Family dynamics and postnatal depression

Associations between breastfeeding intention, breastfeeding practices and post-natal depression during the COVID-19 pandemic: A multi-country cross-sectional study

Associations between breastfeeding intention, duration and post-natal depression (PND) have been shown in pre-COVID-19 studies. However, studies during COVID-19 have not examined the associations between breastfeeding intention, breastfeeding practices, and PND in an international sample of post-natal women, taking into consideration COVID-19 related factors. This is the first study to address this gap as both PND and breastfeeding may be affected by COVID-19, and have important long-term effects on women's and infant's health. A cross-sectional internet-based survey was conducted with 3253 post-natal women from five countries: Brazil, South Korea, Taiwan, Thailand, and the United Kingdom from July to November 2021. The results showed that women who intended to breastfeed during pregnancy had lower odds of having PND than women who did not intend to. Women who had no breastfeeding intention but actually breastfed had greater odds (AOR 1.75) of having PND than women who intended to breastfeed and actually breastfed. While there was no statistical significance in expressed breast milk feeding in multivariable logistic regression models, women who had shorter duration of breastfeeding directly on breast than they planned had greater odds (AOR 1.58) of having PND than those who breastfed longer than they planned even after adjusting for covariates including COVID-19-related variables. These findings suggested the importance of working with women on their breastfeeding intention. Tailored support is required to ensure women's breastfeeding needs are met and at the same time care for maternal mental health during and beyond the pandemic.

Using Levine's conservation model in postpartum care: a randomized controlled trial

This randomized controlled trial was conducted with 117 puerperae who were assigned into 2 groups: the intervention group and the control group. While the participants in the intervention group participated in a full program based on the module trainings, the participants in the control group received routine care. There was a significant difference between the women in the intervention and control groups in terms of the variables such as fatigue, sleep, and quality of life. The women in the intervention group experienced less fatigue, and their quality of sleep and quality of life improved considerably. Levine's conservation model enables the provision of the integrative care to women in their postpartum period.

Transformation of attitude through brief psychoeducation program for the husbands of women with postpartum psychiatric disorders

According to existing literature on Perinatal Psychiatric Services, husbands have not often been involved in the treatment of their spouses with Perinatal Psychiatric disorders, especially in India, despite the advantages as an adjunctive form of therapy. The current study aimed at evaluating the effectiveness of brief psychoeducation on the attitude of husbands of women with postpartum psychiatric disorder through a biopsychosocial based informative and supportive model of intervention. A 3 session based Brief Psychoeducation Program (BPP) was developed for the targeted population and its effectiveness was evaluated through quasi-experimental research design. Using Community Attitude towards Mentally Ill Scale (CAMI) assessment of the outcome variable was done at 3 levels i.e., Pre (baseline), Post (immediately after the intervention) and Follow-up post (1 month after the intervention). A total of 21 participants were recruited meeting the study criteria. Friedmans test and descriptive statistics were used to analyze the data. Results indicated the transformation in the attitude of the participants in all the 4 domains of the scale from pre-intervention to post-intervention phase. The study has a strong implication for mental health professionals in this area at both clinical (medical and psychiatry settings) and nonclinical settings.

Experiences, mental well-being and community-based care needs of fathers of late preterm infants: A mixed-methods pilot study

Aims

We explore fathers' experience of caring for a late preterm infant including their stressors, needs and corresponding interventions proffered by public health nurses.

Design

Pilot mixed-methods exploratory sequential design.

Methods

We collected (a) qualitative data from semi-structured interviews (N = 5) and (b) quantitative data (N = 31) about fathers' levels of stress (Parenting Stress Index), anxiety (Speilberger State-Trait Anxiety) and depression (Edinburgh Postnatal Depression Scale) at 6-8 weeks after birth of their infant.

Results

Fathers appreciated their infant was born 'early', however, discovered through experience the demands of their infant, which appeared as stress (child and parent domains) and anxiety. Themes: hypervigilance in care explained the fathers' sense of competency and role restriction; infant fatigue and parental feeding elucidated the stressful aspect of father-infant interaction. Unscientific advice from healthcare providers was confusing and frustrating while uncertainty of rehospitalization caused worries, fears or stress. One father experienced depressive symptoms.

Mothers' views of health problems in the 12 months after childbirth: A concept mapping study

AIMS

To identify the health problems that women feel require help and subsequent help-seeking behaviour during the 12 months period after childbirth.

BACKGROUND

Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems.

DESIGN

A mixed method concept mapping study.

METHOD

Two groups of Australian women were recruited by an online platform and purposive sampling (N = 81) in 2017-2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements about post-childbirth health problems and help-seeking and a second group sorted and rated the statements based on their perception of the prevalence of the issues and the help-seeking advice they would offer to others. Bradshaw`s Taxonomy of Needs was used to theoretically underpins the explanation of the results of women's felt need after childbirth.

RESULTS

Multidimensional scaling resulted in six clusters of issues which were categorized into three domains: 'health issues and care', 'support' and 'fitness'. Despite being directly asked, about two-thirds of the women did not report experiencing any health problems.

CONCLUSION

Our findings showed women had a broader perception of healthcare needs which included support and fitness. There is a potential gap in services for women who do not have good social support.

IMPACT

Family and friends were a key source of help-seeking. Post-childbirth routine care was focused on infant care and limited to the first 6 weeks after childbirth. The content of current post-childbirth care must be reviewed.

Cost-effectiveness of interventions for perinatal anxiety and/or depression: a systematic review

OBJECTIVES

Anxiety and/or depression during pregnancy or year after childbirth is the most common complication of childbearing. Economic evaluations of interventions for the prevention or treatment of perinatal anxiety and/or depression (PAD) were systematically reviewed with the aim of guiding researchers and commissioners of perinatal mental health services towards potentially cost-effective strategies.

METHODS

Electronic searches were conducted on the MEDLINE, PsycINFO and NHS Economic Evaluation and Health Technology Assessment databases in September 2017 to identify relevant economic evaluations published since January 2000. Two stages of screening were used with prespecified inclusion/exclusion criteria. A data extraction form was designed prior to the literature search to capture key data. A published checklist was used to assess the quality of publications identified.

RESULTS

Of the 168 non-duplicate citations identified, 8 studies met the inclusion criteria for the review; all but one focussing solely on postnatal depression in mothers. Interventions included prevention (3/8), treatment (3/8) or identification plus treatment (2/8). Two interventions were likely to be cost-effective, both incorporated identification plus treatment. Where the cost per quality-adjusted life year (QALY) gained was reported, interventions ranged from being dominant (cheaper and more effective than usual care) to costing £39 875/QALY.

CONCLUSIONS

Uncertainty and heterogeneity across studies in terms of setting and design make it difficult to make direct comparisons or draw strong conclusions. However, the two interventions incorporating identification plus treatment of perinatal depression were both likely to be cost-effective. Many gaps were identified in the economic evidence, such as the cost-effectiveness of interventions for perinatal anxiety, antenatal depression or interventions for fathers.

PROSPERO REGISTRATION NUMBER

CRD42016051133.

Mother-Father Differences in Postnatal Psychological Distress and Its Determinants in Iran

AIM:

The aim of this study was to investigate the mother-father differences in Postnatal Psychological Distress (PPD) and its determinants among the parents with 8-weeks old children.

MATERIALS AND METHODS:

In this cross-sectional study, applying simple random sampling, 306 postnatal parents with an 8-weeks old infant in Saqqez County, Iran, were invited to answer the General Health Questionnaire-28 (GHQ-28) items through the telephone interview. Fifty-eight subjects declined to participate in the study (Response Rate = 81.04%). The data were analysed using the SPSS Statistics v. 21.

RESULTS:

About 16.9% of all the parents had PPD. The difference in the prevalence of PPD in three dimensions between the two groups were statistically significant (p < 0.01): social dysfunction (25.8% for fathers vs. 5.6% for mothers), somatic disorders (21% for fathers vs. 7.3% for mothers), and anxiety (21% for fathers vs. 6.5% for mothers). The mode of delivery of the mothers and the level of education, the number of children, monthly income, and being consent with pregnancy among the fathers were significant predictors for PPD.

CONCLUSION:

The level of PPD was more prevalent among the new fathers compared to the new mothers. Among the fathers, but not the mothers, socioeconomic characteristics were contributed to PPD. Considering the differences in risk factors for maternal and paternal PPD, our findings may help family health care providers and policymakers in designing gender-specific intervention programs and diagnosis tools aimed at PPD prevention among new parents.

Postpartum social support of women in Singapore: A pilot study

This pilot study aimed to identify the levels of support expected and received by postpartum women in Singapore. Another objective was to compare the different subdomains of social support. A descriptive design was adopted using a self-administered questionnaire comprising demographics and the Postpartum Support Questionnaire. The study took place at a subsidized obstetrics and gynaecology clinic at a restructured hospital in Singapore from the end of December 2009 to the end of February 2010. The 25 participants were 6 to 8 weeks postpartum and had delivered healthy term infants. They were recruited via convenience sampling. Data were analysed using descriptive statistics and inferential statistics. The overall support needs of the participants were met. Only their informational support needs were unmet. Assessing the needs of postpartum women and teaching them how to convey and manage expectations are recommended initiatives for health-care practitioners to consider.

Development and evaluation of a newborn care education programme in primiparous mothers in Nepal

BACKGROUND

the health and survival of newborns depend on high levels of attention and care from caregivers. The growth and development of some infants are unhealthy because of their mother's or caregiver's lack of knowledge or the use of inappropriate or traditional child-rearing practices that may be harmful.

OBJECTIVE

to develop a newborn care educational programme and evaluate its impact on infant and maternal health in Nepal.

DESIGN

a randomised controlled trial.

PARTICIPANTS

one hundred and forty-three mothers were randomly assigned to the intervention (n=69) and control (n=74) groups. Eligible participants were primiparous mothers who had given birth to a single, full-term, healthy infant, and were without a history of obstetric, medical, or psychological problems.

METHODS

prior to being discharged from the postnatal unit, the intervention group received our structured newborn care education programme, which consisted of one-on-one educational sessions lasting 10-15minutes each and one postpartum follow-up telephone support within two weeks after discharge, in addition to the hospital's routine general newborn care education. The control group received only the regular general newborn care education. Outcomes were measured by using Newborn care Knowledge Questionnaires, Karitane Parenting Confidence Scale, State-Trait Anxiety Inventory for Adults and infant health and care status.

FINDINGS

the number of mothers attending the health centre due to the sickness of their babies was significantly decreased in the intervention group compared to the control group. Moreover, the intervention group had significant increases in newborn care knowledge and confidence, and decreases in anxiety, compared with the control group.

CONCLUSIONS

the structured newborn care education programme enhanced the infant and mother health. Moreover, it increased maternal knowledge of newborn care and maternal confidence; and reduced anxiety in primiparous mothers. Thus, this educational programme could be integrated into routine educational programs to promote maternal and infant well-being in Nepalese society.

The strengths of families in supporting mentally-ill family members

BACKGROUND

Although families caring for a mentally-ill family member may experience challenges, some of these families may display strengths that help them to overcome difficulties and grow even stronger in caring for their family member. In cases where these families are unable to cope, the mentally-ill family member tends to relapse. This indicated the need to explore the strengths of families that cope with caring for mentally-ill family members.

OBJECTIVE

The purpose of this study was to explore and describe the strengths of families in supporting mentally-ill family members in Potchefstroom in the North-West Province.

METHOD

A qualitative, explorative, descriptive and contextual design was employed, with purposive sampling and unstructured individual interviews with nine participants. Tesch's eight steps of thematic content analysis were used.

RESULTS

Twelve themes emerged from the data. This involved strengths such as obtaining treatment, utilising external resources, faith, social support, supervision, calming techniques, keeping the mentally-ill family member busy, protecting the mentally-ill family member from negative outside influences, creative communication, praise and acceptance.

CONCLUSION

Families utilise external strengths as well as internal strengths in supporting their mentally-ill family member. Recommendations for nursing practice, nursing education and for further research could be formulated. Psychiatric nurses should acknowledge families' strengths and, together with families, build on these strengths, as well as empower families further through psycho-education and support.

Substitute consent in women with psychosis

When treating patients with schizophrenia, substitute consent for treatment is often needed because of the patient's decisional incapacity. The goal of this article is to illustrate the potential problems involved in surrogate decision-making in a mental health service for women. A composite case vignette that highlights these issues is presented. The vignette was developed based on files from a women's clinic for psychosis and a selective literature review. The quality of the relationship between marriage partners and the possibility of pregnancy, motherhood, and child custody disputes all complicate the ethics of next- of-kin surrogate decision-making. The concept of "best interests" (the mother's or the child's) is not straightforward. A related ethical issue is whether/when to disclose psychiatric information to spouses. It is hoped that this paper will engender further discussion in medicine, cultural studies, ethics, and the law.

Postpartum depression in Pakistan: a neglected issue

Postpartum depression (PPD) is common among women in Pakistan, with a prevalence rate ranging from 28 percent to 63 percent, placing it among the highest in Asia. PPD has devastating effects on mothers, infants and families. Several factors contribute to the development of PPD in Pakistan, including environmental, cultural and social factors. Pakistani women living in other countries are also at risk. Nurses can play an important role in identifying women at risk and helping them get the necessary treatment.

A nurse-led initiative to improve obstetricians' screening for postpartum depression

Although up to 20 percent of women experience postpartum depression, screening is not standard practice. In a metropolitan area where only 1 of 30 obstetricians and two primary care clinics reported routine screening for postpartum depression, a nurse-led initiative to implement routine screening using the Edinburgh Postnatal Depression Scale was carried out. Twenty-two obstetricians (76 percent) agreed to consistently implement screening for 3 months. Of the 21 participating obstetricians, 71.4 percent indicated that postpartum depression screening would become their standard care. This article describes implementation strategies and lessons learned.

Impact of an internet-based intervention on Finnish mothers' perceptions of parenting satisfaction, infant centrality and depressive symptoms during the postpartum year

OBJECTIVE

this study evaluates how an internet-based intervention affects mothers' parenting satisfaction, infant centrality and depressive symptoms.

DESIGN

a quasi-experimental design and repeated measures were used.

SETTINGS

this study was conducted in two Finnish public maternity hospitals (intervention/control).

PARTICIPANTS

a convenience sample (N=1300) of primiparous and multiparous Finnish-speaking mothers were invited to participate. Multiple-birth and early discharge mothers receiving home visits were excluded. The analysis included 760 mothers.

INTERVENTION

the intervention offered online support for parenting, breast feeding and infant care beginning from the middle of pregnancy. It consisted of an information database, a peer discussion forum and expert advice.

MEASUREMENTS

Outcomes were measured by the Evaluation and Infant Centrality subscales of the What Being the Parent of a New Baby is Like-Revised, and the Edinburgh Postnatal Depression Scale after childbirth, and six weeks, six months and 12 months post partum. Age, parity, parenting self-efficacy, and perception of infant and family functioning were used as the covariates.

FINDINGS

during the first postpartum year, mothers' parenting satisfaction increased significantly, whereas infant centrality and depressive symptoms decreased within groups. However, these changes were not linear. The mean difference between groups in parenting satisfaction and depressive symptoms was not significant within any of the four assessments. The mean difference in infant centrality between control and intervention mothers was significant only at six weeks post partum. Primiparas scored significantly higher in infant centrality and significantly lower in depressive symptoms than multiparas.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

an internet-based intervention did not significantly affect mothers' perceptions of parenting satisfaction and depressive symptoms, but intervention mothers experienced higher infant centrality compared with control mothers at six weeks. Parenting self-efficacy was a significant covariate for all measures. Parity needs to be taken into account when infant centrality and depressive symptoms are used as outcome variables in intervention studies. More research is needed to study the potential of information data bank, professional, and peer online support. This study also highlights the need to pay more attention to the selection of the target population, the selection of outcome measures, and implementation issues in intervention research.

A review of postpartum depression, preterm birth, and culture

Postpartum depression (PPD) varies worldwide and is considered a serious issue because of its devastating effects on mothers, families, and infants or children. Preterm birth may be a risk factor for PPD. In 2005, the global incidence of preterm birth was estimated to be 9.6%, and of these births, 85% occurred in Africa and Asia. Among Asian countries, Pakistan has a preterm birth rate of 15.7% and the highest prevalence rate of PPD (63.3%). A literature review was therefore undertaken to better understand the potential contribution of preterm birth to PPD and to identify gaps in the scientific literature. Limited studies compare prevalence rates of PPD in mothers of full-term infants and mothers of preterm infants. Furthermore, meta-analyses examining predictors of PPD have not included preterm birth as a variable. The interrelationship between preterm birth and PPD may be explained by early parental stress and mother-infant interaction among mothers of preterm infants. Culture plays an important role in shaping communication between mothers and their infants and defines social support rituals that may or may not mediate PPD. More research is needed to provide evidence for practice.

Can a brief antepartum preventive group intervention help reduce postpartum depressive symptomatology?

BACKGROUND

Psychosocial and psychological interventions are generally effective in reducing depressive symptomatology in the postpartum period. Our aim was to evaluate the effectiveness of a brief preventive group intervention for postpartum depression (PPD) in a naturalistic setting, and study the effect of this on social and psychological risk factors.

METHODS

We conducted a randomized controlled trial (n = 1,719) in south-eastern Hungary in 62 antepartum centers. Pregnant women (n = 710) underwent a 4-session preventive group intervention whereas a control group (n = 1,009) attended 4 sessions providing the same information given in usual care.

RESULTS

Our intervention appeared to significantly reduce the risk of PPD, as defined by Leverton Questionnaire total scores (OR = 0.69). It resulted in an absolute risk reduction of about 18% in those with antepartum depression and 0.5% in those with no depression at recruitment. A multiple logistic regression analysis revealed a much reduced risk in those with a perceived lack of partner support (OR = 0.4) in the treatment group. Unplanned pregnancy, an irreversible risk factor affecting every fifth woman, also seemed to have a reduced effect on PPD after our group intervention (OR = 0.81).

CONCLUSIONS

A brief preventive antepartum group intervention focusing on psychoeducation, stress management, improving coping mechanisms, and the development of social support can be effective in reducing postpartum depressive symptomatology.

Clinically identified postpartum depression in Asian American mothers

OBJECTIVE

To identify the clinical diagnosis rate of postpartum depression (PPD) in Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) compared to non-Hispanic Whites.

DESIGN

Cross-sectional study using electronic health records (EHR).

SETTING

A large, outpatient, multiservice clinic in Northern California.

PARTICIPANTS

A diverse clinical population of non-Hispanic White (N = 4582), Asian Indian (N = 1264), Chinese (N = 1160), Filipino (N = 347), Japanese (N = 124), Korean (N = 183), and Vietnamese (N = 147) mothers.

METHODS

Cases of PPD were identified from EHRs using physician diagnosis codes, medication usage, and age standardized for comparison. The relationship between PPD and other demographic variables (race/ethnicity, maternal age, delivery type, marital status, and infant gender) were examined in a multivariate logistic regression model.

RESULTS

The PPD diagnosis rate for all Asian American mothers in aggregate was significantly lower than the diagnosis rate in non-Hispanic White mothers. Moreover, of the six Asian American subgroups, PPD diagnosis rates for Asian Indian, Chinese, and Filipino mothers were significantly lower than non-Hispanic White mothers. In multivariate analyses, race/ethnicity, age, and cesarean were significant predictors of PPD.

CONCLUSION

In this insured population, PPD diagnosis rates were lower among Asian Americans, with variability in rates across the individual Asian American subgroups. It is unclear whether these lower rates are due to underreporting, underdiagnosis, or underutilization of mental health care in this setting.

Social energy exchange theory for postpartum depression

Postpartum depression (PPD), a significant health problem affecting about 19.4% of postpartum women worldwide, may result in long-term cognitive and behavior problems in children, spousal depression, widespread family dysfunction, and chronic and increasingly severe maternal depression. Although current theoretical frameworks provide a rich context for studying PPD,none provides a framework that specifically addresses the dynamic relationship of the inner personal experience with the social and cultural context of PPD. The authors propose the social energy exchange theory for postpartum depression to understand how PPD impedes this dynamic relationship and suggest it as a theoretical framework for the study of interventions that would target intra- and interpersonal disturbance within the social and cultural context.

Social dynamics of postpartum depression: a population-based screening in South-Eastern Hungary

PURPOSE

To determine contributing psychosocial factors to postnatal depression (PND) in Hungary in 1996 and in 2006.

METHODS

In 1996 and 2006, a total of 2,333 and 1,619 women, respectively, were screened for PND in South-Eastern Hungary, based on a Leverton questionnaire (LQ) score of ≥ 12 at 6-10 weeks after delivery.

RESULTS

The LQ scores indicated an increase in PND from 15.0% in 1996 to 17.4% in 2006. The best predictors for PND in a multiple regression analysis were living in an urban environment [adjusted odds ratio (AOR) = 11.26], unstable relationship (AOR = 3.1) and a perceived lack of social support from partner (AOR = 3.65) in 1996, and recent major life events (AOR = 3.38), unstable relationship (AOR = 3.84), self-reported low income (AOR = 1.82), and intention to return to work soon after delivery (AOR = 0.47) in 2006.

CONCLUSIONS

A self-defined low socioeconomic status and an intention to return to work have become significant factors in the development of PND. Besides the family factors recognized as salient variables in 1996, economic features came into prominence as newly identified main predictive factors for PND in 2006.

Correlates of ante- and postnatal depression in fathers: a systematic review

BACKGROUND

Contemporary research findings suggest that depression during the ante- and postnatal periods is a significant problem not only for women but also for many men. This paper provides a conceptual and methodological review of the literature on cross-sectional and prospective correlates of depressive symptoms in men during both pregnancy and the postpartum period.

METHODS

The search, via several electronic databases, was limited to English papers published between January 1996 and August 2009, and identified 30 relevant articles.

RESULTS

The most common correlate of paternal depressive symptoms pre- and post birth was having a partner with elevated depressive symptoms or depression; poor relationship satisfaction was also frequently associated with elevated depressive symptoms or depression in men.

LIMITATIONS

There were significant methodological limitations of existing studies, including small sample sizes; the use of cross-sectional designs; varied measures of depression; focus on depression in the postpartum only; and in the few longitudinal gestational studies, the inclusion of only one assessment point. The limitations of the current systematic review include the inclusion of only papers written in English and potential publication bias, where studies with null findings are less likely to be published.

CONCLUSION

The scientific study of predictors of men's depressive symptoms pre and post birth remains in its infancy. Given the implications of clinical depression in men both during the gestational and postpartum periods, further systematic investigation of direct and indirect predictors of elevated depressive symptoms in men during this time is warranted.

The role of family and friends in providing social support towards enhancing the wellbeing of postpartum women: a comprehensive systematic review

BACKGROUND

Maternal postpartum health is a neglected area both in research and practice. This aspect warrants more attention as the health of postpartum mothers has a considerable influence on her infant and also other family members. Social support provided by family and friends has been identified as a buffer against the many stressors faced by the women. Outcomes such as self-esteem, stress, postnatal depression, breastfeeding levels, infant care, and maternal adaptation have been studied and found to be significantly related to social support. The need to understand the role of social support provided by family and friends provide the impetus for conducting this review.

OBJECTIVES

The objective of this systematic review was to appraise and synthesise the best available evidence which discusses the impact of social support from family and friends on enhancing the wellbeing of postpartum women.

INCLUSION CRITERIA

This review includes women who were within their first year postpartum period, with any number of children, and had given birth to healthy infants. Mothers who had co-existing morbidities such as depression were excluded. Mothers from low socio-economic groups were excluded.This review considered any study that involved the provision of social support by family and/or friends. Interventions provided by peer counsellors were also considered.The six outcomes were stress, self esteem, breastfeeding levels, mental health in relation to postnatal depression, infant care and maternal adaptation.Quantitative This review considered any randomised controlled trials that examined the effectiveness of social support from family and friends on the well being of the postpartum women. As it was not likely to find RCTs on this topic, this review also considered observational studies (cohort, case control, quantitative descriptive studies such as surveys).Qualitative This review considered any interpretive studies that drew on the experiences of social support from family and friends in postpartum women including, but not limited to, designs such as phenomenology, grounded theory and ethnography.The search was conducted only in published literature in English. A search was conducted in the following databases: PsycINFO, MEDLINE, CINAHL, SCOPUS, THE COCHRANE LIBRARY, BMJ Clinical Evidence, Wiley Interscience, ScienceDirect and MEDNAR.Each paper was assessed independently by two reviewers prior to critical appraisal using Joanna Briggs Institute-System for the Unified Management, Assessment and Review of Information (JBI-SUMARI) developed by Joanna Briggs Institute (JBI).

DATA COLLECTION/EXTRACTION

Qualitative and quantitative data were extracted using the tools from the JBI-SUMARI DATA SYNTHESIS: Qualitative data was synthesised using QARI (Qualitative Assessment and Review Instrument). Quantitative data could not be pooled due to the lack of comparable RCTs or cohort studies and was thus presented in a narrative form.

RESULTS

This review included 24 quantitative articles, comprising of two RCTs and 22 descriptive studies. From these studies, social support was shown to have a significant positive correlation with outcomes such as breastfeeding, infant care, maternal adaptation, and self esteem. In addition, social support was shown to have a negative correlation with the levels of stress and postnatal depression. This indicated that increasing the social support of postpartum women will promote breastfeeding, infant care, maternal adaptation and self esteem. Rendering social support also aids in buffering their levels of stress and postnatal depression.Three qualitative articles were included in this review. Meta-synthesis of the qualitative findings yielded 17 findings which were grouped into seven categories and then further categorised into one synthesised finding which was, "Motherhood as a period of learning, adjustment, seeking positive social support whilst buffering against stressors'. This synthesised finding suggested that social support offered by family and friends has both positive and negative effects with which the postpartum mothers have to learn to cope.

CONCLUSIONS

Family members such as the partners and grandmothers should be involved in the provision of care towards the postpartum women. The support from peer volunteers may also contribute to the desired health outcomes. Healthcare professionals ought to be equipped with the knowledge on social support so that they can better assess the needs of the postpartum women and develop a support plan.Further research is necessary to better understand the negative effects of social support and to test interventions to buffer them. The effectiveness of the various types of social support interventions should be subject to further testing in future research. Further research may help to identify which support provider is more effective in enhancing a particular health outcome.

Adaptação e validação da Family Dynamics Measure II para familiares de mulheres com câncer de mama

O estudo objetivou adaptar e validar a Family Dynamics Measure II para uso com famílias de mulheres com câncer de mama. O processo incluiu tradução, retrotradução, análise da equivalência semântica pela autora principal do instrumento, análise semântica por amostra da população-alvo, análise de conteúdo por juízes e avaliação das propriedades psicométricas da escala aplicada a 251 familiares de mulheres com câncer de mama. Obteve-se versão adaptada com fidedignidade geral boa (α = 0,90); a análise fatorial não confirmou a dimensionalidade teórica do instrumento original; as correlações com a Escala de Ansiedade e Depressão Hospitalar foram invertidas e de baixa a moderada intensidade. A escala foi considerada válida para uso no Brasil. Novos estudos foram sugeridos para fortalecer as evidências.

Post-natal depression screening and treatment in maternity and child health clinics

Post-natal depression is a major mental health problem in many western countries. The children of depressed parents face an elevated risk of depression before reaching adulthood. In primary health care, there is an obvious need to improve competence in mental health among those working with mothers and their children. In this practice development project the aim was to improve recognition and treatment of post-natal depression in primary health care in City of Vantaa, Finland. Mothers scoring 13 points or more on Edinburgh Postnatal Depression Scale were asked to participate in a cognitive behavioural therapy-based and goal-orientated session with a mental health nurse. Based on analysis of 166 mothers it can be concluded that one or two sessions with a mental health nurse were sufficient for over 50% of the mothers, and 68% of the mothers were able to get post-natal depression care in the same clinic where their children are monitored without a need for specialized psychiatric services. In addition, the appropriate use of antidepressant medication was enhanced.

Family nursing research for practice: the Finnish perspective

This article summarizes the efforts of the Department of Nursing Science, University of Tampere, Finland, to advance knowledge about family nursing over the past 15 years. Definitions of family, family nursing, and family nursing science are offered. Programs of research include families' experiences of care received in health care settings, family violence and child maltreatment, and the psychometric development of instruments to assess family functioning and family health. Research is currently examining the effectiveness of family nursing interventions. Recommendations are offered to strengthen collaboration between family nursing researchers, educators, and practitioners at the local level and initiate greater collaboration between family researchers at the interdisciplinary and international levels.

Women with postpartum depression: "my husband" stories

BACKGROUND

The research on Postpartum Depression (PPD) to date suggests that there is a knowledge gap regarding women's perception of their partners' role as carer and care activities they perform. Therefore, the purpose of this study was to describe women's understanding of their partners' or husbands' involvement in the midst of PPD.

METHODS

This study used interview data from a larger study of northern and rural Ontario women's stories of help-seeking for PPD. The interpretive description approach was used to illustrate the complexity of women's spousal connections in PPD. Data from a purposive community sample of 27 women who self-identified as having been diagnosed with PPD was used. From the verbatim transcribed interviews a number of data excerpts were identified and labeled as "my husband" stories. Narrative analysis was employed to examine these stories.

RESULTS

During this time of vulnerability, the husbands' physical, emotional and cognitive availability positively contributed to the women's functioning and self-appraisals as wife and mother. Their representations of their husbands' 'doing for' and/or 'being with' promoted their well-being and ultimately protected the family.

CONCLUSION

Given that husbands are perceived to be central in mitigating women's suffering with PPD, the consistent implementation of a triad orientation, that includes woman, child and partner rather than a more traditional and convenient dyadic orientation, is warranted in comprehensive postpartum care. Finally, this study contributes a theoretical understanding of responsive as well as reactive connections between women and family members during the postpartum period.

Challenges faced by new mothers in the early postpartum period: an analysis of comment data from the 2000 Pregnancy Risk Assessment Monitoring System (PRAMS) survey

OBJECTIVE

To identify challenges that women face 2-9 months postpartum using qualitative data gathered by the Pregnancy Risk Assessment Monitoring System (PRAMS).

METHODS

PRAMS is an on-going population-based surveillance system that collects self-reported information on maternal behaviors and experiences before, during, and after the birth of a live infant. We analyzed free text comment data from women in 10 states who answered the PRAMS survey in 2000. Preliminary analysis included a review of the comment data to identify major themes and a demographic comparison of women who commented (n = 3,417) versus women who did not (n = 12,497). Subsequent analysis included systematic coding of the data from 324 women that commented about postpartum concerns and evaluation to ensure acceptable levels of reliability among coders.

RESULTS

We identified the following major themes, listed in order of frequency: (1) need for social support, (2) breastfeeding issues, (3) lack of education about newborn care after discharge, (4) need for help with postpartum depression, (5) perceived need for extended postpartum hospital stay, and (6) need for maternal insurance coverage beyond delivery.

CONCLUSION

The themes identified indicate that new mothers want more social support and education and that some of their concerns relate to policies regarding breastfeeding and medical care. These results can be used to inform programs and policies designed to address education and continuity of postpartum care for new mothers.

Patterns of sleep disruption and depressive symptoms in new mothers

OBJECTIVES

This study describes the patterns of sleep disturbance and depressive symptoms in a sample of childbearing women from the third trimester through the postpartum period. The relationship between sleep and depressive symptoms is also examined. A secondary aim of this study was to examine the relationship between self-report measures of sleep and depressive symptoms between women with depressive symptoms in comparison with women with minimal or no depressive symptoms in the third trimester and in the third month postpartum.

METHODS

This longitudinal, descriptive study followed 124 primiparous women from their last month of pregnancy through 3 months postpartum. Questionnaires on sleep and depressive symptoms were completed during the third trimester (Time 1), 1 month postpartum (Time 2), 2 months postpartum (Time 3), and during the third month postpartum (Time 4). Sleep measures in a subset of women with depressive symptoms were compared with those of women with minimal or no symptoms at Time 1 and Time 4.

RESULTS AND CONCLUSIONS

Sleep disturbance and depressive symptoms were associated at Time 1 and Time 4. For new mothers, a complaint of trouble falling asleep (delayed sleep onset latency) may be the most relevant screening question in relation to their risk for postpartum depression.

Addressing depression and anxiety among new fathers

Fathers may be unintentionally marginalised by perinatal health services and by the maternal focus of social practices surrounding new babies. There is increasing recognition that a fathers' depression and anxiety in the perinatal period can have serious consequences for his family. Health services could better support new fathers by providing them with information on parenting from a father's perspective, or by running father-specific sessions as part of routine antenatal care programs.