Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Early postnatal demoralisation among primiparous women in the community: measurement, prevalence and associated factors

Authors: Irene Bobevski, Heather Rowe, David M. Clarke, Dean P. McKenzie, Jane Fisher

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

Login to get access

Abstract

Background

Demoralisation is a psychological state occurring in stressful life situations where a person feels unable to respond effectively to their circumstances, characterised by feelings of distress, subjective incompetence, helplessness and hopelessness. The period after the birth of a first baby is a time of great changes and disruptions to many aspects of the mother's physical, psychological and social functioning. This can lead to feelings of distress, a sense of incompetence and helplessness. This study aimed to examine: (1) the psychometric properties of the Demoralisation Scale in a community setting; (2) the prevalence of demoralisation symptoms among primiparous women in the community; and (3) factors that are uniquely associated with demoralisation in the early postnatal period.

Methods

Primiparous women attending community maternal health centres (n = 400) were recruited and administered the study's questionnaires through a telephone interview.

Results

The Demoralisation Scale was found to be a reliable and valid tool among women in the community who had recently given birth. Higher levels of demoralisation were independently associated with lower confidence on going home from the hospital after birth, lower rating of mother's self-rated global health, more than 3 h of infant crying and fussing in the last 24 h, and a controlling partner, after symptoms of depression and anxiety, and vulnerable personality characteristics were controlled for.

Conclusions

The relevance of demoralisation to postnatal health practitioners in the community is in helping them to better understand women's experiences and to intervene in a way that is more meaningful and less stigmatising to women.
Literature
1.
de Figueiredo JM. Some issues in research on the epidemiology of demoralization. Compr Psychiatry. 1983;24(2):154–7.PubMedCrossRef
2.
3.
Clarke DM, Kissane DW, Trauer T, Smith GC. Demoralization, anhedonia and grief in patients with severe physical illness. World Psychiatry. 2005;4(2):96.PubMedPubMedCentral
4.
Clarke DM, Mackinnon AJ, Smith GC, McKenzie DP, Herrman HE. Dimensions of psychopathology in the medically ill. Psychosomatics. 2000;41(5):418–25.PubMedCrossRef
5.
Clarke DM, Smith GC, Dowe DL, McKenzie DP. An empirically derived taxonomy of common distress syndromes in the medically ill. J Psychosom Res. 2003;54(4):323–30.PubMedCrossRef
6.
McKenzie M, Clarke DM, McKenzie DP, Smith GC. Which factors predict the persistence of DSM-IV depression, anxiety, and somatoform disorders in the medically ill three months post hospital discharge? J Psychosom Res. 2010;68(1):21–8.PubMedCrossRef
7.
Weber S. Factor structure of the Reynolds Adolescent Depression Scale in a sample of school-based adolescents. J Nurs Meas. 2000;8(1):23–40.PubMed
8.
American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Washington, DC: American Psychiatric Publishing; 2013.CrossRef
9.
Clarke DM. Depression, demoralization, and psychotherapy in people who are medically ill. In: Alarcon RD, Frank JB, editors. The Psychotherapy of Hope: The Legacy of Persuasion and Healing. Baltimore: The John Hopkins University Press; 2011. p. 125.
10.
de Figueiredo JM. Demoralization Subjective Incompetence and Distress in Adversity. The Psychotherapy of Hope: The Legacy of Persuasion and Healing. 2011;107.
11.
Robinson S, Kissane DW, Brooker J, Burney S. A Review of the Construct of Demoralization: History, Definitions, and Future Directions for Palliative Care. American Journal of Hospice and Palliative Medicine. 2014;49(3):595–610.
12.
Bobevski I, Rowe H, Clarke D, McKenzie D, Fisher J. Postnatal demoralisation among women admitted to a hospital mother-baby unit: validation of a psychometric measure. Archives of women's mental health. 2014, Advance online publication. doi:10.​1007/​s00737-014-0486-8.
13.
Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM. The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care. 2004;20(4):269.PubMed
14.
Fisher J, de Mello MC, Izutsu T. Pregnancy, childbirth and the postpartum period. In: Mental health aspects of women’s reproductive health: a global review of the literature. Edited by World Health Organization. Geneva, Switzerland: WHO Press; 2009: 8–30.
15.
Rowe H, Fisher J. Development of a universal psycho-educational intervention to prevent common postpartum mental disorders in primiparous women: a multiple method approach. BMC Public Health. 2010;10(1):499.PubMedPubMedCentralCrossRef
16.
Woolhouse H, Brown S, Krastev A, Perlen S, Gunn J. Seeking help for anxiety and depression after childbirth: results of the Maternal Health Study. Arch Womens Ment Health. 2009;12(2):75–83.PubMedCrossRef
17.
Fisher JRW, Feekery C, Rowe‐Murray H. Nature, severity and correlates of psychological distress in women admitted to a private mother–baby unit. J Paediatr Child Health. 2002;38(2):140–5.PubMedCrossRef
18.
19.
Small R, Brown S, Lumley J, Astbury J. Missing voices: what women say and do about depression after childbirth. Journal of Reproductive and Infant Psychology. 1994;12(2):89–103.CrossRef
20.
Boyce P, Hickey A, Gilchrist J, Talley N. The development of a brief personality scale to measure vulnerability to postnatal depression. Arch Womens Ment Health. 2001;3(4):147–53.CrossRef
21.
Josefsson A, Larsson C, Sydsjö G, Nylander P-O. Temperament and character in women with postpartum depression. Arch Womens Ment Health. 2007;10(1):3–7.PubMedCrossRef
22.
Masih S, Spence SH, Oei TP. Sociotropic and autonomous personality and stressful life events as predictors of depressive symptoms in the postpartum period. Cogn Ther Res. 2007;31(4):483–502.CrossRef
23.
Verkerk GJ, Denollet J, Van Heck GL, Van Son MJ, Pop VJ. Personality factors as determinants of depression in postpartum women: a prospective 1-year follow-up study. Psychosom Med. 2005;67(4):632–7.PubMedCrossRef
24.
Rowe H, Wynter K, Lorgelly P, Amir LH, Ranasinha S, Proimos J, et al. A cluster randomised controlled trial of a brief couple-focused psychoeducational intervention to prevent common postnatal mental disorders among women: study protocol. BMJ open. 2014;4(9):e006436.PubMedPubMedCentralCrossRef
25.
Spitzer R, Kroenke K, WJ W. Validation and utility of a self-report version of prime-md: The phq primary care study. JAMA. 1999;282(18):1737–44.PubMedCrossRef
26.
Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):509–15.CrossRef
27.
Flynn HA, Sexton M, Ratliff S, Porter K, Zivin K. Comparative performance of the Edinburgh Postnatal Depression Scale and the Patient Health Questionnaire-9 in pregnant and postpartum women seeking psychiatric services. Psychiatry Res. 2011;187(1–2):130–4.PubMedCrossRef
28.
Gjerdingen D, Crow S, McGovern P, Miner M, Center B. Postpartum depression screening at well-child visits: validity of a 2-question screen and the PHQ-9. Ann Fam Med. 2009;7(1):63–70.PubMedPubMedCentralCrossRef
29.
Yawn BP, Pace W, Wollan PC, Bertram S, Kurland M, Graham D, et al. Concordance of Edinburgh Postnatal Depression Scale (EPDS) and Patient Health Questionnaire (PHQ-9) to assess increased risk of depression among postpartum women. J Am Board Fam Med. 2009;22(5):483–91.PubMedCrossRef
30.
Rl S, Kroenke K, Williams JW, Löwe B. A brief measure for assessing generalized anxiety disorder: The gad-7. Arch Intern Med. 2006;166(10):1092–7.CrossRef
31.
Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.PubMedCrossRef
32.
Ware J, Snow K, Kosinski M, Gandek B. SF-36 health survey: manual and interpretive guide. Boston: The Health Institute, New England Medical Center; 1993.
33.
Schytt E, Waldenström U. Risk factors for poor self-rated health in women at 2 months and 1 year after childbirth. J Womens Health. 2007;16(3):390–405.CrossRef
34.
World Health Organisation. Indicators for assessing breast feeding practices. Geneva, Switzerland: WHO Document WHO/CDD/SER. vol. 91; 1991. p. 14.
35.
36.
Wilhelm K, Parker G. The development of a measure of intimate bonds. Psychol Med. 1988;18(01):225–34.PubMedCrossRef
37.
Baldessarini RJ, Finklestein S, Arana GW. The predictive power of diagnostic tests and the effect of prevalence of illness. Arch Gen Psychiatry. 1983;40(5):569–73.PubMedCrossRef
38.
Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.CrossRef
39.
Agresti A. An introduction to categorical data analysis. New York: Wiley; 1996.
40.
Long JS, Freese J. Regression models for categorical dependent variables using Stata. College Station, Texas: Stata Press; 2006.
41.
Wessel MA, Cobb JC, Jackson EB, Harris GS, Detwiler AC. Paroxysmal fussing in infancy, sometimes called" colic". Pediatrics. 1954;14(5):421–35.PubMed
42.
Corp IBM. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.; 2011.
43.
Australian Bureau of Statistics. Births, Australia, 2013. Canberra, Australia: Australian Bureau of Statistics; 2013.
44.
Consultative Council on Obstetric and Paediatric Mortality and Morbidity. Births in Victoria 2007 and 2008. Melbourne, Australia: Quality, Safety and Patient Experience Branch, Department of Health; 2011.
45.
Mehnert A, Vehling S, Hocker A, Lehmann C, Koch U. Demoralization and depression in patients with advanced cancer: validation of the German version of the demoralization scale. J Pain Symptom Manage. 2011;42(5):768–76.PubMedCrossRef
46.
Tabachnick B, Fidell L. Using Multivariate Statistics. 6th ed. Boston, MA: Pearson; 2011.
47.
Mullane M, Dooley B, Tiernan E, Bates U. Validation of the Demoralization Scale in an Irish advanced cancer sample. Palliat Support Care. 2009;7(3):323–30.PubMedCrossRef
48.
Child D. The essentials of factor analysis. 3rd ed. London: Continuum; 2006.
49.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.PubMedCrossRef
50.
Brown S, Small R, Lumley J. Missing voices: The experience of motherhood. Melbourne, Australia: Oxford University Press; 1994.
51.
Cox J, Holden J, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150(6):782–6.PubMedCrossRef
52.
Beck CT. The lived experience of postpartum depression: A phenomenological study. Nurs Res. 1992;41(3):166–70.PubMedCrossRef
53.
Knudson‐Martin C, Silverstein R. Suffering in Silence: A qualitative meta‐data‐analysis of postpartum depression. J Marital Fam Ther. 2009;35(2):145–58.PubMedCrossRef
54.
Slade T, Johnston A, Oakley Browne MA, Andrews G, Whiteford H. 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Australas Psychiatry. 2009;43(7):594–605.CrossRef
55.
Lam P, Hiscock H, Wake M. Outcomes of infant sleep problems: a longitudinal study of sleep, behavior, and maternal well-being. Pediatrics. 2003;111(3):e203–7.PubMedCrossRef
56.
Rowe H, Fisher J. The contribution of Australian residential early parenting centres to comprehensive mental health care for mothers of infants: evidence from a prospective study. Int J Ment Heal Syst. 2010;4(1):6.CrossRef
57.
Phillips J, Sharpe L, Matthey S. Rates of depressive and anxiety disorders in a residential mother–infant unit for unsettled infants. Aust N Z J Psychiatry. 2007;41(10):836–42.PubMedCrossRef
58.
Phillips J, Sharpe L, Nemeth D. Maternal psychopathology and outcomes of a residential mother-infant intervention for unsettled infant behaviour. Aust N Z J Psychiatry. 2010;44(3):280–9.PubMedCrossRef
59.
Matthey S, Speyer J. Changes in unsettled infant sleep and maternal mood following admission to a parentcraft residential unit. Early Hum Dev. 2008;84(9):623–9.PubMedCrossRef
60.
Fisher J, Rowe H. Building an evidence base for practice in early parenting centres. A systematic review of the literature and a report of an outcome study. Melbourne: Key Centre for Women's Health in Society, Melbourne School of Population Health, University of Melbourne; 2004.
61.
Jones TL, Prinz RJ. Potential roles of parental self-efficacy in parent and child adjustment: A review. Clin Psychol Rev. 2005;25(3):341–63.PubMedCrossRef
62.
Dias CC, Figueiredo B. Breastfeeding and depression: A systematic review of the literature. J Affect Disord. 2014;171:142–54.PubMedCrossRef
63.
Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, et al. Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord. 2008;108(1):147–57.PubMedCrossRef
64.
65.
Bilszta J, Ericksen J, Buist A, Milgrom J. Women's experience of postnatal depression-beliefs and attitudes as barriers to care. Aust J Adv Nurs. 2010;27(3):44–54.
66.
Oddy B, Rowe H, Fisher J. Consumers' views on the use of diagnostic labels to describe psychological distress in the postpartum: implications for health care. Aust J Prim Health. 2009;15(1):9–16.CrossRef
67.
Slavney PR. Diagnosing demoralization in consultation psychiatry. Psychosomatics: Journal of Consultation Liaison Psychiatry. 1999;40(4):325–9.CrossRef
68.
Clarke DM, Kissane DW. Demoralization: its phenomenology and importance. Aust N Z J Psychiatry. 2002;36(6):733–42.PubMedCrossRef
69.
de Figueiredo JM. Deconstructing demoralization: subjective incompetence and distress in adversity. In: Alarcon RD, Frank JB, editors. The Psychotherapy of Hope: The Legacy of Persuasion and Healing. Baltimore: The John Hopkins University Press; 2012. p. 107.
70.
71.
Beck A, Emery G. Anxiety disorders and phobias: A cognitive perspective: Basic Books; 2005
72.
Dori GA, Overholser JC. Depression, Hopelessness, and Self‐Esteem: Accounting for Suicidality in Adolescent Psychiatric Inpatients. Suicide Life Threat Behav. 1999;29(4):309–18.PubMed
73.
Wetzel RD, Margulies T, Davis R, Karam E. Hopelessness, depression, and suicide intent. Journal of Clinical Psychiatry: Journal of Clinical Psychiatry; 1980.
Metadata
Title
Early postnatal demoralisation among primiparous women in the community: measurement, prevalence and associated factors
Authors
Irene Bobevski
Heather Rowe
David M. Clarke
Dean P. McKenzie
Jane Fisher
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0680-3

Other articles of this Issue 1/2015

BMC Pregnancy and Childbirth 1/2015 Go to the issue

Research article

Obesity and normal birth: A qualitative study of clinician’s management of obese pregnant women during labour

Study protocol

Proyecto Mamá: a lifestyle intervention in overweight and obese Hispanic women: a randomised controlled trial – study protocol

Research article

Physical fitness, serum relaxin and duration of gestation

Research article

The triple threat of pregnancy, HIV infection and malaria: reported causes of maternal mortality in two nationwide health facility assessments in Mozambique, 2007 and 2012

Research article

The estimated incidence of induced abortion in Kenya: a cross-sectional study

Research article

Alcohol consumption among pregnant women in Northern Tanzania 2000–2010: a registry-based study