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Identifying the difficulties women face in transitioning to motherhood and creating interventions may help women cope

Thriving vs surviving in new motherhood

For many new mothers, the transition to motherhood can be difficult. Up to 70% of new mothers experience the "baby blues." Across the globe, 13% of women experience a mental disorder after giving birth. The most common disorder in these women is depression. In developing countries, the rate is even higher. About 19.8% of women will experience a mental health issue after having a baby.1,2

While this depression can have a large negative impact on women, including the inability to care for themselves, the effects on their infants is equally problematic. When a mother suffers from depression she may be unable to respond properly to her infant's needs. In addition, mother-infant bonding and breastfeeding may be compromised. All of this has negative implications for the infant's overall development.2

Researchers at Johnson &Johnson in collaboration with Dr. Wendi Gardner, Professor of Psychology at Northwestern University, set out to identify the factors that may be associated with a risk of depression or predict well-being. With this understanding, it is possible to begin developing behavior models and interventions to help women adjust to their new role of mother.3

CES-D and maternal intuition tension chart and CES-D and social connection tension chart

Method

This study included the administration of an online survey to 2 separate study populations. The first group included 745 first-time mothers to a child under the age of 6 months in the US, UK, India, China, and Brazil. The second population consisted of 123 first-time mothers in the US with a child under the age of 12 months. These surveys asked the mothers to rate themselves against 8 tensions often felt by new parents3:

  • Intuition: "I love you baby, but I don't know you"
  • Insecurity: "I'm new at this, but I'm supposed to be a natural"
  • Efficacy: "I want to be Supermom, but don't have superpowers"
  • Autonomy/Control: "I can't control you baby, but you are a measure of me"
  • Connection: "I need connection, but my relationships have been disrupted"
  • Identity: "I am a new me, but the world expects the old me"
  • Conflicting needs: "I have the responsibilities of a mom, but also have needs of my own"
  • Autonomy/Control: "I want to let you be you, but you are a reflection of me"

In addition to taking the online survey, mothers in the second study group also wrote about each tension, identifying whether they had never experienced, had resolved, or were currently experiencing the tension. They were also given well-being measures and the Center for Epidemiological Studies-Depression (CES-D), a 20-item questionnaire that helps identify the risk of clinical depression.3

Results

A cluster analysis of the first survey group identified 5 types of mothers3:

  • Type 1: have resolved 3 key tensions of intuition, identity, and connection
  • Type 2: experiencing connection conflict
  • Type 3: experiencing identity conflict
  • Type 4: have resolved all tensions
  • Type 5: experiencing intuition and identity conflicts

Of these 5 types, 2 showed significantly higher levels of well-being than the others. These types of mothers were those who rated low on all tensions (Type 4) and those who had resolved the 3 key tensions of intuition, identity, and connection (Type 1).3

The results from the second study group established the relationship between 3 key tensions and depression. Mothers currently experiencing any of 3 key tensions scored significantly above the threshold for risk of clinical depression (a CES-D score of 16). It was also observed that intuition tension negatively impacts the development of a maternal identity, aligning with the Type 5 mother.3, 4

Intervention

Study 3 began after analyzing the results of the 2 survey groups. In this study, researchers created a journaling intervention. Women received literature explaining traits of self-verification. They then wrote down the personality traits that first caused their partner to fall in love with them. They also wrote about how they still have these traits and the ways in which they can continue to express these traits as a mother. Results showed that the writing intervention significantly improved their ratings on the identity and connection tensions.3

Conclusions

New mothers experience not only physical change, but also a mental and emotional transitions. While many cultural differences exist globally, there are more similarities than differences in the fundamental struggles that mothers face during this transition. This study identified 3 key tensions—intuition, identity, and connection—that disrupt a mother's well-being and inhibit ability to bond with her child. Survey results showing that 35% to 52% of study participants had not yet resolved these tensions demonstrate the need for support of women transitioning into motherhood.1-3

The behavior interventions in this study lead to significant improvement in these tensions, suggesting interventions may be developed to help mothers transition to motherhood, leading to a long-term benefit for a mother's well-being. Intervening with mothers to resolve key tensions may help them avoid mental health issues, such as postpartum depression, and ensure they can raise happy, healthy babies.3

REFERENCES

1. American Psychiatric Association. What is postpartum depression? https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression. Accessed March 22, 2018.

2. World Health Organization. Maternal mental health. http://www.who.int/mental_health/maternal-child/maternal_mental_health/en/. Accessed March 9, 2018.

3. Data on File 1, Johnson & Johnson Consumer Inc. (Thriving vs Surviving in New Motherhood).

4. American Psychiatric Association. Center for Epidemiological Studies-Depression. http://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/depression-scale.aspx. Accessed March 26, 2018.

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