Psychometric Properties of the Maternal Postpartum Stress Scale in Czech Mothers

ObjectiveTo translate the Maternal Postpartum Stress Scale (MPSS) into Chinese and validate its psychometric properties in postpartum women.MethodsA total of 406 postpartum women were recruited from six hospitals in Nantong, Jiangsu Province, China. Cronbach’s α co-efficient, split-half reliability, and test-retest reliability were used to evaluate the reliability of the translated scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The Edinburgh Postnatal Depression Scale, Depression Anxiety Stress Scale-21 anxiety dimension, and Perceived Stress Scale were used as calibration scales to measure the correlation of MPSS. All data were analyzed using SPSS 25.0 and Amos 24.0.ResultsThe Cronbach’s α co-efficient of the Chinese version of MPSS and its three dimensions were 0.940 and 0.882–0.911, respectively. The split-half reliability was 0.825, and the test-retest reliability was 0.912. The scale’s content validity index was 0.926. Three common factors were extracted from the EFA. The CFA validated the explored 3-factor structure, and the indicators were fitted well (χ2/Df = 2.167, comparative fit index = 0.918, Tucker–Lewis index = 0.907, incremental fit index = 0.919, and root mean square error of approximation = 0.075).ConclusionThe translated Chinese version of MPSS had suitable reliability and validity in assessing postpartum stress in Chinese women. The translated scale can also help with the early identification of postpartum stress and provide a scientific basis for the formulation of early personalized intervention measures. Overall, the scale has certain clinical value and practical significance for enhancing the physical and mental health of postpartum women. However, future studies including large, diverse populations are warranted.

Although scales that evaluate postpartum stress exist, they lack specificity in maternal postpartum stress. The MPSS was created because there was a need to assess maternal stress during the postpartum stage. The introduction of the MPSS has enriched the evaluation tools for postpartum stress and has helped understand maternal stress at various postpartum time points and identify women at high risk for postpartum stress during this period. The aim was to translate the MPSS into Spanish and study its psychometric properties. Postpartum women (N = 167) with a mean age of 34.26 (SD = 4.71) were involved in this study. In addition to the MPSS, a battery of instruments was administered: a demographic sheet, the Birth Satisfaction Scale-Revised (BSS-R) and the Edinburgh Postnatal Depression Scale (EPDS). The MPSS data were analyzed, checking item communality first. As a result, three items showed unsatisfactory communality values (h2 < 0.40). Confirmatory Factor Analysis was conducted, comparing factor models using the full pool of MPSS items or the version without items with unacceptable communality. As a result, the original three-factor structure was endorsed on the Spanish MPSS, with better fit indices when removing items with low communality (RMSEA = 0.067, CFI = 0.99, TLI = 0.99). The reliability of this version was satisfactory (ω = 0.93). Finally, group comparisons for some perinatal variables were performed, showing no significant differences between groups of interest (p = 0.05 and above). To conclude, the MPSS will contribute to the existing literature, having a wider capacity to assess perinatal mental health difficulties in Spanish-speaking populations.

Correlates of First-Time Mothers' Postpartum Stress

Mao et al. (2011) explored the differences in the prevalence of depression and related factors between new mothers and fathers during the postnatal period. Three instruments – the Edinburgh Postnatal Depression Scale (EPDE), the Perceived Stress Scale (PSS) and the Social Support Rating Scale (SSRS) – were used in this study. The PSS measures the degree to which situations in one’s life are appraised as stressful and asks how unpredictable, uncontrollable and overloaded respondents find their lives during the last month. Because the levels of appraised stress are influenced by daily hassles, major events and changes in coping resources, the PSS is an index of general life stress appraisal (Cohen et al. 1983). However, women after childbirth commonly experience postpartum stress in addition to general life stress (Hung 2005). Therefore, they have to adjust to yet another type of stress during the postpartum period, characterised by dramatic change, new demands and structural constraints (Hung 2001). Accordingly, postpartum stress is different from general life stress. The PSS can be used in any life stage to test a person’s general life stress. In Mao et al. (2011)’s study, the PSS was used at 6–8 weeks postpartum to measure new mothers’ and fathers’ general life stress perceived in the last month. As a result, the PSS failed to measure women’s specific childbearing stress during the postpartum period. Postpartum stress was conceptualised comprehensively by Hung (2001) in terms of events and situations specific to the postpartum period. Hung developed the Hung Postpartum Stress Scale (Hung PSS) for measuring low-risk (Hung 2005) or both low-risk and high-risk women’s postpartum stress (Hung 2007). Thus, postpartum women experiencing specific postpartum stressors may be identified and then be offered supportive nursing interventions that provide stressor-specific coping resources (Hung 2005). Nursing interventions can be tailored to address the items on the Hung PSS that postpartum women indicate to be the most stressful (Hung 2005). Improvement in detecting postpartum stressors may lead to improved means of reducing postpartum stress and preventing more severe postpartum health problems (Hung 2005). When women’s general life stress is appraised during their postpartum period using the PSS, it is impossible to identify their general life stressors, and coping resources cannot be provided when the specific general life stressors are unknown. Mao et al. (2011) claimed that both the Chinese versions of the PSS and SSRS have adequate test–retest reliability. However, test–retest reliability is an inappropriate index for either the PSS or the SSRS because they do not measure enduring attributes. The PSS assesses participants’ feelings and thoughts experienced in the last month. The EPDE is used to assess postpartum depression in the past seven days. In this study, the PSS assessed women’ feelings and thoughts experienced 2–4 weeks postpartum, whereas the EPDE assessed the women’s depression 5–7 weeks postpartum. It is very difficult for a woman at 6–8 weeks postpartum to answer the questions in the two scales within an inconsistent time frame. A total score of the EPDE ranges from 0–30, and a cut-off point of 13 or above indicates that the criteria for postpartum depression have been met. Accordingly, participants should be divided into two groups: depression and

IntroductionThere is a need to implement routine perinatal mental health screening in Spain. Therefore, it is necessary to systematise the detection of depressive and anxious symptoms in pregnancy and postpartum using the same instrument. The Edinburgh Postnatal Stress Depression Scale (EPDS) is frequently used as a rapid, effective and cross-culturally validated screening tool for perinatal depression. In several countries, an Anxiety subscale, the EPDS-A, was identified within the EPDS. Although the factorial structure of the EPDS has been investigated in Spanish population, the EPDS-A has not yet been validated. This study aimed to validate the EPDS-A as a measure of perinatal anxiety in Spanish population.Methods161 women were evaluated with the EPDS and the State–Trait Anxiety Inventory (STAI) during pregnancy and postpartum. Confirmatory factor analysis (CFA) was used to confirm the trifactorial structure of the EPDS, comprising the dimensions of Depression, Anhedonia and Anxiety. Likewise, the invariance of the trifactorial model between pregnancy and postpartum was tested. Finally, the correlations between the EPDS-A and the STAI subscales (State Anxiety and Trait Anxiety) were calculated.ResultsThe Exploratory factor analysis (EFA) driven three-factor structure of the EPDS, consisting of an Anhedonia factor (Items 1, 2, and 10), an Anxiety factor (Items 3, 4, 5, and 6) and a Depression factor (Items 7, 8, and 9), was the best measurement model for the current data compared to the alternative model tested [χ2 = 34.592, df = 32, p = 0.34; χ2/df = 1.08; RMSEA = 0.023, 90% Confidence Interval [CI] [0.000, 0.064], CFI = 0.996, GFI = 0.960]. The model’s invariance between pregnant and postpartum women was confirmed. The existence of an Anxiety subscale within the EPDS was also confirmed. The scores obtained with the EPDS-A correlated moderately with scores on both subscales of the STAI during pregnancy and after delivery. Using the STAI as a criterion and prioritising the instrument’s sensitivity, a cut-off point of 4 points was established for the EPDS-A.ConclusionOur results confirm the trifactorial structure of the EPDS in Spanish population. The Anxiety subscale was validated for routine perinatal mental health screening.

ObjectivesThe objective is to to explore the longitudinal change trajectories of postpartum stress and its related factors.DesignA longitudinal study with follow-ups from 42 days to 6 months after delivery.Settings and...

Eastern sociocultural systems differ in many ways from Western ones, and these differences influence many aspects of the postpartum period. 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. 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. 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. 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.

First-time mothers’ confidence mood and stress in the first months postpartum. A cohort study

Perinatal mental health services in pregnancy and the year after birth: the ESMI research programme including RCT

To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. Australian New Zealand Clinical Trials Registry ACTRN12618001580268.

ObjectiveThis study aimed to assess the prevalence of postpartum anxiety and the factors influencing it, while also exploring the multiple mediating roles of related factors between social support and postpartum anxiety symptomatology among postpartum women in China.MethodsBetween April and August 2023, we recruited a total of 824 postpartum women through a convenience sampling method. These participants completed a series of general survey questionnaires and were evaluated using the depression anxiety stress scale, perceived social support scale, 10-item Connor–Davidson resilience scale, maternal postpartum stress scale, and Pittsburgh sleep quality index. Additionally, we employed a hierarchical multiple regression model to investigate the relevant factors and mediators of postpartum anxiety symptomatology. A structural equation model was used to examine the mediating role of resilience, postpartum stress, and sleep problems in the relationship between social support and postpartum anxiety symptomatology.ResultsOur study found a postpartum anxiety symptomatology prevalence rate of 18.40%. The factors influencing postpartum anxiety symptomatology included age, education of their husband, mastitis, social support, resilience, postpartum stress, and sleep problems. Through a multiple mediation analysis, we found that resilience, postpartum stress, and sleep problems completely mediated the effects of social support on postpartum anxiety symptomatology, with the mediating effect accounting for 83.57% of the total effect.ConclusionThe multiple mediation analysis revealed that among postpartum women, the impact of social support on postpartum anxiety symptomatology is channeled through resilience, postpartum stress, and sleep problems. Therefore, enhancing social support, resilience, postpartum stress, and sleep problems might alleviate postpartum anxiety symptomatology.

Cross-Cultural Adaptation of the Male Genital Self-Image Scale in Iranian Men

A prospective study of maternal anxiety, perceived stress, and depressive symptoms in relation to infant cognitive development

This study aimed to assess the knowledge level of first-time mothers regarding digestive health issues in infancy and to examine the utilization of healthcare facilities for such problems. Data from 119 first-time mothers of infants under 6 months of age were analyzed. Descriptive statistics, t-test, and one-way analysis of variance (ANOVA) were conducted using the SPSS software. The average correct response rate for first-time mothers' knowledge of digestive health problems in infancy was 61.9%. The highest correct response rate was observed for infantile colic, while diarrhea had the lowest. Less than 50% of mothers received education on infant digestive health problems across all categories. Among digestive health problems in infancy, diarrhea exhibited the highest rate of healthcare utilization, whereas infantile colic had the lowest. First-time mothers' knowledge of digestive health problems in infancy varied based on maternal age (t=-3.66, p<.001), education level (t=-2.26, p=.026), and planned pregnancy (t=3.24, p=.002). Moreover, mothers who received education on infant digestive health problems demonstrated better overall knowledge of digestive health problems. The rate of education regarding digestive health problems during infancy among first-time mothers was < 50%. Furthermore, mothers educated on infant digestive health issues exhibited improved knowledge. Therefore, it is necessary to provide appropriate pre-education to primiparous common gastrointestinal health issues in infants.

To examine the relationships between social support, maternal parental self-efficacy and postnatal depression in first-time mothers at 6 weeks post delivery. Social support conceptualised and measured in different ways has been found to positively influence the mothering experience as has maternal parental self-efficacy. No research exists which has measured the relationships between social support, underpinned by social exchange theory and maternal parental self-efficacy using a domain-specific instrument, underpinned by self-efficacy theory and postnatal depression, with first-time mothers at 6 weeks post delivery. A quantitative correlational descriptive design was used. Data were collected using a five-part questionnaire package containing a researcher developed social support questionnaire, the Perceived Maternal Parental Self-Efficacy Scale and the Edinburgh Postnatal Depression Scale. Four hundred and ten mothers completed questionnaires at 6 weeks post delivery. Significant relationships were found between functional social support and postnatal depression; informal social support and postnatal depression; maternal parental self-efficacy and postnatal depression and informal social support and maternal parental self-efficacy at 6 weeks post delivery. Nurses and midwives need to be aware of and acknowledge the significant contribution of social support, particularly from family and friends in positively influencing first-time mothers' mental health and well-being in the postpartum period. The development of health care policy and clinical guidelines needs to define and operationalise social support to enhance maternal parental self-efficacy. These findings suggest that nurses and midwives need to be cognisant of the importance of social support for first-time mothers in both enhancing maternal parental self-efficacy and reducing postnatal depressive symptomatology in the early postpartum period.