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Bdier D, Mahamid F, Fallon V, Amir M. Posttraumatic stress symptoms and postpartum anxiety among palestinian women: the mediating roles of self-esteem and social support. BMC Womens Health 2023; 23:420. [PMID: 37559047 PMCID: PMC10413689 DOI: 10.1186/s12905-023-02567-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/23/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Women are estimated to develop several mental disorders during pregnancy and/or for up to a year postpartum, with anxiety and depression being the most common co-morbidities. Postpartum anxiety is less well studied compared with postpartum depression in the Palestinian context in terms of risk factors, mental health outcomes and protective factors. PURPOSE The aim of the current study was to investigate whether self-esteem and social support mediated the association between posttraumatic stress symptoms and postpartum anxiety among Palestinian women. METHODS Berlin Social Support Scales, Postpartum Specific Anxiety Scale, Impact of the Event Scale, and Rosenberg self-esteem scale were administered to 408 Palestinian women recruited from health centers in northern of the West Banks/ Palestine using a convenience sample. RESULTS The findings of our study revealed that postpartum anxiety positively correlated with posttraumatic stress symptoms (r = .56, p < .01), and negatively correlated with social support (r = - .30, p < .01), and self-esteem (r = - .27, p < .05). Moreover, posttraumatic stress symptoms negatively correlated with social support (r = - .24, p < .01), and self-esteem (r = - .25, p < .01). Results of structural equation modeling (SEM) showed a good fit of the hypothesized model. CONCLUSIONS Given this, it is recommended to conduct similar studies with diverse samples in the Palestinian society. It would also be useful for health professionals who work with Palestinian pregnant women (i.e., mental health providers, nurses, midwives, physicians) to assess self-esteem and social support in an effort to identify women who may be at greater risk of developing postpartum anxiety. It may also be worthwhile to develop and implement interventions during pregnancy which serve to enhance a women's sense of self-esteem during this particularly stressful period.
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Affiliation(s)
- Dana Bdier
- Psychology and Counseling Dept, An-Najah National University, Nablus, Palestine
- University of Milano-Bicocca, Milan, Italy
| | - Fayez Mahamid
- Psychology and Counseling Dept, An-Najah National University, Nablus, Palestine.
| | - Vicky Fallon
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Moath Amir
- Department of Medical Laboratory, Palestinian Ministry of Health, Thabet-Thabet Hospital, Tulkarm, Palestine
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Yan P, Xu J. The Effects of Perceived Social Support on Postpartum Anxiety: A Moderated Mediation Model. Matern Child Health J 2023:10.1007/s10995-023-03712-6. [PMID: 37273134 DOI: 10.1007/s10995-023-03712-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Previous literature showed that perceived social support, self-esteem and optimism all played critical roles in the developing of postpartum anxiety. However, the mechanisms of influence were still unclear. This study aimed to explore the underlying mechanism of the relationship among perceived social support, self-esteem, optimism and postpartum anxiety. METHOD 756 women within one year after childbirth were surveyed using the Perceived Social Support Scale, Self-Assessment of Anxiety Scale, Self-Esteem Scale and Life Orientation Test Questionnaire. Pearson correlation analyses were performed to determine the direction and size of the all variables. The mediation model and the moderated mediation model were performed using the PROCESS macro. RESULTS Postpartum anxiety negatively correlated with perceived social support, self-esteem and optimism. A significant positive relationship existed among perceived social support, self-esteem and optimism. Self-esteem played a mediating role in the association between perceived social support and postpartum anxiety, with a mediating effect value of - 0.23. Optimism moderated the mediating process by which perceived social support affected postpartum anxiety via self-esteem. At the three levels of optimism (mean minus 1 SD, mean and mean plus 1 SD), the mediating effect values of self-esteem in the relationship between perceived social support and postpartum anxiety tended to diminish. CONCLUSION Self-esteem partially mediated the relationship between perceived social support and postnatal anxiety, and this mediating process was moderated by optimism.
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Affiliation(s)
- Panpan Yan
- School of Psychology, Weifang Medical University, Weifang, China
| | - Jihong Xu
- National Research Institute for Family Planning, No. 12 Dahuisi Road, Haidian District, Beijing, 100081, China.
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Caregiver-oncologist prognostic concordance, caregiving esteem, and caregiver outcomes. J Geriatr Oncol 2022; 13:828-833. [DOI: 10.1016/j.jgo.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/19/2022]
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Sanchez AL, Jent J, Aggarwal NK, Chavira D, Coxe S, Garcia D, La Roche M, Comer JS. Person-Centered Cultural Assessment Can Improve Child Mental Health Service Engagement and Outcomes. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:1-22. [PMID: 34905434 DOI: 10.1080/15374416.2021.1981340] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children's mental health care. METHODS Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child's problems and family help-seeking. RESULTS Implementation data showed strong provider fidelity and clinical utility. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families' values. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher treatment attendance, homework completion, and treatment response. CONCLUSIONS The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. Registered at clinicaltrials.gov (NCT03499600).
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Affiliation(s)
- Amanda L Sanchez
- Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Jason Jent
- Mailman Center for Child Development, University of Miami Miller School of Medicine
| | | | - Denise Chavira
- Department of Psychology, University of California Los Angeles
| | - Stefany Coxe
- Center for Children and Families and Department of Psychology, Florida International University
| | - Dainelys Garcia
- Mailman Center for Child Development, University of Miami Miller School of Medicine
| | - Martin La Roche
- Harvard Medical School, Boston Children's Hospital at Martha Eliot
| | - Jonathan S Comer
- Center for Children and Families and Department of Psychology, Florida International University
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Hasani S, Aung E, Mirghafourvand M. Low self-esteem is related to depression and anxiety during recovery from an ectopic pregnancy. BMC Womens Health 2021; 21:326. [PMID: 34496785 PMCID: PMC8424942 DOI: 10.1186/s12905-021-01467-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Considering the increasing incidence of ectopic pregnancy and the negative effects of pregnancy loss on mental health, this study aimed to determine the status of mental health in women with ectopic pregnancy and examine its relationship with their self-esteem. METHODS This was a cross-sectional study on 150 women (with a 100% response rate) hospitalized for ectopic pregnancy et al.-Zahra hospital in Tabriz, Iran, during 2018-2019, and recruited via convenience sampling. Data were collected using the General Health Questionnaire-28, which has four subscales (overall score range: 0 to 84; subscale score range: 0 to 21 with a lower score indicating a better mental state), and Rosenberg Self-Esteem Scale (score range: - 10 to + 10 with a higher score indicating higher self-esteem). To determine the association between self-esteem and mental health, independent t-tests, and multivariable logistic regression were used. RESULTS The response rate was 100%. The mean score (SD) of participants' mental health was 31.4 (8.5), and that of self-esteem was 4.5 (3.80). The percentage of participants who were considered as having mental distress (i.e., overall GHQ-28 score ≥ 24) was 76%. Among the subscales of mental health, social dysfunction was the most prevalent (observed in 100% of the participants), followed by somatic symptoms (79.3%). Lower self-esteem was significantly associated with overall mental distress (odds ratio (OR): 0.74; 95% confidence interval (95% CI): 0.64-0.87; P < 0.001), depression (OR: 0.70; 95% CI: 0.60-0.80; P < 0.001) and anxiety/insomnia (OR: 0.76; 95% CI: 0.66-0.87; P < 0.001). DISCUSSION Mental distress was common among women with ectopic pregnancy. This study is the first to examine the relationship between self-esteem and mental health among women with ectopic pregnancy and highlights the important role of self-esteem in mental wellbeing among those women.
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Affiliation(s)
- Sonia Hasani
- Student Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Eindra Aung
- Department of Clinical Pharmacology and Toxicology, St Vincent's Clinical School, University of New South Wales, Kensington, Australia
| | - Mojgan Mirghafourvand
- Midwifery Department, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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The Association of Self-esteem With Caregiving Demands, Coping, Burden, and Health Among Caregivers of Breast Cancer Patients: A Structural Equation Modeling Approach. Cancer Nurs 2021; 45:E820-E827. [PMID: 34483283 DOI: 10.1097/ncc.0000000000001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated how caregiver self-esteem was associated with caregiving demands, coping, burden, and health. OBJECTIVE The aim of this study was to investigate how caregiver self-esteem is associated with caregiving demands, coping, burden, and health. METHODS Sixty-one caregivers of breast cancer patients were selected from a study conducted at a cancer clinic in the Southeastern region of the United States. Guided by the revised Stress and Coping Theory, a secondary analysis of cross-sectional data was conducted. We used structural equation modeling to analyze paths between caregiver self-esteem and caregiving demands (ie, hours spent on caregiving), coping, burden, and health. RESULTS Caregivers who effectively coped with stressful situations through strategies such as positive thinking, seeking social support, and problem solving were more likely to have higher levels of self-esteem; in turn, higher levels of self-esteem decreased caregiver burden and improved caregiver overall health. CONCLUSIONS This study highlights the importance of self-esteem among caregivers of breast cancer patients. Additional research is needed to provide more insight into the influence of coping strategies on caregiver self-esteem, as well as the role of caregiver self-esteem on caregivers' and patients' well-being. IMPLICATION FOR PRACTICE Healthcare providers need to consider caregiver self-esteem and other associated caregiver characteristics to identify caregivers at risk of higher perceived levels of burden and poor overall health.
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Carters MA, Byrne DG. The role of stress and area‐specific self‐esteem in adolescent smoking. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Megan A. Carters
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Don G. Byrne
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia,
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Ji Y, Rana C, Shi C, Zhong Y. Self-Esteem Mediates the Relationships Between Social Support, Subjective Well-Being, and Perceived Discrimination in Chinese People With Physical Disability. Front Psychol 2019; 10:2230. [PMID: 31681073 PMCID: PMC6797620 DOI: 10.3389/fpsyg.2019.02230] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Disabilities have a negative effect on mental health and individuals with such conditions are especially susceptible to mental disorders. Previous research has established that in normal population, social support is significantly correlated with subjective well-being (SWB) through mediating variables; however the internal mechanism underlying this in people with physical disability remains unclear. This study aims to examine whether self-esteem and perceived discrimination play a mediating role in the relationship between social support and SWB in a sample of people with physical disability in China. Methods: A total of 210 people with physical disability of Chinese ethnicity were recruited to complete a series of questionnaires. This included the Chinese Social Support Rating Scale (CSSRS), Rosenberg Self-esteem Scale (RSES), Disability Discrimination Perception Questionnaire (DDPQ), and the Chinese Happiness Inventory (CHI). Path analysis was implemented on the data. Results: The model showed excellent fit to data: χ 2 = 2.314, p > 0.05; root-mean-square error of approximation (RMSEA) = 0.079; standardized root-mean residual (SRMR) = 0.035; comparative fit index (CFI) = 0.989; and Tucker-Lewis index (TLI) = 0.936. The results showed that self-esteem significantly mediated the relationship between social support and SWB, and perceived discrimination in people with physical disability. However, there is no mediating effect of perceived discrimination between social support and SWB. Conclusion: These findings demonstrate that self-esteem may be a critical resource in mediating the relationships between social support, SWB, and perceived discrimination in people with physical disability.
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Affiliation(s)
- Yinyin Ji
- School of Psychology, Nanjing Normal University, Nanjing, China
- Honor College, Nanjing Normal University, Nanjing, China
| | - Chandni Rana
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Congying Shi
- School of Psychology, Nanjing Normal University, Nanjing, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, China
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Shloim N, Lans O, Brown M, Mckelvie S, Cohen S, Cahill J. “Motherhood is like a roller coaster… lots of ups, then downs, something chaotic… “; UK & Israeli women’s experiences of motherhood 6-12 months postpartum. J Reprod Infant Psychol 2019; 38:523-545. [DOI: 10.1080/02646838.2019.1631448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- N. Shloim
- Faculty of Medicine and health, School of Healthcare, University of Leeds, Leeds, UK
| | - O. Lans
- Social Work Department, Tel Hai Academic College, Upper Galilee, Israel
| | - M. Brown
- Faculty of Medicine and health, School of Healthcare, University of Leeds, Leeds, UK
| | - S. Mckelvie
- Faculty of Medicine and health, School of Healthcare, University of Leeds, Leeds, UK
| | - S. Cohen
- Faculty of Medicine and health, School of Healthcare, University of Leeds, Leeds, UK
| | - J. Cahill
- Faculty of Medicine and health, School of Healthcare, University of Leeds, Leeds, UK
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Guintivano J, Sullivan PF, Stuebe AM, Penders T, Thorp J, Rubinow DR, Meltzer-Brody S. Adverse life events, psychiatric history, and biological predictors of postpartum depression in an ethnically diverse sample of postpartum women. Psychol Med 2018; 48:1190-1200. [PMID: 28950923 PMCID: PMC6792292 DOI: 10.1017/s0033291717002641] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Race, psychiatric history, and adverse life events have all been independently associated with postpartum depression (PPD). However, the role these play together in Black and Latina women remains inadequately studied. Therefore, we performed a case-control study of PPD, including comprehensive assessments of symptoms and biomarkers, while examining the effects of genetic ancestry. METHODS We recruited our sample (549 cases, 968 controls) at 6 weeks postpartum from obstetrical clinics in North Carolina. PPD status was determined using the MINI-plus. Psychiatric history was extracted from medical records. Participants were administered self-report instruments to assess depression (Edinburgh Postnatal Depression Scale) and adverse life events. Levels of estradiol, progesterone, brain-derived neurotrophic factor, oxytocin, and allopregnanalone were assayed. Principal components from genotype data were used to estimate genetic ancestry and logistic regression was used to identify predictors of PPD. RESULTS This population was racially diverse (68% Black, 13% Latina, 18% European). Genetic ancestry was not a predictor of PPD. Case status was predicted by a history of major depression (p = 4.01E-14), lifetime anxiety disorder diagnosis (p = 1.25E-34), and adverse life events (p = 6.06E-06). There were no significant differences between groups in any hormones or neurosteroids. CONCLUSIONS Psychiatric history and multiple exposures to adverse life events were significant predictors of PPD in a population of minority and low-income women. Genetic ancestry and hormone levels were not predictive of case status. Increased genetic vulnerability in conjunction with risk factors may predict the onset of PPD, whereas genetic ancestry does not appear predictive.
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Affiliation(s)
- J Guintivano
- Department of Psychiatry,University of North Carolina,Chapel Hill, NC,USA
| | - P F Sullivan
- Department of Psychiatry,University of North Carolina,Chapel Hill, NC,USA
| | - A M Stuebe
- Department of Obstetrics and Gynecology,University of North Carolina,NC,USA
| | - T Penders
- Department of Psychiatry and Behavioral Medicine,East Carolina University,NC,USA
| | - J Thorp
- Department of Obstetrics and Gynecology,University of North Carolina,NC,USA
| | - D R Rubinow
- Department of Psychiatry,University of North Carolina,Chapel Hill, NC,USA
| | - S Meltzer-Brody
- Department of Psychiatry,University of North Carolina,Chapel Hill, NC,USA
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Relationships between Caregiving Stress, Depression, and Self-Esteem in Family Caregivers of Adults with a Disability. Occup Ther Int 2017; 2017:1686143. [PMID: 29114184 PMCID: PMC5664279 DOI: 10.1155/2017/1686143] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 07/17/2017] [Accepted: 08/01/2017] [Indexed: 11/17/2022] Open
Abstract
This study aimed to examine the relationships between caregiving stress, depression, and self-esteem of family caregivers of an adult person with a disability and to identify their effects on their caregiving burden. The study was performed with 108 care providers of adult people with a disability who visited hospital rehabilitation centers. Caregiving stress showed a significant positive correlation with depression and with economic and psychological stress, and it showed a significant negative correlation with self-esteem. When the care provider was aged, female, and without a job and the caregiving cost and time were higher, the caregiving stress was high. When the care provider was female and had a lower income, the depression index was high. When the person with a disability was male and in the forties and the level of disability was higher, the caregiving stress was high. When the disability was related to spinal cord damage, the care provider's depression index was the highest. To reduce caregiving stress and depression in the family caregivers and to improve their self-esteem, continuous support and help from specialists are necessary. Additionally, a variety of intervention programs need to be designed to motivate them to participate regularly at the community level.
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Abstract
BACKGROUND Low-income, unemployed women with low levels of education are more likely to smoke during pregnancy compared to their higher-income, employed, and well-educated counterparts. The reserve capacity model (RCM) offers a theoretical framework to explain how psychosocial factors may serve as pathways connecting socioeconomic status (SES) to health behaviors. Research supports the link between prenatal smoking and several psychosocial variables such as chronic stressors, depressive symptoms, and social support. How these variables interrelate to explain the predominance of prenatal smoking in lower socioeconomic groups of pregnant women has not been fully elucidated. OBJECTIVE The aim of this study was to test the RCM to evaluate the roles of early pregnancy levels of chronic stress, quality of the primary intimate relationship, and depressive symptoms in explaining the relationship between SES and persistent prenatal smoking. METHODS A secondary analysis of data from 370 pregnant nonsmokers, spontaneous quitters, and persistent prenatal smokers was conducted. On the basis of the RCM, chronic stressors, depressive symptoms, and the quality of the primary intimate relationship were evaluated as potential mediating variables linking SES with persistent prenatal smoking using path analysis. RESULTS Path analyses indicated that a simple model with all three psychosocial variables as mediators of the relationship between SES and persistent prenatal smoking provided the best fit. DISCUSSION Findings indicated that chronic stressors, depressive symptoms, and the quality of the primary intimate relationship play important roles in the pathway from SES to prenatal smoking status. This knowledge can assist in the development of prevention and intervention strategies to target these variables and ultimately reduce prenatal smoking.
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Social Support and Psychosocial Well-being Among Low-Income, Adolescent, African American, First-Time Mothers. CLIN NURSE SPEC 2016; 30:150-8. [PMID: 27055037 DOI: 10.1097/nur.0000000000000202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS The aims of this study are to describe for single, low-income, adolescent, African American new mothers how (1) primary sources of social support changed over time, (2) the level of social support (emotional, informational, tangible, and problematic) from these primary sources changed over time, and (3) social support from the primary supporter was associated with mothers' psychosocial well-being (self-esteem and loneliness) over time. DESIGN A secondary analysis was conducted of data from a previous social support intervention study. SAMPLE The sample consisted of 35 single, low-income, adolescent (mean [SD] age, 18.3 [1.7] years), African American new mothers. METHODS Mothers completed social support, self-esteem, and loneliness instruments at 1 and 6 weeks and 3 and 6 months postpartum. RESULTS Most mothers (64.7%) had changes in their primary social support provider during the first 6 months postpartum. The combination of the adolescent's mother and boyfriend provided the highest level of support, no matter the type, relative to any other source of support. At every time point, positive correlations were found between emotional support and self-esteem and between problematic support and loneliness. CONCLUSION Single, low-income, African American, adolescent new mothers are at risk for not having a consistent source of support, which may lead to lower self-esteem and greater loneliness. IMPLICATIONS Clinical nurse specialists could facilitate care guidelines for these new mothers to identify their sources of support at each home visit and advocate for the adolescent's mother and boyfriend to work together to provide support. Bolstering the mothers' natural sources of support can potentially improve self-esteem and reduce loneliness. Improvement in these sources of support could prevent a decline in the mothers' psychosocial well-being. Development and testing support interventions are advocated; findings could guide clinical nurse specialists in addressing these new mothers' needs.
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Thananowan N, Vongsirimas N. Factors Mediating the Relationship Between Intimate Partner Violence and Cervical Cancer Among Thai Women. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:715-731. [PMID: 25381266 DOI: 10.1177/0886260514556108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Previous research suggests that intimate partner violence (IPV), particularly physical or sexual violence, was associated with cervical cancer. However, there is less work examining the mechanism of the relationship between IPV and cervical cancer. The purpose of this cross-sectional study was to examine psychosocial factors (e.g., stress, social support, self-esteem, and depressive symptoms) as mediators of the relationship between IPV and cervical cancer among 532 Thai women with gynecological problems. About 21.1% of participants reported any type of IPV (e.g., physical, sexual, or emotional violence) in the past year and 22.2% had cervical cancer. IPV was significantly positively associated with stress, depressive symptoms, and cervical cancer but negatively correlated with social support and self-esteem. Results from structural equation modeling indicated that not only did IPV exhibit significantly direct effects on social support, stress, and depressive symptoms, and indirect effects on self-esteem, but it also had a significant, positive, total effect on cervical cancer. IPV exhibited the significant indirect effect on cervical cancer through social support, self-esteem, stress, and depressive symptoms. The model fitted very well to the empirical data and explained 9% of variance. The findings affirmed that those psychosocial factors were mediators of the relationship between IPV and cervical cancer. Health care protocols for abused women should include screening for and treatment of IPV-related psychosocial factors. Interventions that provide social support and protect self-esteem should reduce stress and depressive symptoms among abused women, thereby reducing the risk of cervical cancer.
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Gutiérrez-Zotes A, Labad J, Martín-Santos R, García-Esteve L, Gelabert E, Jover M, Guillamat R, Mayoral F, Gornemann I, Canellas F, Gratacós M, Guitart M, Roca M, Costas J, Luis Ivorra J, Navinés R, de Diego-Otero Y, Vilella E, Sanjuan J. Coping strategies and postpartum depressive symptoms: A structural equation modelling approach. Eur Psychiatry 2015; 30:701-8. [PMID: 26141375 DOI: 10.1016/j.eurpsy.2015.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Variables such as the mother's personality, social support, coping strategies and stressful events have been described as risk factors for postpartum depression. Structural Equation Modelling (SEM) analysis was used to examine whether neuroticism, perceived social support, perceived life events, and coping strategies are associated with postpartum depressive symptoms at the 8th and 32nd weeks. METHODS A total of 1626 pregnant women participated in a longitudinal study. Different evaluations were performed 8 and 32weeks after delivery. Several measures were used: the Edinburgh Postnatal Depression Scale (EPDS), the Diagnostic Interview for Genetic Studies (DIGS), the Eysenck Personality Questionnaire (EPQ-RS), the St. Paul Ramsey life events scale and the Duke-UNC Functional Social Support Questionnaire. The brief COPE scale was used to measure coping strategies. SEM analysis was conducted for all women and in those women with a clinical diagnosis of postpartum depression. RESULTS Passive coping strategies were associated with postpartum depressive symptoms at both visits (8th and 32nd weeks). Neuroticism was associated with more passive coping strategies and less active coping strategies. Neuroticism and life stress were positively correlated, and social support was negatively correlated with life stress and neuroticism. CONCLUSIONS Early identification of potential risk for symptomatology of depression postpartum should include assessment of neuroticism, life events, social support and coping strategies.
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Affiliation(s)
- A Gutiérrez-Zotes
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain.
| | - J Labad
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - R Martín-Santos
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, IDIBAPS, CIBERSAM and Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Neuroscience Program, IMIM-Parc de Salut Mar, Autonomous University of Barcelona, RTA, Barcelona, Spain
| | - L García-Esteve
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, IDIBAPS, CIBERSAM and Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - E Gelabert
- Neuroscience Program, IMIM-Parc de Salut Mar, Autonomous University of Barcelona, RTA, Barcelona, Spain; Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
| | - M Jover
- Hospital Clínico, University of Valencia, CIBERSAM, Valencia, Spain
| | - R Guillamat
- Corporación Sanitaria Parc Taulí, Sabadell, Autonomous University of Barcelona, Barcelona, Spain
| | - F Mayoral
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Spain
| | - I Gornemann
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Spain
| | - F Canellas
- Hospital de Son Dureta, Palma de Mallorca, Spain
| | - M Gratacós
- Centre for Genomic Regulation (CRG) and UPF, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - M Guitart
- Corporación Sanitaria Parc Taulí, Sabadell, Autonomous University of Barcelona, Barcelona, Spain
| | - M Roca
- Institut Universitari d'Investigació en Ciències de la Salut, RediAPP, Palma de Mallorca, Spain
| | - J Costas
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS) Servizo Galego de Saúde (SERGAS), Complexo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain
| | - J Luis Ivorra
- Hospital Clínico, University of Valencia, CIBERSAM, Valencia, Spain
| | - R Navinés
- Psychiatry Department, Neuroscience Institute, Hospital Clinic, IDIBAPS, CIBERSAM and Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; Neuroscience Program, IMIM-Parc de Salut Mar, Autonomous University of Barcelona, RTA, Barcelona, Spain
| | - Y de Diego-Otero
- Unidad de Gestión Clínica de Salud Mental, Instituto de Investigación Biomédica de Málaga (IBIMA), Complejo Hospitalario de Málaga, Universidad de Málaga, Spain
| | - E Vilella
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, CIBERSAM, Reus, Spain
| | - J Sanjuan
- Hospital Clínico, University of Valencia, CIBERSAM, Valencia, Spain
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Lee JS, Koo HJ. The relationship between adult attachment and depression in Korean mothers during the first 2years postpartum: A moderated mediation model of self-esteem and maternal efficacy. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2015.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Mastergeorge AM, Paschall K, Loeb SR, Dixon A. The Still-Face Paradigm and bidirectionality: associations with maternal sensitivity, self-esteem and infant emotional reactivity. Infant Behav Dev 2014; 37:387-97. [PMID: 24950466 DOI: 10.1016/j.infbeh.2014.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/12/2014] [Accepted: 05/04/2014] [Indexed: 11/18/2022]
Abstract
The Still-Face Paradigm (SFP) is a structured stressful event within which researchers have investigated the influence of maternal psychological and behavioral characteristics on infant behavior. The present investigation contributes to this body of work by examining the joint contributions of maternal and child behavioral and affective characteristics on subsequent behaviors and affectations following the SFP. A sample of non-clinically depressed mothers and their infants (n=31) engaged in a modified Still-Face Paradigm (SFP), followed by a period of toy play. These interactions were videotaped and behaviorally coded along the following dimensions: maternal sensitivity prior to the SFP and during toy play, infant negative emotional reactivity during the still-face, and infant resistance during the reunion phase. Additionally, mothers reported global self-esteem and this was examined as a predictor of infant behavior. Results revealed significant bidirectional influences such that maternal self-esteem predicted infant emotional reactivity, maternal sensitivity pre-SFP predicted infant resistance during the reunion phase, and infant resistance predicted subsequent levels of maternal sensitivity. Indirect effects were also examined, and provided additional support for bidirectionality in mother-infant interactions. Implications for clinical practice are discussed in light of these findings.
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Affiliation(s)
- Ann M Mastergeorge
- University of Arizona, Family Studies and Human Development, McClelland Park, 650 N. Park Avenue, Tucson, AZ 85721, United States.
| | - Katherine Paschall
- University of Arizona, Family Studies and Human Development, McClelland Park, 650 N. Park Avenue, Tucson, AZ 85721, United States
| | - Sophie R Loeb
- University of Arizona, Family Studies and Human Development, McClelland Park, 650 N. Park Avenue, Tucson, AZ 85721, United States
| | - Ashley Dixon
- University of Arizona, Family Studies and Human Development, McClelland Park, 650 N. Park Avenue, Tucson, AZ 85721, United States
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Jesse DE, Kim H, Herndon C. Social support and self-esteem as mediators between stress and antepartum depressive symptoms in rural pregnant women. Res Nurs Health 2014; 37:241-52. [PMID: 24797585 DOI: 10.1002/nur.21600] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/11/2022]
Abstract
The purpose of this secondary analysis was to determine whether satisfaction with social support and self-esteem mediated the relationship between antepartum stress and depressive symptoms in women attending prenatal clinics in a rural Southeastern community (N = 318). Path analysis with linear regression indicated that the relationship between antepartum stress and depressive symptoms was partially mediated by higher levels of the internal resources of satisfaction with social support and self-esteem. Self-esteem had a greater influence on the relationship between antepartum stress and depressive symptoms than did satisfaction with social support. These findings suggest further study to determine whether developing culturally tailored interventions that emphasize stress reduction activities in addition to enhancing self-esteem and increasing satisfaction with social support can decrease the burden of antepartum depressive symptoms in rural low-income women.
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Affiliation(s)
- D Elizabeth Jesse
- Associate Professor, East Carolina University College of Nursing, 3160 Health Sciences Building, Greenville, NC 27858; Brody School of Medicine, Greenville, NC
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Denis A, Séjourné N, Callahan S. Étude de validation française de la version courte du Maternal Self-report Inventory. Encephale 2013; 39:183-8. [DOI: 10.1016/j.encep.2012.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 04/25/2012] [Indexed: 11/25/2022]
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Cavalcante JCB, de Sousa VEC, Lopes MVDO. [Situational low self-esteem in pregnant women: an analysis of accuracy]. Rev Bras Enferm 2013; 65:977-83. [PMID: 23559177 DOI: 10.1590/s0034-71672012000600014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 02/01/2013] [Indexed: 11/22/2022] Open
Abstract
To investigate the accuracy of defining characteristics of Situational low self-esteem we developed a cross-sectional study, with 52 pregnant women assisted in a family centre. The NANDA-I taxonomy was used as well as the Rosenberg's scale. The diagnosis was present in 32.7% of the sample and all characteristics presented statistical significance, except "Reports verbally situational challenge to its own value". The characteristics "Indecisive behavior" and "Helplessness expressions" had 82.35% of sensitivity. On the other hand, the characteristics "Expression of feelings of worthlessness" and "Reports verbally situational challenge to its own value" were the more specific, with 94.29% of specificity. These results can contribute with the nursing practice because the identification of accurate characteristics is essential to a secure inference.
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Meltzer-Brody S, Bledsoe-Mansori SE, Johnson N, Killian C, Hamer RM, Jackson C, Wessel J, Thorp J. A prospective study of perinatal depression and trauma history in pregnant minority adolescents. Am J Obstet Gynecol 2013; 208:211.e1-7. [PMID: 23246315 DOI: 10.1016/j.ajog.2012.12.020] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/16/2012] [Accepted: 12/10/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adolescent pregnancy is common and minority adolescents are at high risk. We sought the following: (1) to prospectively assess prevalence of antenatal depression (AND) and postpartum depression (PPD) in minority adolescents and (2) to examine the association of social support and adjustment, trauma, and stress on depression status. STUDY DESIGN A total of 212 pregnant adolescents were recruited from public prenatal clinics and administered a prospective research survey during pregnancy and 6 weeks' postpartum. Depression was measured using the Edinburgh Postnatal Depression Scale. Univariate, bivariate, and multivariable analyses were performed using logistic regression to assess predictors of AND and PPD. RESULTS In our cohort, 20% screened positive for AND and 10% for PPD. The strongest predictor of PPD was AND (odds ratio [OR], 4.89; P < .001). Among adolescents with trauma history, there was a 5-fold increase (OR, 5.01) in the odds of AND and a 4-fold increase (OR, 3.76) in the odds of PPD. AND was associated with the adolescent's poor social adjustment (P < .001), perceived maternal stress (P < .001), less social support (P < .001), and a less positive view of pregnancy (P < .001). PPD was significantly associated with primiparity (P = .002), poor social adjustment (P < .001), less social support and involvement of the baby's father (P < .001), and less positive view of pregnancy (P < .001). CONCLUSION Significant independent risk factors for PPD include AND, view of pregnancy, and social support. Trauma history was highly prevalent and strongly predicted AND and PPD. Point prevalence decreased postpartum, and this may be due to transient increased social support following the birth, warranting longer follow-up and development of appropriate interventions in future work.
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Affiliation(s)
- Samantha Meltzer-Brody
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, NC 27599, USA.
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Eastwood JG, Jalaludin BB, Kemp LA, Phung HN, Barnett BEW. Relationship of postnatal depressive symptoms to infant temperament, maternal expectations, social support and other potential risk factors: findings from a large Australian cross-sectional study. BMC Pregnancy Childbirth 2012; 12:148. [PMID: 23234239 PMCID: PMC3556157 DOI: 10.1186/1471-2393-12-148] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 12/03/2012] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND From 2000 a routine survey of mothers with newborn infants was commenced in South Western Sydney. The survey included the Edinburgh Postnatal Depression Scale (EPDS). The aim of the study was to determine the prevalence and risk factors for postnatal depressive symptoms in women living in metropolitan Sydney, Australia. METHODS Mothers (n=15,389) delivering in 2002 and 2003 were assessed at 2-3 weeks after delivery for risk factors for depressive symptoms. The binary outcome variables were EPDS>9 and >12. Logistic regression was used for the multivariate analysis. RESULTS The prevalence of EPDS>9 was 16.93 per 100 (95% CI: 16.34 to 17.52) and EPDS>12 was 7.73 per 100 (95% CI: 6.96 to 7.78). The final parsimonious logistic regression models included measures of infant behaviour, financial stress, mother's expectation of motherhood, emotional support, sole parenthood, social support and mother's country of birth. CONCLUSIONS Infant temperament and unmet maternal expectations have a strong association with depressive symptoms with implications for the design of both preventative and treatment strategies. The findings also support the proposition that social exclusion and social isolation are important determinants of maternal depression.
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Affiliation(s)
- John G Eastwood
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
- School of Women’s and Children’s Health, The University of New South Wales, Sydney, NSW, 2052, Australia
- Community Paediatrics, South Western Sydney Local Health Network, Hugh Jardine Building, Eastern Campus, Locked Mail Bag 7017, Liverpool, BC NSW, 1871, AUSTRALIA
| | - Bin B Jalaludin
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Lynn A Kemp
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Hai N Phung
- School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Bryane EW Barnett
- School of Psychiatry, The University of New South Wales, Sydney, NSW, 2052, Australia
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Pollock MA, Amankwaa LC, Amankwaa AA. First-time fathers and stressors in the postpartum period. J Perinat Educ 2012; 14:19-25. [PMID: 17273429 PMCID: PMC1595242 DOI: 10.1624/105812405x44682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of this pilot study was to examine the everyday stressors of first-time fathers during the postpartum period and to begin the process of establishing reliability and validity for the use of the Everyday Stressors Index with a sample of first-time fathers. A convenience sample of 19 participants included first-time fathers ranging in age from 18 to 45 years and mostly living in medium-sized cities. The results indicated that factors such as a feeling of not having enough time for too many responsibilities, financial issues, and concerns about the health of the child and other family member(s) were sources of stress. However, with the exception of slight differences in the ranking, everyday stressors among first-time fathers closely resembled previously reported stressors of first-time mothers. Although the sample was small and the results nongeneralizable, these findings suggest that educational efforts by health-care professionals could beneficially be directed toward fathers as well as mothers throughout the prenatal and postpartum periods. Policy implications for nursing and new directions for future research are discussed.
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Affiliation(s)
- Melissa Amanti Pollock
- MELISSA POLLOCK is a nurse practioner in the field of pediatrics in Palm Beach Gardens, Florida
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Emmanuel E, St John W, Sun J. Relationship between social support and quality of life in childbearing women during the perinatal period. J Obstet Gynecol Neonatal Nurs 2012; 41:E62-70. [PMID: 22861382 DOI: 10.1111/j.1552-6909.2012.01400.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore demographic and social support predictors of health-related quality of life (HRQoL) (mental and physical) for childbearing women in the perinatal period. DESIGN Longitudinal. SAMPLE Three public hospitals in metropolitan Brisbane, Australia. PARTICIPANTS Four hundred seventy-three (473) women recruited at 36 weeks of pregnancy, and 6 and 12 weeks following childbirth. METHODS The Short Form-12 (SF-12) Version 2 Health Survey was used to measure the mental and physical domains of HRQoL. Social support was measured using the Maternal Social Support Scale (MSSS). RESULTS Mean scores for the mental and physical domains of HRQoL were lower than population norms. Social support was found to be a significant and consistent predictor of higher HRQoL scores, particularly in the physical domain at 12 weeks following child birth and mental domain during the perinatal period. The relationship between social support and HRQoL was found to be independent of other factors including education, length of relationship with partner, age, parity, and antenatal visit. The only other significant predictor was length of relationship with partner in the mental domain at 36 weeks of pregnancy. CONCLUSION Social support is a significant and consistent predictor of a mother's HRQoL during the perinatal period. Nurses and midwives need to assess social support, rather than making assumptions based on demographic factors.
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Affiliation(s)
- Elizabeth Emmanuel
- School of Nursing, Midwifery & Nutrition, James Cook University, Cairns, Australia.
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Kafka S, Hunter JA, Hayhurst J, Boyes M, Thomson RL, Clarke H, Grocott AM, Stringer M, O’Brien KS. A 10-day developmental voyage: converging evidence from three studies showing that self-esteem may be elevated and maintained without negative outcomes. SOCIAL PSYCHOLOGY OF EDUCATION 2012. [DOI: 10.1007/s11218-012-9177-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Denis A, Michaux P, Callahan S. Factors implicated in moderating the risk for depression and anxiety in high risk pregnancy. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.677020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Sword W, Clark AM, Hegadoren K, Brooks S, Kingston D. The complexity of postpartum mental health and illness: a critical realist study. Nurs Inq 2011; 19:51-62. [PMID: 22212370 DOI: 10.1111/j.1440-1800.2011.00560.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The complexity of postpartum mental health and illness: a critical realist study Postpartum depression (PPD) is a major public health issue that profoundly impacts the woman, her infant and family. Although it may be linked to hormone changes, no direct hormonal aetiology has been established. A large body of evidence implicates numerous psychosocial predictors of PPD. While a history of depression predicts about 50% of cases of PPD, it remains unclear why some women with a history do not develop depression following childbirth, even taking psychosocial factors into account. The aim of this study was to identify the main mechanisms and factors associated with the presence or absence of PPD in women with a history of depression, and the presence of PPD in women without a history, using a critical realist approach. The findings indicate a number of personal and contextual factors that influence postpartum mental health and illness. In addition, and perhaps most importantly, women who did not develop depression identified goal-oriented actions that were protective. These factors and processes did not exist in isolation and the interplay among them in influencing health was apparent. More research is needed to explore the effects of these mechanisms in different contexts.
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Affiliation(s)
- Wendy Sword
- McMaster University, Hamilton, ON University of Alberta, Edmonton, AB, Canada.
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Coyle SB. Maternal concern, social support, and health-related quality of life across childhood. Res Nurs Health 2011; 34:297-309. [DOI: 10.1002/nur.20438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2011] [Indexed: 11/09/2022]
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Birthing Positions During Second Stage of Labor and Long-Term Psychological Outcomes in Low-Risk Women. INTERNATIONAL JOURNAL OF CHILDBIRTH 2011. [DOI: 10.1891/2156-5287.1.4.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE: To examine the long-term influence of birthing positions during the second stage of labor, as well as other factors, on birth satisfaction, self-esteem (based on the Rosenberg Self-esteem Scale [RSE]) and emotional well-being (based on the Edinburgh Postnatal Depression Scale [EPDS]).STUDY DESIGN: Three to four years after delivery, a postal questionnaire was sent to all 3,200 women who received care in eight midwifery care practices from all over the country in 2001. Of those who responded (44%), we included 591 low-risk women in the study who were in midwife-led care at the time of birth.MAJOR FINDINGS: Birthing positions were not related to childbirth satisfaction, self-esteem, or emotional well-being. Age between 26 and 35 years was associated with being very satisfied and with enhanced emotional well-being. Pain, fear for own or baby’s life, and negative experience with the midwife were associated with reduced satisfaction. Only age between 26 and 35 years and higher education were related to higher self-esteem.MAIN CONCLUSION: Concern about long-term psychological outcomes is not a reason to recommend either supine or nonsupine positions. Women should use positions that are most comfortable. Further research should clarify whether having a choice in the use of birthing positions rather than the type of position influences psychological outcomes.
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Copeland DB, Harbaugh BL. Psychosocial Differences Related to Parenting Infants Among Single and Married Mothers. ACTA ACUST UNITED AC 2010; 33:129-48. [DOI: 10.3109/01460862.2010.498330] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Armstrong DS, Hutti MH, Myers J. The influence of prior perinatal loss on parents' psychological distress after the birth of a subsequent healthy infant. J Obstet Gynecol Neonatal Nurs 2010; 38:654-666. [PMID: 19930279 DOI: 10.1111/j.1552-6909.2009.01069.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the long-term influence of a previous perinatal loss on parents' psychological distress during a subsequent childbearing experience. DESIGN AND SAMPLE A cohort design was used to examine 36 couples with a history of prior perinatal loss. Data were collected during the third trimester of pregnancy, 3 months postpartum, and again 8 months after birth. MEASURES Outcome measures included posttraumatic stress (The Impact of Event Scale), depressive symptoms (Center for Epidemiologic Studies-Depression Scale), anxiety (Spielberger State-Trait Anxiety Inventory), and parental concerns and attitudes (Maternal/Paternal Attitudes Questionnaire). RESULTS Levels of depressive symptoms (p<.001), anxiety (p<.001), and posttraumatic stress (p=.046) significantly decreased over time in this population. However, levels of posttraumatic stress remained in the moderate range even at 8 months after birth. Depression was significantly correlated with posttraumatic stress at each time point. In addition, depression was significantly related to posttraumatic stress, anxiety, and concerns parents had about their infant's well-being at T3. CONCLUSION While levels of anxiety and depressive symptoms decreased for parents who have experienced a previous perinatal loss, posttraumatic stress levels remained moderately high. It is unclear how this compares to parents without losses. These may be the unique symptoms and concerns these parents have about their new infant. Parents with a history of prior loss should have assessments carefully tailored to their experiences to anticipate continued psychological distress.
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Affiliation(s)
| | | | - John Myers
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
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Emmanuel EN, Creedy DK, St John W, Brown C. Maternal role development: the impact of maternal distress and social support following childbirth. Midwifery 2009; 27:265-72. [PMID: 19656594 DOI: 10.1016/j.midw.2009.07.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 05/28/2009] [Accepted: 07/12/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE to explore the relationship between maternal role development (MRD), maternal distress (MD) and social support following childbirth. DESIGN prospective longitudinal survey. SETTING three public hospital maternity units in Brisbane, Australia. PARTICIPANTS 630 pregnant women were invited to participate in the study, with a 77% (n=473) completion rate. MEASUREMENTS to measure MRD, the Prenatal Maternal Expectation Scale was used at 36 weeks of pregnancy, and the revised What Being the Parent of a New Baby is Like (with subscales of evaluation, centrality and life change) was used at six and 12 weeks post partum. At all three data collection points, the Edinburgh Postnatal Depression Scale was used to measure MD, and the Maternal Social Support Scale was used to measure social support. FINDINGS at 36 weeks of gestation, optimal scaling for MRD produced a parsimonious model with MD providing 39% of predictive power. At six weeks post partum, similar models predicting MRD were found (evaluation: r(2)=0.14, MD providing 64% of predictive power; centrality: r(2)=0.07, MD providing 11% of predictive power; life change: r(2)=0.26, MD providing 59% of predictive power). At 12 weeks post partum, MD was a predictor for evaluation (r(2)=0.11) and life change (r(2)=0.26, 54% of predictive power). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE there is a statistically significant but moderate correlation between MRD and MD. The transition to motherhood can be stressful, but may be facilitated by appropriate acknowledgement and support with an emphasis on MRD.
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Affiliation(s)
- Elizabeth N Emmanuel
- Research Centre for Clinical and Community Practice Innovation, Griffith University, Brisbane, Australia.
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Dias MDS, Silva RAD, Souza LDDM, Lima RDC, Pinheiro RT, Moraes IGDS. [Self-esteem and associated factors in pregnant women in the city of Pelotas, Rio Grande do Sul State, Brazil]. CAD SAUDE PUBLICA 2008; 24:2787-97. [PMID: 19082269 DOI: 10.1590/s0102-311x2008001200007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 05/26/2008] [Indexed: 11/21/2022] Open
Abstract
This study analyzes self-esteem and associated factors in pregnant women treated by the Unified National Health System (SUS) in the city of Pelotas, Rio Grande do Sul State, Brazil. Using a cross-sectional design, 560 pregnant women were interviewed from May to November 2006. The interviews were held in specific locations like University outpatient clinics and hospital wards and a center run by the city government. A full 62.9% were diagnosed as high-risk pregnancies. Mean self-esteem according to the Rosenberg scale was 9.2 (SD = 4.6). Variables showing a positive, significant association with self-esteem were age, schooling, and income. Perception of risk to the unborn infant's health and parity were both negatively associated with maternal self-esteem. These high-risk pregnant women also showed higher self-esteem than low-risk pregnant women.
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Nicotine Addiction in Pregnancy: Preliminary Efficacy of a Mental Health Intervention. ADDICTIVE DISORDERS & THEIR TREATMENT 2008. [DOI: 10.1097/adt.0b013e3181484768] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Castle H, Slade P, Barranco‐Wadlow M, Rogers M. Attitudes to emotional expression, social support and postnatal adjustment in new parents. J Reprod Infant Psychol 2008. [DOI: 10.1080/02646830701691319] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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State of the Science on postpartum depression: what nurse researchers have contributed--part 1. MCN Am J Matern Child Nurs 2008; 33:121-6. [PMID: 18327112 DOI: 10.1097/01.nmc.0000313421.97236.cf] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Abstract
PURPOSE To explore maternal responsiveness in the first 2 to 4 months after delivery and to evaluate potential predictors of maternal responsiveness, including infant feeding, maternal characteristics, and demographic factors such as age, socioeconomic status, and educational level. DESIGN AND METHODS A cross-sectional survey design was used to assess the variables of maternal responsiveness, feeding patterns, and maternal characteristics in a convenience sample of 177 mothers in the first 2 to 4 months after delivery. The 60-item self-report instrument included scales to measure maternal responsiveness, self-esteem, and satisfaction with life as well as infant feeding questions and sociodemographic items. An online data-collection strategy was used, resulting in participants from 41 U.S. states. FINDINGS Multiple regression analysis showed that satisfaction with life, self-esteem, and number of children, but not breastfeeding, explained a significant portion of the variance in self-reported maternal responsiveness scores. In this analysis, sociodemographic variables such as age, education, income, and work status showed little or no relationship to maternal responsiveness scores. CONCLUSIONS This study provides additional information about patterns of maternal behavior in the transition to motherhood and some of the variables that influence that transition. Satisfaction with life was a new predictor of maternal responsiveness. However, with only 15% of the variance explained by the predictors in this study, a large portion of the variance in maternal responsiveness remains unexplained. Further research in this area is needed.
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Affiliation(s)
- Emily E Drake
- University of Virginia School of Nursing, Charlottesville, VA 22908-0782, USA.
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Meadows-Oliver M, Sadler LS, Swartz MK, Ryan-Krause P. Sources of Stress and Support and Maternal Resources of Homeless Teenage Mothers. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2007; 20:116-25. [PMID: 17598805 DOI: 10.1111/j.1744-6171.2007.00093.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PROBLEM Homeless families headed by young mothers are increasing. This preliminary study describes the characteristics of 17 homeless teenage mothers (HTM). METHODS HTMs completed questionnaires researching depression, self-esteem, maternal competence, and sources of stress and support. FINDINGS HTMs had positive maternal competence and self-esteem scores. When compared to housed mothers, HTMs were younger, had more depressive symptoms and negative life events, and fewer social supports. CONCLUSIONS HTMs represent a high-risk group with fewer available supports and many complex life stressors. School-based programs can benefit HTMs by offering support, helping them continue their education, and assisting with on-site school-based childcare.
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Amankwaa LC, Pickler RH, Boonmee J. Maternal Responsiveness in Mothers of Preterm Infants. ACTA ACUST UNITED AC 2007. [DOI: 10.1053/j.nainr.2006.12.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hung CH. Postpartum stress as a predictor of women's minor psychiatric morbidity. Community Ment Health J 2007; 43:1-12. [PMID: 17021954 DOI: 10.1007/s10597-006-9066-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Accepted: 08/10/2006] [Indexed: 10/24/2022]
Abstract
The purpose of this study was to predict women's minor psychiatric morbidity after they had childbirth as measured repeatedly at the first, the third, and the fifth weeks of the postpartum period. The Chinese Health Questionnaire, the Postpartum Stress Scale, the Zung's Self-rating Depression Scale and Anxiety Scale, and the Social Support Scale were used at the three points of time. A total of 526 women in Taiwan participated in the study. The results indicated that postpartum stress and anxiety are important predictors for postpartum women's minor psychiatric morbidity at three points in time.
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Affiliation(s)
- Chich-Hsiu Hung
- College of Nursing and Department of Nursing at Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan,
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Abstract
The purpose of this study was to examine first-time mothers' postpartum stress and its correlates following discharge from the hospital or clinic after vaginal delivery. One hundred and eighty-three first-time mothers were enrolled from hospitals and clinics in Kaohsiung City. All first-time mothers reported normal pregnancies and vaginal deliveries, delivered healthy infants at term, and were surveyed during their postpartum periods after discharge from hospitals or clinics. The Hung Postpartum Stress Scale was used to examine first-time mothers' postpartum stress and stressors during their postpartum periods. The top ten postpartum stressors perceived by the women were: "the baby getting sick suddenly", "the flabby flesh of my belly", "the unpredictability of the baby's schedule", "interrupted sleep", "the shape of the baby's head due to the sleeping position", "not sleeping enough", "lack of information regarding infant's growth and development", "the baby's crying", "my life is restricted", and "the baby choking during feeding". There were no significant differences between the first-time mothers' demographic characteristics and their postpartum stress and its three components (negative body changes, maternal role attainment, lack of social support), respectively. Insight into the study results of first-time mothers' postpartum stress and stressors provides a reference for health professionals that the development of programs and resources addressing primiparous women's unique needs are required.
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Affiliation(s)
- Chich-Hsiu Hung
- College of Nursing, Kaohsiung Medical University, and Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Peden AR, Rayens MK, Hall LA, Grant E. Testing an intervention to reduce negative thinking, depressive symptoms, and chronic stressors in low-income single mothers. J Nurs Scholarsh 2005; 37:268-74. [PMID: 16235869 DOI: 10.1111/j.1547-5069.2005.00046.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To test the effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, negative thinking, and chronic stressors in low-income, single mothers at risk for depression. DESIGN AND METHODS A randomized, controlled prevention trial was conducted with 136 low-income, single mothers with children between the ages of 2 and 6 years. Each participant was screened before enrollment and was determined to be at risk for depression. Participants were randomly assigned to either the control or experimental group. The experimental group was invited to participate in a 4- to 6-week cognitive-behavioral group intervention. Data on depressive symptoms, negative thinking, and chronic stressors were collected via self-report questionnaires from control and experimental groups at baseline, 1 month, and 6 months after the intervention to assess the effects of the intervention. FINDINGS Compared with those in the control group, women who received the intervention had a greater decrease in depressive symptoms, negative thinking, and chronic stressors; these beneficial effects were maintained over a 6-month period. CONCLUSIONS The findings indicate the effectiveness of this cognitive-behavioral group intervention and show the beneficial effects of reducing negative thinking via the use of affirmations and thought-stopping techniques.
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Affiliation(s)
- Ann R Peden
- College of Nursing, University of Kentucky, Lexington, KY 40536-0232, USA.
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Abstract
AIM The aim of this paper is to report a study of the lived experience of postpartum stress among depressed Hong Kong Chinese mothers. BACKGROUND Research consistently relates postpartum stress to the mood and well-being of mothers during the postpartum period. While several studies have used questionnaires to assess the stress levels of mothers or have identified stressors by asking them to list stressful events, the existing literature lacks in-depth information on the lived experience of postpartum stress from the perspective of the depressed mother. METHODS The study adopted a phenomenological approach with a purposive sample of 11 depressed Hong Kong Chinese mothers at around the sixth postpartum month. In-depth interviews were conducted in Cantonese and focused on the stress the mothers experienced during the postpartum period up to the time of the interview. The data were collected in 2000. RESULTS Living in a metropolitan city under the mixed and sometimes conflicting influences of cultures from the East and the West, Hong Kong Chinese mothers face a unique set of challenges which, if not properly managed, may cause stress and/or depression in the postpartum period. We identified five major postpartum stress themes amongst this group of women: parenting competence, the expectation-experience gap, baby-minder arrangements, childcare demands, and conflict with culture and tradition. CONCLUSIONS Health care staff should give anticipatory guidance to mothers and their spouses about the culturally prescribed set of rules that proved stressful. Antenatal education classes need to enhanced, and support is needed to help this population of women manage and overcome the challenges in the postpartum period.
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Affiliation(s)
- Sharron Leung
- Department of Nursing Studies, University of Hong Kong, Hong Kong
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Horowitz JA, Damato EG, Duffy ME, Solon L. The relationship of maternal attributes, resources, and perceptions of postpartum experiences to depression. Res Nurs Health 2005; 28:159-71. [PMID: 15779053 DOI: 10.1002/nur.20068] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The relationships of maternal attributes, resources, and perceptions of the postpartum experience to postpartum depression (PPD) were examined. One hundred and forty-three mothers completed measures of maternal attributes, resources, and perceptions of the postpartum experience, as well as depressed mood and clinical depression symptoms. Results from canonical correlation analysis revealed two patterns. Pattern 1: Women without history of depression, more emotional support from partners, higher parenting evaluation, lower centrality of the infant in the mother's thoughts and actions, and fewer life changes had lower depressed mood and fewer clinical depression symptoms than their counterparts. Pattern 2: Mothers without history of depression who were married, with higher financial stress, and lower parenting evaluation had higher depressed mood, but not more clinical depression symptoms. Maternal age, parity, time since delivery, income, and help from partner were unrelated to either depression indicator. These patterns suggest multiple paths to PPD, and the need for routine mental health assessment and exploration of women's perceptions of their postpartum experience.
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Abstract
AIMS This paper reports a study whose purpose was to revalidate the Hung Postpartum Stress Scale by expanding and revising its contexts to reflect the social changes that have occurred in Taiwan over the last two decades. BACKGROUND Existing measures of general stress, which have also been used to assess postpartum stress, fail to measure women's specific childbearing stressors during the postpartum period. The Hung Postpartum Stress Scale was initially developed 11 years ago by Hung and associates to measure stress in the early postpartum period as it occurred in the Taiwanese social milieu of the time. However, revalidation was needed because of rapid changes in the Taiwanese social system. METHODS Employing a non-experimental, quantitative research design and a proportional stratified quota sampling of hospitals by birth rate, the revised instrument was completed by 861 postpartum women selected from clinics and hospitals in Taiwan. RESULTS An exploratory common factor analysis indicated the structure validity of three dimensions of postpartum stress: concerns about maternity role attainment, concerns about negative body changes, and concerns about lack of social support. With regard to generalizability of the factors across delivery type, education level, and income status subgroups within the population, high coefficients of congruence were shown. Moreover, the internal consistency reliabilities for the total Hung Postpartum Stress Scale and its three dimensions across the full sample and within pertinent sub-samples showed that it is a reliable tool for measuring postpartum stress. CONCLUSIONS A series of analyses supported the validity and reliability of the revised Hung Postpartum Stress Scale. Additional research is recommended using confirmatory factor analysis to determine the stability of the factor structure identified in the present study.
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Affiliation(s)
- Chich-Hsiu Hung
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
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A study to ascertain the effect of structured student tutorial support on student stress, self-esteem and coping. Nurse Educ Pract 2005; 5:161-71. [DOI: 10.1016/j.nepr.2004.09.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Accepted: 09/19/2004] [Indexed: 11/20/2022]
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Abstract
OBJECTIVE The research aimed to investigate how people diagnosed with bipolar mood disorder avoided episodes of illness and managed to stay well. The research also examined the role that personal, social and environmental factors played in helping people with bipolar mood disorder to stay well. METHOD This project used a combination of qualitative research methods. The design contained three (3) components: recruitment from general community, preliminary written questionnaire and semistructured interviews. To meet the criteria for inclusion, the participant must have stayed well for the past 2 years. The two main analytical categories were 'stay well concept' and 'strategies to stay well'. The main category 'strategies to stay well' contained a number of subcategories. These subcategories were acceptance of diagnosis, mindfulness, education, identify triggers, recognize warning signals, manage sleep and stress, make lifestyle changes, treatment, access support, and stay well plans. RESULTS 100 people were eligible for inclusion in the study. The sample included 63 women and 37 men. The ages ranged from 18 to 83 years, with 86% over the age of 30. Duration of time since last episode of illness ranged from 2 years to >50 years. In the sample, 76% of participants were in paid employment. In addition, 36% of participants were parents. Participants actively managed bipolar disorder by developing a range of strategies to stay well. These strategies were based on participants' individual needs and social contexts. The strategies included acceptance of the diagnosis, education about bipolar disorder, identifying both triggers and warning signals, adequate amounts of sleep, managing stress, medication and support networks. CONCLUSION Staying well involved participants being mindful of their illness, which enabled them to develop an individual stay-well plan, including intervention strategies to prevent episodes of illness.
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Armstrong DS. Impact of prior perinatal loss on subsequent pregnancies. J Obstet Gynecol Neonatal Nurs 2005; 33:765-73. [PMID: 15561665 DOI: 10.1177/0884217504270714] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the influence of previous perinatal loss on depressive symptoms, pregnancy-specific anxiety, and prenatal attachment for parents during subsequent pregnancies. DESIGN Cross-sectional, survey design. PARTICIPANTS Forty expectant couples who experienced a prior perinatal loss. MEASURES Influence of loss (Impact of Event Scale [IES]), depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D]), pregnancy-specific anxiety (Pregnancy Outcome Questionnaire [POQ]), and prenatal attachment (Prenatal Attachment Inventory [PAI]). RESULTS Mothers reported higher levels of depressive symptoms, pregnancy-specific anxiety, and prenatal attachment than fathers did. Forty-five percent of mothers and 23% of fathers had CES-D scores greater than or equal to 16 indicating high risk for depression. Eighty-eight percent of mothers and 90% of fathers reported elevated stress related to the prior loss (IES scores greater than or equal to 19). The impact of the previous perinatal loss was moderately correlated with depressive symptoms as well as pregnancy-specific anxiety. There was no relationship between the psychological distress in pregnancy after perinatal loss and prenatal attachment. CONCLUSIONS The extent to which the impact of the prior loss increased parents' stress in the current pregnancy influenced their psychological distress. These findings should heighten awareness of the mixture of hope and fear expectant parents experience during pregnancies subsequent to perinatal loss.
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