Effects of Resilience and Optimism in Maternal Role Attainment after Six to Twelve Months Postpartum in Women Hospitalized for Pregnancy Complications

Marianne Allen

doi:10.17918/etd-7546

Background: Each year in the US, approximately 1,200,000 pregnant women are hospitalized on bed rest with the intent to improve pregnancy outcomes. However, postpartum bed rest is not benign and may contribute to physical debilitation, postpartum depression (PPD), impaired maternal role attainment (MRA), and altered maternal-infant attachment. There are gaps in the literature about the effects of resilience, optimism, and PPD on MRA and the effects of resilience and optimism on PPD at six to 12 months postpartum. Although the effects of resilience and optimism have been studied in general adult populations, few studies have considered resilience and optimism as protectors that support MRA and reduce the risk of PPD. Methods: The theoretical framework was Maternal Role Attainment (Rubin). The purpose of this cross-sectional comparative survey design study was to examine differences in resilience, optimism, PPD, and MRA, the effects of resilience, optimism, and PPD on MRA at six to 12 months postpartum and the effects of resilience and optimism on PPD for mothers with (high-risk) and without hospitalization (low-risk) due to pregnancy complications. The hypotheses were: 1) Low-risk women will have higher resilience scores than high-risk women; 2) Low-risk women will have higher optimism scores than high-risk women; 3) Low-risk women will have lower PPD scores than high-risk women; 4) Low-risk women will have higher MRA scores than high-risk women; 5) Higher levels of resilience will predict lower scores on the MRA scale, controlling for risk status; 6) Higher levels of optimism will predict lower scores on the MRA scale, controlling for risk status; 7) Higher levels of depression will predict higher scores on the MRA scale, controlling for risk status; 8) Higher levels of resilience will predict lower scores on the PPD scale, controlling for risk status; 9) Higher levels of optimism will predict lower scores on the PPD scale, controlling for risk status. A convenience sample of 10 high-risk mothers hospitalized for at least five days during pregnancy and 24 low-risk mothers at six to 12 months postpartum participated in the study. Data collection was accomplished through self-report questionnaires: Being a Mother Scale (MRA); Life Orientation Test-Revised (optimism); Conner-Davidson Resilience Scale (resilience); Edinburgh Postnatal Depression Scale (PPD); and a Demographic Questionnaire (participant demographics). The investigator and the participants met in person or by phone to complete the questionnaires. Data analysis was comprised of descriptive statistics and inferential statistics including Student's t tests and multiple linear regression models to test the hypotheses. Bivariate correlations were run on all continuous variables and crosstabs on categorical variables to check for significant relationships and differences between the groups. Written perceptions of difficult feelings about being a mother were reported by description and themes. Results: This study found no statistical differences between the high-risk and the low-risk mothers at six to twelve months postpartum on resilience, optimism, PPD and MRA. Bivariate correlations found significant relationships between resilience and MRA for all mothers (r = -0.59, p = 0.001), low-risk mothers (r = -0.58, p = 0.003), and high-risk mothers (r = -0.63, p = 0.049), and between optimism and MRA for the low-risk mothers (r = -0.47, p = 0.025). There was no statistically significant correlation between optimism and MRA for the high-risk mothers (r = -0.40, p = 0.23). Low PPD and high MRA were statistically correlated for all mothers (r = 0.79, p <0.000); low-risk mothers (r = 0.81, p <0.000); and high-risk mothers (r = 0.74, p = 0.014). Partner involvement was significantly correlated with PPD ([chi]2 =9.55, p = 0.002). Multiple linear regressions showed that resilience ([beta] = -0.60, p <0.001), optimism ([beta] = -0.76, p = 0.002), and PPD ([beta] = 1.13, p <0.001) predicted MRA and resilience ([beta] = -0.56, p = <0.001) and optimism ([beta] = -0.71, p = 0.001) predicted PPD. In this study, the covariates of income, parity, and age did not meet the criteria for confounding. The sample was not sufficiently powered to detect differences between groups. In order to determine differences between the groups on means of optimism, resilience, MRA and PPD using the Student's t-test, alpha 0.05, and medium effect size, the sample size needed was 64 participants in each group, for a total of 128 participants. Due to the underpowered sample size, statements of association rather than causation were made. The qualitative findings suggest that the experiences that have challenged their becoming mothers for both groups included MRA, managing multiple priorities, support, and mental well-being. Clinical implications: This study may inform interventions to support MRA, reduce the risks of postpartum depression, and enhance partner support. Interdisciplinary interventions to support mothers during pregnancy and the first postpartum year should address facilitation of optimism and resilience to promote MRA and reduce PPD. The examination of the coping strategies of women during pregnancy through screening using resilience and optimism surveys can identify women who may benefit from interventions including education and behavioral health referrals to help develop coping skills to facilitate adaptation during stressful live events and to manage stressors during pregnancy and the postpartum period. Establishment of nurse-directed warm lines for provision of information and support for the first postpartum year may help to fill the gaps of access to accurate information and support. The expansion of nurse-facilitated new mother groups to other geographic areas including the city where public transportation is available and offering the groups in the predominant language of the community, with a facilitator who is culturally sensitive to participant needs may improve support. Strategies to enhance partner support may include providing anticipatory guidance to the couple the first postpartum year and engagement of the partner in the care of both mother and baby facilitate the transition to providing a supportive environment at home. In addition, providing information about PPD and referral sources to both the mother and her partner may facilitate the mother's receiving treatment or couples counseling if indicated. Recommendations for future research include the protective factors of resilience and optimism for both the low-risk and high-risk mothers with samples that are sufficiently powered to replicate these findings. In addition, future studies that attempt to engage a more financially, racial, and ethnically diverse sample may improve the ability to generalize the findings to other populations. Repeating the study at different times such as six to 12 weeks postpartum and three months to six months postpartum may better capture the differences between the low-risk and high-risk mothers the processes of MRA and the occurrence of PPD. The addition of more substantive qualitative questions are needed to unearth effects of resilience and optimism on MRA at six to 12 months after delivery for women having hospitalizations with activity restrictions for complications during pregnancy compared to women who did not have complications of pregnancy that required hospitalization. The effect of partner involvement and support on MRA and PPD warrants investigation.

Effects of Resilience and Optimism in Maternal Role Attainment after Six to Twelve Months Postpartum in Women Hospitalized for Pregnancy Complications

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Effects of Resilience and Optimism in Maternal Role Attainment after Six to Twelve Months Postpartum in Women Hospitalized for Pregnancy Complications

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