Women's Health Nursing (여성건강간호학회지)

Korean Society of Women Health Nursing (한국여성건강간호학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of postpartum fatigue, parenting stress, and family support on postpartum depression in Chinese first-time mothers: a cross-sectional study

  • Feiyan Yi (College of Nursing, Chungnam National University) ;
  • Sukhee Ahn (College of Nursing, Chungnam National University)
  • Received : 2024.06.03
  • Accepted : 2024.09.02
  • Published : 2024.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study aimed to explore the levels of postpartum fatigue, parenting stress, family support, and postpartum depression (PPD) experienced by first-time Chinese mothers and to investigate their impact on PPD. Methods: This cross-sectional survey involved 150 primigravida women attending postnatal checkups in Hebi City, Henan Province, China. Demographic data and information on environmental variables (living conditions, family relationships), postpartum fatigue, parenting stress, family support (expected vs. actual level), and PPD were collected. Results: The average age of the women was 26.25 years (SD, ±3.90), with 78.7% at risk for PPD (score ≥10). Significant correlations were found between PPD and postpartum fatigue (r=.63, p<.001), parenting stress (r=.59, p<.001), and family support (r=.40, p<.001). In model 1, which examined the influence of women's demographic variables on PPD, significant factors included a poor relationship with parents (β=.24, p=.001), a poor relationship with parents-in-law (β=.18, p=.029), and a poor relationship with the husband (β=.20, p=.013). When the three research variables were incorporated into model 2, the factors contributing to a higher level of PPD included a poor relationship with parents-in-law (β=.14, p=.033), increased postpartum fatigue (β=.37, p<.001), increased parenting stress (β=.33, p<.001), and less family support than expected (β=.12, p=.048). Conclusion: The most critical factors influencing PPD include postpartum fatigue, parenting stress, poor relationships with parents-in-law, and low family support among Chinese primiparas. To mitigate PPD levels, healthcare professionals should screen mothers for depression in outpatient clinics and offer education and counseling to both mothers and their families or companions regarding PPD.

Keywords

Acknowledgement

This study was supported by the National Research Foundation (NRF) of Korea (NRF No. 2020R1A2C201086511).

References

  1. Yoo H, Ahn S, Park S, Kim J, Oh J, Koh M. Factors influencing prenatal and postpartum depression in Korea: a prospective cohort study. Korean J Women Health Nurs. 2021;27(4):326. https://doi.org/10.4069/kjwhn.2021.11.17
  2. Shi X, Ying Y, Yu Z, Xing M, Zhu J, Feng W, et al. Risk factors for postpartum depression in Chinese women: a cross-sectional study at 6 weeks postpartum. J Psychosom Res. 2021;140:110295. https://doi.org/10.1016/j.jpsychores.2020.110295
  3. Nguyen J. A literature review of alternative therapies for postpartum depression. Nurs Womens Health. 2017;21(5):348-359. https://doi.org/10.1016/j.nwh.2017.07.003
  4. Ding G, Niu L, Vinturache A, Zhang J, Lu M, Gao Y, et al. "Doing the month" and postpartum depression among Chinese women: a Shanghai prospective cohort study. Women Birth. 2020;33(2):e151-e158. https://doi.org/10.1016/j.wombi.2019.04.004
  5. Shorey S, Chee CYI, Ng ED, Lau Y, Dennis CL, Chan YH. Evaluation of a technology-based peer-support intervention program for preventing postnatal depression (Part 1): randomized controlled trial. J Med Internet Res. 2019;21(8):e12410. https://doi.org/10.2196/12410
  6. Wilson N, Wynter K, Fisher J, Bei B. Related but different: distinguishing postpartum depression and fatigue among women seeking help for unsettled infant behaviours. BMC Psychiatry. 2018;18(1):309. https://doi.org/10.1186/s12888-018-1892-7
  7. Johansen SL, Stenhaug BA, Robakis TK, Williams KE, Cullen MR. Past psychiatric conditions as risk factors for postpartum depression: a nationwide cohort study. J Clin Psychiatry. 2020;81(1):19m12929. https://doi.org/10.4088/jcp.19m12929
  8. Upadhyay RP, Chowdhury R, Aslyeh Salehi, Sarkar K, Singh SK, Sinha B, et al. Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ. 2017;95(10):706-717C. https://doi.org/10.2471/BLT.17.192237
  9. Liu S, Yan Y, Gao X, Xiang S, Sha T, Zeng G, et al. Risk factors for postpartum depression among Chinese women: path model analysis. BMC Pregnancy Childbirth. 2017;17(1):133. https://doi.org/10.1186/s12884-017-1320-x
  10. Song C, Leng J, Wang L, Li W, Zhang S, Wang W, et al. ABO blood types and postpartum depression among Chinese women: a prospective cohort study in Tianjin, China. Women Health. 2018;58(6):685-698. https://doi.org/10.1080/03630242.2017.1333077
  11. Wang YY, Li H, Wang YJ, Wang H, Zhang YR, Gong L, et al. Living with parents or with parents-in-law and postpartum depression: a preliminary investigation in China. J Affect Disord. 2017;218:335-338. https://doi.org/10.1016/j.jad.2017.04.052
  12. State Council of the People's Republic of China. The seventh National Census 2021 [Internet]. State Council of the People's Republic of China; 2021 [cited 2022 May 10]. Available from: http://www.gov.cn/guoqing
  13. Huang C, Fan Y, Hu S. The prevalence and influencing factors of postpartum depression between primiparous and secundiparous. J Nerv Ment Dis. 2023;211(3):190-194. https://doi.org/10.1097/NMD.0000000000001591
  14. Song JE, Chae HJ, Kim CH. Changes in perceived health status, physical symptoms, and sleep satisfaction of postpartum women over time. Nurs Health Sci. 2014;16(3):335-342. https://doi.org/10.1111/nhs.12109
  15. Liu Y, Guo N, Li T, Zhuang W, Jiang H. Prevalence and associated factors of postpartum anxiety and depression symptoms among women in Shanghai, China. J Affect Disord. 2020;274:848-856. https://doi.org/10.1016/j.jad.2020.05.028
  16. Oh HJ, Kim SS. Effects of parenting stress, sleep quality, self-compassion and family relationship on mothers' postpartum depression. J Korean Acad Fundam Nurs. 2022;29(2):150-158. https://doi.org/10.7739/jkafn.2022.29.2.150
  17. Zheng J, Sun K, Aili S, Yang X, Gao L. Predictors of postpartum depression among Chinese mothers and fathers in the early postnatal period: a cross-sectional study. Midwifery. 2022;105:103233. https://doi.org/10.1016/j.midw.2021.103233
  18. Yang JW, Jung IS. Convergence effect of spouse's support on postpartum depression and self-efficacy in primipara. J Korea Converg Soc. 2018;9(1):171-180. https://doi.org/10.15207/JKCS.2018.9.1.171
  19. Zhong W, He J, Gao L, Zhou J, Yu S. Research on the mediation effect of expectation gap of postpartum sup-port between perceived stress and postpartum depression. Chin J Pract Nurs. 2021;37(20):1563-1567. https://doi.org/10.3760/cma.j.cn211501-20200420-01964
  20. Doering JJ, Sims DA, Miller DD. How postpartum women with depressive symptoms manage sleep disruption and fatigue. Res Nurs Health. 2017;40(2):132-142. https://doi.org/10.1002/nur.21782
  21. Henderson J, Alderdice F, Redshaw M. Factors associated with maternal postpartum fatigue: an observationalstudy. BMJ Open. 2019;9(7):e025927. https://doi.org/10.1136/bm-jopen-2018-025927
  22. Mori E, Tsuchiya M, Maehara K, Iwata H, Sakajo A, Tamakoshi K. Fatigue, depression, maternal confidence, and maternal satisfaction during the first month postpartum: a comparison of Japanese mothers by age and parity. Int J Nurs Pract. 2017;23(1):10.1111/ijn.12508. https://doi.org/10.1111/ijn.12508
  23. Lee DJ, Park JS. The effects of fatigue, postpartum family support on postpartum depression in postpartum women. Korean Parent-Child Health J. 2018;21(1):39-49.
  24. Park M, Park KM. Effects of a reinforcement program for postpartum care behavioral skills of couples with their first baby. J Korean Acad Nurs. 2019;49(2):137-148. https://doi.org/10.4040/jkan.2019.49.2.137
  25. Woolhouse H, James J, Gartland D, McDonald E, Brown SJ. Maternal depressive symptoms at three months postpartum and breastfeeding rates at six months postpartum: Implications for primary care in a prospective cohort study of primiparous women in Australia. Women Birth. 2016;29(4):381-387. https://doi.org/10.1016/j.wombi.2016.05.008
  26. Estiningtyas E, Cahyaningtyas AY, Sugiarsi S. The effect of family support and social support on the incidence of postpartum depression. J Ilmu Kesehatan. 2021;12(2):485-495. https://doi.org/10.35966/ilkes.v12i2.219
  27. Peng S, Lai X, Du Y, Meng L, Gan Y, Zhang X. Prevalence and risk factors of postpartum depression in China: a hospital-based cross-sectional study. J Affect Disord. 2021;282:1096-1100. https://doi.org/10.1016/j.jad.2021.01.012
  28. Qi W, Liu Y, Lv H, Ge J, Meng Y, Zhao N, et al. Effects of family relationship and social support on the mental health of Chinese postpartum women. BMC Pregnancy Childbirth. 2022;22(1):65. https://doi.org/10.1186/s12884-022-04392-w
  29. Chi X, Zhang P, Wu H, Wang J. Screening for postpartum depression and associated factors among women in China: a cross-sectional study. Front Psychol. 2016;7:1668. https://doi.org/10.3389/fpsyg.2016.01668
  30. Honjo K, Kimura T, Baba S, Ikehara S, Kitano N, Sato T, et al. Association between family members and risk of postpartum depression in Japan: does "who they live with" matter? -the Japan environment and children's study. Soc Sci Med. 2018 Nov;217:65-72. https://doi.org/10.1016/j.socscimed.2018.09.043
  31. Li Q, Yang S, Xie M, Wu X, Huang L, Ruan W, Liu Y. Impact of some social and clinical factors on the development of postpartum depression in Chinese women. BMC Pregnancy Childbirth. 2020;20(1):226. https://doi.org/10.1186/s12884-020-02906-y
  32. Xiong R, Deng A. Prevalence and associated factors of postpartum depression among immigrant women in Guangzhou, China. BMC Pregnancy Childbirth. 2020;20(1):247. https://doi.org/10.1186/s12884-020-02946-4
  33. Fan Q, Long Q, De Silva V, Gunarathna N, Jayathilaka U, Dabrera T, et al. Prevalence and risk factors for postpartum depression in Sri Lanka: a population-based study. Asian J Psychiatr. 2020;47:101855. https://doi.org/10.1016/j.ajp.2019.101855
  34. Zhang M, Gong X, Li W, Chen S, Yan Q, Dong C. The influence of original family cohesion and adaptability on the puerperant postpartum depression. J Wenzhou Med Univ. 2021;51(4):323-326,329. https://doi.org/10.3969/j.issn.2095-9400.2021.04.014
  35. Xiong R, Deng A, Wan B, Liu Y. Prevalence and factors associated with postpartum depression in women from single-child families. Int J Gynaecol Obstet. 2018;141(2):194-199. https://doi.org/10.1002/ijgo.12461
  36. Zheng X, Morrell J, Watts K. Changes in maternal self-efficacy, postnatal depression symptoms and social support among Chinese primiparous women during the initial postpartum period: a longitudinal study. Mid-wifery. 2018;62:151-160. https://doi.org/10.1016/j.midw.2018.04.005
  37. Rong XF, Li MQ, Perez-Lopez FR, Wu JN, Zhang B. Maternal expectations of fetal gender and risk of post-partum depression. BMC Pregnancy Childbirth. 2023;23(1):112. https://doi.org/10.1186/s12884-023-05419-6
  38. Wang TF, Zhang CZ, Liu YF, Jiao Y. A study on the characteristics of fatigue, depression, anxiety, and life events, and their correlation in patients with chronic fatigue syndrome. Chin J Behav Med Sci. 2000;9(2):84-86. https://doi.org/10.3760/cma.j.issn.1674-6554.2000.02.002
  39. Guo X, Wang Y, Chen J. Study on the efficacy of the Edinburgh postnatal depression scale in puerperas in Chengdu. Chin J Pract Nurs. 2009;(36):4-6. https://doi.org/10.3760/cma.j.issn.1672-7088.2009.01.002
  40. Cox JL, Chapman G, Murray D, Jones P. Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord. 1996;39(3):185-189. https://doi.org/10.1016/0165-0327(96)00008-0
  41. Abidin RR. Parenting stress index-short form. Vol. 118. Charlottesville, VA: Pediatric Psychology Press; 1990.
  42. Geng L, Ke X, Xue Q, Chi X, Jia J, Chen P, Lu ZH. Maternal parenting stress and related factors in mothers of 6-month infants. Chin Pediatr Integr Tradit West Med. 2008;27(6):457-459. https://doi.org/10.3969/j.issn.1674-3865.2008.06.001
  43. Qian X, Xu XJ, Zhang F, Gao Q, Meng Y, Bai T. Reliability and validity of the Chinese version of postpartum fatigue scale. J Nurs Sci. 2020;35(13):33-36. https://doi.org/10.3870/j.issn.1001-4152.2020.13.033
  44. Milligan RA, Parks PL, Kitzman H, Lenz ER. Measuring women's fatigue during the postpartum period. J Nurs Meas. 1997;5(1):3-16. https://doi.org/10.1891/1061-3749.5.1.3
  45. Lu Z, Gao Z, Zhang J, Li H, Zhang J. Reliability and validity of the Chinese version of the Postpartum Social Support Scale. Chin J Pract Nurs. 2014;30(15):26-28. https://doi.org/10.3760/cma.j.issn.1672-7088.2014.15.009
  46. Logsdon MC, McBride AB, Birkimer JC. Social support and postpartum depression. Res Nurs Health. 1994;17(6):449-457. https://doi.org/10.1002/nur.4770170608
  47. Zhou J, Gao Y, Zou F, Zhao M. Analysis of the relationship between postpartum depression and expectation gap of postpartum support. Chin J Pract Nurs. 2016;32(9):651-654. https://doi.org/10.3760/cma.j.issn.1672-7088.2016.09.003
  48. Levine N, Li D. Zero-COVID policy puts China in crisis [Internet]. Asia Society; 2022 Apr [cited 2024 Jun 3]. Available from: https://asiasociety.org/korea/jelo-kolona-zero-covidjeongchaegeulo-wigie-mollin-junggug
  49. Korea Trade-Investment Promotion Agency (KOTRA). KOTRA Overseas News: The current status of postpartum care centers in China and market potential in Heilongjiang Province [Internet]. Harbin Trade Office, China; 2022 Mar [cited 2024 Jun 3]. Available from: https://dream.kotra.or.kr/user/extra/kotranews/bbs/linkView/jsp/Page.do?dataIdx=193610