciliárias para a execução de entrevistas em profundidade. Os dados foram analisados conforme a técnica de análise de conteúdo proposta por Morse e Field. RESULTADOS: As principais alterações emocionais relatadas foram o choro fácil e nervosismo. As puérperas sentiam-se frustradas e/ou inseguras quanto ao exercício da maternidade. Como agravante foi observado que familiares desconheciam o problema da depressão pós-parto. CONCLUSÃO: O cuidado de enfermagem nessa situação deve começar no pré-natal com avaliação da auto-estima, da rede de suporte social e da satisfação das futuras mães.

Mindfulness-Based Childbirth and Parenting Education: Promoting Family Mindfulness During the Perinatal Period

We present the conceptual and empirical foundation and curriculum content of the Mindfulness-Based Childbirth and Parenting (MBCP) program and the results of a pilot study of n = 27 pregnant women participating in MBCP during their third trimester of pregnancy. MBCP is a formal adaptation of the Mindfulness-Based Stress Reduction program and was developed and refined over the course of 11 years of clinical practice with 59 groups of expectant couples. MBCP is designed to promote family health and well-being through the practice of mindfulness during pregnancy, childbirth, and early parenting. Quantitative results from the current study include statistically significant increases in mindfulness and positive affect, and decreases in pregnancy anxiety, depression, and negative affect from pre- to post-test (p < .05). Effect sizes for changes in key hypothesized intervention mediators were large (d > .70), suggesting that MBCP is achieving its intended effects on maternal well-being during pregnancy. Qualitative reports from participants expand upon the quantitative findings, with the majority of participants reporting perceived benefits of using mindfulness practices during the perinatal period and early parenting. Our future research will involve conducting a randomized controlled trial of MBCP to test effects on psychophysiological stress mechanisms and to examine effects on birth outcomes, family relationship quality, and child development outcomes.

Traditional postpartum practices and rituals: clinical implications

OBJECTIVES

In many cultures, postpartum rituals are observed because they are believed to have beneficial mental health effects. Our systematic review examines the research literature investigating the effects of postpartum rituals on postpartum depression (PPD) to determine if the rituals protect against PPD.

METHODS

MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Library were searched (from 1966 to October 31, 2008). Reference lists of relevant articles and links to related articles were also examined. Both qualitative and quantitative studies that focused on traditional practices and rituals in the postpartum period (that is, within the first year following childbirth) and their relation to PPD or mood were included.

RESULTS

Seventy-two studies were considered, with 12 meeting the inclusion criteria. The data were summarized according to the type of ritual including: organized support, diet, and other or multiple postpartum practices, and evidence for or against a protective effect on PPD. Although limited, not all studies suggested that the rituals prevent PPD. Overall, there is some evidence that postpartum rituals dictating appropriate and wanted social support may be of some protective value, depending on numerous contextual factors.

CONCLUSIONS

This area needs more culturally sensitive and systematic research. Current studies suggest that the key protective element may be the presence of welcome support rather than the specific ritual.

State of the Science on postpartum depression: what nurse researchers have contributed--part 1

Postpartum depression has been described as a thief that steals motherhood. It can result in tragedy and sometimes in headline-gripping maternal suicide or infanticide. Because one of the highest priorities for nursing is to continually advance the knowledge that underlies nursing practice, it is essential that we understand what nurse researchers have done to advance the knowledge base of postpartum depression. This integrative review is a two-part series for MCN that summarizes 141 postpartum depression studies conducted by nurse researchers from around the globe, including United States, Australia, Canada, China (Hong Kong, Taiwan), Finland, Iceland, Sweden, Turkey, and Malaysia. Specific areas of postpartum depression to which nurse researchers have devoted their primary attention include epidemiology, risk factors, transcultural perspectives, instrument development, screening, interventions, and mother-infant interactions.

Quality of life, postnatal depression and baby gender

AIMS AND OBJECTIVE

To study the impact of postnatal depression on the quality of life of young French mothers and to evaluate if the gender of their child influences this.

BACKGROUND

Postnatal depression (PND) constitutes a major public health problem considering its high prevalence and consequences upon quality of life and parental skills.

DESIGN

This research is a cross-sectional study during the postnatal period.

METHODS

This study was carried out during a two-month period. Data were collected by interview and questionnaires. The authors compared the prevalence rate of PND and life quality in a cohort of 181 women and measured the short-term impact of the child's birth.

RESULTS

Postnatal depression strongly negatively influences all dimensions of life quality explored through the SF36, e.g. physical functioning (PF), physical Role (RP), bodily pain (BP), mental health (MH), emotional role (RE), social functioning (SF), vitality (VT), general health (GH), standardized physical component (PCS) and standardized mental component (MCS). The baby's gender (having a boy) also significantly reduces quality of life, irrespective of depressive state. There is a relationship between baby gender and PND.

CONCLUSION

This research is the first to show that the birth of a boy reduces several dimensions of the mothers' quality of life.

RELEVANCE TO CLINICAL PRACTICE

The importance of the impairment of quality of life in case of PND, as well as its effects on mother-child interaction, could justify prevention programs and early psychotherapeutic care. Further research needs to explore the effectiveness of programmes targeting the construction of parenting skills as a preventative measure against PND, especially for parents of boys.

Translation and Validation of a Chinese Version of the Parenting Sense of Competence Scale in Chinese Mothers

BACKGROUND

Women's sense of competence and satisfaction in the maternal role are essential for positive parenting practices and child development. Measures of maternal role competence and satisfaction are limited in the Chinese population.

OBJECTIVES

To translate the Parenting Sense of Competence Scale into Chinese (C-PSOC) and to examine the psychometric properties of the C-PSOC.

METHODS

A cross-sectional survey was conducted using a convenience sample of 170 mothers recruited from a postnatal unit. Participants completed the C-PSOC, Rosenberg's Self-Esteem Scale, and the Edinburgh Postnatal Depression Scale. A randomly selected subsample of 57 mothers participated in the 4-week retest.

RESULTS

The C-PSOC demonstrated good internal consistency (Cronbach's alpha = .85) and test-retest reliability (intraclass correlation coefficient = .87). Factor analysis supported the two-factor structure reflecting the efficacy and satisfaction dimensions of the original instrument. The scale discriminated between primiparas and multiparas (t = 2.2, p < .05). Significant correlations with Rosenberg's Self-Esteem Scale (r = .60, p < .01) and the Edinburgh Postnatal Depression Scale (r = -.48, p < .01) demonstrated good construct validity.

CONCLUSION

The C-PSOC has satisfactory psychometric properties. It has the potential to be used as a clinical and research instrument for measuring maternal role competence and satisfaction in the Chinese population.

Postnatal depression: prevalence, mothers' perspectives, and treatments

This article presents an overview of research on postnatal depression conducted with postnatal women only. Research spanning three areas is reviewed, namely, prevalence, mothers' experiences ,and treatments. The review shows prevalence rates varying from 4.4% to 73.7%, with the most recent systematic review suggesting a rate of 13%, indicating a serious clinical issue for nurses providing postnatal care to mothers. Mothers' experiences of living with postnatal depression exemplify such feelings as loneliness, anxiety, hopelessness, and loss of control at a time when expectations of joyousness are anticipated. Results of research on treatment options show limited success with antidepressant medications, some success with psychotherapeutic options, and the importance of social support for mothers with postnatal depression. Comparisons of studies are made from methodological perspectives, drawing on their strengths and limitations. Overall, this review highlights the high prevalence rates of postnatal depression, negative feelings exemplified by mothers' living with this condition, and the limited success of treatment options available to mothers. Postnatal depression is a significant clinical issue for nurses providing postnatal care for mothers and is underassessed, misunderstood, and very often poorly treated.