1. Background
Postpartum depression (PPD) is a kind of major depression with symptoms, including low mood, lack of pleasure, forgetfulness, irritability, sleep disorder, and poor performance, beginning five weeks postpartum (1, 2). Postpartum depression is a multifactorial disorder from different biological, psychological, and sociological aspects (3). It is dangerous for the mother and infant, and it can lead to infanticide (4), impaired growth and health of the baby (5), and even suicide (6). A meta-analysis study in Iran reported the average prevalence of PPD at 28.7% (7). Evidence shows that PPD has been a significant factor affecting maternal self-efficacy (8).
Self-efficacy is one of the significant factors in the successful transition of the mother to the maternal role (9). Maternal self-efficacy plays a major role in the mother's care skills and can lead to better adaptation to the situation (10). Moreover, infant care behaviors are those behaviors that the mother does to care for, rear, and improve the infant’s health, such as meeting all the physical needs of the infant, like feeding, clothing, and bathing, to ensure the baby's health (11).
2. Objectives
Given the consequences of depression and the significant role of the mother as a spouse and infant caregiver, we sought to perform this study to compare maternal self-efficacy and infant care behavior among depressed and non-depressed mothers.
3. Methods
This study was a part of a large case-control study with the code of ethics IR.TBZMED.REC.1398.218, and the results of other parts of the study have been published previously (12). This study was conducted from February 2019 to May 2019 among 80 postpartum women admitted to Tabriz health centers.
The inclusion and exclusion criteria were reported in the previous article (12). For the sampling, the researcher attended Tabriz health centers and selected primiparous mothers or those with their second deliveries based on their health records. After calling them and giving brief description of the study and its significance, we invited the mothers to visit the relevant health centers on a specified date. After the mothers attended the centers, the researcher gave them more details about the study. If they were willing to participate and met the eligibility criteria, a written informed consent was obtained, and Edinburgh Postnatal Depression Scale (EPDS) was completed. According to obtained scores by the participants, the case and control groups were determined. The two groups were matched based on parity and delivery type. Moreover, other questionnaires, including a socio-demographic characteristics form Infant Care Behavior and Maternal Self-efficacy Questionnaire (MSQ), were completed.
Edinburgh Postnatal Depression Scale contains 10 multiple-choice questions, and each question is assigned a score of zero to three. The overall score ranges from 0 to 30. Obtaining a score of 12 or higher is a sign of possible depression. Montazeri et al. (2007) (13) validated the questionnaire in Iran. Maternal Self-efficacy Questionnaire has ten items, nine of which are related to maternal activities, and one is a general item. Each item has four options rated based on a Likert scale. The psychometric study of the questionnaire was conducted by Mirghafourvand et al. (2016) (14) in Iran. The Infant Care Behavior questionnaire was developed by Jamalivand et al. (15). It has 22 items and is scored based on a Likert scale ranging from always (score 4) to never (score 1), with scores ranging from 22 to 88. The validity and reliability of the questionnaire were confirmed.
The sample size was calculated at 38 participants in each group according to the study by Jamalivand et al. (15) using G-Power software. Data was analyzed in SPSS version 24. Independent t-test was used to compare maternal self-efficacy infant and care behavior scores in depressed and non-depressed mothers.
4. Results and Discussion
There were no significant differences in socio-demographic data between the case and control groups. The socio-demographic characteristics of the participants have been reported in another article (12).
Mean (SD) maternal self-efficacy score was 29.3 (3.6) in the depressed group and 33.0 (3.3) in the non-depressed, which was significantly higher in the non-depressed group compared to the depressed (P < 0.001). The mean score (SD) of infant care behavior was 72.2 (5.2) in the depressed group and 73.0 (9.0) in non-depressed, indicating no significant difference between the groups (P = 0.627; Table 1).
Table 1.Comparison of Maternal Self-efficacy and Infant Care Behaviors in the Study Groups
| Variables | Depressed (N = 40) Mean (SD) | Non Depressed (N = 40) Mean (SD) | Mean Difference (95% Confidence Interval) | P-Value a |
|---|---|---|---|---|
| Maternal self-efficacy (score range: 10 to 40) | 29.3 (3.6) | 33.0 (3.3) | - 3.7 (-5.3 to -2.2) | < 0.001 |
| Infant care behaviors (score range: 22 to 88) | 72.2 (5.2) | 73.0 (9.0) | - 0.8 (-4.1 to 2.5) | 0.627 |
a Independent t-test
In the present study, compared to depressed mothers, maternal self-efficacy was higher in non-depressed mothers. The study by Yaman et al. (2011) showed that low maternal self-efficacy was associated with maternal stress and depression (16). The study by Abdollahi et al. (2014) (5). among 2 - 12 weeks postpartum mothers exhibited that the increase in maternal self-efficacy was associated with a reduced risk of PPD. A study has reported decreased self-efficacy, self-confidence, self-esteem, and sense of self-worth, and increased guilt were related to depression (17), which is consistent with the results of the present study.
In this study, no significant difference was observed between the two group in terms of infant care behavior. In a cross-sectional study, Fathi et al. (2015) showed that there were no significant relationships between PPD and infant care (18). In a longitudinal study by Teti and Gelfand (1991), the results showed that mothers with high self-efficacy were successful in caring for their infants despite having PPD (9). The findings of the above studies were consistent with the present results. Women with postpartum depression may feel obliged to provide physical care for their infants despite the experience of negative thoughts (19).
Among the strengths of the study was using validated postpartum screening tools. Among the limitations of the study was conducting it in urban areas; thus, it is recommended to replicate this study in rural regions.
