Effects of a residential psychoeducational parenting program on maternal anxiety and fatigue symptoms

Figures & data

Table 1. Measures.

Variable	Measure	Details
Outcome: Maternal anxiety symptoms	Edinburgh Postnatal Depression Scale – Three Anxiety Items (EPDS-3A)	Three anxiety-related items from the Edinburgh Postnatal Depression Scale Cox et al., (1987): (1) I have blamed myself unnecessarily when things went wrong; (2) I have been anxious or worried for no good reason; (3) I have felt scared or panicky for no very good reason. Each item is scored 0 (No, never), 1 (Not very often), 2 (Yes, some of the time), and 3 (Yes, most of the time). The total score ranges from 0 to 9. A cut off score of ≥ 6 indicates high anxiety symptoms (sensitivity: 66.7%; specificity: 88.2%) Matthey, (2008). In this study, the internal consistency (Cronbach’s alpha) coefficient was 0.79.
Maternal fatigue symptoms	Modified Fatigue Assessment Scale (FAS) Giallo et al., (2014)	The short version comprises 5 items assessing the symptoms of physical and mental chronic fatigue. The items are (1) I am bothered by fatigue, (2) I get tired very quickly, (3) I have enough energy for everyday life, (4) Physically, I feel exhausted, and (5) Mentally, I feel exhausted. These items are scored on a 5-point ordinal scale for frequency (1=Never; 2=Sometimes; 3=Regularly; 4=Often; 5=Always). The total scale scores range from 5 to 25 (higher scores indicating more symptoms). In this study, Cronbach’s alpha was 0.83.
Determinant
Demographic and socio-economic characteristics	Clinical assessment questions	Women’s age, marital status, countries of birth, and current residential post code. Index of Relative Socio-economic Advantage and Disadvantage (SEIFA) were derived from women’s postcodes using the most recent Australian Bureau of Statistics (ABS) data Australian Bureau of Statistics, (2019).
Family and social support	Clinical assessment questions	Extent to which other people are providing help and support with four options of answers: As much as I need; quite a bit; not much at all; and not able to help.
Intimate partner relationship	Partner Interaction after Birth Scale (PIBS) Wynter et al., (2017)	The PIBS yields two sub-scales: Considerate Partner Behaviours and Emotionally Abusive Partner Behaviours. The first sub-scale includes four items on communication, problem solving, and sharing of workload with the partner with possible scores ranging from 0 to 12 (higher scores are optimal). In this study, Cronbach’s alpha was 0.71. The other sub-scale includes three items about specific partner interactions, such as critical comments with the possible scores range from 0 to 6 (lowers cores are optimal). Cronbach’s alpha was 0.74.
Parenting confidence	Selected items from the Karitane Parenting Confidence Scale Črnčec et al., (2008)	The 7 selected items are: 1. I can soothe my child when she/he cries or is distressed 2. I know how to settle my child to go to sleep 3. I am confident about helping my child to have a good sleep routine 4. I am confident about feeding my child 5. I am confident about caring for my child such as changing nappies and bathing 6. I am confident about playing with my child 7. I am good at keeping my child amused Total scoring ranges from 0–21 (higher scores indicate more confidence). In this study, Cronbach’s alpha was 0.70.
Borderline personality disorder symptoms	MacLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) Zanarini et al., (2003)	The MSI-BPD comprises a set of ten items aligned with the borderline module of the Diagnostic Interview for DSM-IV Personality Disorders Zanarini et al., (2003). Each endorsed item is worth 1 point on a scale that ranges from 0 to 10 (higher scores indicate more symptoms). In this study, Cronbach’s alpha was 0.74.
Chronic health problems	Clinical assessment questions	Include: heart disease, diabetes, asthma, epilepsy, hepatitis, and allergies.
Obstetric and reproductive health history	Clinical assessment questions	This child’s conception (spontaneous & expected; spontaneous & unexpected; assisted by reproductive technology/surrogacy) Admitted to hospital at any stage during this pregnancy for severe vomiting, vaginal bleeding, threatened early labour, high blood pressure, pre-eclampsia, gestational diabetes, or other condition. Current health problems related to complications at the birth: pain from an episiotomy/tear/caesarean wound, unhealed wounds, incontinence of urine or faeces, pain assisted with sexual intercourse. Number of children
Maternal mental health history	Clinical assessment questions	Seen a mental health professional prior to having this baby; Currently seeing a mental health professional.
Major life events in the last 12 months	Clinical assessment questions	Eight major life events: personal injury or illness/surgery; divorce/separation from partner; death of a close family member; change in employment situation; change in living arrangement; financial stress; trouble/disagreement with close family member or friend; legal troubles.
Health risk behaviours	Clinical assessment questions	Smoking and alcohol use.
Breastfeeding problems	Clinical assessment questions	Mastitis, nipple pain, breast pain, blocked ducts
Infant/toddler characteristics	Clinical assessment questions	Age and birthweight

Table 2. Psychosocial and demographic characteristics at pre-admission.

	Whole sample N = 1,220	Complete follow-up N = 559
Woman’s age (in years), Mean (SD)	35.2 (3.8)	35.1 (3.8)
Marital status, n (%)
Single	33 (2.8)	15 (2.7)
Defacto	240 (20.5)	117 (21.3)
Married	893 (76.2)	415 (75.6)
Separated	4 (0.3)	2 (0.4)
Widowed	2 (0.2)	0 (0.0)
SEIFA, n (%)^(1)
Quintiles 1 to 3	206 (17.5)	98 (17.7)
Quintile 4	263 (22.3)	131 (23.7)
Quintile 5 (Most advantaged)	709 (60.2)	324 (58.6)
Country of birth, n (%)
Australia or English-speaking countries^(2)	949 (77.8)	450 (80.5)
Non English-speaking countries	180 (14.8)	83 (14.9)
Did not answer	91 (7.5)	26 (4.7)
PIBS^(2) Caring Partner Behaviours score, Mean (SD)	8.3 (2.4)	8.3 (2.5)
PIBS Emotionally Abusive Partner Behaviours score, Mean (SD)	0.5 (0.9)	0.5 (0.8)
Extent to which they receive help, (%)
As much as I need	311 (25.5)	149 (26.7)
Quite a bit	667 (54.7)	309 (55.3)
Not much at all/Not able to help	242 (19.8)	101 (18.1)
Parenting Confidence scale score, Mean (SD)	16.0 (4.9)	16.4 (4.2)
McLean Borderline Personality Disorder score, Median (interquartile range)	1 (0 to 3)	1 (0 to 3)
Number of coincidental stressful life events, Mean (SD)	1.3 (1.2)	1.3 (1.3)
Consulted a mental health professional prior to having this baby, n (%)	523 (42.9)	241 (43.1)
Currently seeing a mental health professional, n (%)	261 (21.4)	117 (20.9)
Having a chronic health problem, n (%)	246 (20.1)	117 (20.9)
Currently smoke tobacco, n (%)	17 (1.4)	7 (1.3)
Drink alcohol more than once a month, n (%)	443 (36.3)	175 (31.3)
This child’s conception, n (%)
Spontaneous & expected	888 (72.8)	417 (74.6)
Spontaneous & unexpected	142 (11.6)	63 (11.3)
Assisted by reproductive technology/Surrogacy	190 (15.6)	79 (14.1)
Admitted to hospital at any stage during this pregnancy, (%)	171 (14.0)	171 (12.9)
Current health problems related to complications at birth including persistent pain, unhealed wounds, incontinent of urine or faeces, pain with sexual intercourse, n(%)	1,010 (82.7)	465 (83.2)
Any breastfeeding problems, n (%)	438 (35.9)	202 (36.1)
Baby age (in months), mean (SD)	8.4 (4.4)	8.1 (4.1)
Child low birthweight (<2.5kg), n (%)	68 (5.6)	29 (5.2)
Having two children or more, n (%)	643 (52.7)	288 (51.5)
Twin, n (%)	17 (1.4)	9 (1.6)

¹Index of Relative Socio-economic Advantage and Disadvantage; ⁽²⁾Parenting Confidence Scale, Partner Interaction after Baby Scale; ⁽²⁾Canada, Republic of Ireland, New Zealand, South Africa, United Kingdom and United States of America. This table will also be published elsewhere.

Figure 1. Distributions of anxiety scale (EPDS-3A) total scores at pre-admission, discharge, and follow-up.

Table 3. Anxiety scale total scores and categories.

	Anxiety scale total score Mean (95% CI)	High Anxiety symptoms (EPDS-3A ≥ 6) % (95% CI)
Pre-admission (N=1,220)	4.7 (4.6; 4.9)	40.1 (37.3; 42.9)
Pre-discharge (N=1,220)	3.4 (3.2; 3.5)	17.4 (15.3; 19.6)
Follow-up (N=559)	2.8 (2.6; 2.9)	10.4 (8.0; 13.2)

Table 4. Models predicting the reduction of EPDS-3A anxiety scores.

	Reduction between pre-admission and pre-discharge	Reduction between pre-discharge and follow-up
Woman’s age (in years)	−0.00 (−0.03; 0.03)	−0.03 (−0.07; 0.02)
SEIFA
Quintiles 1 to 3	ref.	ref.
Quintile 4	−0.09 (−0.42; 0.23)	−0.14 (−0.6; 0.31)
Quintile 5	0.00 (−0.28; 0.28)	0.06 (−0.34; 0.46)
PIBS Caring Partner Behaviours	0.03 (−0.02; 0.07)	0.04 (−0.03; 0.11)
PIBS Emotionally Abusive Partner Behaviours	0.02 (−0.11; 0.16)	−0.04 (−0.24; 0.15)
Extent family and friends are able to help
As much as I need	ref.	ref.
Quite a bit	0.09 (−0.16; 0.33)	−0.05 (−0.4; 0.3)
Not much at all/Not able to help	0.31 (0.03; 0.60)	0.08 (−0.38; 0.55)
Parenting Confidence score	0.06 (0.03; 0.09)	0.03 (−0.03; 0.08)
McLean Borderline Personality Disorder Scale score	-0.18 (−0.24; −0.12)	-0.17 (−0.26; −0.07)
Number of stressful life events	−0.07 (−0.16; 0.01)	−0.01 (−0.13; 0.12)
Consulted a mental health professional prior to having this baby	−0.01 (−0.23; 0.22)	−0.29 (−0.61; 0.04)
Currently consulting a mental health professional	-0.36 (−0.63; −0.09)	−0.13 (−0.53; 0.27)
Having a chronic health problem	−0.04 (−0.29; 0.21)	0.09 (−0.27; 0.46)
Drinking alcohol > once/week	0.04 (−0.17; 0.25)	0.12 (−0.2; 0.43)
Child’s conception
Spontaneous & expected	ref.	ref.
Spontaneous & unexpected	−0.12 (−0.44; 0.20)	0.08 (−0.4; 0.55)
Assisted by reproductive technology/Surrogacy	−0.11 (−0.40; 0.18)	−0.16 (−0.61; 0.29)
Admitted to hospital at any stage during this pregnancy	−0.12 (−0.41; 0.17)	−0.07 (−0.51; 0.37)
Current having any health problem related to complications at the birth	0.08 (−0.19; 0.35)	−0.01 (−0.41; 0.39)
Any breastfeeding problems	0.09 (−0.12; 0.30)	0.06 (−0.24; 0.37)
Baby age (in months)	−0.01 (−0.04; 0.01)	0.01 (−0.03; 0.05)
Child had low birthweight	0.10 (−0.34; 0.55)	0.30 (−0.41; 1.01)
Having at least two children	0.37 (0.16; 0.59)	−0.29 (−0.61; 0.03)
Married	−0.02 (−0.25; 0.20)	0.24 (−0.1; 0.58)
Woman born in Australia or main English- speaking countries	0.06 (−0.20; 0.31)	−0.05 (−0.45; 0.35)
Fatigue score at admission	0.00 (−0.03; 0.04)	0.03 (−0.02; 0.08)
Anxiety score at Preadmission	0.59 (0.54; 0.64)	0.45 (0.37; 0.53)

Data cell: Coefficients (95% CI) estimated using multiple linear regression.

Figure 2. Distributions of FAS fatigue scores at pre-admission and 6-week post discharge (follow up).

Table 5. Multiple linear regression model predicting the reduction in fatigue scores (pre-admission score – follow-up score).

	Coefficients^(1) (95% CI)
Woman’s age (in years)	-0.09 (−0.17; −0.01)
SEIFA
Quintiles 1 to 3	ref.
Quintile 4	0.05 (−0.75; 0.85)
Quintile 5	0.31 (−0.39; 1.01)
PIBS Caring Partner Behaviours	0.10 (−0.02; 0.23)
PIBS Emotionally Abusive Partner Behaviours	−0.16 (−0.51; 0.19)
Extent family and friends are able to help
As much as I need	ref.
Quite a bit	0.13 (−0.48; 0.74)
Not much at all/Not able to help	0.58 (−0.23; 1.39)
Parenting Confidence score	−0.06 (−0.15; 0.04)
McLean Borderline Personality Disorder Scale score	-0.27 (−0.43; −0.11)
Number of stressful life events	-0.32 (−0.54; −0.10)
Consulted a mental health professional prior to having this baby	0.02 (−0.55; 0.60)
Currently consulting a mental health professional	−0.40 (−1.1; 0.30)
Having a chronic health problem	−0.12 (−0.76; 0.52)
Drinking alcohol > once/week	0.01 (−0.54; 0.57)
Child’s conception
Spontaneous & expected	ref.
Spontaneous & unexpected	−0.08 (−0.9; 0.75)
Assisted by reproductive technology/Surrogacy	0.56 (−0.23; 1.35)
Admitted to hospital at any stage during this pregnancy	−0.50 (−1.27; 0.28)
Current having any health problem related to complications at the birth	−0.23 (−0.93; 0.47)
Any breastfeeding problems	0.15 (−0.38; 0.69)
Baby age (in months)	0.09 (0.03; 0.016)
Child had low birthweight	0.43 (−0.81; 1.67)
Having at least two children	−0.06 (−0.62; 0.50)
Married	0.27 (−0.33; 0.86)
Woman born in Australia or main English- speaking countries	−0.42 (−1.12; 0.27)
Anxiety score at Preadmission	0.01 (−0.11; 0.14)
Fatigue score at admission	0.80 (0.72; 0.88)

⁽¹⁾Estimated using multiple linear regression.

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