Factores asociados a la percepción de eficacia materna durante el posparto / Factors associated to maternal perceptions of efficacy in the postpartum

ABSTRACT

The objective was to study maternal efficacy at two moments during the postpartum at 6 weeks, and at between 4 and 6 months after delivery and its relationship with various socio-demographic and psychological factors in Mexican postpartum women. Maternal self-efficacy (MSE) is a concept that alludes to the mother's ability to perform her maternal role. It is defined as the judgment that the mother formulates concerning her own competence and the effectiveness with which she copes with the demands and needs of the infant. Some studies show that mothers who perceive themselves as possessing high self-efficacy exhibit more effective behaviors, as well as a greater ability to adapt and a capacity to respond and interpret the needs of the infant, as well as to encourage and stimulate him or her. Some of the factors that influence the perception of self-efficacy are social support, especially when provided by significant others, and when the support networks reinforce the belief that the task is being carried out adequately. Educational attainment and living with a partner ad similarly. On the other hand, variables that have a negative effect include depression and high stress levels. In one way or another, MSE affects child rearing practices those who perceive themselves to be effective are more involved in the activities of their children, in their cognitive stimulation at home during the pre-school period. Thus, MSE during the postpartum period exerts an influence on the mother-child relationship and the development of the latter, with long-term consequences. In short, the study of the perception of maternal self-efficacy is not only of theoretical interest, but also, knowledge of the manner in which it takes place and the factors that act upon it opens up the possibility of influencing the MSE, improving the maternal role and the infants'well-being. In Mexico, we were unable to find published data on this subject, which is why it is particularly important to study it. Materials and methods Participants. The study is a secondary data analyses from a research directed toward evaluating a psycho-educational intervention during pregnancy. The sample included women attending prenatal care at three health care institutions in Mexico City. Participants were interviewed at 6 weeks (n= 149) and at between 4-6 months postpartum (n = 156). Inclusion criteria were being >18 years of age, not being <26 weeks pregnant, having completed primary school and having depressive symptomatology and/or a prior history of depression. Exclusion criteria were presenting bipolar disorder or substance abuse. The sample was taken as a sole group, independent of whether the participants had taken part in intervention (eight psycho-educational group sessions oriented toward preventing postpartum depression)or control conditions (treatment as usual provided by the institution), because no differences were found between these groups in terms of relevant variables (e.g. symptoms of depression). Instruments. These included measurements in the following areas 1. socio-demographic information; 2. the Maternal Self-Efficacy Questionnaire; 3. the Beck Depression Inventory second edition (BDI-II); 4. Social Support Rate Scale (SSRS) and the Family Adaptation, Partnership, Growth, Affection, and Resolve (Family APGAR); 5. Anxiety scale, the Hopkins Symptoms Check List-90 (HSCL-90); 6. the Coopersmith Self-Esteem Inventory, and 7. stressing events, with a 12 item scale. Procedure. After selection of participants based on inclusion criteria, these were assigned randomly to either the control or the intervention group. After delivery, the aforementioned instruments were applied to participants by means of an interview at the two moments of the postpartum period. Two logistic regression analyses were conducted (one for each postnatal point) to evaluate the relationship between socio-demographic (age, schooling, civil status, number of pregnancies) and psychological (symptoms of depression and anxiety, self-esteem, stressing events, social support) variables on MSE. Additionally, pertaining to the intervention and control condition was introduced in the analyzes in order to control for the possible effect of participation in the intervention. Results With respect to sample characteristics, there was a similar number of women <26 (47.3%) than women aged >26 years (52.7%); the majority had > 1 0 years of schooling (66.7%), had a partner (married or cohabitating) (86%), and had less than one pregnancy (62.7%). Logistic regression analyzes for 6 weeks postpartum showed that not having a partner (Odds ratio [OR] = 1.98), postpartum depressive symptomatology (OR = 2.39), stressful events (OR = 2.18), and belonging to the control group (OR=4.37) were related to a low maternal self-efficacy; for the period of 4-6 months postpartum, not having a partner (OR = 2.97), less schooling (OR = 2.18), and postpartum depressive symptomatology (OR=3.97) were associated with the variable under study. Discussion Postnatal depressive symptomatology and not having a partner predicted low perception of maternal self-efficacy at 6 weeks and at 4-6 months postpartum, which indicates that its effect is more chronic. The repercussion of depression can be explained by the reduction of the sensation of maternal capacity that it produces, while not having a partner, which is one of the most important supports for the adaptation of the women to maternity, renders maternal performance difficult. The presence of stressful events at 6 postnatal weeks also hampers the perception of self-efficacy in the care of the infant, which is explicable because of the great demands to which the mother is submitted due to the baby's young age during this period. For its part, limited schooling exerted adverse effects 4-6 months after delivery. It has been documented that this variable is closely associated with mental health in general; it reduces the resources for coping with stress and deteriorates self-esteem. Finally, being part of the control group, that is, not having participated in the psycho-educational intervention, negatively influenced maternal self-efficacy, but had no effect at 4-6 months postpartum. This result that shows that in a first instance participating in a certain condition affected the dependent variable plus the fact that the selection criterion for the main study was that they all scored in depressive symptoms restricts the generalization of these findings. The implications of these findings are that perception of maternal self-efficacy could be improved through specific programs directed toward women displaying limited educational attainment, lack of a partner, postpartum depressive symptoms, and stressing events. The benefit would not only translate into a more positive feeling of the mother with respect to her abilities, but also, theoretically, into a better performance of her maternal role, and consequently, into the well-being and development of their infants.

RESUMEN

El objetivo es estudiar la percepción de la eficacia materna (PEM) en el posparto y su relación con diversas variables sociodemográficas y psicológicas. La PEM se define como el juicio que la madre formula sobre su propia competencia y efectividad para enfrentar las demandas y necesidades del infante. Conocerla facilita la comprensión de su actitud y sus respuestas frente a los requerimientos de los hijos. Evaluar los factores que la afectan abre la posibilidad de influir sobre la misma para mejorar el desempeño materno y, por ende, el bienestar de los infantes. Método Participantes. El estudio es un análisis secundario de datos de una investigación dirigida a evaluar una intervención psicoeducativa durante el embarazo. La muestra incluyó a mujeres que asistían a atención prenatal en tres instituciones de salud de la Ciudad de México. Fueron entrevistadas a las seis semanas (N = 149) y entre los cuatro y seis meses posparto (N = 156). Un criterio de inclusión fue presentar síntomas de depresión. La muestra se tomó como un solo grupo independiente- mente de que las participantes hubieran tomado parte en la condición de intervención (ocho sesiones psicoeducativas orientadas a prevenir la depresión posparto) o control (tratamiento regular de la institución), por no encontrarse diferencias entre las mismas en las variables relevantes (por ejemplo, síntomas de depresión). Instrumentos. Se incluyeron las siguientes áreas 1. Información sociodemográfica, 2. Cuestionario de Eficacia Materna [Maternal Efficacy Questionnarié), 3. Inventario de Depresión de Beck (IDB-II), 4. Apoyo social [Social Support Apgar), 5. Escala de Ansiedad [Hopkins Symptoms Check Lisf-90¡, 6. Inventario de Autoestima (Coopersmith) y 7. Sucesos estresantes. Se condujeron dos análisis de regresión logística (uno para cada punto de medición posnatal) para evaluar la relación de las variables sociodemográficas (edad, escolaridad, estado civil, número de embarazo) y psicológicas (síntomas de depresión y ansiedad, autoestima, sucesos estresantes, apoyo social) sobre la percepción de eficacia materna. Adicionalmente, la pertenencia al grupo de intervención o control se introdujo en los análisis para evaluar el posible su efecto sobre la variable dependiente. Resultados A las seis semanas posparto dicho análisis mostró que no tener pareja y presentar sintomatología depresiva y sucesos estresantes, así como pertenecer al grupo control, se relacionaron con baja percepción de eficacia materna. En el periodo de cuatro a seis meses posparto, no tener pareja, una menor escolaridad y sintomatología depresiva fueron las que se relacionaron con dicha variable. Discusión La sintomatología depresiva posparto y no tener pareja predijeron baja percepción de eficacia materna en ambos momentos en que se midieron, lo que indica que su efecto es más crónico. Los síntomas de depresión influyen en la sensación de capacidad de la madre, mientras que, al ser la pareja uno de los apoyos más importantes en este momento, su ausencia dificulta su desempeño, al recaer sobre ella todas las responsabilidades. Los sucesos estresantes a las seis semanas posnatales también dificultan la percepción de eficacia ya que se conjuntan con las grandes demandas a las que la madre está sometida por la corta edad del bebé. Pertenecer al grupo de intervención y control sí tuvo un efecto sobre la eficacia a las seis semanas pertenecer al segundo tuvo uno menos favorable sobre la variable en estudio. Este resultado, ¡unto con el hecho de que la muestra del estudio primario tenía como requisito para su conformación que las mujeres presentaran síntomas de depresión, restringe la generalización de los mismos. Una de las implicaciones de estos datos es que la percepción de eficacia materna podría mejorarse con programas dirigidos a mujeres que presenten baja escolaridad, que no tengan pareja y padezcan síntomas de depresión posnatales o sucesos estresantes.