The aim of this study is to assess the depression of pregnant women in the aftermath of an earthquake, and to identify the social support that they obtained, their coping styles and socio-demographic factors associated with depression.
Immediately after the earthquake, the incidence rate of depression in pregnant women was 35.2%, higher than that of the general pregnant population (7%-14%). The EPDS scores were significantly correlated with gestation age at the time of the earthquake, objective support, subjective support, use of support, negative coping style, and positive coping style. The regression analysis indicated that risk factors of prenatal depression include the number of children, relatives wounded, subjective support, and coping styles. A further analysis of the interaction between social support and two types of coping styles with depression showed that there was interaction effect between subjective social support and positive coping styles in relation to EPDS scores. There was an inverse relationship between low EPDS scores and positive coping styles and high social support, and vice versa.
coping styles questionnaire csq-3 pdf 76
The timing of the occurrence of the earthquake may not necessarily affect the progress of the illness and recovery from depression, and psychological intervention could be conducted in the immediate aftermath after the earthquake. The impact of coping styles on prenatal depression appeared to be linked with social support. Helping pregnant women to adopt positive coping styles with good social support after a recent major earthquake, which is a stressor, may reduce their chances of developing prenatal depression.
The mean EPDS score was 11.255.71. The mean scores for the objective, subjective, and support usage subscale were 8.482.79, 24.734.54, and 8.052.0, respectively. The mean scores for negative and positive coping styles were 24.697.23, 34.598.20, respectively.
EPDS scores were significantly correlated with gestation age at the time of the earthquake, with three dimensions of social support, and with two dimensions of coping styles (Table 4). Higher EPDS scores were significantly related with exposure to the earthquake later in pregnancy (r = 0.181, p
Although EPDS scores were significantly and inversely correlated with three dimensions of social support, and with two dimensions of coping styles, the correlation coefficients between them were moderate, with the value of r ranging from -0.32 to -0.42 (Table 4).
In order to determine whether demographic factors, social support, and coping styles were significantly associated with prenatal depression immediately after a major earthquake, a multivariate linear regression analysis was further conducted against the EPDS scores. Since the number of dead relatives was less than 5, this variable was excluded. The results are shown in Table 5. The stepwise regression screened out five variables that could be put into the regression model. The five variables included number of children (β = 2.189), relatives wounded (β = 3.466), subjective support (β = -0.312), negative coping styles (β = 0.218), and positive coping styles (β = -0.134).
A correlation analysis (Table 4) showed that social support, coping styles, and EPDS scores were significantly correlated with each other. Although the multiple linear regression analysis found that not all types of social support could predict the variance of EPDS scores after the earthquake (Table 5), it is reasonable to investigate possible interactions between social support and coping styles on depression. In this connection, an interaction analysis was conducted. Since objective social support and support use were excluded from the regression model (Table 5), only subjective social support, which was an associated factor for depression, was used to create interaction terms with two coping styles.
The multiple linear regression analysis (Table 6) of subjective social support scores (centered), negative coping styles (centered), and positive coping styles (centered) in relation to the EPDS scores indicated that the interaction between subjective social support and positive coping styles (centered) had statistical significance. On this basis, a scatter diagram (Fig 1) for positive coping styles with different levels of subjective social support on EPDS scores was produced to illustrate the effects of these variables. Positive coping styles were found to be strongly associated with EPDS scores when subjective social support was high.
The results of a one-way ANOVA (Table 3) showed that the EPDS scores of pregnant women differed significantly depending on their occupation, number of children, gestation age at the time of the earthquake, and whether they had any wounded or dead relatives. Our analyses (Tables 4 and 5) showed that, five factors, namely, number of children, having wounded relatives, subjective social support, and coping styles (positive and negative) were significant determinants of prenatal depression immediately after the earthquake. The results of these analyses indicated that women who used higher levels of negative coping, lower levels of positive coping and who reported lower levels of subjective social support, particularly those who farmed, had more than two children, and had wounded relatives were at higher risk of prenatal depression following the earthquake.
According to the above analyses, it could be concluded that using higher levels of negative coping, having lower levels of subjective social support, working as a farmer, having more than two children, and having wounded relatives were risk factors for prenatal depression following the earthquake. Regulating these factors immediately after an earthquake may decrease the depression of pregnant women and lead to favorable outcomes for those suffering from prenatal depression. Therefore, the following directions should be considered in the interventions to relieve the psychological problems of pregnant women: better attention and psychological support for farming women; more efficient communication between pregnant women and their families to let them knowing that their families were unhurt; higher quality medical services for wounded relatives; facilitating the feeling of being supported; and directing women to adopt more positive coping strategies and avoid negative strategies. For example, based on operational definitions for positive and negative coping styles [39], interventions could help women adopt actions associated with positive coping styles such as actively talking and listening, seeing events from a favorable perspective, and seeking solutions to problems, and avoid actions associated with negative coping styles such as evading reality, depending on others to solve problems, and performing bodily harm activities.
According to the interaction analysis, lower EPDS scores were observed when women, with lower subjective social support, adopted more positive coping strategies. This may be due to the situation that women with lower social support tend to adopt negative rather than positive coping strategies [47, 84]. In contrast to women with low social support, women who had high social support have invested more on positive coping styles. Analogous to the law of diminishing marginal effect [85], adopting more positive coping strategies may cause less increase of effect for women with high social support, and greater improvement of effect for those with low social support. This result imply that supportive relationships may impact on prenatal depression by helping women adapt to stress and changes in the aftermath of the earthquake. Clinical healthcare workers should pay more attention to other pregnant women who have negative coping styles and little social support. This also implies that a new intervention can be developed to prevent pregnant women from developing depression, involving by improving their feeling of being supported and helping them to develop positive coping styles in the aftermath of a major earthquake.
It is worth mentioning that the correlation coefficients between EPDS scores and social support and coping styles appear to be moderate, with the value of r ranging from 0.32 to 0.42 (Table 4). According to Burnand [86], the strength of the association is moderate when r is > 0.30 and
Since the earthquake in this study caused great inconvenience to transportation, communications, and everyday life, the sample size was not very large and the participants were recruited by convenience sampling. It is also difficult to obtain a comparison group in the immediate aftermath of the disaster, which made us unable to compare the results of the prenatal women after the earthquake with their depression status before the earthquake or with a similar group that had not experienced the earthquake. These limitations may impact the interpretation of incidence rate of prenatal depression after the earthquake. However, the authors of this study managed to compare the incidence rate of depression of this study with the results of other study that focused on similar earthquakes in China. Furthermore, this study was performed using a cross-sectional approach under time and resource constraints in the immediate aftermath of an earthquake; thus, causality between variables could not be clearly demonstrated. Conducted only 2 to 6 weeks after the earthquake, it was only possible to collect information about the depression, social support, and coping styles of pregnant women. To obtain more rigorous and comparable evidence, a longer time frame for follow-up observations or an extended longitudinal study may be necessary. 2ff7e9595c
댓글