The Relationship between Maternal Functioning and Mental Health after Childbirth in Iranian Women

Abstract

The postpartum period is critical for new mothers, in terms of performing maternal functions, which can be affected by physical or psychological complications. The purpose of the present study is to determine the relationship between maternal functioning and mental health in the postpartum period. This cross-sectional descriptive-analytic study was conducted on 530 eligible women who referred to health centers in Tabriz, Iran in 2018. The participants were selected through randomized cluster sampling, and data were collected by using a socio-demographic characteristics questionnaire, Mental Health Inventory (MHI), and the Barkin Index of Maternal Functioning (BIMF). These assessments were collected between 1 and 4 months postpartum. The relationship between maternal functioning and mental health was determined by conducting bivariate analysis via Pearson and Spearman correlation analysis and the general linear model (GLM) in a multivariate analysis. The mean (SD) mental health score in women was 79.1 (15.0) in the obtainable score range of 18 to 108, and the mean (SD) BIMF score in women was 97.4 (12.9) in the obtainable score range of 0 to 120. Based on Pearson or Spearman correlations, mental health and its sub-domains had positive, significant correlations with infant care, mother-child interaction, mental well-being, social support, management, adjustment, self-care, and maternal functioning (p < 0.001). Based on the GLM, increased maternal functioning was associated with higher total mental health score, having a moderate income, and receiving support for infant care (p < 0.05). High levels of postpartum mental health can have a positive impact on maternal functioning. Additionally, having support with infant care tasks can also improve functioning.

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“… 50 55 Another evidence in Iran reported similar finding with our study that having a low to moderate income was associated with higher maternal functioning. 54 The association of lower monthly expenditure with less likelihood of belonging to the poor functional status in the present study might be because of women in this social class may engage more in physical works in order to afford their income. Thus, the more engagement in physical work might have improved their functional status as it has been reported in an evidence that women who are highly physically active at 6 weeks and 12 weeks postpartum were more likely to have higher functional status.…”

“…57 Another possible explanation might be since infant care, breastfeeding practices and the use of neonatal care standards to improve neonatal and maternal healthcare practices are provided for mothers in health facilities and home visits through health extension programme for free; visiting public health facilities and receiving all these services may lead to better maternal functioning in women with less monthly expenditure. 54 58 …”

“… 53 54 Receiving social support is a powerful predictor for postpartum maternal health and functioning since positive social environment and support in the form of provision of resources and assurance can act as a stress buffering mechanism, protecting the mental health and functional status of mothers. 54 Considering the fact that receiving support is a predictor of maternal functioning, interventions of social support should be included in programmes for improvement of maternal functioning.…”

“…The WHO pilot study in Jamaica, Kenya and Malawi found that anxiety and depression were associated with a significant loss of functioning 11. Other studies conducted in the USA and Iran reported that maternal functional status had an inverse significant relationship with postpartum anxiety 53 54…”

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“…Since mental health indicators were examined as continuous variables, the interpretation of our findings as high scores could be less clinically relevant if they were not within the range of the case definition for depression or anxiety. Despite this, there are limited reports in the literature on the use of cut-offs for MHI-38 and its subscales [ 37 ], while there are references to the continuous scores [ 38 , 39 ]. Another limitation was that there was no diagnosis for mental health issues and no information was collected about history of psychiatric disorders or medication history.…”