Revalidation of the postpartum stress scale

The effect of perceived social support on postpartum stress: the mediating roles of marital satisfaction and maternal postnatal attachment

BACKGROUND

Multiple factors may be responsible for the development of postpartum stress, including perceived social support, marital satisfaction, and maternal postnatal attachment. However, the underlying mediation mechanisms remain unclear. This study examined the complex relationships between perceived social support and postpartum stress among Chinese women.

METHODS

A convenience sample comprising 406 postpartum women was recruited from six hospitals in Nantong, Jiangsu Province, China. The participants completed general survey questionnaires and were evaluated using the Maternal Postpartum Stress Scale, the Perceived Social Support Scale, the Maternal Postnatal Attachment Scale, and the Marital Satisfaction Scale. Furthermore, we evaluated the relationship between postpartum stress and the various influencing factors by performing a multiple linear regression analysis. The potential mediating roles of marital satisfaction and maternal and infant attachment in the association between perceived social support and postpartum stress were explored by performing a mediation analysis.

RESULTS

According to the multivariate regression analysis, perceived social support, marital satisfaction, and maternal postnatal attachment contributed to postpartum stress levels (P < 0.05). The mediation analysis revealed that marital satisfaction and maternal postnatal attachment played parallel mediating roles in the association between perceived social support and postpartum stress, and the mediating effect of marital satisfaction was - 0.1125 (95% confidence interval [CI]: -0.1784 to -0.0520), accounting for 33.20% of the total effect, and the mediating effect of maternal postnatal attachment was - 0.0847 (95% CI: -0.1304 to -0.0438), accounting for 25.00% of the total effect.

CONCLUSION

Our study revealed that perceived social support could influence postpartum stress not only through direct effect (41.80% of the total effect), but also through the indirect effect (mediation effect) of marital satisfaction and maternal postnatal attachment (58.20% of the total effect), suggesting that improving postpartum women's social support, enhancing maternal and infant attachment, and improving their marital satisfaction could help lower postpartum stress.

Measuring stress after childbirth: development and validation of the Maternal Postpartum Stress Scale

BACKGROUND

Due to a wide range of stressors during the first postpartum year, this study aimed to develop and validate a self-report measure of stress intensity specific for postpartum.

METHOD

Postpartum women (N= 603) completed the Maternal Postpartum Stress Scale in a cross-sectional online study. They also filled out questionnaires on general stress, depression, and anxiety . Factor analysis, reliability, and validity were examined.

RESULTS

Exploratory factor analyses revealed a three-factor structure: Personal needs and fatigue , Infant nurturing , and Body changes and sexuality. The reliability of the total scale and all subscales was good. Significant positive correlation with general stress indicated good convergent validity, and with depression and anxiety good divergent validity. Primiparous mothers had a higher score on the Infant nurturing subscale, and the mothers of infants with health problems had a higher score on the total scale, Personal needs and fatigue, and Infant nurturing.

CONCLUSION

Maternal Postpartum Stress Scale is a new, valid, and reliable 22-items scale that measures stress during the first postpartum year. The total scale and tree subscales can be calculated separately to provide detailed information about stressors that mothers struggle with. The scale can be used for research and practical purposes.

Dietary Patterns Associated with General Health of Breastfeeding Women 1-2 Months Postpartum: Data from the Japanese Human Milk Study Cohort

Background

The effects of dietary patterns on health outcome of lactating women remain unclear.

Objectives

To describe the dietary patterns of lactating Japanese women and explore the association between dietary patterns and their general health.

Methods

This study included 1096 lactating women from the Japanese Human Milk Study Cohort. The maternal diet during lactation 1-2 mo postpartum was determined using a FFQ. Dietary patterns were identified using a factor analysis based on the energy-adjusted intake of 42 food items. Trend associations between maternal and infant variables and quartiles of dietary pattern scores were tested, and logistic regression was performed to estimate the OR and 95% CI of maternal self-reporting anemia, constipation, rough skin, sensitivity to cold, and mastitis.

Results

Four dietary patterns were identified in this study. The versatile vegetable diet, characterized by a high intake of vegetables, mushrooms, seaweeds, and tofu, was associated with maternal age, BMI prepregnancy and during the lactation periods, education, household income, and anemia. The plain Japanese diet contained a high intake of typical Japanese foods such as rice and miso soup and a low intake of bread and some confectioneries and was associated with maternal BMI during both periods. The salad vegetable diet, characterized by a high intake of raw vegetables and tomatoes with mayonnaise or dressing, was associated with parity and season in which data collection was conducted. The seafood diet, characterized by a high intake of fish, squid, octopus, shrimp, and shellfish, was associated with days postpartum and sensitivity to cold.

Conclusions

Four dietary patterns were identified and were independently associated with socioeconomic factors. The versatile vegetables diet and seafood diet were associated with anemia and sensitivity to cold, respectively, among the participants. This trial was registered at the Japanese Clinical Trials Registry (https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000017649) as UMIN000015494.

Factors Affecting Women's Adjustment to Postpartum Changes: A Narrative Review

Background

Postpartum period is associated with stress and pressure, and the woman must adjust herself to these changes. This study aimed to review the factors affecting women's adjustment to postpartum changes in conducted studies.

Materials and Methods

This review was conducted by searching databases such as ISI Web of Science, Science Direct, Scopus, Cochrane, PubMed and Scientific Information Database (SID), Iranian Medical Articles Database (IranMedex), Iranian Research Institute for Information Science and Technology (IranDoc), and the Iranian Magazine Database (MagIran), as well as searching through Google Scholar (as a Web search engine) in December 2019. Publications from July 2004 to October 2019 were reviewed and limited to Persian and English. The keywords used included "Postpartum", "Women's needs", "Adjustment" and "Coping". After reviewing the articles, out of 60 original articles, 17 articles were selected for final evaluation.

Results

Factors affecting adjustment to postpartum changes were divided into personal and social factors. Personal factors included previous experiences, coping styles and strategies, personality traits, self-efficacy and awareness, and social factors included family and relatives, healthcare providers, cultural context, and laws and regulations.

Conclusions

Adjustment to postpartum changes depends on the personal and social factors that can interact with each other. Women's awareness enables them to use positive coping strategies in this critical situation. Educating women's spouse and family members can contribute to increase the women's social support. Additionally, the law support guarantees the implementation of many interventions in promoting the mother's health.

Psychometric properties of the Persian version of postpartum distress measure scale

BACKGROUND

The purpose of the present study was to determine psychometric properties of the Persian version of Postpartum Distress Measure Scale (PDM Scale).

METHODS

In this psychometric explorative study, the data were collected using a questionnaire containing demographic information, PDM Scale, and Depression and Anxiety Stress Scale-21 (DASS-21). The content, face and construct validity of the questionnaire was examined with participation of ten experts, 10 and 150 women referring to health care centers, who were under common care during their postpartum period, respectively. The concurrent validity of the tool was evaluated using DASS-21. The reliability of the items was evaluated with the participation of 30 women, calculating Cronbach's alpha coefficient and intra-class correlation coefficient.

RESULTS

The Content Validity Index, Content Validity Ratio and Impact Score of the Persian version of the PDM were 0.94, 0.73, and 2.97, respectively. The ten items of the questionnaire were loaded in two factors (general distress and obsessive compulsive symptoms subscale). Those two factors explained 50.78% of the total variance of women's distress. Internal consistency of the items and stability of the results were confirmed by Cronbach's alpha of 0.72 and Intra-class correlation coefficient of 0.75.

CONCLUSION

According to the study results, the Persian version of PDM Scale has acceptable psychometric properties. Care providers and researchers can use it as a tool for screening anxiety, depression and obsessive-compulsive disorder in women.

Exploring the Experience of Life Stress Among Black Women with a History of Fetal or Infant Death: a Phenomenological Study

INTRODUCTION

Disparate birth outcomes among Black women continue to be a major public health problem. Whereas prior research has investigated the influence of stress on Black women's birth outcomes, few studies have explored how stress is experienced among Black women across the life course. The objectives of this study were to describe the experience of stress across the life course among Black women who reported a history of fetal or infant death and to identify stressful life events (SLE) that may not be represented in the widely used SLE inventory.

METHODS

Using phenomenological, qualitative research design, in-depth interviews were conducted with six Black women in Kansas who experienced a fetal or infant death.

RESULTS

Analyses revealed that participants experienced multiple, co-occurring stressors over the course of their lives and experienced a proliferation of stress emerging in early life and persisting into adulthood. Among the types of stressors cited by participants, history of sexual assault (trauma-related stressor) was a key stressful life event that is not currently reflected in the SLE inventory.

CONCLUSION

Our findings highlight the importance of using a life-course perspective to gain a contextual understanding of the experiences of stress among Black women, particularly those with a history of adverse birth outcomes. Further research investigating Black women's experiences of stress and the mechanisms by which stress impacts their health could inform efforts to reduce disparities in birth outcomes. An additional focus on the experience and impact of trauma-related stress on Black women's birth outcomes may also be warranted.

Nurses' Experiences of Nonpatient Factors That Affect Nursing Workload: A Study of the PAONCIL Instrument's Nonpatient Factors

In the RAFAELA patient classification system, the professional assessment of optimal nursing care intensity level (PAONCIL) instrument is used to assess the optimal nursing intensity level per unit. The PAONCIL instrument contains an overall assessment of the actual nursing intensity level and an additional list of central nonpatient factors that may increase or decrease the total nursing workload (NWL). The aim of this cross-sectional study was to assess and determine which nonpatient factors affect nurses' experiences of their total NWL in both outpatient settings and hospitals, as captured through the PAONCIL instrument. The data material consisted of PAONCIL questionnaires from 38 units and 37 outpatient clinics at 11 strategically selected hospitals in Finland, and included nurses' answers (n = 1307) to the question of which factors, other than nursing intensity, affect total NWL. The methods for data analyses were qualitative content analyses. The nonpatient factors that affected nurses' experiences of total NWL are "organization of work," "working conditions," "self-control," and "cooperation." The actual list of nonpatient factors in the PAONCIL instrument is to a reasonable extent relevant, but the list should be improved to include nurses' actual working conditions and self-control.

Development, validity and reliability of the Turkish version of the Hung Postpartum Stress Scale

AIM

The aim of the current study was to translate the Hung Postpartum Stress Scale into Turkish and test the reliability and validity of the Turkish version of the scale.

METHODS

The translation process of the Hung Postpartum Stress Scale into Turkish and the testing of reliability and validity of the newly developed scale on postpartum stress in women are described. The questionnaire was translated using a back-translation technique. Expert review of internal consistency reliability, content validity, factor analysis of construct validity and criterion-related validity were examined.

RESULTS

Cronbach's alpha for the Turkish version of the Hung Postpartum Stress Scale was 0.931, indicating very good reliability. Factor analyses resulted in a two factor scale structure: maternal concerns and acceptability of the newborn by the family. Analyses also indicated good test-re-test reliability for the Turkish version of the Hung Postpartum Stress Scale (P < 0.01).

CONCLUSIONS

The present study describes the design of a Turkish version of the Hung Postpartum Stress Scale. The newly developed scale proved to be reliable and valid and will be a valuable instrument for women's healthcare professionals.