Contributions of maternal identity and lifestyle to young children's adjustment

Maternal Stressors and Coping Strategies During the Extended Postpartum Period: A Retrospective Analysis with Contemporary Implications

Background: Despite recent emphasis on the "fourth trimester" and beyond, most knowledge of stressors affecting women is focused on the first 6 postpartum weeks. Our aim was to identify postpartum-specific stressors and coping over the extended postpartum period. Methods: We analyzed data from two surveys for a combined sample of 346 postpartum women. Principal components analysis of survey items on sources of stress was used to identify categories of postpartum-specific stressors. Content analysis was used to categorize text data on coping strategies. Results: Seven stressors were identified: Overload, Working mother concerns, Isolated motherhood, Limited supportive resources, Exhaustion, Parenting demands, and Changes in body and sexuality. Overload was the most frequent stressor (F = 49.32, p < 0.001) and was significantly higher at 9-12 months than at 5-8 months or at 13 months or more (F = 6.42, p = 0.002). Fulltime employment and having more than one child were associated with elevated scores on several stressors. Content analysis yielded seven coping strategies, such as Take time alone or with others, Manage emotions and thoughts, and Maintain a manageable workload. Five of the seven stressors were associated with at least one of the top five coping strategies; none was associated with Overload or Limited supportive resources. Conclusions: Women's predominant source of stress was from overload and was highest at 9 to 12 months postpartum. Community resources and public health policy and programming are needed to prepare and support women during the challenging first postpartum year.

Maternal health needs and interest in screening for depression and health behaviors during pediatric visits

INTRODUCTION

Our aims were to assess postpartum health care barriers; health status (including depression and health behaviors); missed opportunities to discuss maternal health at health visits; acceptability of maternal screening in pediatric settings; and association of these variables with income level and race/ethnicity.

METHOD

A mail survey was used with names randomly drawn from birth files and balanced for race/ethnicity and income level.

RESULTS

The adjusted response rate was 27.6%, with 41% reporting one or more health care barrier(s), 22% screening positive for depression, and 30% screening positive for alcohol abuse. Women of lower income were eight times more likely than those of higher income to have health care barriers (adjusted odds ratio = 8.15; 95% confidence interval: 3.60, 18.44). Missed discussions of postpartum depression or behavioral health during pediatric or other health care visits ranged from 26% to 79%. Acceptability of discussing topics, including depression, smoking, and alcohol use at pediatric care visits generally exceeded 85%.

DISCUSSION

Postpartum women experienced income-associated barriers to health care and generally had favorable views about maternal screening in pediatric settings.

[Life transition of mothers of children with autism]

PURPOSE

While there are a number of studies on children with disabilities, there have been few studies on mothers of children with autism. The purpose of this study was to explore the process of life transition of mothers who have children with autism.

METHODS

From June 2007 to May 2009, the researcher interviewed 15 mothers of children with autism living in Seoul City, Gyeonggi or Chonbuk Provinces, and then analyzed the data gathered using the constant comparative method of grounded theory.

RESULTS

"Living together holding a string of fate" was a core category showing along the continuum of life. The basic social process of life transition encompassed 5 stages: stages of denying, wandering, devoting, mind controlling, and finally accepting. These five stages proceeded in phases, though returned back to the wandering stage occasionally.

CONCLUSION

This study has opened the door to understanding how mothers of children with autism experienced life transition. The findings suggest that differentiated support and care at each stage should be given and there is the need to develop transition assessment tools for mothers of children with autism.

Maternal predictors of toddler health status

PURPOSE

The purposes of this study were to examine the relationships among maternal and environmental variables in the first 6 months postpartum and toddler health status, and to identify predictors of toddler health.

DESIGN AND METHODS

A secondary analysis was conducted on an existing dataset of a longitudinal parent-child survey.

RESULTS

Maternal stress predicted 8% of the variance in child health status at 18 months of age. Children in nonparental care more than 20 hr per week were perceived as less healthy.

PRACTICE IMPLICATIONS

Pediatric nurses should assess levels of maternal stress in the early months postpartum and anticipate poorer health status in toddlers who spend more than 20 hr per week in nonparental care.

Pre- and postnatal influences on preschool mental health: a large-scale cohort study

BACKGROUND

Methodological challenges such as confounding have made the study of the early determinants of mental health morbidity problematic. This study aims to address these challenges in investigating antenatal, perinatal and postnatal risk factors for the development of mental health problems in pre-school children in a cohort of Western Australian children.

METHODS

The Raine Study is a prospective cohort study of 2,868 live born children involving 2,979 pregnant women recruited at 18 weeks gestation. Children were followed up at age two and five years. The Child Behaviour Checklist (CBCL) was used to measure child mental health with clinical cut-points, including internalising (withdrawn/depressed) and externalising (aggressive/destructive) behaviours (n = 1707).

RESULTS

Multinomial logistic regression analysis showed that the significant risk factors for behaviour problems at age two were the maternal experience of multiple stress events in pregnancy (OR = 1.20, 95% CI = 1.06, 1.37), smoking during pregnancy (OR = 1.30, 95% CI = 1.06, 1.59) and maternal ethnicity (OR = 3.34, 95% CI = 1.61, 6.96). At age five the experience of multiple stress events (OR = 1.17, 95% CI = 1.08, 1.27), cigarette smoking (OR = 1.19, 95% CI = 1.03, 1.37), male gender (OR = 1.43, 95% CI = 1.02, 2.00), breastfeeding for a shorter time (OR = .97, 95% CI = .94, .99) and multiple baby blues symptoms (OR = 1.08, 95% CI = 1.02, 1.14) were significant predictors of mental health problems.

CONCLUSIONS

Early childhood mental health is significantly affected by prenatal events in addition to the child's later environment. Interventions targeting adverse prenatal, perinatal and postnatal influences can be expected to improve mental health outcomes for children in the early years.

Maternal empathy, self-confidence, and stress as antecedents of preschool children's behavior problems

PURPOSE

To test psychosocial antecedents (maternal stress, self-confidence, and empathy) of preschoolers' behavior problems.

DESIGN AND METHODS

One hundred and twenty-two postpartum mothers completed a 24-month longitudinal mail survey. A structural equation model that included empathy was tested.

RESULTS

Stress, but not maternal self-confidence or empathy, was directly related to child behavior problems (t=1.98, p=.05). Maternal empathy in combination with self-confidence or stress, however, moderated adverse effects on behavior problems (p=.03). Predictors explained 16% of variance of behavior problems.

PRACTICE IMPLICATIONS

Empathy was protective when stress was high. Empathy training may enhance high-risk parent education.

Health-promoting behaviors and psychosocial well-being of university students in Hong Kong

The objective of this study was to examine health-promoting behaviors and psychosocial well-being of university students in Hong Kong. A cross-sectional study was conducted using convenience sample (n = 247) of students recruited at various locations on campus. The Chinese version of the Health Promotion Lifestyle Profile II (HPLP-II; S. Walker, K. Sechrist, & N. Pender, 1995) was given to students as a questionnaire. Relatively few university students had a sense of "health responsibility" (6.5-27.1%), engaged in any form of physical activity (31.2%), or exercised regularly (13.8%). Less than half ate fruits (35.2%) and vegetables (48.9%) every day. Positive personal growth was reported by 50.6% of the students; 42.5% used stress-management skills and 74.1% rated their interpersonal relationships as meaningful and fulfilling. Students' scores on the health responsibility, nutritional habits, spiritual growth, interpersonal relations, or stress-management subscales of the HPLP-II did not differ significantly by gender, but males scored better than females (p = 0.001) on the physical exercise subscale. This study provides information on gender differences and specific needs of students which can help university administrators, curriculum planners, and community health professionals design guidelines for structuring a healthier environment and developing health education programs that support healthy choices among university students.

Health-promoting behaviors of sheltered homeless women

To expand the body of knowledge and provide further insight into the complex area of homelessness and health, health practices of sheltered homeless women were investigated using a cross-sectional, descriptive, and non-experimental design using Pender's Health Promotion Model as the theoretical framework. The sample (n=137) was well educated, mostly unemployed, primarily single, and homeless due to relationship problems/conflict per self-report. Homeless women were noted to practice health-promoting behaviors in all areas but scored the lowest on physical activity and nutrition. Significant findings reflected women's personal strengths and resources in the areas of spiritual growth and interpersonal relations.

THE ROLE OF CONTEXTUAL, CHILD, AND PARENT FACTORS IN PREDICTING CRIMINAL OUTCOMES IN ADOLESCENCE

This study examined predictor variables that would contribute toward an explanatory model linking child maltreatment and the outcome of crime seriousness. A secondary data analysis was completed on a random sample of youth committed and detained by a juvenile justice system in the northeast United States. Although existing data indicate a predisposition to crime and violence among youth that are maltreated, more research is needed to determine the exact nature of the link, as well as the need to determine the relationship of associated factors. The aim of this analysis was to identify key contextual, child, and parental factors related to maladaptive behavior in abused and neglected adolescent offenders. Logistic regression was used to predict serious criminal outcomes. Overall, 73% of the cases were correctly classified. Ten variables remained in the model to predict serious juvenile criminal behavior. Youth who had been exposed to community violence or who had a mother with mental illness were four times as likely to commit serious criminal behaviors.

Mothers and others. African-American women's preparation for motherhood

PURPOSE

To describe motherhood, maternal role requirements, and family life as perceived by poor, urban, African-American women.

DESIGN

Ethnographic qualitative research.

METHOD

Using ethnographic methodology, 15 new mothers between the ages of 14 and 44, along with their families and significant others, were observed and interviewed in their homes and communities, using semi-structured and open-ended questions. The initial interview occurred within 24 hours of birth of a normal healthy infant. The interviews were analyzed for emergence of themes. Descriptions of select actions, interactions, and activities exemplified themes.

RESULTS

Motherhood was found to be a significant demarcation in the women's lives, and they described both positive and negative maternal experiences. The mothers followed organized, culturally grounded steps in their pursuit of the maternal role; these steps were learned in the family of origin. The four steps discovered were preparing, checking, becoming, and evaluating. Role failure involved undesirable consequences for the mother. The results of this study reveal that these women are mothers by design, not by default.

CLINICAL IMPLICATIONS

These mothers expended a great deal of energy to maintain their families; they valued successful maternal role fulfillment. If health care providers could become better sensitized to mothers' cultural values and social stresses, it could be possible to better help identify mothering needs. Health care providers could use culturally sensitive information to help support positive healthy mothering techniques for young mothers from diverse cultural groups.

A review of research instruments for use during the postpartum period

Locating existing instruments available to measure key variables is critical to the success of a research study. However, this process can be a time-consuming activity. In this article, selected instruments available for use in research during the postpartum period are reviewed. These instruments are divided into two categories. The first category deals with instruments that focus on mothers only. These questionnaires measure mothers' perceptions of their deliveries, their adaptation to motherhood, and their breastfeeding experiences. The second category centers on instruments that both parents can complete. These instruments measure parents' perceptions of their parenting role, sense of competence, problem-solving ability, and perceptions of their newborns. The psychometric properties of each instrument are described, and selected nursing research studies that used the instrument are reviewed.