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Research in Nursing & Health, 2009, 32, 582–591

Effects of Stress and Social Support on Postpartum Health of Chinese Mothers in the United States
Ching-Yu Cheng,1* Rita H. Pickler2**


1 Taipei Medical University, Taipei, Taiwan Virginia Commonwealth University, Richmond, VA Accepted 22 September 2009

Abstract: Postpartum maternal well being across cultures has received limited research attention. We examined relationships among stress, social support, and health in 152 Chinese mothers < 1 year postpartum in the United States. These mothers did not perceive high levels of stress, although they did not receive as much support as they indicated they needed; 23.7% of mothers scored high for depressive symptoms. About half of the mothers experienced interrupted sleep, decrease in memory, and lack of sexual desire. All health measures were inter-correlated. Social support moderated the effects of stress on depressive symptoms. Culturally relevant care that is perceived as supportive may promote postpartum maternal health. ß 2009 Wiley Periodicals,
Inc. Res Nurs Health 32:582–591, 2009

Keywords: stress; social support; maternal competence; postnatal physical condition; postnatal depression

Becoming a mother is an important developmental task and may be perceived as a personal achievement, yet new mothers often experience psychological distress (Z. J. Huang, Wong, Ronzio, & Yu, 2007; McGovern et al., 2006) and physical discomforts (Cheng & Li, 2008). In addition, new mothers may not be satisfied with their maternal role performance (Knauth, 2000; Mercer, 1985). Stress may worsen a new mother’s health and has been associated, not only with less parenting confidence and satisfaction with the infant (Reece & Harkless, 1998) but also with postpartum depression (Beck, 2001). According to Lazarus and Folkman (1984), during stress the demands in the environment exceed the ability to manage or cope with them. Social support may buffer the

negative effects of stress on an individual’s health by influencing modulations to the hypothalamic– pituitary–adrenal axis (DeVries, Glasper, & Detillion, 2003), which is a complex set of interactions between the brain and other organs in the body that controls reactions to stress and affects numerous body processes. Indeed, findings from recent studies of new mothers confirm that social support has positive effects on postpartum mood (Surkan, Peterson, Hughes, & Gottlieb, 2006). The number of women of Chinese descent giving birth in the US has steadily increased since 1970 (National Center for Health Statistics, 2007). Like other immigrants, new mothers of Chinese descent may experience higher levels of stress.

The authors gratefully appreciate Dr. Lorraine O. Walker for her support and insightful guidance in conducting the study. Correspondence to Ching-Yu Cheng. *Assistant Professor. **Professor. Published online 29 October 2009 in Wiley InterScience ( DOI: 10.1002/nur.20356

ß 2009 Wiley Periodicals, Inc.

1989a. Chinese-born mothers may have fewer available social supports than non-Chinese mothers born in the US (Cuellar. Chinese mothers with postpartum depression described their controlling and powerful in-laws as the major cause of their depression. postpartum Chinese mothers in Hong Kong and in Research in Nursing & Health . & Adam.. compared to women in the general community. and health differently from non-Chinese born women owing to cultural differences. Stress. Carey. & Guo. Leung. Researchers who investigated Chinese mothers in Hong Kong and in Taiwan found that the prevalence of postpartum depression ranged from 12. which. (2004) reported that. which is known as doing-the-month. the women had a high level of depression when their mother-in-law was their key helper during the postpartum period. & Ha. 1998. Chou. less vitality. In addition to depressive symptoms among new mothers worldwide. and measurement periods (Huang. For example.. in the Chan et al. Depression is common among postpartum mothers. Otchet. Lee. cut-off points. Coombes. Yip. in turn. 2003) and has not addressed some important topics related to these mothers’ health needs and postpartum experiences. Hung & Chung. 2001). (2002) study. Social Support. 2004. and Postpartum Maternal Health New mothers often experience increased levels of stress.STRESS. Yet. reported that new mothers who are stressed have a greater chance of experiencing psychiatric morbidity during the early postpartum period. Yet. & Braccio. BACKGROUND Postpartum Maternal Health Status Postpartum mothers generally perceive their health as good. Chun. 2004. and dissatisfaction with marital life and with their husbands (Chan et al. and health status. because of the detrimental influence of some cultural attitudes toward new mothers’ responsibilities and position at home. Tseng. among their sample of Taiwanese new mothers. Chinese new mothers may not always perceive family members’ involvement during the postpartum period as a positive source of support. Katie. Research on Chinese mothers has not been focused on U. New Chinese mothers usually benefit from receiving positive support from family members. and care providers who can help alleviate the stress and challenges of motherhood. & Wang. residents (Chan. Chiu. worse physical health and functioning. They may also perceive stress. AND MATERNAL HEALTH / CHENG AND PICKLER 583 Yet. These new mothers’ caregivers take over house responsibilities and prepare foods for them (Holroyd. friends. those who receive the most support experience lower mental distress (Heh. Bastida. 2001). disappointment in not being able to give birth to a boy. for about 30 – 40 days postpartum. In a metanalysis on studies conducted in developed countries and published in English by Gaynes et al.3%. (b) relationships among stress. Chinese new mothers with a high level of depressive symptoms often receive limited family support. 2002.9%. depending on measuring scales. Patel. and maternal health in postpartum mothers of Chinese-descent living in the US. Hung and Chung (2001). and pain at the cesarean incision or perineum (Cheng & Li. & Lee. Carter. may negatively affect maternal health. backaches.S.5 – 12. 1999). & Bartlett. & Chung. 2004. To & Wong. 1994). Few investigators have examined the effect of stress on new mothers’ physical health. The purpose of our study was to examine relationships among stress. mothers at 2 months postpartum have a high rate of physical exhaustion. For example. SUPPORT. The new mothers follow cultural practices related to activity and foodand herb-intake in order to prevent diseases and promote health. social support. Weng. Taiwan also described emotional challenges related to pressure from their in-laws. Chung. Chen. 2002. social support. depending on the screening tool used and the measurement period. and more physical limitations (McGovern et al. 1999). postpartum women experience more pain. The majority of Chinese new mothers are supported and taken care of by their female relatives. 2008). who focused on Chinese mothers. Heh et al. and (c) moderating effects of social support on the relationship between stress and health status. the point prevalence for major and minor depression among mothers in developed countries within 1 year postpartum was 6. 2006. and health status. support. 1997.b). The findings of these studies suggest that stress is strongly related to mothers’ healthpromoting lifestyle (Walker. We examined: (a) levels of stress. Physical health problems are highly prevalent among postpartum mothers worldwide. Similarly. 1992). Wu.0% to 50. which places them in a subservient position to their own mothers or mothers-in-law. sore nipples or breast tenderness. especially their mother or mother-in-law. Levy. (2005). Lai. social support.

employed French mothers experienced more constipation. Lelong. Maternal health status changes over time. Gamboa.1% spoke languages other . In this study. had given birth to a healthy child. most depressed mothers become depressed by the third postpartum month (Loh & Vostanis.. For physical health. decreased (Brown & Lumley. Social support was identified as the moderating element because. range . and lack of sexual desire increased over time (Saurel-Cubizolles et al. Uretsky & Mathiesen. 2000. and electronic announcements on Web sites. Although employed Italian mothers did not have physical symptoms that were different from non-employed mothers. and lived with their newborn in the US. The theory includes three Research in Nursing & Health components: causal antecedents. parity. study. Although some researchers have shown that the longer immigrants lived in the US. although Hung’s study (2004) showed older mothers had a lower level of depression.. Froberg. Kahramanian.S. Brooks-Gunn. Honey. were older than 17 years. distribution of paper flyers. 2004. 1991). The outcomes of the framework included general health. 2007). Data were collected from paper and electronic questionnaires that were sent and returned via postal mail and e-mail. The majority of participants (94. Morgan. backache. declining thereafter until 6 months postpartum (Gjerdingen. Most participants (55. Only results of the main study are reported here. & Heagarty study (1992) showed that unemployed mothers more often reported fair or poor health than did employed mothers. the percentage of mothers who self-rated their health as good or very good decreased from 2 months to 12 – 18 months ¨ m. 87. and health outcomes (Lazarus & Folkman. Holmes. & Solon. Currie. & Bautista. Other conditions. Eligible participants were mothers who had children under 1 year old. employment status. physical health.. & Kochevar. Design and Procedure We used a cross-sectional correlational design. and a main study. lack of sexual desire. 2000. Romito. which tested reliability and validity of all translated instruments. Participants were recruited through professional referrals. 2002). Sample Of 162 Chinese mothers who responded to invitations or advertisements for the main study. & Ancel.2%) was born outside the US and had lived an average of 8. length of stay in the US. Morales. but was negatively correlated with depressive symptoms in Hung’s (2004) study of Chinese mothers. METHODS Conceptual Framework The Lazarus and Folkman theory of stress was used to guide the study. 10 mothers were excluded because their youngest child was older than 13 months or they did not complete the questionnaires. still not addressed is how immigrant mothers’ length of stay in the US affects their postpartum health status. 2004) and depressive symptoms peaked at 6 weeks postpartum. the prevalence of physical conditions. For example. 2005. such as tiredness/fatigue. Health outcomes result from how an individual manages stress. Mediating processes involve how individuals appraise and cope with stress. Roberts. Their mean age was 33.29. identified themselves as being of Chinese or Taiwanese descent including US-born and nonUS-born Chinese mothers. mediating processes. The McCormick. Damato. In addition. Duffy. 2005).584 RESEARCH IN NURSING & HEALTH Maternal Contextual Factors and Maternal Health Whether the health status of mothers differs by demographic factors is controversial. Wallace.08) years in the U. Instruments in both English and Chinese languages were available for participants to choose. & Bennett.). Employment did not affect postpartum depressive symptoms among Chinese mothers in the Heh et al. Schytt et al. 1986). such as hemorrhoids and perineal pain. 2003. & Waldenstro 2005). Thompson. Horowitz.66 (SD ¼ 8. Thompson et al.42 (SD ¼ 3. Stress was also viewed as an antecedent within the framework. the poorer their health (Lara. and extreme tiredness than did unemployed mothers (Saurel-Cubizolles. and baby’s age.9%) had an educational level higher than a bachelor’s degree. the antecedents were identified as maternal contextual factors.75) years. Lindmark. In addition.08 – 41. The investigation included a pilot study. postpartum (Schytt. & Ellwood. such as the mothers’ age. social support is the moderator of stress and health. 2000). The antecedents are personal and environmental factors that may result in stress. The Institutional Review Board of the sponsoring university approved the study protocol. as previous studies have found. and depressive symptoms. other studies did not (Heh et al.

General health. In the current study.5% of the total variance of stress (Chen. the KR-20 for the PHCC was . & Sheu. Stress. doingthe-month). spinal headache. In the current study. interrupted sleep. Cronbach’s a for the SHS in the current study was . and decreased memory. A score of 16 or higher indicates a high degree of depressive symptomatology. carpal tunnel problems. a factor analysis derived one factor that explained 77. 32. and Children Program. 1977). and 5. seven conditions that had a high incidence rate. hemorrhoids. The discriminant validity was evidenced by negative or low positive correlation between CES-D and other scales for positive affects or different concepts (r ranged from À. and poor (scores 4 – 1). 71.7% received the Chinese traditional cultural postpartum care (i. good. and social support. Cronbach’s a for the SHS was . The 10-item Perceived Stress Scale (PSS-10) measures the degree to which an individual appraises situations as stressful (S.72. retained body weight. had an impact on postpartum mortality..5%) of the participants were primiparas.e. self-report measures of depressive symptoms (Radloff. In addition to the 15 physical health conditions listed in the original checklist. 1988). Mental health. The reliability of the Chinese PSS-10 was satisfactory (Cronbach’s a ¼ . Respondents are asked to mark the conditions they are experiencing at the moment and also what they experienced at 2 months postpartum. 2002).43 – . total score ranges 0 – 40). Research in Nursing & Health Physical health. . In the current study.32. The convergent validity was established by CES-D’s positive correlation with other scales that measured depression or psychopathology (r ranged .85). 90. Corry. The Self-Rated Health Subindex (SHS) is a four-item instrument measuring the general health of an individual (Lawton.2% were in the Women. For the current study. such as headache. itch.76 when tested on Chinese postpartum mothers in Taiwan (Chien. and delayed incision wound healing. the Cronbach’s a for the PSS-10 was .88. The total score of the SHS ranges from 4 to 13. total score ranges 0 – 60) response.9% worked full time. the PHCC was modified from the original tool (Declercq. The Physical Health Condition Checklist (PHCC) presents a list of physical health conditions that may occur after childbirth. & Risher. as recommended by Bracken and Barona (1991). sore nipples. The scale has been translated into Chinese and used in research involving Chinese new mothers. SUPPORT. A sample question from the SHS is ‘‘How would you rate your overall heath at the present time?’’ with options of excellent. The last question asks participants whether their health problems prevent them from doing things they want to do (scores 3 – 1). 2006). Applebaum. The mean infant age at the time of data collection was 6.0%). and 13.3% experienced postpartum complications including breast lump. Infants. Higher scores indicate the respondent is experiencing more depressive symptoms. Higher scores indicate higher levels of perceived stress. Tai. The reliability and validity of all translated instruments were tested in a pilot study with 30 Chinese postpartum mothers in the US. Moss. Lawton et al. The Center for Epidemiologic Studies Depression (CES-D) scale is a 20-item. Sakala.76.75. back-translation. 1982). & Kleban. The PSS-10 is a 5-point scale (item score ranges 0 – 4. Cohen & Williamson. the Cronbach’s a of the CES-D was .1% had delivered vaginally. and comparison of the original and back-translated versions of the instruments.89.4% were homemakers. eating disorder. excessive vaginal bleeding. Fulcomer.STRESS. fair.55 to . 1994). or were recommended by the participants in the pilot study were included: sleep disturbance. Huang. The Cronbach’s a of the CESD was . The total number of physical conditions (0 – 22) mothers experienced was used for data analysis.74). stress. mental health.47 between the SRHS and physical health domain index. urinary and bowel incontinence. all instruments were translated into Chinese following a series of procedures: translation. Most (60.00 (SD ¼ 3. physical health. Radloff). 45. AND MATERNAL HEALTH / CHENG AND PICKLER 585 than English. Before the main study began. and physical exhaustion. The validity was evidenced by internal validity (multiple correlation R ¼ . The other two questions ask the participants to compare their current health with their health 3 years ago and with the health of most people their age (scores 3 – 1). four-point (item score ranges 0 – 3.3%) were males and were breastfed (96. infection (unspecified).).46) months. Measures Five instruments were used to measure the five study concepts: general health. Four Chinese nurses who were also mothers reviewed the Chinese versions of the instruments to confirm their readability and content validity. with higher scores indicating higher levels of general health. In the original developmental study. Most infants (55. Ko.

employment. range 10 – 132. and .64. The scale results in two scores derived from the same set of items.19. The number of physical conditions experienced was positively correlated with both depressive symptoms and stress. whereas mothers’ length of stay in the US was positively related to general health and inversely related to depressive symptoms.586 RESEARCH IN NURSING & HEALTH Social support. and support received accounted for 41. In regression analysis for moderating effects. range 0 – 32) on the SHS.96. including baby’s age. Effects of Stress and Social Support on Health-Related Variables General health. Usui. . À. RESULTS Levels of Tested Variables Participants had a mean score of 18.39 (SD ¼ 5. Maternal contextual variables. The baby’s age was inversely related to general health and number of physical health conditions. homoscedasticity. More mothers within 6 months postpartum experienced sore nipple/breast tenderness and painful intercourse than mothers over 6 months postpartum (see Table 1). Higher scores indicate higher levels of the perceived importance of support or the amount of support received (Logsdon. length of stay in the US. In a study conducted by Leung (2002). range 0 – 32) on the PSS-10.94. number of physical conditions. Birkimer.77 (SD ¼ 2.2% of the variance in general health (F ¼ 34. 1996). perceived stress. SD ¼ 28. depressive symptoms. and normality were tested. The first score reflects the respondent’s perception of the importance of particular supportive behaviors and the second score reflects the amount of help the respondent reports receiving. Mothers had a mean score of 11. Mothers’ age was not related to any health variables but was related to support received. 2003).1% of mothers Research in Nursing & Health self-rated their health as good or excellent on the question asking about overall health. p ¼ . and parity were entered in the first set of regression terms. Assumptions of independence.10. and the importance of support. Baby’s age (B ¼ À. stress. Cohen.85.00 (SD ¼ 8. West. general health was negatively correlated with number of physical conditions. . Results of hierarchical regression showed that the maternal contextual variables of baby’s age.94 and . Data Analysis All data were tested for normality before conducting inferential statistics.63.34.84) on the CES-D. and positively correlated with support received. Relationships Among Tested Variables As shown in Table 2. Mothers had significantly higher scores on the PSQimportance (M ¼ 95.17.001. stress. d ¼ .4. & McBride. Employment status was coded as 0 for employed while not-employed was coded as 1 in the regression analyses.09. and À1. and stress. & Aiken. and 65.15. respectively.70. p < .58.34. stress and social support were centered to avoid multicollinearity (J.56. Participants had a mean score of 18. and interaction terms were entered in the third set.27.53). t[151] ¼ 8. Cohen. a factor analysis derived four factors that explained 58. p < . The participants experienced a mean of 3.001). the Cronbach’s alphas for the PSQ-importance and PSQ-received scales were .07% of the variance in support. The Postpartum Support Questionnaire (PSQ) is a 34-item.003) and stress (B ¼ À. SD ¼ 23. or depressive symptoms from mothers without postpartum complications (Mann – Whitney Z ¼ À. 23. it was not included in the regression analyses. p ¼ . Depressive symptoms were negatively correlated with support received but were positively correlated with stress. The Cronbach’s a for the Cantonese PSQ was . respectively).39 (SD ¼ 5.05 were used to analyze relationships among variables and moderating effects of social support. Linearity and equal variance were confirmed by examining scatter plots of the data. 5-point (item score ranges from 0 to 4. t ¼ À2.98. Descriptive statistics were used to analyze demographic information and the participants’ level of health status. Pearson’s correlation and hierarchical regression with a two-tailed test and a level of . total score ranges from 0 to 136) scale. linearity. Because maternal age was not correlated with any health variables. the PSQ was translated into Cantonese. Those mothers who experienced postpartum complications did not differ in general health.7% of mothers had scores over the 16 cut-off for high depressive symptoms.and support-related variables were entered in the second set.00. range 0 – 11) physical conditions at the time of data collection. In the current study. range 27 – 136) than the PSQ-received (M ¼ 75.11.

2%) 0 (. p < .001).0%) 0 (. t ¼ 9. t ¼ À5.0%) 0 (. p < .01) and support received (B ¼ À.74 1. Thus.0%) 0 (. b CS.0%) 5 (7.0%) 23 (16.8%) 30 (44. The interaction term of stress and social support added only another 2% of variance to the level of general health. p ¼ . p ¼ .2%) 8 (5.2%) 2 (1.7%) 25 (18.0%) 3 (4. SUPPORT.3%) 5 (6.19 .75.8% of the variance in the number of reported physical conditions (F ¼ 9.4%) 18 (25.5%) 0 (.0%) 1 (1. p ¼ .9%) 16 (23.0%) 13 (8.38).7%) 32 (47.8%) 31 (22. Research in Nursing & Health Depressive symptoms. gastrointestinal.23 .3%) 26 (18.90.3%) 22 (30.001).35 — — — — — — Fisher’s Exact Test was used to compare occurrence rate of physical health conditions between mothers who were within 6 months and mothers at 6 – 12 months postpartum. t ¼ 2.97.002 .9%) 4 (19. Mothers’ length of stay in the US (B ¼ . p < . The interaction between stress and the social support and support received accounted for an additional 7% of variance in depressive symptoms (F change ¼ 18.44.0%) 13 (16.0%) 0 (.43.3%) p .55 . p ¼ . p < .7%) 1 (1.9%) 3 (2. t ¼ 4.3%) 6 (13.7%) 6 (8. and social support accounted for 16. and social support accounted for 65.5%) 2 (3.6%) 13 (18. stress.001).05. p < . p < .6%) 10 (7.42.0%) 0 (.43. a GI. t ¼ À7.5%) 38 (52.8%) 32 (47. p ¼ .0%) 2 (2.40 .6%) 63 (45. p ¼ < .01.01) had a negative effect on physical health conditions.02) and stress (B ¼ . AND MATERNAL HEALTH / CHENG AND PICKLER 587 Table 1.001) had negative effects on maternal general health while support received (B ¼ .8%) 6 (4.51. baby’s age.6%) 70 (50. p ¼ .01.8%) 37 (51. p < .3%) 18 (26.17.19 .001) and importance of support (B ¼ .6%) 4 (2.6%) Within 6 Months Postpartum (n ¼ 72) 45 (62.0%) 6 – 12 Months Postpartum (n ¼ 80) 42 (62.13.0%) 0 (.10 .4%) 69 (49.02) had positive effects on depression. stress. Results of hierarchical regression showed that the maternal contextual variables of mothers’ length of stay in the US. social support did not moderate the relationship between stress and general health (F change ¼ 1. p ¼ . t ¼ 5.0%) 8 (11.10 .9%) 6 (9. Results of hierarchical regression showed that the maternal contextual variables of parity.06.15 . The interaction term of stress and social support accounted for less than 1% of variance in the number of physical conditions reported (F change ¼ .6% of the variance in depressive symptoms (F ¼ 69.0%) 0 (.00 .15.65. social support did not moderate the relationship between stress and reported physical conditions.3%) 57 (41.81. t ¼ À2. Physical health conditions. Parity (B ¼ À1.5%) 4 (6.39 .3%) 29 (43.14 .95. Thus. Comparisons of Physical Health Conditions by Baby’s Age Groups Current Point in Time (N ¼ 152) Interrupted sleep Decrease in memory Lack of sexual desire Backache Retained body weight Physical exhaustion Sleep disturbance Hemorrhoids Frequent headaches Sore nipples/breast tenderness Painful intercourse Bowel problems Eating disorder/GI upsetsa Urinary problems Breast infection CS wound painb. DISCUSSION This study was one of the first to examine USliving Chinese postpartum mothers’ health status . c Only those who had cesarean section were compared.1%) 7 (9.3%) 25 (37. the relationship between perceived stress and depressive symptoms was moderated by support received (B ¼ À.003 .5%) 2 (8. t ¼ 2.97.5%) 3 (4.001) showed positive effects.06.18.33 .STRESS.001) and importance of support (B ¼ .1%) 10 (13. p < . while stress (B ¼ .0%) 0 (.4%) 33 (45.0%) 3 (4.5%) 12 (8. t ¼ À5.03). t ¼ À2.4%) 24 (33.92.c Perineal pain Excessive vaginal bleeding Urinary tract infection Episiotomy wound infection CS wound infection Uterine infection Without above conditions 87 (62.39. Thus.81.001) showed negative effects.8%) 25 (37. cesarean section.4%) 0 (.25 .001) had positive effects while baby’s age (B ¼ À. t ¼ 2.0%) 53 (38.8%) 32 ( 19 (26.8%) 0 (.14).1%) 47 (33.

04 À. Parity 10. PSS 5. We found also that the mothers’ length of time living in the US was related to general health and that both perceived stress and support received accounted for a large portion of the variance in both general and physical health. and Health-Related Variables 1 1. S.. Similar to findings from previous studies—either in western countries or with Chinese mothers—stress. 1992). & ¨ ikko ¨ nen.01 À.07 .21ÃÃ À. which was much lower than the percentage (88%) reported in an earlier study of American mothers that used questions similar to those on the SHS (McCormick et al. mothers berg.16Ã .44ÃÃ . Parks.21ÃÃ 1 À. Center for Epidemiologic Studies Depression scale for depressive symptoms.05. Ã p < .. however.13 .01. this percentage was lower than the rate (35. PSQ-received 7. J. Third.17Ã À. Second. 2005.09 . The small sample size in our study and the fact that Z. J. did not use a Chinese version of the CES-D in their investigation may explain the difference in percentages.73ÃÃ .16Ã .50ÃÃ À. particularly childcare stress. stress and support received influenced all dimensions of health. Mother age 8. In addition.02 .16 . social support—either support mothers received or the importance of support—moderated only the relationship between stress and depression. Lobel. CES-D. was a predictor of postpartum depressive symptomatology (Hung. PSS. Self-Rated Health Subindex for general health. Leung. Culturally appropriate supportive interventions may help new mothers manage their depressive symptoms as well as manage their stress.05 À. Employmenta 9. and mental—were correlated with each other. Pearson Correlations Between Maternal Stress. In addition.23ÃÃ 1 . The moderating effect of support on stress and depression was similar to the results of Collins. Cohen & Williamson. PSQ-importance 6.10 À. Dimensions of health—general. PHCC 3. Huang et al.13 1 À. 2007). Chinese mothers in our study did not have a high level of depressive symptoms.05 À. 2004. and the support mothers received moderated the effects of stress on depression. Ra ¨ rvenpa ¨a ¨ .. who found that overall social support during pregnancy had a buffering effect on postpartum depression.00 1 .18Ã À. 2005). These results are similar to findings from other studies in the US (Fowles.48ÃÃ .14 1 . Howell.58ÃÃ À.14 . and life stress.27ÃÃ À. 2005).11 . These findings suggest that Chinese postpartum mothers who have not been in the US long may have higher levels of stress and feel less supported during the postpartum period. Regardless of the difference in the rate of depressive experiences.07 À.31ÃÃ .06 .06 À.29ÃÃ À.01 SHS.06 . StrandMartinson. stress was strongly correlated with depression. 1988). and Scrimshaw (1993). via the Lazarus and Folkman theory of stress.25ÃÃ . who found that support did not moderate the relationship between life change and illness.588 RESEARCH IN NURSING & HEALTH Table 2. In the current study. Gjerdingen & Chaloner.11 1 .32ÃÃ À. SHS 2.1% of Chinese mothers self-rated their current overall health as good Research in Nursing & Health or excellent.34ÃÃ 1 À.6%) of Chinese mothers in a national study of the 2001 birth cohort in the US (Z. Physical Health Condition Checklist for physical health conditions. and Jarrett (1986). Postpartum Support Questionnaire for social support. Support did not moderate the relationship between stress and general health or stress and physical health. Pesonen.13 À.50ÃÃ À. Leung. Dunkel-Schetter. Yet. This finding is similar to that of Lenz. 1998.47ÃÃ . Jenkins.05 . Baby age 11. Perceived Stress Scale for perceived global stress. although almost a quarter of them scored above the cut-off. 1994. physical. Horowitz. Years lived in the US 1 À.11 À. mothers’ stress scores were significantly higher than the general population norm for females in the US or ethnic minorities in the US (S. S. CES-D 4. Arthur.24ÃÃ À. 2004) and to report a higher level of depressive symptoms (E. PSQ.14 À.28ÃÃ À.22ÃÃ À.16Ã 1 . in our study. Huang et al. & Leventhal. . Support.04 À. a Employed was coded as 0 whereas unemployed was coded as 1.22ÃÃ À.17Ã À. 65.36ÃÃ À. PHCC.11 À. Mora. 1985).20Ã 2 3 4 5 6 7 8 9 10 1 . ÃÃ p < . In general. & Ja who perceived having inadequate social support tended to report their general health as poor or fair (Haas et al. in this current study.

399 – 407. Bracken. we measured only participants’ general perceived stress. 10. E. West.. L. P. as the care received by Chinese mothers in the US is not known. M. in particular among the growing population of postpartum mothers of Chinese descent.J. 31 – 67).. Cohen. Spacepan & S.Y.. 229 – 238.. & Lee. Y. I. Huang.. & Risher. P.. lack of sexual desire..K. Tai..H. A. (1991). 267 – 280. & Sheu. (2006). Sakala.. (2003). H. Applebaum. Nursing Research. applied in healthcare practices to improve maternal health. Glasper. Social support in pregnancy: Psychosocial correlates of birth outcomes and postpartum depression. State of the art procedures for translating.J.M. Collins. L. (2003). Oskamp (Eds.. 16. & Barona. Physical health problems after childbirth and maternal depression at six to seven months postpartum. School Psychology International. Women’s Health Issues. 447 – 466. S. & Detillion. Wu. Physiology & Behavior. Journal of Personality and Social Psychology. More research also is needed to examine the positive effects of culturally based care on the overall maternal health of foreign-born new mothers living in the US. Cohen. Chan. (2000). retained body weight. Levy. BJOG: An International Journal of Obstetrics and Gynaecology.. 275 – 285. Lobel. (2006).. AND MATERNAL HEALTH / CHENG AND PICKLER 589 Implications Further studies are needed to examine postpartum mothers’ general physical health and also the morbidities of ongoing health conditions over time during the postpartum period. T. Predictors of postpartum depression: An update. decreased memory. Studies focused on the effects of traditional cultural approaches to postpartum healthcare with mothers of various ethnicities are recommended. E.. C. Corry. Perceived stress in a probability sample of the United States. The Kaohsiung Journal of Medical Sciences.H. Such focused scales may help identify and enhance understanding of prevalent events that most often increase new mothers’ level of stress. Research in Nursing & Health REFERENCES Beck. & Scrimshaw. & Wang.. C. subjective wellbeing. (2001).. Chou... DeVries. whether the care received by Chinese mothers in China is the same. 571 – 579. Declercq.Y. C. 44 – 51... CA: Sage. New York: Maternity Center Association. Chung. S. S.) Mahwah.R.S. (1999). C.W. Thus. postpartum health conditions may persist over a long period of time. 79. 18.. V. and physical exhaustion. Newbury Park. & Aiken. SUPPORT. Adherence to ‘‘doing-the-month’’ practices is associated with fewer physical and depressive symptoms among postpartum women in Taiwan.G. C.E. S. In: S.C. For many mothers of all ethnicities.Y... S. 65. Social modulation of stress responses. C. D. or has the same effect. A qualitative study of the experiences of a group of Hong Kong Chinese women diagnosed with postpartum depression. Integrative review of research on general health status and prevalence of common physical health conditions of women after childbirth. N.H.. (2004). Research is needed also that addresses the long-term effects of particular intervention strategies on postpartum physical health conditions. Q.. (2002). Dunkel-Schetter. backache. Chen. Chen. .P. 39. The social psychology of health (pp. Bastida.A. As we found in our study.C. and depression in an older Mexican-origin sample. Y. if successful.M. (2002). 29. Residency in the United States. S. Journal of Advanced Nursing. Brown. 107. C. & Braccio.C. A. 119 – 132. numerous postpartum health conditions have a high rate of prevalence among Chinese mothers and are associated with their overall physical health status.Y.F. C.. NJ: Lawrence Erlbaum Associates. We recommend further research using scales to identify and measure specific stressful events. G. 12.H. B. Tseng.L. Journal of Aging and Health. The Kaohsiung Journal of Medical Sciences. Research in Nursing & Health.L.T. F. Additional studies are also needed to focus on intervention strategies that prevent or moderate the occurrence of prevalent postpartum health conditions and improve maternal physical health status. & Li... 50.. An exploration of postpartum depression model using LISREL. C.. not only for Chinese postpartum mothers but for all new mothers.R. their study was not conducted in the US. 1243 – 1258. Ko. validating and using psychoeducational tests in cross-cultural assessment. survey of women’s childbearing experiences. & Williamson. J. Psychosocial aspects of Taiwanese postpartum depression phenomenological approach: A preliminary report. Cuellar.). Chinese new mothers who adhere to their culture’s traditional postpartum care practices experience less severe rates of physical symptoms. According to Chien et al. J. S. M. Interventions that reduce particular influences on maternal stress can then be developed and tested and. Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.S. Listening to mothers: Report of the first national U. 15. particularly sleep concerns. (2008). Cohen. S. developing an instrument to measure long-term postpartum maternal morbidities may help identify those physical conditions new mothers experience most often and about which they are most concerned.H. Cheng. 374 – 383. S. Yet. E. (1988).M. 1194 – 1201. (1993). Chien. To examine maternal stress among Chinese postpartum mothers living in the US. (1994). & Lumley.STRESS.

M. Journal of Advanced Nursing. New York: Springer. Predictors of postpartum women’s health status.R.S. Dean.. Leung.H.H. (1992). H.. Coombes. Gaynes.. Lohr. Heh. Chiu. 14. Jenkins. Gjerdingen.S. Kahramanian. Journal of Family Practice. D. 19. Changes in women’s mental and physical health from pregnancy through six months postpartum. P. S. & McBride. Holroyd. (1997). Brooks-Gunn. Journal of Women’s Health.K.S.. 161 – 166.T. Predictors of parental sense of competence for the couple during the transition to parenthood. Family support and postnatal emotional adjustment. & Bennett. 159 – 171. P. Changes in the health status of women during and after pregnancy.. & Ha. C..M. Kenney. (1986).P. Honey..A.S. The relationship of maternal attributes. Rockville. (1986). 32 – 46. New York: Plenum Press. Lara. E. 45 – 55. C. M. Diet restriction in postnatal period from the point of Chinese and Western medicine. Postpartum depression: Perceived social support and stress among Hong Kong Chinese women. screening.Y. & Chaloner. 17 – 24.. 45 – 51. G. & Bautista. S.H. K. N. Horowitz. Morgan. Carter. Meltzer-Brody. M. Hong Kong.W. M. et al. Lazarus. & Folkman. and perceptions of postpartum experiences to depression. Z. C. Perceived motherinfant relationship difficulties in postnatal depression. & Guo. Ukestad. D. 129 – 143.C.C. (1991). T. D..H. L. 20 (1). A stress-coping transactional model of low mood following childbirth.. S.. R.. A research and service oriented multilevel assessment instrument. ‘‘Doing the month’’: An exploration of postnatal practices in Chinese women. 91 – 99. Leung. 301 – 313. Lawton. E. Dynamics of stress: Physiological. (1985). et al. (2004). Leung. M.S. M. 51.S. Stewart. A psychiatric epidemiological study of postpartum Chinese women. Infant and Child Development.L. & Chung. D. International Journal of Nursing Studies. S. Ronzio. 05E006-1). (2001). H.. L.A.L. S.A. Research in Nursing & Health. W. Leung. Jackson.S.. Gartlehner. 225 – 230. 4.K. Huang.E.and foreignborn mothers. C. K. (2000).. Chun. McCormick.. F. Journal of General Internal Medicine. J. (1998). & Heagarty. (2004). (2006).. M.. 41.. American Journal of Psychiatry. 18. J. & Solon. Journal of Advanced Nursing. 257 – 267. McGovern. Stress in women with postpartum depression: A phenomenological study. 1442 – 1450. Bulletin of the Hong Kong Psychological Society. & Bartlett. Research in Nursing & Health. Hong Kong Polytechnic University. (1982).. Damato. accuracy.S.C. Fuentes-Afflick. D.Y. (2002)..S.. L. A. psychological.B. childbirth. Acculturation and Latino health in the United States: A review of the literature.H... P.K. 1. L. (2004).. Swinson. resources. 38.L...E. E. The relationship of women’s postpartum mental health to employment. Howell. Fulcomer. (1998). 159 – 171.S. 11. 37. People’s Republic of China. (2005)..R. & Martinson... G.I. C. J. & Leventhal... Cognitive theories of stress and the issue of circularity.S. L. C. R. J.. J.. Maternal and Child Health Journal. Usui... C.R. Moss. A.. B. Arthur.). M.A.. Lazarus. 4 (3).. Research in Nursing & Health .S. & Chung.590 RESEARCH IN NURSING & HEALTH Fowles. 105. 36.J. E. Journal of Nursing Measurement.. Life change and instrumental support as predictors of illness in mothers of 6-month-olds. Perinatal depression: Prevalence. and screening outcomes (AHRQ Publication No. 36... L. Journal of Reproductive and Infant Psychology. Morales..M. B.N. T. (1984).N. appraisal. Mora. Yip.. (1994). 9. C. Trumbull (Eds. J.F.R.G.Y.. The effects of postpartum stress and social support on postpartum women’s health status... Journal of Gerontology. 32. Journal of Nursing Scholarship. I. Gjerdingen. 13. Hung. Lenz. Depressive symptomatology and mental health help-seeking patterns of U... Gjerdingen. D. 158.R. S. The Postpartum Support Questionnaire: Reliability and validity. (2003).. L..C. (2004). 465 – 472.. (2004). and social perspectives (pp. 287 – 295. Knauth. M. & Yu. and social support. & Kleban. 676 – 684. Horowitz. 367 – 397.. 345 – 351.K. 23.. & Vostanis.. S.. Gross. Haas. D. 129 – 142. Hung. Wallace. Unpublished doctoral dissertation. Postpartum health of employed mothers 5 weeks after childbirth.C.K. Obstetrics & Gynecology. Brawarsky.. & Jarrett. The association between depressive symptoms and social support in Taiwanese women during the month. Lee. 573 – 579. M.. 83 – 94. Dowd. Parks. Health Care for Women International. Health Care for Women International. Birkimer. H. E. 28. D. Logsdon. The Taipei Journal of Chinese Medicine (Taiwan).. Annals of Family Medicine. Wong. (2005). et al. E.G. S. Huang.H. The Journal of Family Practice. 21. Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Loh. 26. 63 – 98). K.. S. P. F.C. E. M. Annual Reviews in Public Health. 486 – 509..H. T. Froberg.E. Gavin. C. MD: Agency for Healthcare Research Quality. Stress. H.L. C. P. 159 – 167... (2005). Duffy. Holmes. Gamboa. A comparison of sleep and daytime sleepiness in depressed and nondepressed mothers during the early postpartum period.K.. 353 – 360.. (2005). Appley & R. 4. 12. P. & Kochevar. Journal of Nursing Research.. P. Maternal health status in the year after delivery among lowincome women. In: M. 220 – 226. Katie. and coping. (2001).K. (2005).K. M.. Research in Nursing & Health. (2007). Lai. & Folkman.L.G. R. M.S. The relationship between maternal role attainment and postpartum depression. (1996). A.

(1998). 935 – 941.K. (2002). (1992). Government Printing Office. Saurel-Cubizolles.. Carey. 83 – 94.. 9. SUPPORT. S.D. Ra ¨ rvenpa ¨a ¨ A. & Waldenstro Physical symptoms after childbirth: Prevalence and associations with self-rated health. Nursing Research. Weng. L. Journal of Immigrant Health.. 198 – 215. Lelong. (1985). ¨ ikko ¨ nen. N. & Pesonen. 210 – 217. M. 1202 – 1209. BJOG: An International Journal of Obstetrics and Gynaecology. (1989a). 1. Ma-yu-chi de mi sz: Han ren fu niu tzuo yue tz de tan tau [The myth of chicken cooked with sesame oil: An investigation of the behaviors of doing-the-month of Chinese women]. (2007). Maternal and Child Health Journal.STRESS.A. Thompson. Factors associated with back pain symptoms in pregnancy and the persistence of pain 2 years after pregnancy. & Ellwood. The CES-D Scale: A self-report depression scale for research in the general population. Uretsky. 4. 38.S.. M. M. Otchet. G.S.L. L. (2005). Acta Obstetricia et Gynecologica Scandinavica. Patel.O.M. Continuity of maternal stress Ja from the pre. Health. stress. & Adam. Infant Behavior & Development.R. Counselling Psychology Quarterly. The process of maternal role attainment over the first year. 10.. Radloff. Surkan. 198 – 204.L. 34.T. K. Birth. Currie. A longitudinal analysis of stress process among mothers of infants. ¨ m. and parental adaptation: Applications to the care of childbearing families. negative and overall temperamental reactivity. 1086 – 1091. AND MATERNAL HEALTH / CHENG AND PICKLER 591 Mercer. Prevalence and persistence of health problems after childbirth: Associations with parity and method of birth. DC: U. social support and stressors: A community survey of immigrant Asian women and the indigenous population. M. Romito.W...N. T. & Harkless. 2007 with chartbook on trends in the health of Americans (Library of Congress Catalog No. Journal of Family Nursing. Strandberg. 385 – 401. Reece. 107. & the postnatal period associations with infant’s positive.. Walker. United States.E.. N. E.. Psychological disturbance. Self-efficacy.Y.J. C. 82.. 339 – 343. Roberts.. (1989b).W. (1999). & Mathiesen. Newsletter of Chinese Ethnology (Taiwan). 32. W. National Center for Health Statistics. L. 29. J..E. Research in Nursing & Health .F. (2006). 38.. 263 – 276. F.G. 15 – 31. Hughes. R. Schytt. To..L. 36 – 47. A.J. (2007). 10 – 16. 125 – 136. Stress process among mothers of infants: Preliminary model testing. (2003). P. Washington.K. U. 375 – 383. L. (1994).. Nursing Research.. P.C.O.S. P. M. The role of social networks and support in postpartum women’s depression: A multiethnic urban sample. & Wong.C. BJOG: An International Journal of Obstetrics and Gynaecology. K. Applied Psychological Measurement. Lindmark. (1977). B. Women’s health after childbirth: A longitudinal study in France and Italy.. (2005). 94. L. 28. S. D. The effects of years lived in the United States on the general health status of California’s foreign-born populations. G. Peterson. 76-641496).. & Gottlieb. General health and psychological symptom status in pregnancy and the puerperium: What is normal? Obstetrics & Gynecology. 5. 112. M. (2000). Walker. Nursing Research.