Weak Social Support Research Articles

Threatened with death but growing: changes in and determinants of posttraumatic growth over the dying process for Taiwanese terminally ill cancer patients.

Posttraumatic growth at end of life, a positive psychological consequence of dealing with a life crisis, may be catalyzed by the trauma of facing mortality. Studies on cancer patients' posttraumatic growth have overwhelmingly examined early-stage survivors. Of the few studies on advanced cancer patients, none anchored posttraumatic growth with the patient's death. Therefore, the purposes of this study were to describe longitudinal changes in and to identify determinants of posttraumatic growth over the dying process. A convenience sample of 313 cancer patients was recruited and followed until death. Posttraumatic growth was measured by the Posttraumatic Growth Inventory. Determinants were evaluated from sociodemographics, cancer characteristics, social context variables, and coping strategies using a multiple linear regression model. The dying process may be too threatening and stressful for cancer patients to experience profound posttraumatic growth as manifested by low Posttraumatic Growth Inventory scores (26.13 ± 21.59 to 40.33 ± 27.71 on a 0-105 scale) without significant changes as death approached. However, terminally ill cancer patients who were not defeated by the initial threat of death experienced posttraumatic growth. Patients were at risk for low-level posttraumatic growth if they were male, were non-middle aged, had low educational attainment, had a non-metastatic disease, recently recognized terminally ill status, had severe symptom distress, had high functional dependence and weak social support, and were unaware or had low acceptance of their prognosis. Interventions are needed to appropriately relieve symptom distress, facilitate functional independence, enhance social support, and improve prognostic awareness and acceptance to inspire positive changes for cancer patients at end of life.

일부 대학생들의 자아존중감 및 사회적 지지와 우울과의 관련성

본 연구는 대학생들의 개인적 특성, 가정생활, 학교생활 및 건강관련행위 특성에 따른 자아존중감, 사회적지지 및 우울수준을 파악하고, 특히 자아 존중감 및 사회적지지와 우울과의 관련성을 규명하고자 실시하였다. 조사대상은 대전 충청지역에 소재하고 있는 4년제 대학에 재학 중인 남녀 대학생 471명으로 하였으며, 자료 수집은 2013년 4월 23일부터 약 2주에 걸쳐 표준화된 자기기입식 설문지를 사용하여 수집하였다. 연구결과, 조사대상자들의 자아존중감과 사회적지지에 따른 우울 수준은 자아존중감이 낮을수록(p=0.000), 사회적지지가 낮을수록(p=0.000) 우울수준이 유의하게 높았다. 조사대상자들의 자아존중감과 사회적지지는 우울수준과 유의한 음의 상관관계를 보였으며, 사회적 지지와 자아존중감은 유의한 양의 상관관계를 보였다. 위계적 다중회귀분석 결과, 조사대상자들의 우울수준에 영향을 미치는 요인으로는 성별, 연령, 체형에 대한 스트레스 유무, 주관적인 경제 상태, 공부시간, 자아존중감 및 사회적지지가 유의한 요인으로 지적되었으며 이들의 설명력은 23.8%이었다. 위와 같은 결과는 조사대상 대학생들의 우울수준은 자아존중감 및 사회적 지지와 유의한 관련성이 있음을 시사하고 있으며, 특히 우울수준은 사회적지지에 의해 더 큰 영향을 받고 있음을 알 수 있다. The purpose of this study was to estimate self-esteem, social support and depressive symptoms among college students, as well as to reveal its related factors. The self-administered questionnaire was filled out by 471 students from university located in Daejon city and Chungnam during two weeks from April 23, 2013. As a results, lower the self-esteem is, the depression level comes out to be higher. Also weaker social support is the factor to give rise to depression. Self-esteem and social support showed negative correlation with depression. Social support showed positive correlation with self-esteem. According to hierarchical multiple regression analysis, following factors influence depression level with explanatory powers of 23.8%: sex, age, stress for body shape, perceived economical status, studying time, self-esteem, and social support. In the conclusion, this result imply that depression level of college students is closely related to self-esteem and social support. Especially, social support showed higher correlation with depression.

Functional performance and social relations among the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a population-based epidemiological study.

This study was conducted in a probabilistic sam- ple of 2,055 elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, to examine components of social network (conjugal status and visits by the children, other relatives, and friends) and social support (satisfaction with personal relations and having persons on whom to rely) associated with limitations in performing basic activities of daily living (ADL). Multivariate analysis used the Hurdle model. Performance of ADL showed independent and statistically significant associations with social network (fewer meetings with friends and not having children) and personal support (dissatisfaction/indifference towards personal relations). These associations remained after adjusting for social and demographic characteristics, health status, and other indicators of social relations. Our results emphasize the need for greater attention to social network and social support for elderly with functional limitations and those with weak social networks and social support.

Abstract T MP70: Dense Households and Weak Social Networks Increase Risk of Recurrent Vascular Events

Background: Social isolation is associated with increased vascular events post stroke, but the role of living arrangements versus social networks on stroke outcomes has not been well explored. We aim to characterize these associations overall and by race-ethnicity. Methods: The Stroke Warning Information and Faster Treatment (SWIFT) study tested a stroke preparedness intervention on arrival times for stroke/TIA recurrence to the ED. Stroke/TIA patients able to consent were prospectively recruited and randomized. Baseline data collection included demographics, medical history, socioeconomic status (SES), and social support networks. Living arrangements were categorized as living alone, living with one or 2 people, or living with three or more people (dense household). Weak social support networks defined as 4 or less family or friend visits in past week. Participants were followed for a mean of 2.9 years. An outcome of vascular event was defined as stroke, TIA, MI, or death post enrollment. Multivariate logistic regression models examined the relationship between vascular outcomes, living arrangements and social support networks adjusting for demographics, health and SES. Results: Between 2005 and 2009 1193 participants were enrolled: mean age 63 years; 51% Hispanics, 26% whites, and 17% Blacks; 50% female; and 42% < high school education. Over 24% lived alone, 23% lived with spouse/partner only, and 21% lived in dense households. In adjusted logistic models, post stroke vascular events were associated with dense households [RR 1.5 (95% CI: 1.1 - 1.9)], and weak family networks [RR 1.9 (95% CI: 1.4 - 2.8)]. Stratifying by race-ethnicity, the results remained significant for Hispanics where dense households [RR 1.9 (95% CI: 1.3 - 2.6)], weak family networks [RR 2.8 (95% CI: 1.5 - 5.1)], and weak friend networks [RR 1.5 (95% CI: 1.0 - 2.5)] increased vascular events post stroke. Conclusion: Living in dense households can increase risk of vascular events post stroke, while stronger social support networks can decrease this risk especially among Hispanic stroke survivors. Future research is needed to explore the mechanism of these associations and to identify possible racial/ethnic tailored interventions based on living arrangements and social networks.

Medium- to Long-term Psychological Support for Women Living in Areas Affected by the Great East Japan Earthquake: Empirical Studies on the Impact of Horticultural Therapy

Copyright: © 2014 Kotozaki Y. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. In the near future, three years will have passed since the Great East Japan Earthquake. Despite the passage of time, several residents living off the Pacific coast of Tohoku continue to suffer from mental and physical repercussions of the event. In other words, numerous survivors of the Great East Japan Earthquake continue to live with emotional trauma and stress. Previous studies suggest that mental health problems among natural disaster survivors are most pronounced within a specified period after the event [1]. Although recovery among survivors is progressing incrementally in the disaster area of Tohoku, one may argue that availability of mediumto long-term psychological care for these people is important. Immediately following the earthquake, our research team provided horticultural therapy as a mediumto longterm psychological support to the survivors. The motivation behind this study is based on previous research suggesting that women are more susceptible to experiencing anxiety in post-disaster environments than men [2], that women are more likely to be diagnosed with PostTraumatic Stress Disorder (PTSD) than men after experiencing natural disasters [3], and that weak social support is associated with a higher susceptibility to PTSD.

The individual determinants of care‐seeking among middle‐aged women reporting urinary incontinence: Analysis of a 2273‐woman cohort

Our main objective was to analyze individual determinants that lead middle-aged women to seek medical care for urinary incontinence (UI). Observational longitudinal study among GAZEL cohort participants: 2,640 women aged 50-62 completed a self-administered questionnaire at baseline. Eight years later (2008) 2,273 (86%) responded to a follow-up questionnaire. Seeking care for UI was defined as any consultation for UI during the 8-year follow-up period. Individual determinants considered in the regression analysis were social and demographic characteristics, social relations, UI type and severity, and other health factors. Among 1,192 women reporting incontinence at baseline, 24.4% had visited a physician at least once for UI during the follow-up period (56.0% of those reporting severe UI). The care-seeking rate increased with age at baseline. Multivariate analysis showed that women who reported severe UI (OR = 4.1; 95% CI 2.6-6.5), mixed UI (2.0; 1.3-3.0), or neurologic disease (1.6; 1.1-2.6), had weak social support (1.4; 1.0-2.0), or talked about their UI with close friends or family (1.5; 1.0-2.1) were more likely to seek care for UI. A model including these factors had a 78% probability of correctly differentiating women with incontinence who chose to seek care from those who did not. Our analysis could not take factors related to the organization of health services into account. Women do not always seek care for UI, even when it is severe. Besides UI severity and type, consultation is associated with aging, weak social support, conversation about it with close friends and family, and neurologic disorders.

Qualitative study of care burden of caregivers who take care of patients with spinal cord injury

Objective To investigate the real situation of the burden of the caregivers who take care of patients with spinal cord injury.Methods Using phenomenological research methods of qualitative study,information of 15 family caregivers of patients with spinal cord injury were collected through semi-structured interviews in Jiangxi province,and data were analyzed with Colaizzi 7-step analysis method.Results Four themes were summarized:weak social support system,heavy economic burden,insufficient care ability,mental and physical exhaustion; mental and physical exhaustion concluded three sub-themes:burnout,lifestyle changes,sad/helplessness.Conclusions Care burden of caregivers of patients with spinal cord injury includes four aspects:social,physical,psychological,and less caring capacity.Care workers should be concerned about the health status of the caregivers,give targeted care intervention,so that caregivers can be adapted to the caregivers' role,maintain and promote a high level of health of the patients and their families. Key words: Spinal cord injury; Caregivers; Care burden; Qualitative study

Work-related post-traumatic stress disorder

Work-related post-traumatic stress disorder (PTSD) is an important condition encountered by many occupational health practitioners. To carry out an in-depth review of the research on occupational groups that are at particular risk of developing work-related PTSD. A literature search was conducted in the databases OVID MEDLINE, OVID Embase, Ovid PsycINFO, ISI Web of Science and CSA Health and Safety Science Abstracts. Professionals such as police officers, firefighters and ambulance personnel often experience incidents that satisfy the stressor criterion for the PTSD diagnosis. Other professional groups such as health care professionals, train drivers, divers, journalists, sailors and employees in bank, post offices or in stores may also be subjected to work-related traumatic events. Work-related PTSD usually diminishes with time. Mental health problems prior to the traumatic event and weak social support increase the risk of PTSD. Prevention of work-related PTSD includes a sound organizational and psychosocial work environment, systematic training of employees, social support from colleagues and managers and a proper follow-up of employees after a critical event.

Factors influencing peritoneal dialysis patients' psychosocial adjustment

The specific aims of this study were as follows: (1) to describe psychosocial adjustment in adults with end-stage renal disease who underwent maintenance peritoneal dialysis; (2) to explore the influence of demographics, clinical variables, symptom distress and social support on psychosocial adjustment and (3) to determine predictive factors of psychosocial adjustment. Proper psychosocial adjustment is important for patients with end-stage renal disease to cope with multiple stressors of their disease and to balance their lives within the restrictions imposed by peritoneal dialysis treatment. Knowledge on psychosocial adjustment in patients receiving long-term peritoneal dialysis has been limited. The study was based on a predictive correlational design. One hundred peritoneal dialysis patients were recruited from outpatient peritoneal dialysis clinics of a general hospital in Taipei, Taiwan. Data were collected with the study questionnaires, including the Physical Symptom Distress Scale, the Social Support Scale and the Psychosocial Adjustment to Illness Scale - self-report. The mean score on the Psychosocial Adjustment to Illness Scale was 359.7 (SD = 40.0), indicating that these participants were moderately struggling in adjusting to their illness. Symptom distress, family social support and financial status explained 38.3% of the variance in psychosocial adjustment (F3,96 = 21..5, p < 0.001). The level of psychosocial adjustment in peritoneal dialysis patients is suboptimal. Overall, the patients with high physical symptom distress, weak family social support and poor financial status reported deficient psychosocial adjustment to their illness. The findings of this study are relevant to the understanding of preconditions that enable peritoneal dialysis patients to successfully adjust to the disease and its diverse consequences. Patients with insufficient income, higher symptom distress and less family social support have a greater risk of psychosocial maladjustment. Medical professionals may use these variables to identify higher risk groups for early intensive intervention.

Gender differences in predictors of self-rated health in Armenia: a population-based study of an economy in transition

IntroductionSelf-rated health is a widely used health outcome measure that strongly correlates with physical and mental health status and predicts mortality. This study identified the set of predictors of fair/poor self-rated health in adult female and male populations of Armenia during a period of long-lasting socio-economic transition to a market economy.MethodsDifferences in self-rated health were analyzed along three dimensions: socioeconomic, behavioral/attitudinal, and psychosocial. The study utilized data from a 2006 nationwide household health survey that used a multi-stage probability proportional to size cluster sampling with a combination of interviewer-administered and self-administered surveys. Both female and male representatives of a household aged 18 and over completed the self-administered survey. Multivariate odds ratios (OR) for fair/poor self-rated health were calculated for different sets of variables and logistic regression models fitted separately for women and men to identify the determinants of fair/poor self-rated health.ResultsOverall, 2310 women and 462 men participated in the survey. The rate of fair/poor self-rated health was 61.8% among women and 59.7% among men. For women, the set of independent predictors of fair/poor self-rated health included age, unemployment, poverty, low affordability of healthcare, depression, and weak social support. For men, the set included age, lower education, depression, weak social support, and drinking alcohol less than once a week. For both genders, depression and weak social support demonstrated the strongest independent association with fair/poor self-rated health.ConclusionsThe prevalence of fair/poor self-rated health was similar among men and women in this study, but the sets of independent predictors of perceived health differed somewhat, possibly, reflecting lifestyle differences between men and women in Armenia. Nevertheless, psychosocial variables were the strongest predictors of fair/poor self-rated health for both genders, indicating the importance of improving the country’s psychosocial environment through social reforms and poverty reduction.

Sustaining Multifunctional Forestry Through the Developing of Social Capital and Promoting Participation: A Case of Multiethnic Mountain Communities

Communities with multicultural, ethnically diverse populations located in forest areas of the Carpathian Mountains often face serious social and economic problems, including high unemployment rates, weak social support and institutions with little stakeholder participation in decision-making. In this paper, we apply participatory scenario processes to address the development of multifunctional forestry in these mountains by taking as an example the case study of Slovensky Raj National Park and specifically focusing on the involvement of local communities, particularly the Roma minority, in sustainable forest management (SFM). The paper argues that development of local institutions and promotion of horizontal and vertical participation to increase social capital is necessary for addressing social and economic problems, managing potential conflicts and sustaining multifunctional forestry development. The results suggest that the way forward is the integration of multi-purpose forest management with community development, and that learning, repeated stakeholder interaction, trust-building and cooperation between and within multiethnic local communities are important preconditions for success. The scenario process applied turned out to be beneficial for both the majority and the minority populations, particularly allowing for discussions about future development of mountain regions, their local economies and communities, and for providing some guidance about what are the preferred actions for participation in multifunctional SFM.

P1-431 Social support networks and mental health: evidence from share

IntroductionThis study investigates whether the social support networks (SSNs) of older Europeans exert a causal influence on their mental health. The manner in which social support influences mental health has...

Prevalence of Low Physical Activity and its Relation to Social Environment in Deprived Areas in the London Borough of Redbridge

Achieving adequate levels of physical activity (PA) is important to maintain health and prevent chronic disease. The costs of inadequate physical activity to the NHS have been estimated at over a billion pounds annually. While socio-demographic characteristics such as age, sex and ethnicity have been reported to be associated with different levels of PA, there is evidence that people’s social environments may also be important in encouraging a physically active lifestyle. The objective of this paper is to describe associations between the social environment and physical activity among the poorer communities in an outer London Borough, when other socio-demographic factors are controlled for. A household survey was carried out in six poorer neighbourhoods in Redbridge in 2008 as part of a wider health needs assessment. The questionnaire included questions allowing estimation of levels of physical activity as well as extent of social environment [social network score (SNS) and social support score (SSS)]. A random sample of households was taken and a total of 799 completed responses from over 16 year old were obtained. The association between physical activity and the social environment controlling for socio-demographic characteristics was estimated using a logistic nested model. Higher SNS was significantly associated with younger age, Black ethnicity, higher education level, higher household income and higher levels of PA in bivariate analyses. Higher SSS was positively associated with Indian ethnicity, higher household income and area of residence. In multivariate analyses higher levels of PA were significantly associated with wider social networks and stronger social support, educational level and marital status. Despite its limitations, our findings confirm that the relationship between low physical activity and weak social networks and low social support, observed in general population studies, also occurs in deprived communities in London. The relationship merits further exploration given the limited evidence on the effectiveness of interventions to promote physical activity.

Victims of Bullying Among Students With a Disability or Chronic Illness and Their Peers: A Cross-National Study Between Ireland and France

To explore bullying victimization among French and Irish students with a disability or chronic illness (D/CI), considering individual, social, and family factors. We investigated this issue in France and Ireland because of the documented differences between these two countries on relevant contextual factors. Data from 12,048 students aged 11, 13, and 15 years (50.1% were boys) as part of the cross-national study 2006 Health Behaviour in School-aged Children were analyzed. Self-completion questionnaires were administered in classrooms; information on socio-demographic characteristics, bullying involvement, D/CI, school participation, social network, and family were collected. Multivariate logistic regressions were performed with individual, social, and family cofactors. Overall, the prevalence of bullying victimization was significantly higher in France compared with Ireland (34.2% [33.1-35.5] and 25.9% [24.5-27.4, respectively]). Youngest were more likely to report victimization; however, no gender differences were observed. In both countries, students with D/CI were significantly more likely to report that they have been bullied compared with students without D/CI, and a significant additional risk of being bullied was found when students reported D/CI with restriction in school participation. Regardless of country and D/CI status, being bullied was significantly associated with weaker social support and difficulty of communication with fathers, with even stronger associations found among students with D/CI. Adolescents with D/CI are more likely to be victimized than their peers, with a similar risk in both countries. Besides individual, social and family factors are consistently associated to bullying victimization across countries. These results will guide future antibullying prevention programs.

Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD&lt;350 cells/μL) in eastern Uganda

This study explores reasons for late ART initiation among known HIV positive persons in care from a client/caretaker perspective in eastern Ugandan where ART awareness is presumably high yet AIDS related mortality is a common function of late initiation of ARVs. In Iganga, Uganda we conducted in-depth interviews with clients who started ART at 50-200 CD4 cells/microL and those initiated very late at CD4<50 cells/microL. Focus-group discussions were also conducted with caretakers of clients on ART. Content analysis was performed to identify recurrent themes. ARV stock-outs, inadequate pre-antiretroviral care and lack of staff confidentiality were system barriers to timely ART initiation. Weak social support and prevailing stigma and misconceptions about ARVs as drugs designed to kill, cause cancer, infertility or impotence were other important factors. If the new WHO recommendations (start ART at CD4 350 cells/microL) should be feasible, PLHIV/communities need sensitization about the importance of regular pre-ARV care through the local media and authorities. The ARV supply chain and staff attitudes towards client confidentiality must also be improved in order to encourage timely ART initiation. PLHIV/communities should be sensitization about drug package labeling and the use and importance of ARVs. Stronger social support structures must be created through public messages that fight stigma, enhance acceptance of PLHIV and encourage timely ART initiation.

The Gender Gap in Depressive Symptoms Among Japanese Elders: Evaluating Social Support and Health as Mediating Factors

Depression has been described as the world's most prevalent illness and a leading cause of disability across age groups. The global literature on aging and depression reports greater prevalence of depressive symptoms among women than men. This research applies data from the Nihon University Japanese Longitudinal Study of Aging to the gender gap in depressive symptoms reported by Japanese elders. This study takes the position that cultural norms centered on obligations to care determine both the prevalence of social support and its application by family members. Since gender is the lens through which social and cultural expectations are filtered, the experiences of men and women are distinguished from one another. This study hypothesized that coresidency and filial obligations should protect elders from depression. At the same time, combative relationships within households were posited to aggravate depressive symptoms among mothers-in-law and daughters-in-law. Weak social support networks, as captured through not being married, living alone and lack of community contact were also hypothesized to exacerbate isolation and heighten depressive symptoms. The analyses found that receipt of support both protected elders as well as worsened depressive symptoms. While women reported greater frequency of depressive symptoms overall, results indicated that men experienced a larger effect of decreased mobility and transitions to poor physical health on depressive symptoms than women.

Self-assessment of stress in the workplace: a misleading health indicator

The purpose of this study is to document the relationships between some psychosocial constraints in the workplace and some mental health problems based on data for Québec from Cycle 1.2 of the Canadian Community Health Survey. From 2002 to 2005, results indicate a significant increase in weak social support from 45% to 49%, while for the same period, the number of persons indicating being stressed at work decreased significantly, dropping from 42% to 38%. However, while less autonomy in the workplace is associated with less stress at work, this dimension is also recognized as pathogenic for mental health. Therefore, self-assessment of stress in the workplace appears to be a misleading health indicator, since it fails to assess dimensions recognized as pathogenic for mental health.

Care for the Most Vulnerable Children in Tanzania: A Faith-Based Model of Care and Support for Children Affected by HIV

In the fight against HIV and AIDS in sub-Saharan Africa, the plight of orphaned and vulnerable children was long overlooked. The first United Nations report on orphans and vulnerable children did not emerge until 2002 after more than two generations of children and youth had struggled to survive with limited family, institutional, or government support. The major social determinants of health for infants and children with one or more parents dying or dead from HIV include pervasive poverty, weak community social support systems, lack of policy commitment by governments or foreign donors, lack of access to anti-retroviral drugs, limited access to schools, and gender. In this paper, we present a model of care and support to the most vulnerable children (MVC) affected by HIV that brings together faith-based institutions in partnership with the government and community volunteers in 13 rural districts of Tanzania. Although still being implemented, the project has a number of valuable lessons learned for program managers, donors, and researchers working with faith-based organizations in the development and delivery of services to the most vulnerable children in a resource-limited setting.

Is Seasonal Variation Another Risk Factor for Postpartum Depression?

Postpartum depression (PPD) occurs in the first 6 months after delivery in 10% to 20% of mothers. Despite the availability of screening tools, there is a general consensus that PPD is under-diagnosed. A number of risk factors contributing to PPD have been investigated, but role of seasonal variability in PPD is unclear. Our purpose was to assess whether seasonal variation is another risk factor for PPD. This cross-sectional pilot study was conducted at 2 family medicine clinics and an obstetrics/gynecology clinic over 24 months. During their postpartum visit, mothers who gave consent were asked to fill out a survey requesting demographic data, followed by the Edinburgh Postpartum Depression Scale (EPDS). The EPDS is a well-validated tool shown to be highly effective in detecting postnatal depression. A score >12 on the EPDS indicated a likely risk of PPD. Of the 556 patients approached, 530 completed the EPDS. Mean (+/-SE) patient age was 24.9 +/- 0.2 years; 71% were African Americans; 74% were single mothers; and 39% had at least some college education. On the EPDS, 17.8% scored > or =13. Of the depressed patients, 18.1% had babies born during the winter, 19.2% had babies born during the spring, 13.4% during the summer, and 21.5% during autumn (chi(2); P = .342). Mothers with very good or excellent support at home had lower EPDS scores (12.6%) than mothers with just adequate support (44.0%) or very little or no support (30.8%; P < .0005). A greater proportion of women with a history of depression (42.9% vs 12.9%) or who were currently taking antidepressives (58.3% vs 15.9%) were in the depressed group (P < .0005). Logistic regression analysis with the above variables, excluding education and income (excess missing data), on the 452 women with complete datasets found 4 significant predictors of an EPDS score >12. Predictors were history of depression (odds ratio [OR], 4.003; 95% CI, 2.016-7.949); parity (OR, 1.431; 95% CI, 0.204-1.701); social support (OR, 3.904; 95% CI, 2.08-7.325); and currently taking medication for depression (OR, 3.613; 95% CI, 1.207-10.817). The slight seasonal variation in PPD in our pilot study was not statistically significant. Our study was underpowered to detect the projected differences in seasons. Additional patients are needed to diversify the participants and provide an adequate sample to test the projected seasonal differences. The high ORs found for greater parity, weak social support, history of depression, and currently taking antidepressants suggest that new mothers with these characteristics should be questioned about symptoms of PPD.

Social support and psychological distress before and after childbirth

Although there is a substantial literature on the prevalence and determinants of postnatal depression (PND), less attention has been given to the more general distress that women may experience both before and after childbirth. The emphasis in the literature on PND can at least partly be attributed to the dominance of a biomedical model (that stresses conditions internal to the patient) over a psychosocial model (that stresses the social context of experience) in research on maternal mental health. In this paper we combine elements of these two models to explore the social context of well-being for women before and after childbirth. In particular, we grant attention to the influence of support from partners, relatives and friends in predicting levels of antenatal and postnatal distress. Our data derive from a longitudinal survey of 80 women in Auckland, New Zealand, in which we included the Edinburgh Postnatal Depression Scale (EPDS) and measures of perceived social support. In order to focus on distress, we treated the EPDS as a continuous scale rather than using it to focus on “cases” of depression. Interviews were carried out at approximately 36 weeks gestation and 10 weeks post-partum. The ratings for distress were lower postnatally than antenatally and whereas mean ratings for partner support improved between interviews, levels of perceived support from friends and relatives declined. One interpretation of the latter finding is that, at least within the social context of this study, there are higher expectations of informal support in the postnatal period from beyond the household than occurs in actuality. In further analysis we found a strong tendency toward distress among younger and less affluent women who perceive themselves as having weaker social support. This finding supports recent attempts to establish places such as women's centres which generate informal support in the community.