Psychosocial factors in post-partum parents in India

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1 Iteratioal Joural of Commuity Medicie ad ublic Health Salia SC et al. It J Commuity Med ublic Health Apr;4(4): pissn eissn Origial Research Article DOI: sychosocial factors i post-partum parets i Idia Shivai Chowdhury Salia 1 *, Krisha. Shah 2 1 Departmet of Electrotherapy ad Electrodiagosis, School of hysiotherapy, 2 Iter, D. Y. atil Uiversity, Navi Mumbai, Idia Received: 20 February 2017 Accepted: 14 March 2017 *Correspodece: Dr. Shivai Chowdhury Salia, chowdhury.shivai@gmail.com Copyright: the author(s), publisher ad licesee Medip Academy. This is a ope-access article distributed uder the terms of the Creative Commos Attributio No-Commercial Licese, which permits urestricted o-commercial use, distributio, ad reproductio i ay medium, provided the origial work is properly cited. ABSTRACT Backgroud: ost-partum period brigs alog with it a lot of chages ad resposibilities. Fatigue, Stress, Depressio ad Bodig are some of the factors which have show to affect the parets durig this period. reset study assesses the psychosocial factors i post-partum parets ad differeces observed amogst them. The effect of other factors like the type of delivery of the yougest child, the workig status of the mother ad the type of family they reside i were also assessed. Methods: 128 pair of parets (64 mothers & 64 fathers) were iterviewed usig a Case Report Form after procurig their iformed coset. The various psychosocial domais were evaluated usig Multidimesioal Assessmet of Fatigue (MAF) Scale, erceived Stress Scale (SS), Ediburgh ostatal Depressio Scale (EDS) ad the ost- artum Bodig Questioaire (BQ). For each participat, the total score (factorial total score i case of BQ) i each scale was calculated ad aalysed. Results: O comparig the various psychosocial factors, fatigue (p ), stress (p ) ad depressio (p ) levels were foud to be sigificatly higher i mother as compared to fathers. rimiparous mothers had sigificatly high levels of stress (p ) ad depressio (p ) i compariso to primiparous fathers. Also, mothers who uderwet C-sectio showed a sigificat differece (p ) towards their tedecy of icipiet abuse towards the child as compared to the other groups. Coclusios: The preset study reveals that the bodig of mothers ad fathers with their childre is equal. However, the mothers are observed to be more fatigued, stressed ad depressed as compared to fathers. Keywords: sychosocial factors, ost-partum parets, Fatigue, Stress, Depressio, Bodig INTRODUCTION ost-partum period is the time of major chages i the lives of mothers as well as fathers, especially for firsttime parets. 1 They are compelled to chage their priorities owig to the fact that they ow have a resposibility of a ew life. ost-partum period i a wome s life, is the time durig which there is restoratio of muscle toe ad coective tissue to the pre-pregat state. 2 The puerperium stage lasts from about 6 moths to a year. 3 Therefore, the reversal of body structure ad fuctio goes o util a log period after parturitio. Fatigue is a commo problem for ew mothers ad ca have detrimetal effects o health ad daily fuctioig as well as materal mood ad spousal relatioship quality. It is sometimes associated with icreased axiety ad depressio. 4 Accordig to a study, both mothers ad fathers had comparable levels of post-partum fatigue. 5 Hece, its assessmet is importat i order to be able to treat it ad prevet cliically sigificat fatigue. Iteratioal Joural of Commuity Medicie ad ublic Health April 2017 Vol 4 Issue 4 age 1324

2 Salia SC et al. It J Commuity Med ublic Health Apr;4(4): Adaptig to the paretig role ca be really stressful for parets. Mothers may feel exhausted ad isecure regardig their capability to urture a ifat. 6 Overload of resposibilities ad ot havig sufficiet time to do thigs as they wat have proved to be the most commo stressors amog fathers. 1 Their perspective is ot take ito cosideratio very ofte. ostpartum depressio is a metal state characterised by mood disturbaces, disturbed sleep ad poor cocetratio. It has bee observed i both the paret pairs. 7,8 It ca sometimes take a mild cliical course or ca affect a perso to a poit where they have suicidal thoughts. The term Bodig was itroduced by Klaus ad Keell (1976) referrig to the developmetal chages i the parets durig the postpartum period. These chages are show to have a log-term effect o paret-child relatioships as well as child developmet. 9 Motherifat bodig disorders like lack of materal feelig, irritability, resetmet, aggressive impulses ad dowright rejectio have also bee observed i the past. 10 Icipiet abuse could also be icluded as oe of the bodig disorders. revious studies have show differeces amogst parets based o factors like parity, type of delivery ad employmet of mothers This itrigued us to look ito these domais. Various psychosocial factors are kow to have a ifluece over the couples relatioship, relatioship with childre ad their health status. 1 Oe of the factors to be cosidered i the Idia sceario would be the existece of couples stayig i a joit family or a uclear family. 16 The icidece of joit families i cotemporary urba Idia is kow to be high, however with the icrease i wome empowermet, curret sceario of digitizatio, idividualistic thikig, growig populatio ad space cruch has led to existece of smaller broke uclear families. 17 There have t bee may studies which assessed the psychosocial domais ad the associated factors ifluecig the former i postpartum parets amogst the Idia populatio. The preset study therefore aims to assess the same. Questioaires are very useful tools of assessmet. For the preset study, Multidimesioal Assessmet Of Fatigue (MAF) Scale, erceived Stress Scale (SS), Ediburgh ostatal Depressio Scale (EDS), ost- artum Bodig Questioaire (BQ) were used MAF scale was developed ad validated to measure the severity of fatigue. 4 It cosists of 16 items that measure four dimesios experieced durig the precedig week, amely severity, distress, degree of iterferece i activities of daily livig ad timig of the fatigue. It is most ofte used as a sigle score by calculatig the Global Fatigue Idex. SS is oe of the most widely used tools for measurig the level of stress amogst the commuity. 22 It cosists of 10 items which try to measure the degree to which situatios i their life are expected to be stressful. It also icludes direct questios regardig curret levels of experieced stress. EDS is a very helpful ad efficiet tool which helps i idetifyig patiets at risk of depressio. 23 It cosists of 10 questios which are desiged to scree for symptoms of emotioal distress durig ad after pregacy. 24 BQ cosists of 25 statemets aimig at assessig the extet of bodig disorders, each followed by six alterative resposes varyig from always to ever. It assesses four factors, amely problems i mother-ifat relatioship, rejectio ad pathological ager with respect to the baby, ifat-focussed axiety ad thoughts about harmig the child. 25 BQ has bee employed i the past to assess mother-ifat bodig. However, sice there was o disclaimer to its use i assessig father-ifat bodig, the curret study uses BQ to assess father-ifat bodig too. Aim To assess the psychosocial factors like fatigue, stress, depressio ad bodig i post-partum parets i Idia. METHODS A o-radomized, cross-sectioal survey of 128 Idia parets iclusive of both mothers (=64) ad fathers (=64) from Wester ad Navi Mumbai whose yougest child was aged 5 years or less was carried out over a period of 6 moths from August 2016 to Jauary The parets were erolled for the survey oce they gave their coset to participate o uderstadig the purpose ad eed of the study udertake, via a prited iformatio sheet. The protocol of study was sactioed by the Ethics committee of School of hysiotherapy, D. Y. atil Uiversity, Nerul, Navi Mumbai. A iterview based survey was coducted usig a case report form, Multidimesioal Assessmet of Fatigue (MAF), erceived Stress Scale (SS), Ediburgh ostatal Depressio Scale (EDS) ad ost-artum Bodig Questioaire (BQ) to assess levels of fatigue, perceived stress, ad postatal depressio. 4,20,25,26 All the assessmet tools were icorporated i the study after procurig prior permissio ad licesig via from the respective authors. Oly marries couples, physically ad metally ormal childre util the age of 5 years ad o-hospitalised ew mother after delivery were icluded i the study with especially abled childre, ew mothers ot yet discharged from hospital after delivery ad divorced/sigle parets were excluded from the study. Scorig of the scales which were used as outcome measures were all validated tools of assessmet. The targeted sample was from the urba populatio with a fairly decet level of educatio. Hece the scales were used as they are with o chages i ay of the questios. Iteratioal Joural of Commuity Medicie ad ublic Health April 2017 Vol 4 Issue 4 age 1325

3 Salia SC et al. It J Commuity Med ublic Health Apr;4(4): For every participat, the total score i each scale was calculated ad aalysed. RESULTS The mea age of mothers (=64) was 32.7 years ad fathers (=64) was years. The study populatio was from the urba sector ad all the mothers were educated. 47% of mothers were post graduates, 44% graduates ad 9% ladies completed their basic studies of higher secodary studies. All fathers were equally educated with 37% beig post graduates, 55% beig graduates ad 8% with basic educatio. Of the study populatio 50 % were primiparous ad 50% were multiparous parets. 50% of wome uderwet a ormal vagial delivery, 36% had a elective caesarea sectio ad 14% had a emergecy caesarea sectio. It was observed that 56% wome were homemakers ad 44% were employed mothers. 39% of parets lived i uclear families, while 61% lived i joit families. Table 1:, stadard deviatios ad rage of scores of the tools used. Global Fatigue Idex erceived Stress Scale Ediburgh ostatal Depressio Scale ostpartum Bodig Questioaire (BQ)-Factor 1 BQ-Factor 2 BQ-Factor 3 BQ-Factor 4 Groups N SD Rage Mothers Fathers Mothers Fathers Mothers Fathers Mothers Fathers Mothers Fathers Mothers Fathers Mothers Fathers Table 2: rak s of fatigue, stress, depressio ad BQ-factors i mothers ad fathers. Mothers, N=64 Father, N=64 BQ-Factor 1 (roblem i BQ-Factor BQ-Factor BQ-Factor Table 3: rak s of fatigue, stress, depressio ad BQ-factors i betwee primiparous mothers ad multiparous mothers. Mother s rimipa rous, Multipa rous, BQ-Factor 1 (roblem i BQ-Factor BQ-Factor 3 (Axiety) BQ- Factor 4 (Harmful Iteratioal Joural of Commuity Medicie ad ublic Health April 2017 Vol 4 Issue 4 age 1326

4 Salia SC et al. It J Commuity Med ublic Health Apr;4(4): Table 4: rak s of fatigue, stress depressio ad BQ-factors i betwee primiparous mothers ad multiparous fathers. Fathers rimipar ous, Multipar ous, BQ-Factor 1 (roblem i BQ-Factor BQ-Factor BQ-Factor 4 (Harmful Table 5: rak s of fatigue, stress, depressio ad BQ-factors i betwee primiparous mothers ad fathers. rimip arous Mothe rs, Father s, valu e BQ-Factor 1 (roblem i BQ-Factor valu e BQ-Factor BQ-Factor 4 (Harmful Table 6: rak s of fatigue, stress, depressio ad BQ-factors i betwee multiparous mothers ad fathers. Multiparous Mothers, Fathers, BQ-Factor 1 (roblem i BQ-Factor BQ-Factor BQ-Factor Statistical calculatios were doe for the data usig the SSS software. For comparisos amog mothers ad fathers based o various factors, Ma-Whitey U test (o-parametric) was performed. For comparisos based o type of delivery of the yougest child, Kruskal Wallis test (o-parametric) was performed. s of <0.05 were cosidered sigificat for all the aalyses. Descriptive statistics of the Total Score obtaied for all the scales is show i Table 1. There was a sigificat differece i the levels of fatigue, stress ad depressio betwee mothers ad fathers ad accordig to Test, mothers showed sigificatly higher levels of fatigue, stress ad depressio. Accordig to mea raks as show i Table 2, mothers had more problems i relatioship ad more feeligs of rejectio ad ager whereas fathers had more axiety ad harmful thoughts. The followig tables represet the statistical s for Fatigue, Stress, Depressio, Bodig Factor 1 (Geeral Factor), Bodig Factor ad athological Ager), Bodig Factor 3 (Axiety about the Ifat), Bodig Factor 4 (Icipiet Abuse); betwee betwee primiparous mothers ad multiparous mothers.accordig Iteratioal Joural of Commuity Medicie ad ublic Health April 2017 Vol 4 Issue 4 age 1327

5 Salia SC et al. It J Commuity Med ublic Health Apr;4(4): to mea rak as show i Table 3, primiparous mothers were more stressed ad had more problems i motherifat relatioship whereas multiparous mothers were more fatigued, depressed ad had more feeligs of rejectio, ager, axiety ad harmful thoughts. Table 7: Variatios i mea rak s of fatigue, stress, depressio ad BQ-factors with respect to type of delivery of yougest child i the family. Type of Delivery of Yougest child Vagial, Elective C- Sectio, N=23 Emergecy C-Sectio, N= BQ-Factor 1 (roblem i BQ-Factor 2 (Rejectio BQ-Factor 3 (Axiety) BQ-Factor Table 8: Variatios i mea rak s of fatigue, stress, depressio ad BQ-factors with respect to workig (occupatio) status of the mother. Mothers Homemaker, N=36 Employed, N=28 BQ-Factor 1 (roblem i BQ-Factor BQ-Factor BQ-Factor Table 9: Variatios i mea rak s of mother s fatigue, stress, depressio ad BQ-factors with respect to type of family. Type of Family Mothers Nuclear, N=25 Joit, N=39 BQ-Factor 1 (roblem i BQ-Factor BQ-Factor BQ-Factor Betwee primiparous fathers ad multiparous fathers accordig to mea rak as show i Table 4, primiparous fathers had more feeligs of rejectio, ager ad harmful thoughts whereas multiparous fathers were more fatigued, stressed, depressed ad have more problems i relatioship ad axiety. Betwee primiparous mothers ad primiparous fathers,there was a sigificat differece i the levels of stress ad depressio betwee mothers ad fathers ad accordig to Test as show i Table 5, primiparous mothers showed sigificatly higher levels of stress ad depressio. Iteratioal Joural of Commuity Medicie ad ublic Health April 2017 Vol 4 Issue 4 age 1328

6 Salia SC et al. It J Commuity Med ublic Health Apr;4(4): Table 10: Variatios i mea rak s of father s fatigue, stress, depressio ad BQ-factors with respect to type of family. Type of Family Fathers Nuclear, N=25 Joit, N=39 BQ-Factor 1 (roblem i paretifat BQ-Factor BQ-Factor BQ-Factor Accordig to mea rak, mothers were more fatigued, had more problems i relatioship ad had more feeligs of rejectio ad ager whereas fathers had more axiety ad harmful thoughts. Betwee multiparous mother ad multiparous fathers, accordig to mea rak as show i Table 6, mothers were more fatigued, stressed, depressed, had more problems i relatioship ad more feeligs of rejectio, ager ad harmful thoughts whereas fathers have more axiety. Based o the type of delivery of the yougest child, there was a sigificat differece i oe of the factors amogst all three groups ad accordig to Test, mothers who uderwet emergecy C-sectio showed sigificatly higher levels of BQ Factor 4 (icipiet abuse) as compared to the other two groups. Accordig to mea rak as show i Table 7, those who uderwet vagial delivery were more stressed, depressed ad more feeligs of rejectio ad ager whereas those who uderwet elective C-sectio were more fatigued, had more problems i relatioship ad had more axiety. Betwee Homemaker mothers ad employed mothers, employmet as a factor had o sigificat role to play i ay of the psychosocial domais amogst mothers. However; accordig to mea rak as show i Table 8, homemaker mothers were more stressed, depressed ad had more feeligs of rejectio ad ager whereas employed mothers were more fatigued, had more problems i relatioships ad had more axiety ad harmful thoughts. Based o the type of family the mother resides i, accordig to mea rak as show i Table 9, mothers i uclear families were more fatigued ad had more harmful thoughts whereas mothers i joit families were more stressed, depressed, had more problems i paretifat relatioship ad had more feeligs of rejectio, ager ad axiety. Based o the type of family the father resides i, accordig to mea rak as show i Table 10, father i uclear families were more fatigued, depressed, had more problems i relatioship ad had more feeligs of rejectio ad ager whereas fathers i joit families were more stressed ad had more axiety ad harmful thoughts. DISCUSSION ostpartum period comes with its ow set of challeges. Both mothers ad fathers experiece differet levels of fatigue, stress, depressio ad bodig with the child. I our study, mothers showed a higher mea score (23.75±8.88) of fatigue, as compared to fathers (19.87±6.36). Rage of scores varied from 7 to 48 for mothers ad 8 to 36 for fathers. 16% of mothers experieced low levels of stress whereas 70% of them showed high levels. However 22% of fathers experieced low levels of stress but oly 55% experieced high levels. The cut off s used were from a previous article. 27 It was statistically prove (p<0.05) that the mothers were more fatigued ad stressed as compared to fathers. This fidig is i accordace with a study which also foud a similar result. The uderlyig reaso may be that mothers are ivolved i household activities ad workplace resposibilities alog with childcare. Fathers o the other had usually take up the helper role whe it comes to childcare activities. 28 Also mothers are usually more stressed about maitaiig fu activities, providig proper ourishmet ad safety of the child at all times. About 56% of the mothers ad 30% of fathers showed depressive symptoms. The cut off (>10) was based o a previous study. 29 It was statistically prove (p<0.05) that the mothers were more depressed as compared to fathers. Similar observatio was made i a previous study where more umber of mothers showed symptoms of depressio tha fathers. 30 ostpartum depressio ca last for up to 4 years i mothers. 7 It is also sigificat amog fathers especially durig the first year postpartum. 8 Factors like paret-child iteractios, resposiveess towards childre ad ivolvemet with them may have a Iteratioal Joural of Commuity Medicie ad ublic Health April 2017 Vol 4 Issue 4 age 1329

7 Salia SC et al. It J Commuity Med ublic Health Apr;4(4): ifluece over this aspect. 30 For such parets, it becomes difficult to hadle their resposibilities effectively. About 23% of mothers ad 19% of fathers showed mother-ifat bodig disorders. High levels of axiety about the ifat were see i 2% of mothers. Thoughts about harmig the child have bee observed i 2% of mothers ad 3% of fathers. ostpartum depressio also has a effect over mother-ifat relatioships. It is ecessary to tackle this as it hampers the child s cogitive ad emotioal developmet. 31 Traits of excessive ager, axiety ad feeligs of harmig the child may develop due to uplaed pregacies or challegig ifat behaviour. 32 revious studies have show that primiparous mothers are at a greater risk of post-partum metal disorders tha multiparous mothers. 11 Also the levels of fatigue, 1 moth postpartum are higher i primigravidae tha multigravidae mothers. 12 It has also bee observed that primiparous fathers experiece more axiety ad depressio tha multiparous fathers, 4 to 8 moths postpartum. 13 I this study, o sigificat differece amog ay of the psychosocial factors was foud whe the compariso was doe betwee paret-pairs o the basis of parity. However, whe primiparous mothers were compared with primiparous fathers, it was see that mothers showed sigificatly (p<0.05) higher levels of stress ad depressio. This is i accordace with a previous study which stated that mothers reported higher scores o axiety, depressio ad stress as compared to fathers. This is predisposed to the fact that mothers are more vulerable to emotioal difficulties ad are directly ivolved i all the childcare activities. Not feelig cofidet as a paret, dissatisfactio of oe s relatioship with their child ca be idicators of paretig stress. 33 Whe comparisos were made betwee the mothers based o the type of delivery of the yougest child, is was foud that the levels of icipiet abuse were sigificatly higher for those who uderwet emergecy C-sectio as compared to the oes who uderwet vagial delivery elective C-sectio. Mothers udergoig emergecy c- sectio experiece more metal stress as compared to those udergoig elective C-sectio as well ormal vagial delivery. 14 This may probably be the uderlyig reaso for the same. Studies have show that employed mothers seemed to be less depressed as compared to homemakers. 15 Also they were reportedly less worried ad axious whe their baby was away from them as compared to homemaker mothers. 34 However, o sigificat differeces were observed i our study whe these comparisos were made amog mothers. I Idia, childre i joit families have a strog emotioal attachmet with the family. Their foudatio of skills, attitude ad iterests are laid dow i the family. Amog uclear families, parets give more freedom to their childre ad do t have much ifluece over their decisios ad behaviour. This may act as a factor i differig levels of psychosocial domais amog parets. 17 However, o sigificat differeces were observed i ay of the psychosocial factors whe the paret-pairs were compared o the basis of the family type (uclear/joit). Due to time costraits it was ot feasible to iclude a large sample size. This ca be cosidered as a limitatio to this study. 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