ABSTRACT
BACKGROUND: One life event that requires extensive resilience and adaptation is parenting. However, resilience and perceived support in child-rearing vary, making the real-world situation unclear, even with postpartum checkups. OBJECTIVE: This study aimed to explore the psychosocial status of mothers during the child-rearing period from newborn to toddler, with a classifier based on data on the resilience and adaptation characteristics of mothers with newborns. METHODS: A web-based cross-sectional survey was conducted. Mothers with newborns aged approximately 1 month (newborn cohort) were analyzed to construct an explainable machine learning classifier to stratify parenting-related resilience and adaptation characteristics and identify vulnerable populations. Explainable k-means clustering was used because of its high explanatory power and applicability. The classifier was applied to mothers with infants aged 2 months to 1 year (infant cohort) and mothers with toddlers aged >1 year to 2 years (toddler cohort). Psychosocial status, including depressed mood assessed by the Edinburgh Postnatal Depression Scale (EPDS), bonding assessed by the Postpartum Bonding Questionnaire (PBQ), and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) between the classified groups, was compared. RESULTS: A total of 1559 participants completed the survey. They were split into 3 cohorts, comprising populations of various characteristics, including parenting difficulties and psychosocial measures. The classifier, which stratified participants into 5 groups, was generated from the self-reported scores of resilience and adaptation in the newborn cohort (n=310). The classifier identified that the group with the greatest difficulties in resilience and adaptation to a child's temperament and perceived support had higher incidences of problems with depressed mood (relative prevalence [RP] 5.87, 95% CI 2.77-12.45), bonding (RP 5.38, 95% CI 2.53-11.45), and sleep quality (RP 1.70, 95% CI 1.20-2.40) compared to the group with no difficulties in perceived support. In the infant cohort (n=619) and toddler cohort (n=461), the stratified group with the greatest difficulties had higher incidences of problems with depressed mood (RP 9.05, 95% CI 4.36-18.80 and RP 4.63, 95% CI 2.38-9.02, respectively), bonding (RP 1.63, 95% CI 1.29-2.06 and RP 3.19, 95% CI 2.03-5.01, respectively), and sleep quality (RP 8.09, 95% CI 4.62-16.37 and RP 1.72, 95% CI 1.23-2.42, respectively) compared to the group with no difficulties. CONCLUSIONS: The classifier, based on a combination of resilience and adaptation to the child's temperament and perceived support, was able identify psychosocial vulnerable groups in the newborn cohort, the start-up stage of childcare. Psychosocially vulnerable groups were also identified in qualitatively different infant and toddler cohorts, depending on their classifier. The vulnerable group identified in the infant cohort showed particularly high RP for depressed mood and poor sleep quality.
ABSTRACT
Background: Postpartum mothers may experience psychological stress due to the sudden changes in their bodies and situation. This study investigates the changes in depressive symptoms among nursing mothers and their child-rearing difficulties before and one month after the declared state of emergency due to COVID-19 pandemic in Japan. The study also assesses whether adding the stress induced by the pandemic to parenting difficulties affected women's depressive symptoms. Method: An online survey was conducted with 309 postpartum women. Participants completed questionnaires that included the Quick Inventory of Depressive Symptomatology (QIDS-SR-J), draft version of the Comprehensive Scale for Parenting Resilience and Adaptation (CPRA+α), and original questions about the COVID-19 stress. Results: A factor analysis was performed on CPRA+α, which found five main factors: difficulty in coping with child and oneself, dissatisfaction with husband, distrust in parents, being tired of the child, and distrust in physician. As a result of t-test of these five factors and the QIDS revealed that there was a significant difference in depressive symptoms before and after the COVID-19 outbreak. In addition to these five factors, the COVID-19 stress of impact on income and employment increased depressive symptoms, while the stress of refraining from going out decreased depressive symptoms. Limitation: Differences in the characteristics of children and mothers were not considered in the study. Longitudinal studies focusing on the period after the declaration of a state of emergency in 2020 are considered necessary. Conclusion: Childcare difficulties and the COVID-19 pandemic induced stress are associated with postpartum women's depressive symptoms.
ABSTRACT
BACKGROUND: Adapting to child-rearing is affected by multiple factors, including environmental and individual factors. Previous studies have reported the effect of a single factor on childcare maladjustment; however, to prevent maladaptation in and to support child-rearing, a comprehensive evaluation of factors is necessary. Therefore, this study developed a comprehensive assessment tool for childcare adaptation. METHODS: We conducted semi-structured interviews with specialists whose jobs entailed supporting parents. Items were extracted from the interview data and used to develop a new questionnaire. Mothers with a child aged 0-3 years completed the Quick Inventory of Depressive Symptomatology as a depression index. We performed both factor and correlation analyses on the collected, data and multiple regression analyses to determine which factors predict depressive tendencies leading to childcare maladaptation. Subsequently, an assessment algorithm model was built. RESULTS: 1,031 mothers responded to the questionnaire which had 118 items in five domains. A factor analysis was performed on each domain to develop the Comprehensive Scale for Parenting Resilience and Adaptation (CPRA). The CPRA comprised 21 factors and 81 items in five subcategories: Child's Temperament and Health (1 factor, 5 items); Environmental Resources (5 factors, 20 items), Perceived Support (4 factors, 15 items); Mother's Cognitive and Behavioural Characteristics (6 factors, 22 items), and Psychological Adaptation to Parenting (5 factors, 19 items). Correlations between all factors and depressive symptoms were identified. Depressive symptoms were predicted by factors from four subcategories: Environmental Resources, Perceived Support, Mother's Cognitive and Behavioural Characteristics, and Psychological Adaptation to Parenting. A comprehensive model of mothers' psychological adjustment was developed using the CPRA's domain structure. CONCLUSIONS: The CPRA enables researchers to understand the strengths and weaknesses of mothers. Mother's maladaptive states can potentially be predicted by understanding the interactions between these multiple factors. The developed model can provide the necessary support to mothers and increase mothers'-and others'-awareness of the support that can prevent childcare maladjustment.
