Quality of life during the transition to parenthood in Hong Kong: a longitudinal study

Process evaluation of couple-based psychoeducation program for first-time parents

RATIONALE

Postpartum depression is a worldwide public health issue that can have long-term impact on the family. It is crucial to evaluate intervention program to help new parents cope with the stress of parenthood to reduce the risk of postpartum depression. The aim of this study was to explore the perceived benefits of the couple-based psychoeducation to first-time Hong Kong Chinese parents, and the crucial factors influencing the effectiveness of this program underpinned by the concept of process evaluation.

METHOD

Using an exploratory qualitative design, a purposeful sample of 27 couples who had participated in the program were interviewed at 1-3 months postpartum. Data were collected using semi-structured interviews and analysed by thematic analysis.

FINDINGS

The findings showed that the parents perceived the program to be useful in enhancing their parenting skills and emotional control, and increasing their sense of support. The effectiveness of the program was facilitated by (a) the predisposing factors such as couple-based approach to enhance mutual expectation and shared decision making when experiencing and managing challenges, and telephone follow-up calls to sustain the continuity of care from hospital to the community, (b) the enabling factor for instance, the time of intervention arranged in non-working hour, and (c) reinforcing factor namely involvement of midwives during program implementation and telephone follow-up consultation.

CONCLUSIONS

The results of this study suggest the potential of the couple-based psychoeducation to support first-time parents in taking care of their children and controlling their emotions in this critical transition. The program could be integrated into maternal and child care services on a regular basis, and thus accessible to all first-time parents.

Stress, Marital Relationship and Quality of Life of Couples Across the Perinatal Period

OBJECTIVES

Transition to parenthood is characterized by a high level of stress, which can affect couples' relationship and quality of life. Limited research compares the relationships and trends in stress, marital relationship and quality of life between both couples across the perinatal period. This study examined the associations, changes over time and gender differences in the stress, marital relationship and quality of life of Chinese couples during the perinatal period.

METHODS

A convenience sample of 130 couples participated in this longitudinal study. Data on the assessment of stress, marital relationship and quality of life were collected by validated measures during the second or third trimester of pregnancy and at 6 weeks, 6 months and 12 months postpartum.

RESULTS

Both couples experienced an increased level of stress at 6 weeks postpartum and a gradual decline in marital relationship from pregnancy to 1 year postpartum. The mental component of women's quality of life declined sharply at 6 weeks postpartum and recovered at 6 months postpartum. The physical component of quality of life showed gradual improvements from pregnancy to 1 year postpartum for the women, but a decline for the men. The women showed more stress and poorer marital relationship and quality of life than their partners, and the women's levels of stress, marital relationship and mental component of quality of life were closely related to those of their partners' across the perinatal period. Stress was related negatively to marital relationship and quality of life, and a positive marital relationship was associated with better quality of life during the perinatal period.

CONCLUSION

The study highlights the need to adopt couple-based approaches in clinical practice directed at helping partners develop realistic expectations and manage stress, which are essential to promoting marital relationships and quality of life during the transition to parenthood.

Maternal lack of sleep in the first two years after childbirth: Perceived impacts and help-seeking behaviors

Most evidence-based sleep interventions (e.g., graduated extinction of nighttime crying) are in opposition to many parents' values. This warrants taking a step back and asking the parents about their main concerns regarding their baby's sleep and the type of help they would be likely to use. This study aimed to describe and identify, among mothers of a 0- to 24-month-old child, the perceived impact of lack of sleep, sleep-related help-seeking behaviors as well as the most concerning aspects of the child's sleep, and preferred sleep intervention modalities. Another objective was to identify the factors associated with a negative impact of postpartum sleep, concerns for the child's sleep, and interest in sleep interventions. Canadian mothers (N = 932) were recruited by email snowball sampling and through Facebook to complete an online questionnaire designed for the purposes of the study. Most mothers reported a negative impact of postpartum sleep on their romantic relationship (79.4%) and quality of life (76.7%). Low parental self-efficacy (PSE) about managing the child's sleep was the best predictor of a negative impact of lack of sleep and sleep-related concerns, above and beyond any other child's or mother's characteristics. The preferred intervention modalities were reliable websites and online courses on child sleep, with a greater interest in home visits among mothers who need help the most (low self-efficacy, high concerns). Interventions should aim at increasing PSE about the child's sleep in both parents and include home visits for those who need it the most.

Does Dyadic Coping Predict Couples' Postpartum Psychosocial Adjustment? A Dyadic Longitudinal Study

The way couples jointly manage pregnancy-related demands may prevent both members from experiencing psychosocial maladjustment after childbirth. This study examined (a) changes in dyadic coping (DC) and indicators of psychosocial adjustment [depressive and anxiety symptoms and quality of life (QoL)] from the second trimester of pregnancy (T1) to 6 weeks postpartum (T2), (b) the actor and partner effects of DC at T1 on couples' adjustment at T2, and (c) whether changes in DC over time would be associated with changes in the adjustment of both women and their partners. This study adopted a prospective quantitative dyadic longitudinal design. A total of 303 couples from Portugal answered self-report questionnaires assessing DC, depressive and anxiety symptoms, and QoL at T1, of which 290 were contacted at T2 to complete the same measures (n = 138 couples returned the questionnaires). Results showed that first-time fathers' QoL and both first and experienced fathers' stress communication decreased over time, as did common DC (i.e., the way couples cope together with stress) perceived by both partners. First-time mothers reported higher increases in negative DC. The more positive DC the women provided to men at T1, the higher the internalizing symptoms of women at T2; the more the women communicated stress at T1, the higher the internalizing symptoms of men at T2. Both partners' common DC at T1 positively predicted their QoL at T2. The larger the decrease in common DC over time, the greater the increase in internalizing symptoms of couples and the greater the decrease in their QoL. These findings suggest that DC strategies should be considered into the psychosocial care of couples becoming parents, as a relevant coping resource that partners could use to help each other in situations of stress. More than (exclusively) encouraging the men's role as support providers, couples should be encouraged to reserve time for one another, to discuss each other's concerns, and to seek for solutions as a team. These strategies should be promoted before, and fostered after, childbirth. Likewise, clinicians should be aware that partners might not feel equally comfortable with specific DC strategies and then should be carefully addressed among couples.

High risk of depression, anxiety, and poor quality of life among experienced fathers, but not mothers: A prospective longitudinal study

BACKGROUND

Mental distress patterns in first-time or experienced mothers and fathers during the transition to parenthood have been inadequately studied. This longitudinal study thus investigated changes in depression, anxiety, and health-related quality of life in both parents from early pregnancy until 1 year postpartum. Parity effects were specifically examined.

METHODS

In total, 531 pregnant women and their partners were recruited in Taiwan during early prenatal visits from 2011 to 2015, with five follow-ups from midpregnancy to 1 year postpartum. The participants' self-reported data were collected and analyzed using generalized estimating equation models.

RESULTS

Maternal mental distress levels were highest at 1 month postpartum. During postpartum periods, depression scores increased and social relations domain scores decreased in men. Although mental distress levels were higher in mothers than in fathers, parity evidently affected men. Experienced fathers were independently associated with a 70% higher risk of perinatal depression (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.2-2.3) and anxiety (OR = 1.7, 95% CI = 1.2-2.6). Experienced fathers also exhibited significantly lower perinatal scores than first-time fathers in the physical health and social relations domains.

LIMITATIONS

Selection of both parents in metropolitan areas with higher socioeconomic status may restrict the generalizability of our findings.

CONCLUSIONS

In addition to maternal mental distress during the transition to parenthood, we highlighted experienced fathers' psychological difficulties throughout perinatal periods. Such trends may indicate unsatisfied needs and could guide timely intervention to prevent adverse consequences.

Quality of life in Japanese couples during the transition to parenthood

OBJECTIVE

This study aimed to examine the quality of life (QOL) in Japanese couples during the transition to parenthood with their first child.

BACKGROUND

Relevant literature suggests that the health status of women drop during pregnancy and the postpartum period. However, less is known about their partner's well-being during the transition to parenthood and little research has addressed the relationship between couples' QOL across multiple domains.

METHOD

Participants included 9216 married Japanese men and women, including 3729 couples, who were expecting or raising their first child under the age of three. They independently completed questionnaires on baseline demographics and on WHOQOL-BREF.

RESULTS

Men showed higher scores for psychological QOL, while women had higher scores for social and environment QOL. A significant interaction between gender and stage of transition to parenthood was found. The moderating effect of age between the stage and QOL was found for men on the physical and psychological domains. Couples' QOL scores were weakly to moderately correlated.

CONCLUSION

Findings suggest that both men and women had lower QOL, with the exception of women's physical QOL, after childbirth, but they showed different trends during the transition to parenthood across different domains of QOL.

Factors influencing the quality of life of pregnant women: a systematic review

Background

Pregnancy is a period of transition with important physical and emotional changes. Even in uncomplicated pregnancies, these changes can affect the quality of life (QOL) of pregnant women, affecting both maternal and infant health. The objectives of this study were to describe the quality of life during uncomplicated pregnancy and to assess its associated socio-demographic, physical and psychological factors in developed countries.

Methods

A systematic review was performed according to the PRISMA guidelines. Searches were made in PubMed, EMBASE and BDSP (Public Health Database). Two independent reviewers extracted the data. Countries with a human development index over 0.7 were selected. The quality of the articles was evaluated on the basis of the STROBE criteria.

Results

In total, thirty-seven articles were included. While the physical component of QOL decreased throughout pregnancy, the mental component was stable and even showed an improvement during pregnancy. Main factors associated with better QOL were mean maternal age, primiparity, early gestational age, the absence of social and economic problems, having family and friends, doing physical exercise, feeling happiness at being pregnant and being optimistic. Main factors associated with poorer QOL were medically assisted reproduction, complications before or during pregnancy, obesity, nausea and vomiting, epigastralgia, back pain, smoking during the months prior to conception, a history of alcohol dependence, sleep difficulties, stress, anxiety, depression during pregnancy and sexual or domestic violence.

Conclusions

Health-related quality of life refers to the subjective assessment of patients regarding the physical, mental and social dimensions of well-being. Improving the quality of life of pregnant women requires better identification of their difficulties and guidance which offers assistance whenever possible.

Transition to parenthood: consequences on health and well-being. A qualitative study

OBJECTIVE

Parenthood is one of the most dramatic developmental transitions in the family life cycle. It requires profound changes in lifestyle, roles and relationships, can increase stress levels and affects both men and women's quality of life. This study aimed to explore the effects on the health and well-being of parents during the first six months of transition to the parental role.

METHOD

A qualitative study using the grounded theory approach. Data collection was from semi-structured interviews (total of 60 interviews). The constant comparative method was used and theoretical sampling in the process of data collection and analysis, and the study was undertaken in a simultaneous and cyclical way. Five fathers and five mothers (couples) participated.

RESULTS

The category "living on the edge of one's capacities" was described, which is composed of the subcategories "feeling exhaustion", "perceiving exhaustion in the mother", "overflowing emotions" and "feeling less exhaustion", to explain the impact that the birth of a child had on the parents' lives, when taking on all the tasks and responsibilities of parenthood.

CONCLUSIONS

Adapting to parenthood is not easy, linear or fast. It involves numerous situations that generate stress and emotional disturbance, linked to tiredness, sleep disturbance, work overload and readjustments of the dynamics of life, which especially affect the mother. Antenatal and postnatal preparation for this impact should, therefore, be encouraged and effective, as a focus of nursing intervention.

A Qualitative Evaluation of Telephone-Based Cognitive-Behavioral Therapy for Postpartum Mothers

The purpose of this study was to explore postpartum women's perceptions of a telephone-based cognitive-behavioral therapy (T-CBT). Using an exploratory qualitative design, a purposeful sample of 39 first-time Chinese mothers who had participated in the T-CBT was interviewed at 6 weeks postpartum. Data were collected using semi-structured interviews and analyzed by content analysis. The findings revealed that Chinese women perceived T-CBT to be helpful in increasing their confidence in the maternal role, enhancing their emotional control, and increasing their sense of support. The effectiveness of T-CBT was enhanced by the delivery of the intervention by health care professional and the flexibility of intervention to provide individualized and timely information. The evidence suggests T-CBT is a feasible modality with the potential to support mothers in managing the demands of parental transition. T-CBT could be incorporated into perinatal services on an ongoing and regular basis, and therefore readily accessible to all postpartum women.

Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis

BACKGROUND

Pre-eclampsia (PE) prediction based on blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities can result in false-positive diagnoses. This may lead to unnecessary antenatal admissions and preterm delivery. Blood tests that measure placental growth factor (PlGF) or the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to PlGF could aid prediction of PE if either were added to routine clinical assessment or used as a replacement for proteinuria testing.

OBJECTIVES

To evaluate the diagnostic accuracy and cost-effectiveness of PlGF-based tests for patients referred to secondary care with suspected PE in weeks 20-37 of pregnancy.

DESIGN

Systematic reviews and an economic analysis.

DATA SOURCES

Bibliographic databases including MEDLINE, EMBASE, Web of Science and The Cochrane Library and Database of Abstracts of Reviews of Effects were searched up to July 2015 for English-language references. Conferences, websites, systematic reviews and confidential company submissions were also accessed.

REVIEW METHODS

Systematic reviews of test accuracy and economic studies were conducted to inform an economic analysis. Test accuracy studies were required to include women with suspected PE and report quantitatively the accuracy of PlGF-based tests; their risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. The economic studies review had broad eligibility criteria to capture any types of economic analysis; critical appraisal employed standard checklists consistent with National Institute for Health and Care Excellence criteria. Study selection, critical appraisal and data extraction in both reviews were performed by two reviewers.

ECONOMIC ANALYSIS

An independent economic analysis was conducted based on a decision tree model, using the best evidence available. The model evaluates costs (2014, GBP) from a NHS and Personal Social Services perspective. Given the short analysis time horizon, no discounting was undertaken.

RESULTS

Four studies were included in the systematic review of test accuracy: two on Alere's Triage^® PlGF test (Alere, Inc., San Diego, CA, USA) for predicting PE requiring delivery within a specified time and two on Roche Diagnostics' Elecsys^® sFlt-1 to PlGF ratio test (Roche Diagnostics GmbH, Mannheim, Germany) for predicting PE within a specified time. Three studies were included in the systematic review of economic studies, and two confidential company economic analyses were assessed separately. Study heterogeneity precluded meta-analyses of test accuracy or cost-analysis outcomes, so narrative syntheses were conducted to inform the independent economic model. The model predicts that, when supplementing routine clinical assessment for rule-out and rule-in of PE, the two tests would be cost-saving in weeks 20-35 of gestation, and marginally cost-saving in weeks 35-37, but with minuscule impact on quality of life. Length of neonatal intensive care unit stay was the most influential parameter in sensitivity analyses. All other sensitivity analyses had negligible effects on results.

LIMITATIONS

No head-to-head comparisons of the tests were identified. No studies investigated accuracy of PlGF-based tests when used as a replacement for proteinuria testing. Test accuracy studies were found to be at high risk of clinical review bias.

CONCLUSIONS

The Triage and Elecsys tests would save money if added to routine clinical assessment for PE. The magnitude of savings is uncertain, but the tests remain cost-saving under worst-case assumptions. Further research is required to clarify how the test results would be interpreted and applied in clinical practice.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42015017670.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

[Post-partum depressive symptoms: Prevalence, risk factors and relationship with quality of life]

OBJECTIVE

The objective of our study was to estimate the prevalence of the post-partum depressive symptomatology in a sample of Tunisian women, to study associated factors and to assess its relationship to quality of life.

PATIENTS AND METHODS

This is a prospective study carried out in two stages: during the first week (T1), then between sixth and eighth week post-partum (T2). Depressive symptomatology and quality of life were assessed respectively by the Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life scale.

RESULTS

In the first stage, the prevalence of depressive symptomatology in the total sample (150 women) was 14.7% and was related to age above 35 years, low school level, personal psychiatric history, multiparity, caesarean delivery or forceps in the previous pregnancy and unplanned pregnancy. This prevalence was 19.8% among the 126 women reviewed in T2 and was correlated with the exaggerated sympathetic signs during pregnancy, namely perversion of taste and fatigue. Quality of life was strongly correlated with depressive symptoms in T1 and T2.

CONCLUSION

Post-partum depressive symptoms were common in our sample and were correlated with quality of life. Therapeutic measures should be proposed for women with post-partum depressive symptoms and particularly with several risk factors in order to improve their quality of life.

The effect of a telephone-based cognitive behavioral therapy on quality of life: a randomized controlled trial

Health-related quality of life (HRQoL) has emerged as a major public health concern in perinatal care. The purpose of this study was to examine the effect of telephone-based cognitive behavioral therapy (T-CBT) on HRQoL among Chinese mothers at risk of postnatal depression at 6 weeks and 6 months postpartum. A multi-center randomized controlled trial was conducted at the postnatal units of three regional hospitals. Three hundred and ninety-seven women at risk of postnatal depression were recruited and were randomly assigned to the T-CBT (n = 197) or usual care (n = 200). Assessment was conducted at baseline, 6 weeks and 6 months postpartum for HRQoL. Women in the T-CBT experienced greater improvement in the physical component of HRQoL from baseline to 6 weeks and 6 months postpartum than the usual care group. At 6 months postpartum, the T-CBT group also experienced better HRQoL in the mental component of HRQoL than the usual care group. The T-CBT appears to be feasible and effective in improving HRQoL in women at risk of postnatal depression in the primary care practice.

Cultural differences in postnatal quality of life among German-speaking women - a prospective survey in two countries

BACKGROUND

Assessment of quality of life after childbirth is an important health-outcome measurement for new mothers and is of special interest in midwifery. The Mother-Generated Index (MGI) is a validated instrument to assess postnatal quality of life. The tool has not been applied for making a cross-cultural comparison before. This study investigated (a) responses to the MGI in German-speaking women in Germany and Switzerland; and (b) associations between MGI scores on the one hand and maternity and midwifery care on the other.

METHODS

A two-stage survey was conducted in two rural hospitals 10 km apart, on opposite sides of the German-Swiss border. The questionnaires included the MGI and questions on socio-demographics, physical and mental health and maternity care, and were distributed during the first days after birth and six weeks postpartum. Parametric and non-parametric tests were computed with the statistical programme SPSS.

RESULTS

A total of 129 questionnaires were returned an average of three days after birth and 83 in the follow-up after seven weeks. There were no statistically significant differences in the MGI scores between the German and the Swiss women (p = 0.22). Significantly more favourable MGI scores were found associated with more adequate information during pregnancy (p = 0.02), a more satisfactory birth experience (p < .01), epidural anaesthesia (p < 0.01), more information (p = 0.01) and better support (p = 0.02) during the time in hospital and less disturbed sleep (p < 0.01). Significantly lower MGI scores were associated with the presence of a private doctor during birth (p = 0.01) and with exclusive breastfeeding during the first postnatal days (p = 0.04).

CONCLUSION

The MGI scores of these German-speaking women were higher than those in other studies reported previously. Thus the tool may be able to detect differences in postnatal quality of life among women with substantially divergent cultural backgrounds. Shortcomings in maternity and midwifery care were detected, as for example the inadequate provision of information during pregnancy, a lack of individualised postpartum care during the hospital stay and insufficient support for exclusively breastfeeding mothers. The MGI is an appropriate instrument for maternity care outcome measurement in cross-cultural comparison research.