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

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

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.

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

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
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 Nonea 1∼2b 33 (26.6) 39 (31.5) 13.36±6.58 5.85±6.16 15.53 (<.001)
  preparation class >2c 52 (41.9) 5.88±6.96 ab, 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
M±SD t or F (p) M±SD t or F (p)
Fatigue   Nonea 180.50±12.67 4.35 96.80±13.30 2.49
    Moderateb 177.79±23.27 (.015) 98.05±13.19 (.080)
    Highc 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) <20a 168.97±18.92 3.40 92.74±11.92 4.45
  (M±SD=22.40±3.98) 20∼29b 176.89±22.43 (.037) 97.49±12.77 (.014)
  (Min=18, Max=35) ≥30c 187.78±13.99 a<b, c 105.78±7.76 a<b, c
  Educational level ≤Primary schoola 169.18±23.25 3.22 94.82±13.13 0.82
    Secondary schoolb 178.42±20.95 (.043) 97.83±13.34 (.441)
    >Secondary schoolc 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 Nonea 162.94±19.30 9.34 90.58±10.48 6.12
  parenting 1∼2b 177.21±25.74 (<.001) 97.90±14.40 (.003)
  preparation class >2c 182.06±15.24 a<b, c 99.81±11.15 a<b, c
  Antenatal visits Nonea 151.38±32.76 6.04 79.25±17.40 10.41
    <4 visitsb 176.37±21.18 (.003) 97.09±12.25 (<.001)
    ≥4 visitsc 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
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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