The Relationships among Postpartum Fatigue, Depressive Mood, Self-care Agency, and Self-care Action of First-time Mothers in Bangladesh

Fahima Khatun; Tae Wha Lee; Ela Rani; Gulshanara Biswash; Pronita Raha; Sue Kim

doi:10.4069/kjwhn.2018.24.1.49

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This article has been corrected. See "Corrigendum" in Volume 24 on page 229.

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Khatun, Lee, Rani, Biswash, Raha, and Kim: The Relationships among Postpartum Fatigue, Depressive Mood, Self-care Agency, and Self-care Action of First-time Mothers in Bangladesh

Orginal Article

Korean J Women Health Nurs 2018;24(1):49-57.

Published online: 20 March 2018

DOI: https://doi.org/10.4069/kjwhn.2018.24.1.49

The Relationships among Postpartum Fatigue, Depressive Mood, Self-care Agency, and Self-care Action of First-time Mothers in Bangladesh

Fahima Khatun¹, Tae Wha Lee², Ela Rani³, Gulshanara Biswash⁴, Pronita Raha⁴, Sue Kim^2,

¹College of Nursing, Yonsei University, Seoul, Korea

²College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea

³Nursing Institute, Mitford, Dhaka, Bangladesh

⁴Dhaka Nursing College, Dhaka, Bangladesh

Corresponding author: Kim, Sue College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-3276, Fax: +82-2-392-5440, E-mail: suekim@yuhs.ac

Received 5 December 201720 December 2017 Accepted 21 December 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Postpartum fatigue can impact maternal well-being and has been associated with levels of perceived self-care. This study aimed to examine the relationship among fatigue, depressive mood, self-care agency, and self-care action among postpartum women in Bangladesh.

Methods

A descriptive cross sectional survey was done with 124 first-time mothers from two tertiary hospitals in Dhaka, Bangladesh. The Modified Fatigue Symptoms checklist, Denyes' Self Care Instrument, the Edinburgh Postnatal Depression Scale, and items on sociodemographic and delivery-related characteristics, were used in Bengali via translation and back-translation process.

Results

High fatigue levels were found in 18.5% (n=23) and 73.4% had possible depression (n=91). There was a significant negative relationship between fatigue and self-care agency (r=-.31, p<.001), and self-care action (r=-.21, p<.05). Fatigue differed by level of self-care agency (t=4.06, p<.001), self-care action (t=2.36, p=.023), newborn's APGAR score (t=-2.93, p=.004), parental preparation class participation (F=15.53, p<.001), and postpartum depressive mood (t=-4.64, p<.001).

Conclusion

Findings suggest that high level of self-care efficacy and behaviors can contribute to fatigue management, and highlight the need for practical interventions to better prepare mothers for postpartum self-care, which may, in turn, alleviate postpartum fatigue.

Keywords: Postpartum depression, Fatigue, Postpartum period, Self-care

References

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Table 1.

Differences of Fatigue by Depressive mood, Self-care Agency, Self-care Action, Demographic Characteristics, and Delivery Related Information (N=124)

Variables	Characteristics	Categories	Total	Fatigue
Variables	Characteristics	Categories	n (%) or M±SD	M±SD	t or F (p)
Depressive mood		＜9	33 (26.6)	3.15±2.82	–4.64
		≥9	91 (73.4)	9.57±7.75	(＜.001)
Self-care agency		Low (20%)	25 (20.0)	12.12±8.95	4.06
		High (20%)	25 (20.0)	4.16±4.01	(＜.001)
Self-care action		Low (20%)	26 (20.0)	9.58±8.10	2.36
		High (20%)	28 (20.0)	4.96±6.03	(.023)
Demographic	Age (year)	(Min=18, Max=35)	22.40±3.98
characteristics		＜20	35 (28.2)	7.97±8.12	0.74
		20∼29	80 (64.5)	8.14±7.26	(.481)
		≥30	9 (7.3)	5.00±4.69
	Educational level	≤Primary school	45 (36.3)	9.16±7.43	1.11
		Secondary school	59 (47.6)	7.03±7.84	(.333)
		＞Secondary school	20 (16.1)	7.40±5.39
	Living status	Live with husband	57 (46.0)	7.79±8.45	–0.10
		Live with other members	67 (54.0)	7.93±6.35	(.919)
	Occupation	House wife	112 (90.3)	7.90±7.45	0.18
		Working outside	12 (9.7)	7.50±6.76	(.858)
	Monthly	≤10 (low)	51 (41.1)	6.78±6.78	0.93
	family income	11∼20 (moderate)	59 (47.6)	8.64±7.95	(.397)
	(thousand BDT)	＞20 (high)	14 (11.3)	8.50±6.78
	Living area	Urban	81 (65.3)	7.70±7.90	–0.33
		Rural	43 (34.7)	8.16±6.30	(.742)
Delivery-related	Episiotomy	Yes	94 (75.8)	8.50±7.76	1.72
characteristics		No	30 (24.2)	5.87±5.58	(.088)
	Gestational age (wee	ks) (Min=37, Max=41)	38.22±1.13
	Postpartum status	≤2 days	117 (94.4)	8.04±7.46	1.11
		3∼7 days	7 (5.6)	4.86±4.67	(.268)
	APGAR score	7	68 (54.8)	6.10±5.83	–2.93
	at 5 min	8∼10	56 (45.2)	10.00±8.44	(.004)
	Participation in parenting	None^a 1∼2^b	33 (26.6) 39 (31.5)	13.36±6.58 5.85±6.16	15.53 (＜.001)
	preparation class	＞2^c	52 (41.9)	5.88±6.96	a＞b, c
	Antenatal visits	None	8 (6.5)	6.25±8.31	0.21
		＜4 visits	86 (69.3)	7.92±7.02	(.809)
		≥4 visits	30 (24.2)	8.13±8.23

BDT=Bangladesh Taka (Approximately 78 BDT=1 US dollar).

Table 2.

Differences of Self-care Agency, and Self-care Action by Fatigue, Depressive Mood, Demographic Characteristics, and Delivery-related Information (N=124)

Variables	Characteristics	Categories	Self-care agency		Self-care action
Variables	Characteristics	Categories	M±SD	t or F (p)	M±SD	t or F (p)
Fatigue		None^a	180.50±12.67	4.35	96.80±13.30	2.49
		Moderate^b	177.79±23.27	(.015)	98.05±13.19	(.080)
		High^c	163.96±10.66	c＜b, a	91.57±8.24
Depressive mood		＜9	184.18±16.33	2.81	100.24±12.82	1.88
		≥9	172.27±22.24	(.006)	95.48±12.35	(.063)
Demographic characteristics	Age (year)	＜20^a	168.97±18.92	3.40	92.74±11.92	4.45
	(M±SD=22.40±3.98)	20∼29^b	176.89±22.43	(.037)	97.49±12.77	(.014)
	(Min=18, Max=35)	≥30^c	187.78±13.99	a＜b, c	105.78±7.76	a＜b, c
	Educational level	≤Primary school^a	169.18±23.25	3.22	94.82±13.13	0.82
		Secondary school^b	178.42±20.95	(.043)	97.83±13.34	(.441)
		＞Secondary school^c	180.75±15.18	a＜b, c	97.90±8.47
	Living status	With husband	175.19±17.84	–0.12	96.75±11.72	0.00
		With other members	175.66±24.20	(.905)	96.75±13.39	(.997)
	Occupation	House wife	174.67±21.84	–1.23	96.37±12.68	–1.04
		Working outside	182.67±16.09	(.220)	100.33±11.70	(.302)
	Monthly	≤10 (low)	177.35±20.95	1.22	97.92±12.72	0.82
	family income	11∼20 (moderate)	172.49±20.15	(.297)	95.25±12.89	(.444)
	(thousand BDT)	＞20 (high)	180.93±27.54		98.79±10.93
	Living area	Urban	176.94±20.54	1.07	97.68±12.57	1.13
		Rural	172.63±22.99	(.288)	95.00±12.62	(.262)
Delivery-related	Episiotomy	Yes	175.20±23.29	–0.22	96.20±13.00	–0.86
characteristics		No	176.20±14.43	(.825)	98.47±11.28	(.394)
	Gestational age (weeks)	(M±SD=38.22±1.13, M Min=37, Max=41)
	Postpartum status	≤2 days	175.74±20.09	0.62	97.03±12.20	0.10
		3∼7 days	170.57±39.75	(.538)	92.14±18.68	(.321)
	APGAR score	＜8	179.12±22.61	2.13	98.82±13.51	2.09
	at 5 min	8∼10	170.98±19.16	(.035)	94.23±11.00	(.039)
	Participation in	None^a	162.94±19.30	9.34	90.58±10.48	6.12
	parenting	1∼2^b	177.21±25.74	(＜.001)	97.90±14.40	(.003)
	preparation class	＞2^c	182.06±15.24	a＜b, c	99.81±11.15	a＜b, c
	Antenatal visits	None^a	151.38±32.76	6.04	79.25±17.40	10.41
		＜4 visits^b	176.37±21.18	(.003)	97.09±12.25	(＜.001)
		≥4 visits^c	179.20±14.035	a＜b, c	100.43±7.86	a＜b, c

BDT=Bangladesh Taka (Approximately 78 BDT=1 US dollar).

Table 3.

Correlations among Self-care Agency, Self-care Action, Depressive Mood, and Fatigue (N=124)

Variables	Fatigue	Self-care agency	Self-care action
Variables	r (p)	r (p)	r (p)
Self-care agency	–.31 (＜.001)
Self-care action	–.21 (.018)	.84 (＜.001)
Depressive mood	.57 (＜.001)	–.29 (.001)	–.20 (.023)

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