Comparing Taiwanese women's biopsychosocial features by location of postpartum recovery

BackgroundIn Taiwan, a culturally sanctioned ritual of maternal rest and recuperation has been traditionally practiced patrilocally during the first postpartum month. However, in recent years, the places where women may observe the ritual have become more diverse.AimOur goal was to compare women's psychosocial features based on where they stayed during their postpartum recovery.MethodsUsing proportional stratified quota sampling of 18 hospitals and clinics in Taiwan by birth rate, we recruited 784 postpartum women.ResultsWomen stayed in their own home (17.1%), with their parents-in-law (33.3%), with their parents (36.0%), or in a postpartum nursing center (13.6%). Women who stayed in their own residence or who stayed in their parents' residence perceived greater social support than women who stayed with their parents-in-law.ConclusionsFurther research should compare women's adjustment to motherhood and their competence in childcare based on where they stay during postpartum recovery.     

The effects of postpartum stress and social support on postpartum women''s health status

BACKGROUND: Eastern sociocultural systems differ in many ways from Western ones, and these differences influence many aspects of the postpartum period. AIM: The purpose of this study was to determine postpartum women's health status in the wider social context of the Taiwanese family after women return home from the hospital or clinic. METHOD: A longitudinal study was conducted with data collected at the first, the third, and the fifth weeks of the postpartum period. Five hundred and twenty-six postpartum women were included in the study using stratified sampling from clinics and hospitals in Kaohsiung City in the southern part of Taiwan. The Hung Postpartum Stress Scale (HPSS), Smilkstein's Social Support Scale, and the Chinese Health Questionnaire were used to obtain information about the women's postpartum stress, social support, and health status at each time point. Data were analysed with factor analysis, repeated measures MANOVA, and multiple logistic regression. RESULTS: Three factors associated with postpartum stress were identified by factor analysis: (1) maternity role attainment, (2) lack of social support, and (3) body changes. Furthermore, the level of postpartum stress at the third and the fifth postnatal weeks was higher than at the first. Social support scores at this postnatal week were the highest among the three points in time. In addition, 29%, 41% and 41% of the women at the first, third, and fifth weeks, respectively, had minor psychiatric morbidity. CONCLUSIONS: Because the postpartum women's self-reported stress is relatively low whereas the social support is relatively high, especially from the family, this confirms Pillsbury's conclusion regarding the significance of social support during the Chinese women's postpartum period. The study also showed that the three factors associated with postpartum stress were important predictors of postpartum women's health status. Future studies should compare the level of postpartum stress, social support, and women's health status in both Western and Eastern cultures.     

Predictors of Postpartum Women''s Health Status

PURPOSE: To determine the effects of postpartum stress, depression, and social support on postpartum women's health. METHODS: With proportional stratified-quota sampling by birth rates in clinics and hospitals in Kaohsiung City, in southern Taiwan, 861 women were recruited for the study. The Hung Postpartum Stress Scale, the Beck Depression Inventory-Second Edition, the Social Support Scale, and the 12-item Chinese Health Questionnaire were used to examine women's postpartum stress, depression, social support, and health status during the postpartum period. RESULTS: The findings strongly supported the hypothesis that the effects of postpartum stress and depression on postpartum women's health are significant. The results also indicated that social support had an indirect effect on women's health. CONCLUSIONS: Interventions to decrease postpartum stress and to improve social support might decrease the likelihood of postpartum women's depression, which in turn might enhance their overall health status.     

The association between depressive symptoms and social support in Taiwanese women during the month

The purpose of the study was to explore the association between depressive symptoms and social support in Taiwanese women doing the month. A correlational survey design using the Postpartum Social Support Questionnaire (PSSQ) and the Edinburgh Postnatal Depression Scale (EPDS) to measure social support and postnatal depressive symptomatology was employed. Two hundred and forty postpartum women receiving care in two teaching hospitals in Taipei, Taiwan, aged between 20 and 35, with no peri-natal complications or previous psychiatric history, experiencing a normal spontaneous delivery of one full term healthy baby, were selected. Each was mailed the PSSQ and the EPDS as well as a short, semi-structured self-report questionnaire requesting demographic details and subjective data relating to the experience of doing the month and depressive symptoms during the fourth week following birth. One hundred and eighty six women (78%) returned questionnaires. Taiwanese postpartum women were less depressed when they stayed in their parents' home and had their own mothers take care of them. It was found that the greater the level of postpartum social support received by the women doing the month, the lower the risk of postnatal depressive symptoms experienced. Almost a quarter (24%) of the variance of the symptoms was attributed to dissatisfaction with parents' instrumental support and unwanted emotional support from parents-in-law. It is concluded that the ritual of doing the month provides valuable social support and may help to prevent postnatal depression in Taiwanese women.     

产褥期妇女压力及其影响因素的研究

目的描述产褥期妇女的压力状况并探讨其影响因素。方法应用便利抽样方法调查260例产后5～9周门诊复查产妇的临床资料,测量工具包括洪氏产褥期压力量表、社会支持评定量表。结果产褥期妇女压力的总体水平介于"较少担心"和"有时担心"之间,主要影响因素包括产妇的社会支持、保健知识来源、腰痛、文化程度、产褥期个人收入,婴儿的喂养方式、夜间喂奶次数、睡眠异常、因病就诊等。结论产褥期妇女承受着一定程度的压力,受产妇、婴儿、家庭和社会等多因素影响。     

Measuring postpartum stress

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.     

Social support, stress, and health: a comparison of expectant mothers and fathers

The influence of social support and stress on expectant mothers' and fathers' health was determined by testing and comparing different predictive models. Instruments used were the Support Behaviors Inventory, Stress Amount Checklist, and Health Responses Scale. Regression analyses were performed on data from questionnaires completed by 313 couples in the second half of pregnancy to predict health, using the same independent variables for women and men. The regression analyses began with a model that included the variables of stress, satisfaction with partner support, satisfaction with other persons' support, history of chronic illness, education, age, employment status, military status, and family income. The effects of four variables, satisfaction with partner support, satisfaction with others' support, stress, and chronic illness, were tested separately for men and women. Subsets of these variables were deleted to create a series of nested comparisons. Results indicated that social support and stress were useful in predicting health. Partner support appeared to be the most important variable in understanding expectant fathers' health, but social support for mothers included a larger domain and social networks contributed to their health in the same way as partner support. Both stress and chronic illness were more important explanatory variables for pregnant women's health than for their partners' health. These data suggest that nursing interventions targeted at reducing stress and improving expectant parents' satisfaction with their partner support might enhance their health.     

军队医院护理人员工作应激与健康状况的关系

目的了解军队医院护理人员的工作应激状况,并探讨其健康状况与工作应激及其他因素的关系。方法 2009年9-12月采用整群抽样的方法对福建省5所军队医院的护理人员进行问卷调查,调查内容包括一般资料、工作应激状况、健康状况、社会支持状况、行为类型等。结果在被调查的968名护理人员中,高工作应激者占54.96%,正常工作应激者占36.98%,低工作应激者占8.06%;调查对象的健康状况综合评分与年龄、月工资收入、与患者发生口角或纠纷情况、锻炼情况、工作兴趣、工作条件、主观支持、对支持的利用度、行为类型等9个因素有关,其中与患者发生口角或纠纷、不参加体育锻炼、A型行为是影响军队护理人员健康状况的危险因素。结论军队护理人员的工作应激程度较高,而不良的工作应激可对护理人员的健康状况产生负面影响,且后者与护理人员的社会支持、行为方式等有关,护理人员在工作和生活中应重视相关危险因素的控制,以维护身心健康。     

Social support as a predictor of health status among older adults living alone in Japan

The purpose of this study was to determine social support as a predictor of health status among older adults living alone, based on a 2-year longitudinal study in a rural area of Japan. The self-reported questionnaires were distributed to 624 older adults living alone and were collected during home visits by welfare commissioners as baseline survey. After the follow-up survey of 493 respondents as the baseline survey, we analyzed 340 persons who lived alone over the last 2 years. Women had significantly higher emotional and instrumental support scores than men. Receiving positive support from the neighborhood had a significant effect on retaining activities of daily living for older women living alone. Our results suggest that receiving social support from the neighborhood brought an improvement in the health status of older adults, particularly women living alone.     

Hip fractures in primary health care. Evaluation of a rehabilitation programme

The routine follow-up of hip fracture patients was transferred from the Orthopaedic Department, Lund University Hospital, to the primary health care districts in 1985. The medical state and social functions of all 298 patients during the first 12 months of the follow-up rehabilitation programme were registered. Before fracture, 61% lived in their own homes, 22% in old people's homes, and 14% in geriatric hospitals or nursing homes. Four months after fracture, 13% were dead, 47% were living in their own homes, 14% were in old people's homes, 25% in geriatric hospitals or nursing homes, while the rest were in other types of institutional residence. Of patients coming from their own homes, 75% were back at home four months after fracture and their social and functional status were as good as before fracture. The study has shown that routine check-ups at the orthopaedic department can be omitted. Follow-up in primary health care without radiography and orthopaedic expertise gives equally good functional results as in previous studies, provided that patients with pain and walking problems from the hip are guaranteed rapid specialist treatment.     

Testing a bioecological model to examine social support in postpartum adolescents.

PURPOSE: The purpose was twofold and included examining a bioecological model as a framework to describe social support in postpartum adolescents. The second purpose was to determine the relationship between a comprehensive view of the context of social support and symptoms of depression. DESIGN: Cross-sectional design with convenience sampling (n=85) of adolescents at 4-6 weeks postpartum, recruited from two community hospitals. METHODS: Approval was received from the university's IRB (institutional review board), each recruitment site, the adolescent mothers, and their parents or guardians. Data were collected by a research assistant during home visits using a battery of self-report instruments to measure macro, meso, and microsystems of social support. Demographics, exposure to community violence (macrosystem), social support, social network (mesosystem), and perceived stress, mastery, and self-esteem (microsystem) were predictor variables. Depressive symptoms were measured by using the Center for Epidemiologic Studies of Depression (CES-D) Scale. FINDINGS: Variables from each system were significant predictors of depressive symptoms but perceived stress was the strongest predictor. Many postpartum adolescents reported that they had been victims of violence. Significant symptoms of depression were identified in 37% of the postpartum adolescents. CONCLUSIONS: Context is important to consider in comparing international studies of social support. Researchers and clinicians should investigate variables associated with the low incidence of treatment for depressive symptoms in postpartum adolescents. CLINICAL RELEVANCE: Feelings of high self-esteem and mastery should be fostered in nursing interventions with postpartum adolescents and routine screening for symptoms of depression should be considered in relevant healthcare settings.     

A longitudinal study of maternal postpartum depression symptoms

The purpose of this study was to examine changes in maternal depression symptoms over time from the postpartum period to 2 years after delivery among a sample of women identified with elevated depression symptoms at 2 to 4 weeks postpartum, a longitudinal within-subjects design was used to examine changes in maternal depression symptoms. Two years after delivery, 62 women who had elevated depression scores at 2 to 4 weeks postpartum completed mailed questionnaires including a Demographic Information Sheet, the Beck Depression Inventory II, and the Parenting Stress Index. Among this sample of women, 30.6% scored in the depressed range 2 years after delivery. Although depression scores decreased over time, the significant change in mean scores occurred from 4 to 8 weeks to 10 to 14 weeks postpartum, and mean scores did not change significantly from 10 to 14 weeks, to 14 to 18 weeks, to 2 years after delivery. Depression history, lower overall social support, and higher parental distress were associated with higher depression scores among mothers at 2 years after delivery. Initial decrease in depression scores suggests that postpartum depression symptoms posed a time-limited problem for many women with peak occurrence from 4 to 8 weeks after delivery. However, for many women depression symptoms persisted at 2 years after delivery. Previous depression, limited current support, and parental distress increased depression symptom severity. Additional longitudinal research is needed to determine factors that increase and ameliorate risk for chronic maternal depression. Clinical assessment of maternal depression beyond the early postpartum weeks is warranted for at-risk women.     

Postpartum social support experience while "doing the month" in Taiwanese women

The aim of this investigation was to explore the social support experience while "doing the month" in Taiwanese women. A convenience sample of one hundred and eighty-six Taiwanese primiparas was recruited during the fourth week after giving birth. The Postpartum Social Support Questionnaire (PSSQ) was used to measure the degree of postpartum social support. The results showed that postpartum women would like themselves and their babies to be close to their husbands and their own parents while "doing the month". The level of social support depended on where postpartum women stayed and the key person who looked after them. The ritual of "doing the month" may provide valuable social support for Taiwanese postpartum women. However, the support while "doing the month" needs to be evaluated by postpartum women. It seems that an alternative concept of rite considering the individual expectations of postpartum women is needed.     

Social support and postpartum African American women.

The birth of the first child is a major transitional period for the new mother and her family. Social support that women receive seems to buffer the changes experienced during the postpartum period. However, very little is written about the social support of postpartum African American women. The purpose of this pilot study was to investigate the difference between social support expected prenatally, and that actually received postpartally in African American primiparous women. Data were collected utilizing a modified version of the Postpartum Social Support Questionnaire. Findings revealed no significant differences in the social support expected, and what was actually received postpartally. This sample was somewhat unique in that the women were educated with at least a high school education, with a mean age of 25, and possessed health insurance (access to health care). Future research utilizing the tool with larger samples should be conducted to further validate the reliability and validity of the tool.     

Managing the early discharge experience: taking control

The purpose of this study was to understand women's experiences in an early discharge programme Using grounded theory, the investigator collected, coded, compared and contrasted data gathered in unstructured interviews with eight women The women managed their early discharge experience, first, by taking control of their antenatal and intrapartal care once they were accepted into the programme and, later, by taking control of their postpartum recovery and their infants' care Taking control was influenced by the women's beliefs about family and home, their personalities, e g their ability to accept help, and their available support Their beliefs, personalities and available support were central to their motivation to participate in the early discharge programme and to their perception of a successful experience The women used a number of strategies to take control These strategies emerged during organizing antepartal requirements, meeting their own expectations during labour and birth, and learning to trust their abilities to manage self-care and parenting postpartum The women anticipated their increased family involvement, family integration and participation in decision-making They did not, however, anticipate their increased feelings of confidence and competence Taking control has implications for health professionals who are working with childbearing women experiencing early discharge     

产妇产后需求、社会支持与产后焦虑的相关性研究

目的 了解产妇产后需求、社会支持及焦虑现状,分析产后焦虑的影响因素.方法 采用方便抽样法选取西安市某三甲医院342例顺产产妇为研究对象,采用一般资料问卷、产妇产后需求量表、社会支持评定量表(SSRS)、焦虑自评量表(SAS)进行调查,分析产后焦虑的影响因素及其与产妇产后需求、社会支持的相关性.结果 本研究中,产妇产后焦...     

What were the outcomes of home follow-up visits after postpartum hospital discharge?

OBJECTIVES: To assess health outcomes of home follow-up visits after postpartum discharge and assess relationships between the number of home visits and selected outcomes among women who gave birth at two Queensland, Australia, regional hospitals. DESIGN: A cross sectional study. Services provided during the home visits were responsive to a woman's need rather than having a structured protocol of services. MAIN OUTCOME MEASURES: The four measured health outcomes were: 1) postpartum depression; 2) confidence to undertake maternal roles; 3) breastfeeding; and, 4) satisfaction with postpartum care. RESULTS: Of 210 women who were invited to participate in the study, 143 (68.1%) provided information. Women who received a higher number of home visits had significantly lower confidence to undertake maternal roles than those who received fewer home visits. There was a positive correlation between the number of home follow-up visits and postpartum depression among women who gave birth at one hospital (Hospital B), but not at the other (Hospital A). No relationship was found between the home postpartum visits and the other outcomes. CONCLUSION: These results could be explained in that home follow-up visits were offered to all women at Hospital A while Hospital B only provided home visits to women who had a health risk due to their social, physical and psychological characteristics. The lack of protocol home visits and the characteristics of women receiving the visits were probably the major factors which influenced these limited beneficial outcomes.     

Social support and antenatal clinic attendance among Thai pregnant women in Hatyai, a city in southern Thailand

Many studies in western countries have shown that persons who have a high level of social support are likely to have better health behaviours, including use of preventive health services, than those who have low support. The present study aims to investigate the impact of level of social support among Thai pregnant women on their attendance at antenatal care (ANC) clinics. The study was conducted in Hatyai, a city in Southern Thailand, between 1990 and 1991. Relationships between various measures of the women's social support and their use of antenatal clinics were assessed. Open ended and closed ended questions were used to gather information relating to these women's level of social support, including the number of supporters and their age, the percentage of females among the supporters, the sources of support (spouse, kin, friend and health professionals), the frequency of contact, the types of support and the sufficiency of support. Social support indices were constructed: sources of support indices, a social network index, a subjective support index, and a social support index. One hundred and seventy-seven postpartum women were interviewed at their homes. Spouses, relatives and friends were important sources of the four principle types of support, namely emotional, instrumental, information and appraisal supports. Less than 10% of the women studied identified health personnel as providing support. The majority of supporters were women who had daily, face-to-face communication with the women studied. Approximately 76% of the women studied had sufficient support. The majority of supporters, except health personnel, provided all four types of support. Only 47% of the women studied made four or more antenatal clinic visits as recommended by the Thai government. No significant relationship between the indices of social support and the use of ANC clinics was identified. The Thai extended family by its nature generates large numbers of supporters. Little variation in support levels among all the women therefore occurred. Support to the women could have positive and/or negative effects on the women's use of ANC clinics. It was concluded that in Thai communities, social support is not an important determinant of the use of ANC clinics and the indices of social support were not the most appropriate techniques to use in the communities.     

Violence against women and the perinatal period: the impact of lifetime violence and abuse on pregnancy, postpartum, and breastfeeding

Violence against women affects millions of women, including women who are pregnant or have recently given birth. During pregnancy, a woman's history of past abuse increases her risk of depression and posttraumatic stress disorder. And these increase the risk of pregnancy and neonatal complications. Women who have experienced past or current abuse are also at high risk for postpartum depression, which can affect their relationships with other adults and their babies. Violence against women can also affect women's ability to breastfeed, although abuse survivors often express an intention to breastfeed and are more likely to initiate breastfeeding than their nonabused counterparts. Current abuse, depression, posttraumatic stress disorder, social isolation, lack of social support, and cessation of breastfeeding all have negative health effects for mothers and babies.     

Postpartum Taiwanese women: their postpartum depression, social support and health-promoting lifestyle profiles

Background. To reach the Millennium Development Goals, maternal health‐promoting behaviours need to be encouraged after childbirth; little is known about the health‐promoting behaviour among first‐time mothers during their postpartum period. Aim. To examine levels of engagement in health‐promoting behaviours and related factors among postpartum women in Taiwan. Methods. This cross‐sectional study was conducted through a convenience sample of 122 qualified women. Participants self‐completed a questionnaire and mailed it back using a stamped, self‐addressed envelope from July to September 2003. Instruments of this study included a demographic questionnaire as well as three Likert‐type scales: the Health Promotion Lifestyle Profile scale, the Edinburgh Postnatal Depression scale and a self‐developed social support scale. Results. The average overall Health Promotion Lifestyle Profile score was low (mean, 2·83 SD 1·35), with exercise rated lowest among the six subscales. Postpartum women perceived that they had high levels of social support from their mothers‐in‐law, mothers and husbands. An astonishing 42·6% of women experienced postnatal depression. Based on results of multiple regressions, 25% of the variance in health‐promoting lifestyle practices was explained by postpartum depression and social support. Social support was found to predict all subscales significantly except exercise. Postpartum depression can significantly predict self‐actualization, interpersonal relationships, nutrition and stress management. All modifying factors were excluded from the regression model. Conclusions. This study validates the theoretical relationships among concepts in the Health Promotion Model. Nursing interventions are recommended which are tailored to enhance women's social support and decrease their depression to promote their pursuit of healthy lifestyles. Relevance to clinical practice. This study highlights the implications of social support to nursing practice, especially in Chinese culture which has a strict ritual during a women's postpartum period. Findings of this study provide information and data for service planning and community care to support postpartum care in the communities.