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Aim: We evaluated the effectiveness of a nursing intervention program for Chinese women who are giving birth in Japan to reduce cross‐cultural stressors during the postpartum period and prevent postpartum depressive symptoms. Methods: A prospective, before‐and‐after study incorporating a longitudinal mixed‐method design was conducted. Thirty‐eight participants underwent this program from August 2016 to July 2017. The program comprised a maternity class, conversation cards, and a social‐network group. Data collection was initially performed using questionnaires administered in the third trimester (T1)—before the intervention—to obtain participants' basic information, stress levels, depressive symptoms, and cognitive appraisals. Then, stress levels, depressive symptoms, and social support were measured during hospitalization after having given birth (T2) and during the first month postpartum (T3). Finally, through semi‐structured interviews, cognitive appraisal, coping, stress, social support, participants' evaluations of the intervention were determined. Results: Post‐intervention, all participants showed positive cognitive appraisals, although eight also showed some negative appraisals. At T3, 36 participants did not report experiencing stress owing to cross‐cultural stressors. Furthermore, post‐intervention, participants who returned scores that were suggestive of depression remained identical to that at pre‐intervention (21.1%). Among the eight participants who showed postpartum depressive symptoms during T3, seven did not report experiencing cross‐cultural stressors, but did report encountering maternity stressors. Conclusion: The nursing intervention program may be effective for preventing postpartum depressive symptoms in Chinese women who give birth in Japan. Since this was a pre‐post study in which one group was measured pre‐intervention and again post‐intervention, we did not register in a publicly assessible database. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To describe changes in prevalence of shoulder stiffness, back pain, and wrist pain during the first 6 months postpartum, and to examine the association of these symptoms with maternal age and parity. Methods: Participants were recruited from 13 Japanese hospitals between 2012 and 2013. A total of 2709 (response rate 71.9%) women provided longitudinal data, using self‐report questionnaires at 5 time points: during their hospital stay, and at 1, 2, 4, and 6 months postpartum. Shoulder stiffness, back pain, and wrist pain were measured, using checklists with yes‐no responses. The effects of age and parity were assessed in 4 groups of younger (<35 years) and older (≥35 years) mothers: 983 younger primiparas, 481 older primiparas, 649 younger multiparas, and 596 older multiparas. Chi‐square tests and Cochran's Q tests were used to assess effects of group and time. Results: Prevalence of shoulder stiffness, back pain, and wrist pain during the hospital stay significantly increased up to 1 month postpartum for older primiparas, who were also the most vulnerable to back pain and wrist pain at 1 month postpartum. Conclusion: Special attention should be given to older primiparas in assessing and providing nursing care for physical symptoms, especially during the first month postpartum. [ABSTRACT FROM AUTHOR]

Aim This cross-sectional and longitudinal study explored primiparous mothers' functioning and parenting stress on the basis of infant-feeding method over the first 6 months postpartum. Methods Participants were Japanese primiparae who delivered live singleton infants (N = 1120). Questionnaires, completed at 1, 2, 4, and 6 months postpartum, included demographics, feeding method, frequency of feedings, time required from infant's feeding to falling asleep, mother's sleep time, Postnatal Accumulated Fatigue Scale, and the original Japanese version of Parenting Stress Short-Form Scale. Chi-square tests and Welch F tests for one-way analysis of variance were conducted. Results Exclusively breastfeeding mothers fed their infants more frequently, but required less time from infant's feeding to falling asleep than either mixed or formula-feeding mothers. Mixed feeding mothers required more time for infant feeding and reported more severe fatigue and greater parenting stress than breastfeeding mothers at 1 and 2 months postpartum. Exclusively formula-feeding mothers required more time to get their infant back to sleep and reported greater parenting stress than the other groups at 6 months postpartum. Nearly 25% of mothers continued breastfeeding exclusively through the first 6 months postpartum. Mothers often changed feeding methods, with many exclusively breastfeeding by 6 months. Conclusion Feeding methods may affect maternal functioning and parenting stress across the postpartum period. [ABSTRACT FROM AUTHOR]

Aim To examine the relationship between physical symptoms and depressive symptoms among new mothers during the first 6 months postpartum. Methods Prospective cohort study design was used in this study. Participants were recruited in 13 Japanese hospitals between 2012 and 2013. A total of 2709 women (response rate of those invited 71.9%) provided longitudinal data using self-report questionnaires at 5 time points: during the hospital stay and at 1, 2, 4, and 6 months postpartum. Depressive symptoms were measured using the Japanese version of the Edinburgh Postnatal Depression Scale. Also, 37 physical symptoms were measured using a yes-or-no checklist. To examine the association between physical symptoms and depressive symptoms, logistic regression analysis was used. Results There was a significant positive association between physical symptoms and depressive symptoms during the first 6 months postpartum. Fifteen physical symptoms were associated with significantly increased odds of depression at 1, 2, 4, and 6 months post-partum. These symptoms included: loss of appetite, tiredness/languor, and palpitation/shortness of breath. Conclusion Multiple physical symptoms after childbirth were associated with depressive symptomatology. Health professionals should assess for postpartum depression when puerperal women report multiple physical symptoms as independent complaints. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess fatigue, depressive symptoms, and maternal confidence or satisfaction among older primiparae during the first month postpartum. The number of older Japanese primiparae has rapidly increased. Older primiparae are believed to be at high risk for puerperal morbidity. A multicentre prospective cohort study design was used. Data were examined from 2854 Japanese women who participated in a 6-month prospective cohort study conducted between May 2012 and September 2013. The women were classified into 4 groups based on maternal age and parity. All participants completed the Postnatal Accumulated Fatigue Scale, Japanese Edinburgh Postnatal Depression Scale, Postpartum Maternal Confidence Scale, and Postpartum Maternal Satisfaction Scale. Primiparae in all age groups were more severely fatigued and had a higher risk of postpartum depression than multiparous mothers during the first month postpartum. Older primiparae had significantly lower scores on maternal confidence and maternal satisfaction than the other 3 groups at 1 month postpartum. These findings suggest that postpartum nursing should focus on promoting adequate sleep, providing emotional support, and fostering the process of maternal role adaptation among older Japanese primiparae, particularly during the first postpartum month. [ABSTRACT FROM AUTHOR]

Aim: To compare the factors that affect maternal confidence at 1 month post‐partum between older (≥35 years old) and younger (20–34 years old) primiparous Japanese mothers. Methods: A multicenter prospective study of mothers who gave birth to live singleton infants in Japan was conducted. Following ethics approval, the participants completed questionnaires 1 day before discharge and 1 month after childbirth. The questionnaires included the Postpartum Maternal Confidence Scale, demographics and background information, prenatal and obstetric data, situational variables and perceptions of daily life, and social support. The obstetric data were extracted from the hospital medical records. Data from the older primiparae (n = 479) and the younger primiparae (n = 1033) were analyzed by using multiple stepwise regressions, controlling for the delivery mode. Results: Maternal confidence at 1 month post‐partum was positively associated with emotional support for the older primiparae and appraisal support and exclusive breastfeeding for younger primiparae. In both groups, feeling overwhelmed by daily life, a lack of communication with their partner about the parenting role, and a lack of prior experience in caring for babies were negatively related to maternal confidence. Family budget instability was negatively related to maternal confidence in the younger group. Conclusion: Providing care that is based on an understanding of the unique support needs of first‐time mothers in different age groups could promote more effective parenting. [ABSTRACT FROM AUTHOR]

This study examined the psychometric properties of a 13-item fatigue scale for postpartum mothers. Japanese mothers ( n = 2026) from a cohort study completed questionnaires (e.g. fatigue scale, Japanese version of the Edinburgh Postnatal Depression Scale, demographics) during their hospital stay after childbirth (baseline) and at 1, 2, 4 and 6 months postpartum. Initial factor analysis of baseline data revealed that the fatigue scale had three factors or subscales (physical, emotional and cognitive). Within-group analysis across each measurement time revealed the same three-factor structure with acceptable fit. Between-group analysis also showed longitudinal factorial invariance across time. The fatigue subscales had acceptable divergent and convergent validities with the depression scale. The subscale scores differed significantly based on participant background. The Japanese Fatigue Scale is a concise and informative tool for assessing aspects of fatigue in clinical settings and in the community. [ABSTRACT FROM AUTHOR]

Aim: Post‐partum fatigue is a serious concern for mothers worldwide. The aim of this study was to identify age‐specific determinants of self‐perceived fatigue after childbirth among Japanese primiparous women. Methods: A multicenter prospective cohort study was conducted in Japan. The degree of fatigue was assessed using the Postnatal Accumulated Fatigue Scale during the hospital stay after childbirth. Associated factors were stratified into two age groups (<35 or ≥35 years old); data were analyzed using stepwise multiple regression. Results: In the younger group, significant determinants of post‐partum fatigue included: anticipated difficulties in child‐rearing after discharge; perception of inadequate sleep conditions; dissatisfaction with childbirth; shorter sleep and meal times; longer duration between feeding and infant bedtime; unemployment; and having hyperemesis gravidarum. In the older group, significant determinants of post‐partum fatigue included: anticipated difficulties in child‐rearing after discharge; perception of inadequate sleep conditions; shorter meal times; formula feeding; and dissatisfaction with childbirth. Conclusion: Primiparous mothers who anticipated new life with their infants to be difficult and who had an irregular lifestyle tended to report higher levels of fatigue during the post‐partum hospital stay. Nurses and midwives should assess maternal sleep and eating conditions, providing support to ensure adequate maternal rest. Special efforts should be made to reduce anxiety about new life with infants among younger primiparous women who had experienced hyperemesis gravidarum. [ABSTRACT FROM AUTHOR]

Aim: Older maternal age has become more common in Japan. Studies suggest that older maternal age and primiparity are associated with post‐partum depression. The present study aimed to identify predictors of post‐partum depression in older Japanese primiparas at 1 month post‐partum. Methods: Participants were 479 primiparas aged 35 years and over, drawn from a prospective cohort study. Data were collected using self‐report questionnaires. Depression was measured with the Japanese version of the Edinburgh Postnatal Depression Scale. Stepwise logistic regression analysis was conducted on binary outcome variables of depression at 1 month post‐partum, along with a stratified analysis based on the risk status of depression. Results: Five predictors were identified: (i) the depression score during hospital stay; (ii) financial burden; (iii) dissatisfaction with appraisal support; (iv) physical burden in daily life; and (v) concerns about infant caretaking. Stratified analysis identified dissatisfaction with instrumental support in the low‐risk group, and the Child‐care Value Scale score as unique predictors in the high‐risk group. Conclusion: These results highlight the importance of early assessment of depressive symptoms and the provision of continuous care. [ABSTRACT FROM AUTHOR]

Aim: The number of older primiparas is increasing in Japan. These women have been shown to be more vulnerable to post‐partum depression. This study aimed to identify factors for predicting post‐partum depressive symptoms during hospitalization after childbirth in Japanese primiparas aged 35 years and over. Methods: The present authors used the data of 479 primiparas aged 35 years and over from a prospective cohort study. Data were collected using self‐report questionnaires on the day before hospital discharge. The questionnaire consisted of: demographics and background information; depressive symptoms; fatigue; maternal confidence and maternal satisfaction; child‐care values; physical symptoms; perceptions of daily life during hospitalization; concerns about child care and daily life; and infant feeding. Additionally, vital records data were obtained from the hospitals. A stepwise logistic regression analysis was performed on the binary outcome variable of depressive symptoms, measured by the Japanese version of the Edinburgh Postnatal Depression Scale. Women who scored 9 or more were considered to be at high risk for post‐partum depression. The authors obtained informed consent from all participants and institutional ethics approvals before initiating the study. Results: The following six variables reliably predicted the risk of post‐partum depression: emergency cesarean section, lower satisfaction with birth experience, higher physical burden in daily life, long‐term complications with the newborn, more concerns about newborn caretaking after discharge, and more concerns about one's own life after discharge. Conclusion: Recognition of women with these factors will help nurses to identify those at risk for developing post‐partum depression and to provide appropriate care during hospitalization after childbirth. [ABSTRACT FROM AUTHOR]

This cohort study of primiparae was conducted to answer the following questions: Do older (≧ 35 years) and younger (20-29 years) Japanese primiparous mothers differ when comparing biomarkers of stress and measures of fatigue and depression? Are there changes in fatigue, depression and stress biomarkers when comparing older and younger mothers during the postpartum period? The Postnatal Accumulated Fatigue Scale and the Edinburgh Postnatal Depression Scale were administered in a time-series method four times: shortly after birth and monthly afterwards. Assays to measure biomarkers of stress, urinary 17-ketosteroids, urinary 17-hydroxycorticosteroids and salivary chromogranin-A, were collected shortly after delivery and at 1 month postpartum in both groups and a third time in older mothers at the 4th month. Statistical testing showed very little difference in fatigue, depression or stress biomarkers between older and younger mothers shortly after birth or 1 month later. Accumulated fatigue and depression scores of older mothers were highest 1 month after delivery. Additional cohort studies are required to characterize physical/psychological well-being of older Japanese primiparae. [ABSTRACT FROM AUTHOR]

This longitudinal study was designed to examine objective sleep parameters of older primiparous Japanese women during the first 4 months postpartum using actigraphy. The participants were 18 older primiparae (Mean (SD) = 37.06 (2.62) years, range 35-44 years) who gave birth to healthy neonates at one of three urban Japanese hospitals. Objective sleep quality was measured using actigraphy for 48 h at 1, 2 and 4 months postpartum. The Friedman test was used to test for differences in sleep parameters across time. Sleep duration (SMIN) increased significantly from 2 months (Mean (M) = 301.94 min) to 4 months (M = 372.78 min). Sleep efficiency (SE) increased significantly from 1 month (73.52%) to 2 (86.66%) and 4 months (89.05%). Waking after sleep onset (WASO) decreased significantly from 1 month (M = 114.64 min) to 2 (M = 40.18 min) and 4 months (M = 38.36 min) and long waking episodes (LWEP) significantly decreased from 1 month (4.67) to 2 (2.69) and 4 months (3.12). Persistent postpartum sleep problems can be a sign of postpartum depression as well as health problems among infants. [ABSTRACT FROM AUTHOR]

Background: Depressive symptoms are common in postpartum women. The present study aimed to describe changes in the prevalence of depressive symptoms during the first 6 months postpartum, and their association with maternal age and parity.Methods: A prospective cohort study was conducted with 3769 women at 13 hospitals in Japan. Depressive symptoms were measured during hospital stay and at 1, 2, 4, and 6 months postpartum, using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS). The effects of maternal age and parity were assessed by comparing four groups: younger primiparas (aged <35 years); older primiparas (≥35 years); younger multiparas (<35 years); and older multiparas (≥35 years). Data were analyzed using a mixed between/within-subjects analysis of variance, Cochran's Q tests, and chi-square tests.Results: Mean EPDS scores significantly decreased from 1 to 2 months postpartum in all groups. The proportion of women with EPDS scores ≥9 significantly decreased during the same period for primiparas but not for multiparas. Primiparas also had significantly higher EPDS scores than multiparas during hospital stay and at 1 month postpartum.Limitations: As we used convenience sampling, our study sample was not fully representative of Japanese mothers. This study was also limited by our focus on the postpartum period.Conclusions: The first month postpartum represented peak prevalence for depressive symptoms. Primiparity was a risk factor for depressive symptoms only during the first month postpartum. Healthcare professionals should be sensitive to postpartum duration and parity when monitoring depressive symptoms. [ABSTRACT FROM AUTHOR]