Maternal Psychological Health Research Articles

Psychosocial factors associated with postpartum psychological distress during the Covid-19 pandemic: a cross-sectional study

BackgroundTrauma, natural and man-made catastrophic events can be predictors of postpartum psychological distress. In a public health response due to coronavirus disease 2019 outbreak, the Italian government imposed a lockdown from March 9 to May 3. This extraordinary situation may have been challenging for maternal psychological health. The aim of this study was to investigate the prevalence of depressive and post-traumatic stress symptoms in women giving birth during the Covid-19 pandemic and its associations with quarantine measures, obstetrical factors, and relational attachment style.MethodsWomen who gave birth in a high-volume obstetric/gynaecological medical centre located in an epidemic area during the Covid-19 pandemic (March 8 to June 15) were asked to complete an online survey about their childbirth experience and the perceived effect of the pandemic. The Edinburgh Postnatal Depression Scale (EPDS), the Impact of Event Scale-Revised (IES-R), and the Relationship Questionnaire (RQ) were administered to assess levels of postpartum depressive and post-traumatic stress symptoms (PTSS) and relational style of attachment, respectively. Multivariate analysis was applied to identify associations between quarantine measures, childbirth experience, attachment style, and EPDS and IES-R scores.ResultsThe survey was completed by 163 women (response rate 60.8%). The prevalence of depressive symptoms was 44.2% (EPDS cut-off score ≥ 11) and the PTSS rate was 42.9% (IES-R cut-off score ≥ 24). Dismissive and fearful avoidant attachment styles were significantly associated with the risk of depression and PTSS, respectively. Perceived pain during birth was a risk factor for postpartum depression. Perceived support provided by healthcare staff was a protective factor against depression and PTSS. Another protective factor against PTSS was quiet on the ward due to the absence of hospital visitors.ConclusionThis study reports a high prevalence of postpartum depressive and PTSS in women who gave birth during the Covid-19 pandemic. Postnatal psychological distress seemed to be associated more with the prenatal experience and other individual factors than with the pandemic hospital restrictions. Early detection during pregnancy of an insecure attachment style is fundamental to provide targeted preventive and therapeutic psychological interventions.

Resilience During Pregnancy: How Early Life Experiences are Associated with Pregnancy-Specific Stress

High levels of maternal pregnancy–specific stress are associated with an increased risk for adverse birth outcomes as well as anxiety and depression symptoms during and following pregnancy. There is evidence that early childhood experiences play an important role in maternal psychological health and well-being and may be important for shaping maternal vulnerability to pregnancy-specific stress. The current study examined the link between both maternal adverse childhood experiences (ACEs) and protective and compensatory experiences (PACEs) and pregnancy-specific stress and considered the mediating and moderating roles of resilience on these associations. Data came from a high-risk clinic cohort of 138 racially diverse pregnant women (ages 16–38). We found that resilience mediated the associations between PACEs and pregnancy-specific stress and moderated the association between ACEs and pregnancy-specific stress. In particular, high levels of resilience were protective against pregnancy-specific stress at low and moderate levels of ACEs. The findings highlight the importance of early childhood experiences on women’s well-being during pregnancy and demonstrate how both ACEs and PACEs contribute to and are protected by resilience.

Effects of a health education program targeted to Chinese women adhering to their cultural practice of doing the month: A randomized controlled trial

Background“Doing the month” is a prevalent Chinese postpartum custom which is believed to restore health after delivery. However, some traditional practices are potentially harmful for women's health. ObjectivesTo examine the effect of an evidence-based health education program on Chinese postpartum women's adherence to traditional practices of doing the month and the effect of adherence to doing the month on maternal physiological and psychological health. MethodsA randomized controlled trial was conducted. During December 2016-July 2017, we recruited postpartum women at a tertiary hospital. Women randomized to the intervention group received evidence-based health education within 1 week after returning home and received a second visit 1 month later. The control group received routine postpartum home visits. Adherence to doing the month was measured by the Adherence to Doing-the-Month Practices questionnaire (ADP). Maternal physical health was measured by the Chair Stand Test and Postpartum Symptom Checklist. Maternal psychological health was measured by the Edinburgh Postnatal Depression Scale (EPDS). Descriptive statistics, t-test, and chi-squared test were used to analyze the differences in scores and symptoms of the two groups. ResultsWe recruited 124 eligible postpartum women and 108 of them (54 intervention group, 54 control group) completed this study. The ADP score of the intervention group was significantly lower than that of the control group (p < 0.001). The number of participants in the experimental group with poor appetite and indigestion was significantly lower than that of control group. No significant differences were found in numbers of symptoms and average EPDS scores between the 2 study groups (p > 0.05). ConclusionsEvidence-based health education can reduce postpartum women's adherence to some traditional practices of doing the month and improve women's physical health.

'No Austrian Mother Does This to Sleep Without a Baby!' Postnatal Acculturative Stress and 'Doing the Month' Among East Asian Women in Austria: Revisiting Acculturation Theories From a Qualitative Perspective.

Acculturative stress is a phenomenon describing negative emotions experienced by immigrants in their socio-cultural and psychological adaptation process to the host society’s dominant culture and its population. Acculturative stress is assumed to be one the reasons for higher prevalence of postnatal depression among immigrant women compared to non-immigrant women. Theories and models of acculturation and coping strategies suggest that certain cultural orientations or behaviors could mitigate acculturative stress and postnatal depression. Nevertheless, quantitative studies applying these theories have so far revealed inconsistent results. Given this background, we ask: what can a qualitative study of immigrant women’s postnatal experiences tell us about the interrelationships between immigrant mothers’ acculturation behaviors or cultural orientations, and maternal psychological health? Particularly, we explore the postnatal experiences of Chinese and Japanese women who gave birth in Austria, focusing on their experiences and behaviors influenced by their heritage culture’s postnatal practices (zuò yuè zi and satogaeri). Theoretically, we apply Berry’s acculturation model through a focus on what we call ‘Postnatal Acculturative Stress’ (PAS). By doing so, we identify factors that prevent or mitigate PAS. Another aim of this article is to critically reassess Berry’s model in the context of postnatal care and maternal psychological health. Data were analyzed using a combination of deductive and inductive method through the application of directed content analysis and phenomenological approach. Women’s postnatal experiences were summarized as an ‘unexpected solitary struggle in the midst of dual identity change’ in four specific domains: postnatal rest and diet, social support, feelings toward significant others and identity. Preventive and mitigating factors against PAS included trust (in self and one’s health beliefs) and mutual respectful relationships with and between the significant others. The application of Berry’s acculturation model provided a useful framework of analysis. Nevertheless, the multifarious complexity involved in the process of acculturation as well as different power dynamics in the family and healthcare settings makes it difficult to draw causal relationships between certain acculturation behaviors or cultural orientations with specific health outcomes. Health professionals should be aware of the complex psychosocial processes, contexts as well as social environment that shape immigrants’ acculturative behaviors.

California's paid family leave law improves maternal psychological health

To study the effect of California's first in the nation paid family leave policy on maternal postpartum psychological distress for women overall and for disadvantaged groups. We use restricted data from 11 waves of the National Health Interview Survey, from 2000 to 2010, to examine mothers with children under the age of 12 months (n=7379). Outcomes included three measures obtained from the six-item Kessler Psychological Distress Scale: an aggregated score and thresholds for mild and moderate psychological distress. For inference, we used synthetic control models, comparing mothers with infants in California to mothers with infants in the control group, pre-law and post-law. Access to paid family leave was associated with a 0.636-point decrease (95% CI=-1.202, -0.070) in postpartum psychological distress symptoms among mothers with infants, representing a 27.6% decrease from the pre-treatment mean. It was also associated with a 9.1 percentage point reduction (95% CI=-17.8, -0.4) in mild postpartum distress, a 38.4% reduction from the pre-treatment mean. Populations that typically lack access to paid family leave, particularly single and younger mothers, may have seen even larger effects. Paid family leave was associated with improved mental health for California mothers, suggesting that expansions of state or federal paid family leave policies have the potential to improve maternal postpartum health.

Effects of prenatal individualized mixed management on breastfeeding and maternal health at three days postpartum: A randomized controlled trial

BackgroundPregnant women with antenatal depression are more prone to postpartum depression and failure in breastfeeding than women without antenatal depression. The purpose of this study was to evaluate the effectiveness of a prenatal individualized mixed management intervention on breastfeeding and maternal physical and psychological status at three days postpartum. MethodsThis randomized single-blind controlled trial was conducted from December 2017 to August 2018 with 182 primiparous women in Shanghai, China. Participants with Edinburgh Postnatal Depression Scale (EPDS) scores ≥9 were randomly allocated to the intervention group (n = 91) or control group (n = 91). The intervention group underwent a 4-session individualized mixed management intervention and the control group received usual care. Feeding patterns, Breastfeeding Self-Efficacy Scale (BSES), Infant Breastfeeding Assessment Scale (IBAS), and EPDS were used to measure the main outcomes. Two-tailed p-values of p < .05 were considered statistically significant. ResultsThe intervention group had significantly more effective breastfeeding behavior, better breastfeeding self-efficacy, more successful breastfeeding initiation, lower EPDS scores, more sleep time, and better appetite than the control group. ConclusionThe prenatal individualized mixed management intervention demonstrated significant short-term improvement in breastfeeding and maternal physical and psychological health at three days postpartum. Trial registrationChiCTR-IOR-17013761; December 7, 2017.

The effect of mindfulness therapy on the pregnant women’s anxiety level in facing childbirth

Background: The health improvement for pregnant women in antenatal phase is not only focused on maintaining physical health, but also the psychological health. One of the factors of maternal psychological health is anxiety. Anxiety is common in pregnant women caused by maternal concerns about complications that accompany the mother and her fetus. The increasing anxiety in pregnant women can have an impact on pregnancy complications. Therefore an intervention is needed to overcome anxiety in pregnant women. The purpose of this study was to determine the effect of mindfulness therapy on the anxiety level of pregnant women in labor.Methods: This study uses a quasi-experimental design with a pre-test and post-test with control group. Implemented in the Public Health Center working area like Sleman in August-September 2018. There were 26 participants selected using purposive sampling, with 13 assigned in experiment and control groups. The questionnaire used is Pregnancy Related Anxiety Questionnaire-Revised 2. Independent sample t-test used for data analysis.Results: There was a significant difference in the mean of anxiety score after the intervention in the experimental group compared to the control group with a value of p=0.017 (p&lt;0.05). The mean of anxiety score after intervention in the control group was 32.00, while the average of anxiety score after intervention in the experimental group was 24.54.Conclusions: Giving mindfulness therapy to pregnant women is able to reduce maternal anxiety levels significantly in facing labor.

Effectiveness of mindfulness-based cognitive therapy for comorbid depression and anxiety in pregnancy: a randomized controlled trial.

Pregnant women are at high risk of mood and anxiety disorders, and options for non-pharmacological treatment are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among people with mood and anxiety disorders, but limited studies reported the effectiveness of MBCT on perinatal comorbid conditions. This study aimed to examine the effects of an 8-week MBCT intervention on pregnant women with comorbid depression and anxiety. In this randomized controlled study, 38 pregnant women with a diagnosis of depression and varying levels of comorbid anxiety disorders were randomly assigned to either MBCT or a control group. Scores on the Beck Depression Inventory-II, Beck Anxiety Inventory, Emotion Regulation Questionnaire, and Scales of Psychological Wellbeing were used as outcome measures at baseline, after MBCT, and through 1-month follow-up. Intent to treat analyses provided preliminary evidence that MBCT can be effective in reducing depressive and anxiety symptoms and in enhancing the use of adaptive emotion regulation strategies and psychological well-being. Improvements in outcomes were maintained 1month. Results provide cross-cultural support for MBCT as a treatment for depression and anxiety in pregnant women. This brief and non-pharmacological treatment can be used to improve maternal psychological health.

Family stress predicts poorer dietary quality in children: Examining the role of the parent–child relationship

AbstractThe present prospective study investigated a comprehensive model of family stress to explain changes in young children's diet quality from age 3 to 5 years. The direct associations of family stress with child diet quality were examined, as well as the indirect associations via features of the parent–child relationship, including inconsistent parenting practices, negative parent–child interactions, and poor emotional bond. Using an Australian sample of 579 mother–child dyads (child Mage = 3.05 years; 45% boys), higher levels of family stress were predictive of less adequate child dietary quality (i.e., lower fruit and vegetable intake) over time with the effect on fruit intake occurring indirectly via impaired parent–child relationship quality. Notably, it was the relatively less well‐studied indicators of family stress (maternal physical and psychological health difficulties) that were consistently associated concurrently and prospectively with poorer child diet quality. These results provide support for an ongoing broader focus on the family context in which children and parents are embedded, including their exposure to stress, as well as the continued focus on parent–child relationship factors, such as inconsistent parenting practices and negative parent–child interactions, as specific and modifiable predictors of children's diet quality over time.Highlights A comprehensive model of family stress was examined to explain changes in young children's dietary intake from age 3‐5 years. Family stress was predictive of less adequate child dietary intake, with one effect occurring indirectly via impaired parent‐child relationship quality. Results support a broader focus on the family context, including stress exposure, as well as on specific parent‐child relationship factors.

Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial

Objective To determine whether being upright in the second stage of labour in nulliparous women with a low dose epidural increases the chance of spontaneous vaginal birth compared with lying...

Emotional Availability of Parents and Psychological Health: What Does Mediate This Relationship?

The relationship and interaction between a parent and child is of an ever-changing nature. In the first years of the child, parents are more supportive of the child’s development and guide the changes that take place. When adolescence ends and child becomes an adult, parent–child relationship takes on a different pattern in which the relation is more egalitarian. Despite this changing nature, research findings demonstrate that children who continue to receive emotional support from their parents, feel attached to them and care about their contributions and support. Thus, it becomes important to evaluate how certain parental properties affect psychological health within this changing relationship structure. From this point of view, this study examines the mediator role of emotion regulation skills, interpersonal relationship styles, and perceived social support on the relationship between parental emotional availability and general psychological health of individuals aged 16–25 who still live with their parents. It has been found that difficulty in emotion regulation, interpersonal relationship style, and social support has complete mediation effect on the relationship between both maternal and paternal emotional availability and psychological health.

Effects of lay support for pregnant women with social risk factors on infant development and maternal psychological health at 12 months postpartum.

BackgroundThe ELSIPS (Evaluation of Lay Support in Pregnant Women with Social Risk) RCT showed that lay support for women with social risk had a positive effect on maternal mental health and mother-infant bonding. This exploratory study examined whether these observed benefits would impact infant development at 1 year.MethodsA sub-sample of women whose infants were under one year who had participated in the ELSIPS RCT which randomised women to receive either standard care or the services of a Pregnancy Outreach Worker (POW), and who were contactable, were eligible to participate in the follow up. At home visits, the Bayley Scales of Infant Development (3rd Edition) and standardised measures of depression, self efficacy, mind-mindedness and bonding were completed.Results486 women were eligible for follow up, of whom 154 agreed to participate. 61/273 were successfully followed up in the standard maternity care arm and 51/213 in the POW arm. Women who completed follow up were less depressed and had higher selfefficacy scores at 8–12 weeks postpartum than those who did not complete follow up. There were no significant differences in maternal outcomes, infant cognitive development, receptive communication, expressive communication, fine motor development or social/emotional functioning between groups at 12 month follow up. Infants of mothers who received the POW intervention had significantly better gross motor development than infants whose mothers received standard care (p<0.03).ConclusionsThe provision of lay support to women with social risk may facilitate infant gross motor skill development at one year but there were no other demonstrable benefits. The effects of the intervention may be underestimated given that those women who completed follow up had better mental health than the original study sample.Trial registrationControlled-Trials.com ISRCTN35027323.

Unsealing Fate: Policy Practices Aimed at Reducing the Intergenerational Transmission of Poverty

Enabling children born into poverty to transcend the circumstances of their birth requires ensuring that they develop the cognitive, intellectual, and behavioral skills needed to succeed at school, and eventually the workplace. Research in developmental neuroscience highlights how brain systems that support these skills are already influenced by risk factors associated with poverty during prenatal development, indicating the potential value of programs targeted at this developmental stage. Such interventions could include programs that support maternal physical and psychological health, as well as efforts to eliminate known neurotoxins from the environment, all of which are disproportionately represented among low-income families. Maternal stress, environmental nicotine, and lead exposure all represent risk factors that not only directly impact child development, but cascade to translate risk into subsequent generations.

Schedules for home visits in the early postpartum period.

Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles. Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems). Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software. We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no consistent evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. In a cluster randomised trial comparing usual care with individualised care by midwives extended up to three months after the birth, the proportions of women with Edinburgh postnatal depression scale (EPDS) scores ≥ 13 at four months was reduced in the individualised care group (RR 0.68, 95% CI 0.53 to 0.86). There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care. Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women, although overall findings in different studies were not consistent. The frequency, timing, duration and intensity of such postnatal care visits should be based upon local and individual needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.

Benson's Relaxation Therapy: Its effect on Stress and Coping among Mothers with High Risk Pregnancy

Aim: This study aimed to investigate the effects of Benson's relaxation therapy on stress and coping among mothers with high risk pregnancy.Methods: Design: A quasi experimental Pre-Post-test design. Sample type: Purposive sampling was applied. Setting: The study was carried out at High Risk Pregnancy Unit in Mansoura University Hospital on 50 mothers with high risk pregnancy between 24 to 36 weeks of gestation in a period from October, 2016 to March, 2017. Tools: A Structured Interviewing Questionnaire, Perceived Stress Scale and Coping Patterns Scale.Results: The average score of stress scale was significantly decreased post-intervention (13.84 ± 2.53) compared to (24.62± 2.84) pre-intervention and the average scores of all domains of coping were significantly improved post- intervention (P = 0.001). There was a significant difference between the average score of stress scale with education of the mothers pre-intervention (P = 0.001) and it was eliminated post- intervention. Also, there was a significant difference between the average score of coping with stress and gravidity of the mothers pre-intervention (p = 0.05) and it was eliminated post-intervention. There was a significant negative moderate correlation between total stress score and total coping score pre and post-intervention (r = -0.511, r = -0.651, p = 0.001, respectively) that it means when the stress decreases, the coping is better.Conclusion: It has been proved that the Benson’s relaxation therapy serves as a resource for improving maternal psychological health by reducing stress and enhancing coping among high risk pregnant mothers.Recommendation: The maternity nursing services are recommended to use the Benson relaxation therapy as one of the standard non-pharmacological managements in a high risk unit.

The impact of psychological distress during pregnancy on the developing fetus: biological mechanisms and the potential benefits of mindfulness interventions

The in utero environment plays an essential role in shaping future growth and development. Psychological distress during pregnancy has been shown to perturb the delicate physiological milieu of pregnancy, and has been associated with negative repercussions in the offspring, including adverse birth outcomes, long-term defects in cognitive development, behavioral problems during childhood and high baseline levels of stress-related hormones. Fetal epigenetic programming, involving epigenetic processes, may help explain the link between maternal prenatal stress and its negative effects on the child. Given the potential long-term effects of early-life stress on a child's health, it is crucial to minimize maternal distress during pregnancy. A number of recent studies have examined the usefulness of mindfulness-based programs to reduce prenatal psychological stress and improve maternal psychological health, and these are reviewed here. Overall, the findings are promising, but more research is needed with large studies using randomized controlled study designs. It remains unclear whether or not such interventions could also improve child health outcomes, and whether these changes are modulated at the epigenetic level during fetal development. Further studies in this area are needed.

Maternal Depression and Mother-to-Infant Bonding: The Association of Delivery Mode, General Health and Stress Markers

Aim: The aim of the present study was to examine associations among maternal stress level, general health, mother to infant bonding, maternal depression level, and mode of delivery. Methods: Mothers who delivered a single baby at term were recruited with a total 435 mothers participating in the study. Outcome measures: Data were collected 6 months after delivery using General Health Questionnaire (GHQ-28), Mother-to-Infant Bonding Scale (MIBS), Edinburgh Postnatal Depression Scale (EPDS) as well as socio-demographic and medical information at 6 months. Additionally, salivary cortisol and chromogranin levels were determined. Results: The proportion of breast-feeding mothers in the vaginal delivery group (51.4%) was significantly higher than that of the cesarean section group (24%). GHQ-28 scores were significantly related to EPDS scores and MIBS scores (P < 0.001)). EPDS scores were also associated with MIBS scores (P < 0.001)). However, there was no significant relationship between salivary stress marker levels and other questionnaire scores. MIBS scores of the vaginal delivery group (1.3 ± 1.7) were significantly better than those of the planned cesarean section group (2.1 ± 2.8). Multiple regression analysis revealed that maternal age and cesarean section were significantly associated with MIBS and EPDS scores (P < 0.01). Conclusion: Maternal general health is associated with maternal psychological health. These results suggest that the support of maternal health is important to maintain maternal psychological status and bonding to infants. Because EPDS scores were significantly worse in the planned cesarean section group (4.2 ± 3.3), careful management is needed of mothers who deliver by planned cesarean section.

Determinants of Antenatal Psychological Distress in Pakistani Women.

An increasing number of evidence has demonstrated that poor antenatal psychological health can lead to adverse pregnancy outcomes. Studies conducted in various countries demonstrated a wide range of factors associated with psychological distress during pregnancy. A cross-sectional study was conducted between September 2011 and December 2012 in Peshawar, north-west Pakistan. A total of 230 women in their third trimester of pregnancy fulfilled the inclusion criteria. The antenatal psychological health status of women was measured using the Depression Anxiety Stress Scale. Relevant data regarding health and demographic-socioeconomic status were collected through personal interviews using standardized questionnaires. Overall, 45% (n=104) of women exhibited symptoms for composite depression, anxiety, and stress (composite DAS). In the univariate analysis, maternal age, husband support, monthly income, family size, stressful life events, lack of confidence, domestic violence, and pregnancy-related concerns were strongly associated with antenatal composite DAS (p<0.01). The association of maternal composite DAS symptoms with age, monthly income, family size, and lack of confidence remained significant in the multivariate analysis (p<0.01). A major proportion of women exhibited symptoms of antenatal composite DAS, and various factors were found to be related to their psychological distress. A young maternal age, low husband support, low income, large family size, adverse life events, lack of confidence, pregnancy-related concerns, and domestic violence were stronger determinants of poor antenatal psychological status. The study findings concluded that policymakers at the government level should launch special intervention programs to improve maternal perinatal mental and psychological health at the community level.

Household water insecurity, depression and quality of life among postnatal women living in urban Nepal.

This observational study aimed to assess distress related to the household water supply and to examine the relationship between household water insecurity and psychological health among Nepali postnatal women. In total, 300 women consented to participate in the study, of which 267 women were able to participate in a follow-up 1 month after discharge. We developed a household water insecurity scale (HWIS; total score range 0-24 points) by adapting the household food insecurity access scale. The Cronbach's coefficient alpha for the HWIS was moderately acceptable. Psychological health was assessed in terms of postnatal depression and physical health-related quality of life (HRQOL). The median score of the HWIS was 8, and more than 60% of the participants answered that they sometimes or often worried about not having enough water, used only small amounts of water, had a lack of hygiene, and had insufficient time for childrearing. Multiple regression models showed that women with high levels of stress derived from household water insecurity had greater odds of probable depression and lower physical HRQOL scores than did women with low HWIS scores. The results suggest that improving water security is necessary to foster maternal psychological health in developing countries.

An Exploration of Parenting Stress in Immigrant and Taiwanese Mothers

To assess parenting stress and major difficulties experienced in early motherhood among immigrant and Taiwanese women in Pingtung, southern Taiwan. A comparative, descriptive, cohort study of parenting stress and maternal psychological health, using the Child Care Stress Checklist and Edinburgh Postpartum Depression Scale. A purposive sample of 26 foreign-born Vietnamese and 162 Taiwanese mothers were surveyed at 6 weeks' postpartum. Both groups of mothers experienced similar parenting difficulties including the establishment of a regular sleeping schedule for the infant, consoling a crying infant, awareness of infant's needs, conflict with family members, and difficulties managing household chores. Curtailment of social activities was reported more often by Taiwanese mothers, whereas inaccessibility to other experienced mothers and poor maternal-infant bonding were experienced more by immigrant mothers. There were significant differences between groups, with high levels of child care stress and postpartum depression symptoms reported more often by immigrant mothers. Nurses-midwives and community child health nurses need to be sensitive to the particular difficulties and stresses of parenting in mothers from different backgrounds and provide effective interventions and support activities.