The effects of psychosocial factors on the emotional well-being of women during pregnancy: A cross-cultural study of britain and greece

Abstract

The effects of life events, social support and the emotional well-being of partner on the emotional well-being of the mother during pregnancy was examined within the cultural contexts of Britain and Greece. It was proposed that social support, impact of life events and relationship of the mother with her partner would be affected by the different social structures of each culture and would influence emotional well-being. A sample of 200 Greek and 156 British mothers and their partners completed questionnaires which included a life event inventory, measure of social support and measure of emotional well-being (Crown-Crisp Experiential Index). Greek mothers were found to score significantly higher on measures of depression, anxiety and somaticism, experience more stressful life events (most relating to family issues) and report feeling less supported than British mothers. Life events, particularly those relating to family stresses were found to predict poor emotional well-being among Greek mothers. For British mothers, social support was the strongest predictor of emotional well-being. Findings were discussed in the light of differences in social structure and it was suggested that future research might focus on the disruption of established social support structures rather than the differences in availability of social support per se when considering maternal emotional well-being.     

Maternal expectations and postpartum emotional adjustment in first-time mothers: results of a questionnaire survey

Abstract

Objective: Several predictors of postpartum mood have been identified in the literature, but the role of maternal expectations in postpartum mental health remains unclear. The aim of this study was to identify whether maternal expectations during the postpartum hospital stay predict adjustment and depressive symptoms at 6 weeks postpartum.

Methods: The sample included 233 first-time mothers recruited from the postpartum unit of a Midwestern hospital. Participants completed measures of maternal expectations and depressive symptoms (EPDS) at Time 1 (2?d postpartum) and completed EPDS and an Emotional Adjustment Scale (BaM-13) at Time 2 (6 weeks postpartum).

Results: A conditional relationship between the expectation that an infant’s behavior will reflect maternal skill and Time 2 outcomes (BaM-13 and EPDS) was found, such that endorsing this belief predicted increased depression and poorer adjustment in those with higher (but not lower) Time 1 EPDS scores. Time 2 BaM-13 scores were also negatively predicted by expectations of self-sacrifice and positively predicted by expectations that parenthood would be naturally fulfilling.

Conclusions: The expectations that new mothers hold about parenting soon after delivery are predictive of emotional adjustment in the early postpartum period, suggesting a role for discussion of expectations in future preventive strategies.     

A Comparison of the Sexual Well-Being of New Parents With Community Couples

BackgroundChanges in sexual well-being are common for new mothers and their partners after the birth of a baby. However, most research has sampled mothers not couples, assessed only one aspect of sexual well-being, and has not included a control sample of couples.AimThis study aimed to compare the sexual well-being (ie, sexual frequency, sexual satisfaction, sexual desire, sexual distress) of first-time mothers and their partners in the transition to parenthood (first 12-month postpartum) to community couples who are not actively in this transition. We also compared the sexual well-being within couples (eg, mothers to their partners).MethodsCouples in the transition to parenthood (n = 99) completed measures of sexual satisfaction, sexual desire, sexual distress, and sexual frequency at 3, 6, and 12 months postpartum, and community couples (n = 104) completed the measures at a single time point.OutcomesMeasures included the following: (i) Global Measure of Sexual Satisfaction Scale; (ii) Female Sexual Function Index and International Index of Erectile Function sexual desire subscale; (iii) Female Sexual Distress Scale-Revised; and (iv) checklist of sexual behaviors.ResultsCompared with community controls, new parents reported lower sexual satisfaction, lower sexual desire, and higher sexual distress at all time-points; however, these group differences became less pronounced by 12 months postpartum. By 6 months postpartum, there was no difference in sexual frequency between postpartum couples and the control group. Mothers experienced persistently lower sexual desire relative to their partners throughout the 12 months postpartum. Between 39% and 59% of mothers reported clinically low sexual desire, and 47–57% reported significant sexual distress at all time points. There were no significant differences reported in sexual satisfaction, sexual desire, or sexual distress between women and their partners in the community sample.Clinical ImplicationsClinicians should be aware that sexual well-being may be compromised in new parents, and some of these challenges are still present for new parents at 12 months postpartum. Findings can be used to educate new parents regarding their expectations about postpartum sexual well-being.Strengths & LimitationsThe strengths of the present study are the dyadic approach, assessing multiple aspects of sexual well-being in new parents over time, and the comparison with a community sample. An important limitation is that the control sample was not followed up over time.ConclusionEducation regarding postpartum sexual well-being should be incorporated in routine perinatal and postnatal healthcare practices to support new parents in developing realistic expectations about changes during the transition to parenthood, potentially preventing undue distress.Schwenck GC, Dawson SJ, Muise A, et al. A Comparison of the Sexual Well-Being of New Parents With Community Couples. J Sex Med 2020;17:2156–2167.     

Depressive symptoms and psychosocial stress across the transition to parenthood: Associations with parental psychopathology and child difficulty

The transition to parenthood is often accompanied by depression and stress. Several studies have established risk factors for postpartum depression, e.g., antenatal depression. However, only a few studies have involved fathers. Moreover, most studies focus on the prevalence of depression instead of intraindividual changes over time. Our study investigated differential effects of parental psychopathology and child difficulty on the course of depressive symptoms and feelings of stress for first-time mothers and fathers. Seventy-four mothers and 58 fathers completed questionnaires on depressive symptoms (EPDS) and feelings of stress during pregnancy, and at 1, 3, 12, and 18 months postpartum. Parents rated children's difficulty-fussiness at 3, 12, and 18 months postpartum (ICQ). Parental psychopathology was established during pregnancy using self-reports (SCL-90-R) and anamnestic data. In mentally healthy mothers and fathers depressive symptoms decreased from pregnancy to 18 months postpartum, whereas parents with psychopathology in pregnancy showed a tendency to prolonged depressive phases. In parents with psychopathology, feelings of stress peaked at 12 months postpartum. Child difficulty was associated with elevated levels of psychosocial stress, but only for some participants. Parental psychopathological symptoms during pregnancy should thus be considered as a risk factor for elevated and prolonged depression and elevated psychosocial stress in mothers and fathers across the transition to parenthood.     

Depressive symptoms and psychosocial stress across the transition to parenthood: associations with parental psychopathology and child difficulty

The transition to parenthood is often accompanied by depression and stress. Several studies have established risk factors for postpartum depression, e.g., antenatal depression. However, only a few studies have involved fathers. Moreover, most studies focus on the prevalence of depression instead of intraindividual changes over time. Our study investigated differential effects of parental psychopathology and child difficulty on the course of depressive symptoms and feelings of stress for first-time mothers and fathers. Seventy-four mothers and 58 fathers completed questionnaires on depressive symptoms (EPDS) and feelings of stress during pregnancy, and at 1, 3, 12, and 18 months postpartum. Parents rated children's difficulty-fussiness at 3, 12, and 18 months postpartum (ICQ). Parental psychopathology was established during pregnancy using self-reports (SCL-90-R) and anamnestic data. In mentally healthy mothers and fathers depressive symptoms decreased from pregnancy to 18 months postpartum, whereas parents with psychopathology in pregnancy showed a tendency to prolonged depressive phases. In parents with psychopathology, feelings of stress peaked at 12 months postpartum. Child difficulty was associated with elevated levels of psychosocial stress, but only for some participants. Parental psychopathological symptoms during pregnancy should thus be considered as a risk factor for elevated and prolonged depression and elevated psychosocial stress in mothers and fathers across the transition to parenthood.     

Quality of life during the transition to parenthood in Hong Kong: a longitudinal study

Abstract

Objective: Quality of life has emerged as an important health outcome in the care of perinatal families. This study was designed to examine the changes in quality of life among Chinese couples during the transition to parenthood.

Methods: A longitudinal design was used. Participants comprised a convenience sample of 203 Chinese-childbearing couples attending the antenatal clinics, who completed data collection during pregnancy and at six weeks and six months postpartum. At each point, couples completed the Medical Outcomes Study Short Form 12-Item Health Survey.

Results: The results showed that women experienced substantial changes in their quality of life during pregnancy and postpartum, whereas the changes in their partners’ quality of life were less noteworthy. Women had a poorer quality of life than their partners during the early postpartum period. The mental health component of women’s quality of life was closely related to their partners’ across the perinatal period.

Conclusions: The findings of the present study highlight the need for more attention to a couple’s quality of life during the transition to parenthood. Couple-based and culturally relevant interventions should be developed to assist both parents to cope with the new challenges and demands of parenthood, and thus achieve a better quality of life.     

Effects of assisted reproductive technology and of women’s quality of life on depressive symptoms in the early postpartum period: a prospective case-control study

Abstract

This study explored the influence of both assisted reproductive technology (ART) and reduced quality of life (QoL) during pregnancy on postpartum blues (PPB). Sixty-three sub-fertile patients who conceived through ART and 72 women who naturally conceived were enrolled in this prospective study. At 22nd and 32nd gestational weeks, women completed the Edinburgh Postnatal Depression Scale (EPDS) and the Short-Form 36 (SF-36), to investigate depressive symptoms and QoL, respectively; EPDS was again used at 15 days after birth to assess PPB. At both time points, higher EPDS scores and lower mental well-being scores (SF-36) significantly predicted PPB. The number of previous ART cycles emerged as the strongest predictor, whereas no significant effect was observed for the conceiving method. The results suggest the usefulness of assessing QoL during pregnancy and considering previous ART failures in preventing PPB.     

Sexual pleasure and emotional satisfaction in the first 18 months after childbirth

Objectiveto investigate the experiences of first time mothers with regard to emotional and sexual intimacy in the period from birth to 18 months postpartum.Designprospective pregnancy cohort, with follow-up at 3, 6, 12 and 18 months postpartum.Setting and participantsfirst-time mothers were recruited in early pregnancy at 6 public maternity hospitals in Melbourne, Australia.Findings1239 women who completed the baseline questionnaire and all follow up questionnaires were included in the sample for analysis: 78% resumed vaginal sex by 3 months postpartum, 94% by 6 months and 98% by 12 months postpartum. Emotional satisfaction with intimate partner relationships declined over time, from 67.3% reporting high satisfaction at 3 months to 53.9% at 18 months postpartum. In contrast, sex was described as extremely or very pleasurable by 40.1% of women at 3 months postpartum, compared with 49.1% at 18 months postpartum. There was a strong association between emotional satisfaction and the degree to which women experienced physical pleasure in their sexual relationship. Women who were happy with their partner's contribution to household tasks were markedly more likely to report high emotional satisfaction (OR 10.31, 95% CI6.7-15.9) and somewhat more likely to report greater physical pleasure in their sexual relationship (OR 2.32, 95% CI 1.5–3.5).Key conclusionswomen experience profound changes in their sexual and intimate relationships in the first 18 months postpartum. While sex appears to improve over time, emotional satisfaction appears to decline. Partner involvement in household tasks is associated with greater emotional satisfaction.Implications for practicepregnant women and their partners may benefit from information and discussion about the likelihood of changes to their emotional and sexual relationships after childbirth.     

Patterns of emotional responses to pregnancy, experience of pregnancy and attitudes to parenthood among IVF couples: a longitudinal study

The aim of this longitudinal study was to compare couples who had conceived by in-vitro fertilization (IVF) with couples who had conceived naturally, regarding patterns of emotional response to different stages of pregnancy and to compare their expectations of and attitudes to pregnancy, parenthood and children. Fifty-seven IVF women and 55 of their male partners, and a control group of 43 pregnant women and 39 of their male partners participated. They completed scales measuring emotional responses to pregnancy, attitudes to pregnancy, parenthood and children. The IVF couples were interviewed about their experience of pregnancy. The overall anxiety about losing the pregnancy was higher among the IVF couples from early to late pregnancy. The IVF women experienced the pregnancy in a more positive way and they were less concerned about the child's gender and loss of freedom in their future lives as parents compared to controls. The IVF men were more anxious about the baby being injured during birth. The interviews with the IVF couples confirmed the self-ratings. In conclusion, the results suggest that it is important for healthcare providers to pay attention to an elevated anxiety among IVF couples and to give them extra time to discuss emotions during pregnancy and their future life as parents.     

Psychological ill-being experienced by first-time mothers and their partners in pregnancy after abortion: a cohort study

Abstract

The psychological effects of abortion have been much discussed lately, with recently published studies indicating that induced abortion (IA) may, contrary to the general consensus, be contributing to psychological symptoms post-abortion. Using a cohort of first-time mothers, we assessed the likelihood of them experiencing psychological ill-being at the midpoint of their pregnancy, depending on their IA history. We also examined the psychological symptoms of their partners, the hypothesis being that ill-being in IA-experienced mothers might reflect onto their partners. Altogether 680 future first-time mothers (9.8% of whom had an IA history) and their partners were selected. Most mothers attended their 16 check-ups at maternity health clinics (MHC), where the family's physical and emotional well-being were checked. Several internationally validated questionnaires, which gauged psychological ill-being, were filled in at the 20th week of pregnancy. There were no significant differences between the study and the control group in terms of psychological ill-being during the pregnancy. The contribution of prior IA to psychological ill-being during the next pregnancy seems to be minimal. The availability of IA procedures, intensive MHC services in Finland, as well as this society's neutral attitude towards IA, may be among the reasons why the results are so positive for mothers who have previously undergone one or more IAs.     

Intergenerational transmission of postpartum depression

Objective: This study aimed to explore the hypothesis of an intergenerational transmission of postpartum depression. Mother’s postpartum depressive symptomatology was linked to former depression, postpartum depression of her mother as well as the quality of the mother–daughter relationship. Method: A sample of 65 women and their mothers completed questionnaires one month after delivery: the Edinburgh Postnatal Depression Scale (EPDS), dimension A of the International Mini Neuropsychiatric Interview (MINI) assessing a former depressive episode, the Mother and Adult Daughter Questionnaire (MAD) as well as the Inventory of Peer and Relative Attachment (IPPA). Their mothers completed the Bromley Postnatal Depression Scale (BPDS) in order to retrospectively diagnose a postpartum depression. Results: Women whose mother had suffered from a postnatal depression had significantly higher scores on the EPDS. Former depression symptoms and grandmother’s former postnatal depression were significant predictors of postpartum depression symptoms intensity. Conclusion: this study confirms the hypothesis of an intergenerational transmission of postpartum depression and highlights the need to provide an in‐depth examination of these issues.     

Validation of the Edinburgh Postnatal Depression Scale and prevalence of postnatal depression at two months postpartum in a sample of Greek mothers

The EPDS has been validated as a screening instrument for postnatal depression in numerous communities over the last 20 years. Absence of a validation study for the Greek population has limited significantly its use in Greece. A community sample of 109 women was recruited on the second day postpartum in the two largest maternity hospitals in Athens. Ninety‐five women consented to participate and to complete the EPDS, the Beck Depression Inventory (BDI), the 28‐item General Health Questionnaire (GHQ), and the 26‐item WHO‐Quality of Life (WHO‐QOL). Of them, 81 consented to be reassessed 2 months later. At that time, in addition to the baseline questionnaires, the Structured Clinical Interview for DSM‐III‐R (SCID), non‐patient version, was conducted in order to establish psychiatric diagnosis of major and minor depression. The clinical diagnosis was used to test the criterion validity of the EPDS, and the GHQ, BDI and WHO‐QOL scores were used to assess the concurrent validity of the EPDS. Cronbach's alpha coefficient was used to measure the internal consistency of the scales. A cut‐off point of 11/12 on the EPDS showed optimum Receiver Operating Characteristics. The SCID showed that 12.4% of the subjects met criteria for depression at two months postpartum.     

Rates and risk factors associated with depressive symptoms during pregnancy and with postpartum onset

Abstract

The objectives of this study were to evaluate the prevalence of depressive symptoms in the third trimester of pregnancy and at 3 months postpartum and to prospectively identify risk factors associated with elevated depressive symptoms during pregnancy and with postpartum onset. About 364 women attending antenatal clinics or at the time of their ultrasound were recruited and completed questionnaires in pregnancy and 226 returned their questionnaires at 3 months postpartum. Depressed mood was assessed by the Edinburgh Postnatal Depression Scale (EPDS; score of?≥?10). The rate of depressed mood during pregnancy was 28.3% and 16.4% at 3 months postpartum. Among women with postpartum depressed mood, 6.6% were new postpartum cases. In the present study, belonging to a non-Caucasian ethnic group, a history of emotional problems (e.g. anxiety and depression) or of sexual abuse, comorbid anxiety, higher anxiety sensitivity and having experienced stressful events were associated with elevated depressed mood during pregnancy. Four risk factors emerged as predictors of new onset elevated depressed mood at 3 months postpartum: higher depressive symptomatology during pregnancy, a history of emotional problems, lower social support during pregnancy and a delivery that was more difficult than expected. The importance of identifying women at risk of depressed mood early in pregnancy and clinical implications are discussed.     

Early adverse emotional response to childbirth in Turkey: the impact of maternal attachment styles and family support

Early adverse emotional response which is often detected in the form of depressive symptoms is a predictor of postpartum depression following the birth. The aim of our study is to highlight contextual and individual factors that have an impact on mothers' depressive symptoms during the early postpartum period. One hundred mothers participated in the study. Maternal depressive symptoms were screened by Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by State-Trait Anxiety Inventory (STAI) at early postpartum period (7-10 days). The Multidimensional Scale of Perceived Social Support (MSPSS) was used for the assessment of maternal social support. The Adult Attachment Scale (AAS) was used to determine the attachment style of the mother. The mean EPDS score of mothers who live in extended families is found to be significantly lower than others who live in nuclear families (extended families 7.13+/-7.39, nuclear families 11.77+/-5.96, p=0.006). Significant positive correlations were found between EPDS total scores and ambivalent attachment style group (r=.0436, p=.000), and avoidant attachment style group (r=.328, p=.001). The level of perceived family support also showed a negative correlation with EPDS total score (r=-.363, p=.000). The regression of EPDS total score with ambivalent attachment style and state anxiety level are positively predicted and the level of perceived family support and existence of wider social network negatively predict the EPDS total score in the first postpartum week. Maternal attachment patterns, living with the extended family and existence of family support have an important impact on early postpartum emotional adaptation. Early intervention strategies should count towards these individual and contextual factors when designing screening and preventive interventions for postpartum depression.     

Change in 21 Sexual Concerns of New Parents From Three to Twelve Months Postpartum: Similarities and Differences between Mothers and Partners

BackgroundPostpartum sexual concerns are associated with depressive symptoms, distress, and lower relationship satisfaction, and are commonly reported by both mothers and their partners. Previous studies have examined changes in postpartum sexual concern using aggregate scores and have not examined patterns of change for unique concerns, thus ignoring that the initial levels and trajectories of a variety of distinct, postpartum sexual concerns may differ from one another and may differ between mothers and partners.AimsThe aims of the current study were to (i) examine how a variety of postpartum sexual concerns change from 3 to 12 months postpartum for mothers and their partners using a sample of first-time parents, and (ii) examine how mothers and their partners may differ in their initial levels and subsequent changes in postpartum sexual concerns.MethodsFirst-time mothers and their partners (N = 203 couples) independently completed a measure of 21 postpartum sexual concerns at 3, 6, 9, and 12 months postpartum.OutcomesPostpartum Sexual Concerns QuestionnaireResultsGrowth modeling indicated that twelve of mothers’ and 6 of partners’ postpartum sexual concerns declined over time from 3 to 12 months postpartum, only one concern of mothers’ and none of partners’ concerns increased over time, and the remaining 8 and 15 concerns were stable for mothers and partners, respectively. At 3 months postpartum, mothers had higher levels of 11 postpartum sexual concerns than partners, while partners had higher levels than mothers on 4 concerns. Compared to partners, from 3 to 12 months postpartum, mothers showed both steeper decreases in concern about body image changes and steeper increases in concern about returning to work.Clinical ImplicationsVarious postpartum sexual concerns do not all follow the same pattern of change over time, and mothers and their partners share similarities and differences in these patterns. Clinicians should use a checklist to discuss a range of postpartum sexual concerns with both new mothers and their partners.Strengths and LimitationsThis is the first study, to our knowledge, to examine how a variety of postpartum sexual concerns change over time and how mothers and partners both differ and are similar in their experiences. Most couples were in mixed-sex relationships, identified as White, and were relatively affluent; results may not generalize.ConclusionA variety of postpartum sexual concerns follow different patterns of change from 3 to 12 months postpartum, and mothers and partners share similarities and differences in these patterns.Allsop DB, Impett EA, Vannier SA, et al. Change in 21 Sexual Concerns of New Parents From Three to Twelve Months Postpartum: Similarities and Differences between Mothers and Partners. J Sex Med 2022;19:1366–1377.     

The experience of first-time fatherhood: a brief report

Abstract

Over the last ten years a number of studies have examined the relationship between aspects of the medical management of labour and delivery and maternal emotional state. The findings of these studies are contradictory: while some report links between the use of obstetric technology and subsequent negative maternal emotional state, others find no such associations. Data from a study of social support in pregnancy are drawn on to re-examine the hypothesis that maternal postnatal unhappiness is linked with the use of technology in childbirth. Utilizing data from two postal questionnaires sent to mothers six weeks and one year postpartum, and also hospital obstetric casenote information, significant associations are found between overall ‘scores’ of obstetric technology, on the one hand, and, on the other, some measures of control and emotional and physical well-being reported by mothers. Other measures of emotional well-being, particularly those reporting feelings for the baby, do not appear to be linked with obstetric technology scores.     

Body image in breastfeeding women with depressive symptoms: a prospective study

The purpose of this prospective study was to investigate the relationship between body image perception and breastfeeding in puerperae with postpartum depression symptoms. The participants (147 healthy puerperae) completed The Edinburgh Postnatal Depression Scale (EPDS) and the Body Uneasiness Test (BUT-A and BUT-B), investigating body image perception and specific worries about particular body parts or functions. One month after discharge, new mothers participated in telephone interview concerning postpartum lactation practices. The subset of puerperae with EPDS score >9 also participated in psychological EPDS and BUT 6-month follow up. Mothers with EPDS score >9 (28/147, 19.04 %) had significantly higher scores on BUT-A Global Severity Index (0.69?±?0.64 versus 0.37?±?0.31, p?<?0.0001) and on BUT-B Positive Symptom Distress Index (0.74?±?0.57 versus 0.41?±?0.42, p?<?0004). In addition, the mothers with symptoms of depression were more likely (1:2) to interrupt full breastfeeding in the first month postpartum. At the 6-month follow up, the subset of new mothers with depression symptoms maintained elevated BUT-A and BUT-B scores, while EPDS >9 persisted in one-third of these. In conclusion, mothers with symptoms of depression have longlasting negative body image perception, persistent depressive symptoms, and they interrupt early full breastfeeding.