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.     

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。     

Women's postpartum stress, social support, and health status

The purpose of this study was to examine women's postpartum stress, social support, and health status at different places of residence during their postpartum periods. Using proportional stratified quota sampling of hospitals by birth rate from clinics and hospitals in Kaohsiung City in southern Taiwan, postpartum married women were recruited for the study. The results show that the home of the women's parents (25.7%), her own home (with parents-in-law; 23.8%), and her own home (without parents or parents-in-law; 23.1%) were the main places of residence for women during the postpartum period. In addition, postpartum women's mean scores for postpartum stress were low. In contrast, the mean scores for social support were high, although they did not differ significantly for the respective places of postpartum residence. Furthermore, significant differences were not found in these women's postpartum health status at each of the places of postpartum residence.     

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.     

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.     

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.     

领悟社会支持对大学生焦虑抑郁情绪的影响

目的探讨领悟社会支持对大学生焦虑抑郁情绪的影响。方法用领悟社会支持量表、焦虑自评量表和抑郁状态问卷对253名大学生进行心理健康测评。结果253名大学生中57名（22．5％）存在焦虑症状，87名（35．2％）存在抑郁症状。高领悟社会支持组焦虑自评量表与抑郁状态问卷评分显著低于低领悟社会支持组（t=-2．62，-5．21，P〈0．05～0．01）。领悟社会支持和焦虑状况、抑郁指数均呈显著负相关（r=-0．257，-0．257，P〈0．01）。结论大学生易出现焦虑、抑郁情绪，而领悟社会支持可在一定程度上减轻或缓解其不良心理状态，提高个体心理健康水平。     

Vietnamese women immigrants' life adaptation, social support, and depression

The purpose of this study was to explore the relationships between life adaptation, social support, and depression among migrant Vietnamese women living in Meinong Township, Kaohsiung County. With a cross-sectional study design, 143 participants were recruited by purposive sampling. Structured questionnaires including Demographic Inventory Scale, Life Adaptation Scale, Social Support Scale, and Beck Depression Inventory Scale were used. Data were analyzed with Pearson's correlation and One-way ANOVA. The results showed that Vietnamese women's social support was significantly correlated with the length of time living in Taiwan, the length of marriage, and their husbands' age. Women's social support was significantly different with languages in common, the way of acquaintance with her husband, and family members living together. Depression was significantly different with family income. Life adaptation was also significantly different with family income. Moreover, there was a significantly positive correlation between Vietnamese women's social support and life adaptation, and significantly negative correlations between Vietnamese women's social support and depression, and between their life adaptation and depression. The study findings could be used as references for health professionals and government agencies to institute strategies and policies for promoting migrant Vietnamese women's life adaptation.     

Postpartum depression and related psychosocial variables in Hong Kong Chinese women: findings from a prospective study

Research on predictors of postpartum depression (PPD) in Hong Kong (HK) Chinese women is scant. A prospective study with 385 HK Chinese postpartum women was conducted to identify correlations between PPD and demographic variables, and antenatal depression and psychosocial variables, and to determine which of these variables were predictors of PPD. Using the Edinburgh Postnatal Depression Scale (EPDS), we classified 19.8% of participants as postnatally depressed. Fifty-six percent of the variance in PPD was explained by social support and stress factors. However, social support factors accounted for only a small percentage of that variance. The major predictors were antenatal depression, postnatal perceived stress, and childcare stress. HK women may benefit from a culturally appropriate intervention focused on reducing stress in the postpartum period.     

Effectiveness of informational support in reducing the severity of postnatal depression in Taiwan

AIM: The aim of the study was to investigate the effectiveness of informational support in reducing the Edinburgh Postnatal Depression Scale (EPDS) scores in Taiwan. METHODS: Five hundred Taiwanese women were screened during the fourth week after giving birth and those with a score of over 10 on the EPDS were considered to be at risk of postnatal depression. Seventy postpartum women were randomly allocated to the experimental or control group. Only those in the experimental group received informational support about postnatal depression during the sixth week postpartum. Two groups were assessed by the EPDS at 3 months postpartum to explore their depressive status. RESULTS: Taiwanese women who received informational support about postnatal depression 6 weeks after giving birth experienced lower EPDS scores at 3 months postpartum than those who did not receive this information. CONCLUSIONS: The findings suggest that informational support about postnatal depression given to women in the postnatal period may contribute to psychological well-being.     

Women's perceptions of partner support and conflict in the development of postpartum depressive symptoms

AIM: This paper reports a study examining the influence of maternal perceptions of conflict and relationship- and postpartum-specific support from the partner on the development of depressive symptoms in the first 8-weeks postpartum. BACKGROUND: Although the quality of a woman's relationship with her partner has been associated with risk for postpartum depression, few studies have examined which elements of partner-specific support and conflict are determinants of maternal mental health. METHODS: Self-administered measures of partner support (Social Provisions Checklist, Postpartum Partner Support Scale), partner conflict (Quality of Relationships Inventory), and depression (Edinburgh Postnatal Depression Scale) were mailed postnatally to a population-based sample of 396 mothers between April 2001 to January 2002. Differences in partner support and conflict at 1 and 4-weeks postpartum were examined between those women who met criteria for probable depression (Edinburgh Postnatal Depression Scale > 9) and those who did not meet criteria for probable depression at 8-weeks postpartum. FINDINGS: Women with depressive symptoms at 8-weeks postpartum had significantly lower perceptions of relationship-specific and postpartum-specific partner support and significantly higher levels of relationship conflict than women with no depressive symptoms. Multiple regression analyses revealed that three variables, perceived social integration, partner encouragement to obtain help when needed, and partner agreed with infant care, significantly explained the variance in Edinburgh Postnatal Depression Scale scores. CONCLUSIONS: Maternal perceptions of social integration and partner provision of problem-focused informational support and positive feedback are important in determining maternal mental health. Therefore, in the antenatal period healthcare professionals should teach couples appropriate ways to provide feedback and communicate expectations, especially those relating to infant care strategies. The importance of appraisal and emotional support should be highlighted in order to foster maternal feelings of acceptance and being cared for. Partners should also be encouraged to participate actively in household tasks and infant care activities to protect the mother from becoming overwhelmed.     

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.     

产后抑郁及其相关心理社会因素调查

目的探讨产后抑郁的发生率及其相关的心理社会因素,为早期心理卫生干预提供依据。方法采用爱丁堡抑郁量表及自拟的心理社会因素调查表对350例初产妇产后6w的抑郁状况进行测评分析。结果产后抑郁的发生率为22%,其中轻度占90.6%,中度占9.4%。产妇的年龄、学历、婴儿性别、分娩过程、婆媳关系不同,对产后抑郁的影响有显著性差异（P〈0.05）;夫妻关系、产后护理、居住条件、产后睡眠状况不同,对产后抑郁影响有极显著性差异（P〈0.01）;而产妇的职业、家庭收入、喂养方式不同,对产后抑郁影响无显著性差异（P〉0.05）。结论初产妇产后抑郁发生率较高,心理社会因素对产后抑郁的影响不容忽视。我们应做好孕产妇在围产期中的心理卫生保健工作,使产妇愉快地度过情感危险期,从而降低产褥期抑郁的发生。     

孕期情景导入健康教育对产妇产后抑郁的影响

目的 探讨孕期情景导入健康教育对产妇产后抑郁的影响。方法 参加孕期情景导入健康教育的初产妇50例为观察组;参加常规健康教育（集体授课）的初产妇56例为对照组。产后3 d采用爱丁堡产后抑郁量表测定,比较两组产妇产后抑郁情况。结果 观察组产后抑郁发生率明显低于对照组（P〈0.01）。结论 孕期情景导入健康教育能在一定程度上改善初产妇的不良情绪,改变其消极的应对方式,提高产妇生活质量。     

Kangaroo care and postpartum depression: The role of oxytocin

ProblemPostpartum depression occurs in about 10–22% of women after birth and adversely affects their health and the health of their newborn. Kangaroo care is known to have many health-related benefits for both the mother and her newborn.PurposeThe aim of this review was to gather the evidence linking the effects of kangaroo care with postpartum depression, specifically focusing on the proposed underlying mechanism involving the release of oxytocin.MethodThe literature review was conducted by targeting PubMed, CINAHL, and Google Scholar databases. The search terms used were postpartum depression, postnatal depression, oxytocin, oxytocin hormone, postpartum depression, kangaroo care, and skin-to-skin contact.ResultsKangaroo care was found to play an important role in decreasing the risk for postpartum depression. Skin-to-skin contact during kangaroo care was found to trigger the release of oxytocin, which is hypothesized to minimize the risk for depressive symptoms as well as decrease maternal stress. The oxytocinergic system regulates the release of oxytocin, which is an effect that is opposite that which occurs with the human stress response, in which the sympathetic nervous system is activated to release catecholamines in response to harmful or threatening stimuli. The oxytocinergic system regulates calmness, connection, and socialization processes. During kangaroo care, oxytocin blocks the stress response and decreases the circulation of catecholamines, yielding positive outcomes that include maternal stress reduction and prevention of postpartum depression.ConclusionKangaroo care can be used as a non-pharmacological intervention to prevent or decrease the risk of postpartum depression.     

社区医务人员领悟社会支持与抑郁的关系

目的了解江西地区社区医务人员领悟社会支持与抑郁的关系。方法采用自编一般情况调查问卷、领悟社会支持量表(PSSS)和抑郁自评量表(SDS)对1040名社区医务人员进行测评。结果 (1)抑郁情绪检出率为13.65%,男、女分别为12.30%、10.68%,差异无统计学意义(χ2=2.376,P=0.1230.05);(2)教育程度越高、生活压力越大是抑郁情绪的危险因素,与非直系亲属关系越好、对家庭义务履行情况越好和公众对自身职业的态度越好是其保护因素;(3)抑郁与领悟社会支持、领悟家庭内支持及领悟家庭外支持之间呈显著负相关(r=-0.348,r=-0.322,r=-0.309,P0.05);(4)社区医务人员感受到的领悟家庭外支持比领悟家庭内支持对他们抑郁情绪的影响更为重要。结论抑郁是社区医务人员不良的情绪体验,而领悟社会支持在一定程度上可调节这种不良情绪,提高个体心理健康水平。     

驻海岛官兵心理健康状况与社会支持相关性研究

目的：探讨驻岛官兵的心理健康状况与社会支持的相关性。方法采用症状自评量表和社会支持量表对328名驻岛官兵进行问卷调查。结果本组驻岛官兵症状自评量表强迫症状、抑郁、焦虑因子分均显著高于军人常模（ P＜0．05或0．01）,不同兵源、婚姻状况、家庭结构官兵的社会支持量表总分和主观支持维度分比较差异有显著性（P＜0．01）;社会支持量表总分、客观支持维度分与症状自评量表总分、强迫症状、焦虑、抑郁、敌对因子分,主观支持与抑郁、焦虑因子分呈显著负相关（P＜0．05）。结论驻岛官兵的心理健康水平与社会支持有关,部队应开展健康教育改善官兵对社会支持的主观感受,提高社会支持度。     

Depression, perceived stress, and social support among first-time Chinese mothers and fathers in the postpartum period

We compared the prevalence of depression in the postpartum period and its relationship with perceived stress and social support in first-time mothers and fathers. A cross-sectional study was conducted in mainland China with a convenience sample of 130 pairs of parents. Measures taken at 6-8 weeks after delivery included the Edinburgh Postnatal Depression Scale, the Perceived Stress Scale, and the Social Support Rating Scale. Eighteen (13.8%) of the mothers and 14 (10.8%) of the fathers were suffering from depression. No signficant differences were found in their prevalence rates. Perceived stress, social support, and partner's depression were significantly associated with depression. These findings suggest counseling, support, and routine screening for depression should be provided to both mothers and fathers.     

影响急诊科护士健康状况的社会心理因素

目的研究工作压力、社会支持、应对方式、自尊在维护急诊科护士健康状况中的作用.方法采用整群抽样方法,用自测健康评定量表、护士工作压力量表、社会支持评定量表、简易应对方式问卷、自尊量表调查了北京市10家三级甲等综合性医院急诊科的407名护士.结果多元逐步回归分析表明,工作压力是生理健康的最强预测指标,可以解释8.6%生理健康的变异;工作压力和自尊分别可以解释15.7%和8.5%心理健康的变异;对支持的利用度和自尊可以解释13.9%和5.3%社会健康的变异.结论工作压力对急诊科护士健康状况影响最大;社会支持中对支持的利用度对社会健康的保护作用最强;自尊在维护健康中起着重要的作用,主要保护心理健康和社会健康.