Stress, social support, and self-esteem in rural and urban postpartum women
Marcinkiw, Karen Leanne
Studies of the relationships among postpartum women's health status, stress, social support, and self-esteem are limited, particularly in the area of rural postpartum women's health. In 2001, a prospective cohort study was conducted in Saskatoon, Canada to determine the relationship between postpartum length of hospital stay and maternal and infant health outcomes with 150 early (less than 48 hours postpartum) and late discharge (greater than 48 hours) postpartum women. For this thesis, a secondary analysis was undertaken to assess the relationships among stress, social support, and self-esteem and to determine predictors of stress at four months postpartum between rural and urban postpartum women who participated in the study in the immediate postpartum and at four months postpartum. The sample used in this secondary analysis (N = 101) consisted of 63 urban and 38 rural participants. The Prenatal Psychosocial Profile (PPP) instrument was used to measure levels of social support and self-esteem in the immediate postpartum period and stressors/hassles at birth and four months postpartum, using rating subscales. Rural and urban groups did not differ significantly in their total mean score differences from the first interview to the four-month interview. At four months postpartum, both rural and urban groups experienced higher stress due to money worries and feeling generally overloaded compared to the time of the first interview (p < 0.05). Rural and urban groups experienced moderate to high satisfaction with social support in the immediate postpartum, although the rural group had lower satisfaction scores with the scale items "goes out of his/her way to do special or thoughtful things" and "tolerates my ups and downs and unusual behaviours" (p < 0.05). Self-esteem scores did not differ between groups. The best predictors of maternal stress at four months postpartum were age, marital status, income, and ethnicity. Older single, Aboriginal single, and higher income single women were more likely to report stress (p < 0.05). The findings indicate the need to target these women, in both rural and. urban populations, for psychosocial support in the postpartum period.