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

Journal List > Korean J Women Health Nurs > v.24(1) > 1094764

Go to TopGo to Top Go to BottomGo to Bottom

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

TOOLS

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.

Go to :

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

References

1. Eryilmaz G, Kilic M. The determination of women's fatigue levels in the third trimester of pregnancy and in the postpartum period. Healthmed. 2011; 5(4):826–830.

2. Nanda Nursing Diagnoses. Nursing diagnoses for fatigue [cited 2015 September 21] Available from:. http://nandanursingdiagnoses.blogspot.kr/2011/11/nursing. -diagnoses-for-fatigue.html.

3. Ansara D, Cohen MM, Gallop R, Kung R, Schei B. Predictors of women's physical health problems after childbirth. Journal of Psychosomatic Obstetrics & Gynecology. 2005; 26(2):115–125. https://doi.org/10.1080/01443610400023064.

4. Declercq ER, Sakala C, Corry MP, Applebaum S, Risher P. Listening to mothers' report of the first national US survey of women's childbearing experiences. New York: Maternity Center Association;2002.

5. Milligan RA, Parks PL, Kitzman H, Lenz ER. Measuring women's fatigue during the postpartum period. Journal of Nursing Management. 1997; 5(1):3–16.

6. Troy NW, Dalgas-Pelish P. The effectiveness of a self-care intervention for the management of postpartum fatigue. Applied Nursing Research. 2003; 16(1):38–45. https://doi.org/10.1053/apnr.2003.50001.

7. Ream E, Richardson A. Fatigue: a concept analysis. International Journal of Nursing Studies. 1996; 33(5):519–529.

8. Ashrafinia F, Mirmohammadali M, Rajabi H, Kajemnejad A, Sadeghniiat K, Amelvalizadeh M. Effect of pilates exercises on postpartum maternal fatigue. Singapore Medical Journal. 2015; 56(3):169–173.

9. Giallo R, Cooklin A, Dunning M, Seymour M. The efficacy of an intervention for the management of postpartum fatigue. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2014; 43(5):598–613. https://doi.org/10.1111/1552–6909.12489.

10. Runquist J. Persevering through postpartum fatigue. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2007; 36(1):28–37. https://doi.org/10.1111/j.1552–6909.2006.00116.x.

11. Leahy-Warren P, McCarthy G. Maternal parental self-efficacy in the postpartum period. Midwifery. 2011; 27(6):802–10. https://doi.org/10.1016/j.midw.2010.07.008.

12. Doering-Runquist JJ, Morin K, Stetzer FC. Severe fatigue and depressive symptoms in lower-income urban postpartum women. Western Journal of Nursing Research. 2009; 31(5):599–612. https://doi.org/10.1177/0193945909333890.

13. Troy NW, Dalgas-Pelish P. Development of a self-care guide for postpartum fatigue. Applied Nursing Research. 1995; 8(2):92–96.

14. Orem DE. Nursing concepts of practice. 4th ed.New York: McGraw Hill;1991.

15. Kwak YH, Lee ML. The effects of education on knowledge and confidence in postpartal self-care and newborn baby care. Korean Journal of Women Health Nursing. 1996; 2(2):246–256.

16. Nazik E, Eryilmaz G. The prevention and reduction of postpartum complications: Orem's model. Nursing Science Quarterly. 2013; 26(4):360–364. https://doi.org/10.1177/0894318413500402.

17. Taylor J, Jonson M. How women manage fatigue after child birth. Midwifery. 2010; 26:367–375. https://doi.org/10.1016/j.midw.2008.07.004.

18. National Institute of Population Research and Training (NI PORT). Bangladesh demographic health survey. [cited 2015 September 21] Available from:. http://dhsprogram.com/pubs/pdf/PR56/PR56.pdf.

19. Varcho MS, Hill PD, Anderson M. Evaluation of the Tiredness Management Guide: a pilot study. Applied Nursing Research. 2012; 25(2):123–8. https://doi.org/10.1016/j.apnr.2010.04.002.

20. Orem DE. Nursing concepts of practice. 6th ed. St. Louis, MO: Mosby;2001.

21. World Health Organization. Ethical challenges in study design and informed consent for health research in resource-poor settings. 2014. [cited 2015 September 21] Available from:. http://whqlibdoc.who.int/publications/2007/9789241563383_eng.pdf.

22. Sperder AD, Devellis RE. Cross-cultural translation. Journal of Cross Cultural Psychology. 1994; 25:501–525.

23. Denyes MJ. Denyes self-care instrument. Detroit, MI: College of Nursing, Wayne state University;1990.

24. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression development of the 10-items Edinburgh Postnatal Depression Scale. The British Journal of Psychiatry. 1987; 150(6):782–786.

25. Gausia K, Fisher C, Algin S, Oosthuizen J. Validation of the Bangla version of the Edinburgh Postnatal Depression Scale for a Bangladeshi sample. Journal of Reproductive and Infant Psychology. 2007; 25(4):308–315. https://doi.org/10.1080/02646830701644896.

26. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand. 2009; 119(5):350–364. https://doi.org/10.1111/j.1600–0447.2009.01363.x.

27. Selim N. Cultural dimensions of depression in Bangladesh: A qualitative study in two villages of Matlab. Journal of Health, Population & Nutrition. 2010; 28(1):95–106.

28. Dennis CL. Can we identify mothers at risk for postpartum depression in the immediate postpartum period using the Edinburgh postnatal depression scale? Journal of Affective Disorders. 2004; 78(2):163–169.

29. Ko Y, Yang C, Chiang LC. Effects of postpartum exercise program on fatigue and depression during "doing-the-month" period. Journal of Nursing Research. 2008; 16(3):177–185.

30. Dunning M, Seymour M, Cooklin A, Giallo R. Wide Awake Parenting: Study protocol for a randomised controlled trial of a parenting program for the management of postpartum fatigue. BMC Public Health. 2013; 13:1.

31. Giallo R, Dunning M, Cooklin A, Seymour M, Graessar H, Zerman N. Acceptability of wide awake parenting: A psychoeducational intervention to manage parental fatigue. Journal of Reproductive and Infant Psychology. 2012; 30(5):450–460.

Go to :

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)

TOOLS

Similar articles