Interventions to improve social support among postpartum mothers: A systematic review

Low Social Support is Associated With Postpartum Depression Symptoms Among Illinois Postpartum Women

BACKGROUND

Postpartum depression (PPD) occurs after delivery, with severity and onset varying by individual. Women with low social support may be at higher risk for PPD. This study examined the association between social support and self-reported postpartum depression symptoms (PDS) among Illinois postpartum women.

METHODS

Using 2016-2020 data from the Illinois Pregnancy Risk Assessment Monitoring System (PRAMS) (n = 5886), instrumental support (physical, hands-on support) and partner emotional support were each categorized as high/low and were combined in a composite measure (high = high on both types, moderate = high on one type, and low = low on both types). PDS were self-reported. Crude and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated using logistic regression.

RESULTS

Overall, 9.6% (95% CI = 8.8-10.4) of Illinois postpartum women experienced PDS. Of Illinois postpartum women, 63.5% (95% CI = 62.1-64.9) had high composite support, 29.3% (95% CI = 28.0-30.6) had moderate composite support, and 7.1% (95% CI = 6.4-7.9) had low composite support. After adjustment for maternal characteristics, instrumental support, partner emotional support, and a composite measure of support were each significantly associated with PDS. Compared to women with high composite support, women with low composite support had six times the odds of PDS (aOR = 6.1, 95% CI = 4.5-8.2), and women with moderate composite support had nearly three times the odds of PDS (aOR = 2.7, 95% CI = 2.2-3.4).

CONCLUSION

PDS was associated with instrumental support, partner emotional support, and a composite measure of support in Illinois postpartum women. This suggests the importance of addressing social support for postpartum individuals.

Improving postnatal social support using antenatal group-based psychoeducation: a cluster randomized controlled trial

Background

Inadequate social support is the predominant cause of postnatal depression, which needs to be promoted through interventions. The objective of this study was to investigate the effect of antenatal group-based psychoeducation on improving postnatal social support.

Methods

The trial design was a cluster randomized controlled trial. The study was conducted on 32 non-adjusted health centers (clusters) among 550 pregnant women. Using simple randomization, health centers were randomized into 16 intervention and 16 control groups. The intervention group received both standard prenatal care and group-based psychoeducation sessions, whereas the control group received standard prenatal care alone. The study included all pregnant women who were between 12 and 20 weeks gestation and had a Patient Health Questionnaire-9 <10 level of depression. We used a functional social support questionnaire in a face-to-face interview to assess social support at 12-20 weeks of gestation and 6 weeks postpartum. An intention-to-treat analysis was done. We used relative risk and a mixed-effects multilevel logistic regression for data analysis.

Result

Out of 550 enrolled pregnant women, end-line data were collected from 511 participants, with an overall end-line response rate of 92.9%. Statistical analysis revealed that the intervention resulted in a substantial difference in all dimensions of social support between arms, although no difference was detected at baseline. As compared to that in controls, the total postnatal social support in the intervention clusters was considerably higher [190 (66.4%) vs. 88 (33.3%)], P = 0.001). Mothers who were under the intervention arms and received antenatal group-based psychoeducation were 2.04 times more likely to have postnatal social support (RR = 2.044, 95% CI: 1.684-2.481) compared to those who were under the control arms and received the usual care. Finally, mixed-effect analysis indicates that after adjusting for individual and community-level variables, the final model shows the intervention increased the total social support by 3.61 (AOR = 3.61, 95% CI: 2.14-6.09).

Conclusion

The implementation of antenatal group-based psychoeducation intervention resulted in a statistically significant effect in improving postnatal social support. This intervention approach must therefore be implemented and promoted in maternal healthcare services.

Clinical Trial Registration

https://pactr.samrc.ac.za/, identifier (PACTR 202203616584913).

A socially prescribed creative play intervention for new parents: investigating post traumatic stress around birth and changes in postnatal depression and reflective function

BACKGROUND

Parenthood is a key transition period which involve emotional, social and physical adjustments. Social prescribing is a method that connects people to community-based activities, groups, and services to addressing various needs impacting their health and wellbeing. This pilot investigation aimed to assess whether a curated socially prescribed creative play programme would impact upon new parents' social connection, mental health and reflective function through a programme designed to support these changes.

METHODS

This study was part of a 5-week long socially prescribed creative play programme at a family theatre company in the North of England, aimed at providing social capital to families while teaching creative play. In total, 57 parents (M = 30.73, SD = 6.20) completed baseline and post-intervention measures of birth trauma experiences (City Birth Trauma Scale), postnatal depression (Edinburgh Postnatal Depression Scale) reflective function (Reflective Functioning Questionnaire), and qualitative, open-ended questions on social opportunities. Descriptive analyses were completed using t-tests and chi-square tests, while repeated measures ANOVAs were used to answer questions around the main analyses.

RESULTS

The participants experienced a statistically significant reduction in postnatal depression scores following the intervention, but no changes were found in reflective function or birth trauma scores; secondly, birth trauma scores predicted later depression scores as well as reflective functioning uncertainty scores (but not certainty scores). Qualitative analysis found social opportunities were not why parents came but was, after attending, their favourite part of the socially prescribed programme. Those parents reporting on social opportunities were more likely to reference their own needs while non-social activities were associated with their child's needs.

CONCLUSIONS

Socially prescribed creative play programmes for new parents could be a "waiting well" intervention. A longer duration and trauma informed focus would need to be considered in future cohorts.

The reliability and validity of the Postpartum Partner Support Scale among Chinese women

BACKGROUND

The benefits of partner support have been well documented for maternal and child health and wellbeing. Chinese women who practice traditional postpartum rituals may lack support during the confinement and often rely heavily on their partners. Currently, there is no validated measure to assess postpartum partner support in China.

AIM

To translate the Postpartum Partner Support Scale (PPSS) into Chinese, evaluate its psychometric properties and assess postpartum support among Chinese women.

METHODS

The PPSS was translated into Chinese using a validated process and administered to 428 postpartum women residing in the city of Quanzhou in the Fujian Province in China between September 2021 and July 2022.

RESULTS

Reliability analysis demonstrated a Cronbach's α coefficient of 0.97, a split-half coefficient of 0.93, and a retest correlation coefficient of 0.91 (p < 0.01). The item analysis and content validity results fell within the recommended range, with no items requiring deletion. Exploratory factor analysis revealed the extraction of a single common factor, which accounted for 74.05% of the cumulative variance. Confirmatory factor analysis yielded a χ2/df ratio of 1.48 and an RMSEA value of 0.05. Several demographic variables were associated with significantly lower levels of postnatal partner support including older maternal and paternal age, lower maternal education, higher household income, fair relationship with in-law family, female infant sex, and premature birth.

CONCLUSION

The Chinese version of the PPSS exhibited good reliability and validity providing evidence that it may be suitable for evaluating partner support among postpartum women in China.

Psychotherapeutic nursing as Advanced Clinical Practice for the promotion of mental health in Spain

OBJECTIVE

To contribute to the recognition of psychotherapeutic nursing (PTN) as a regulated advanced clinical practice (ACP) in Spain, as is the case in other countries.

BACKGROUND

Nurses are continually evolving to improve overall health outcomes. PTN has become a reality, with several authors describing it as an ACP. In Spain, psychotherapy is not officially regulated, which has led to a significant number of psychiatric nurses adopting an important ACP in this area without recognition.

SOURCES OF EVIDENCE

Evidence confirms that PTN possesses the attributes necessary to be considered an ACP. Nurses, like psychotherapists, independently address the complex needs of individuals and families within the context of therapeutic relationships, and there is a pressing need to advance formal processes of regulation and certification.

DISCUSSION

PTN has evolved at different rates depending on local initiatives, policies and various professional interests. In Spain, it is crucial to evaluate its outcomes, recognise it as an ACP and develop training plans for its regulation and accreditation.

CONCLUSIONS

Mental health nurses in Spain have a strong interest in PTN being recognised as an ACP. To this end, they should join forces with other partners, scientific associations and international bodies such as the International Council of Nurses (ICN) to make PTN an internationally recognised ACP.

IMPLICATIONS FOR NURSING PRACTICE

Psychotherapeutic nurses could contribute to improving mental health outcomes, client satisfaction and health system efficiency, and their formal recognition is an opportunity to enhance their professional identity, competence and autonomy.

IMPLICATIONS FOR NURSING POLICY

Nursing policy needs to be reoriented towards strengthening psychotherapy as an ACP. Synergies and alliances between international nursing associations and the ICN can promote its development and implementation, while research, education and leadership are essential to achieving official regulation and accreditation.

Leveraging the interpersonal context of child development to promote family resilience: A universal prevention approach from preconception through early childhood

Significant mental health problems affect one in five youth in the United States; in tandem with the child mental health epidemic, parents in the United States report high and rising rates of burnout and mental health challenges of their own. Multiple well-established theoretical perspectives demonstrate the high degree of interdependence between children's and their parents' mental health, including intergenerational transmission, prenatal programming, attachment, and temperament and self-regulation theories. Drawing on these perspectives, we argue that a universal prevention approach that centers the development of psychopathology within the context of the parent-child dyad can promote resilience and arrest emerging mental health problems for children and their parents, during sensitive developmental windows (e.g., preconception through early childhood). Derived from this integrated theoretical framework, we review empirical support for the following targets to promote family resilience: screening for current and historical parent risk factors and resilience resources; strengthening healthy, reciprocal social ties; and supporting youth socioemotional skill acquisition. Our review of the literature highlights how improvements in these areas can have cascading benefits across development, for both parents and their children, as well as for future generations. We conclude with actionable, empirically-supported recommendations that can have profound impacts on these targets through changes in federal and state policies, community healthcare settings, and early childhood education and care programs. To achieve enduring, multigenerational impacts, societal and community-level policies, programs, and practices must interweave efforts to support child mental health with efforts to promote parent adjustment and wellbeing.