title: Maternal screening for early postnatal vulnerability.
abstract: Research has highlighted the wide impact of maternal mental health problems during and beyond the postpartum period and the public health role of community health professionals in early detection of women who may be at risk. This paper aims to describe, explore and test an a priori hypothesised conceptual model of postnatal experience, identifying the relationships between postnatal mental vulnerability and postnatal adjustment to maternal roles and attitudes, marital/partner-relationship and sense of coherence. Three validated self-report questionnaires (WAST, MAMA, SOC) measuring the variables of the encompassing framework and EPDS were administered in random order. The conceptual models were tested using the software IBM SPSS Statistics and LISREL and the tests performed were: Student's ttest, chi-square tests, Explanatory factor analysis using a Varimax rotation Principal Components Method, Confirmatory analysis -known as structural equation modelling- of principal components. Psychometric scores indicate high correlation between WAST, MAMA, SOC and EPDS. An exploratory factor analysis confirmed the role of SOC, specific MAMA subscales (maternal roles and attitudes, body image, sex, breasts, nausea) and WAST (relationship tension and emotional and physical abuse) subscales (KMO measure of sampling adequacy=0.735 and Bartlett's test of sphericity=184,786, df=36, p<0.0005). The latent variables confirmed with SEM were marital relationship, maternity experience and self-efficacy (Chi-square=28.45, df=24, P-value=0.24, RMSEA=0.046 p<0.05). Marital Relationship (Factor I: Eigenvalue=3.066) concerning lack of or disappointment with partner support, poor marital relationship and emotional/physical abuse has been associated with high levels of postpartum anxiety and depression. Maternity Experience (Factor II: Eigenvalue=1.280) representing postnatal roles and attitudes towards their infant can be as useful as mood changes for evaluation of mothers. Self-Efficacy (Factor III: Eigen- value=3.144) and especially attitudes regarding body image, sex and coping resources and options of dealing with the stressor, has been demonstrated that serve as a mediator or buffer for psychological distress. The results of this study have implications for the prevention and intervention of postnatal adjustment difficulties both of which need to be intensified in order to minimise perinatal mental vulnerability.
authors.affiliation: Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion.|Department of Midwifery, Technological Educational Institute (TEI) of Athens, Athens.
authors.forename: V G
authors.initials: VG
authors.lastname: Vivilaki
authors.affiliation: Department of Political Sciences, University of Crete, Rethymno, Crete, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Dafermos
authors.affiliation: King's College, Florence Nightingale Faculty of Nursing and Midwifery, London.
authors.forename: Ev
authors.initials: E
authors.lastname: Patelarou
authors.affiliation: King's College, Florence Nightingale Faculty of Nursing and Midwifery, London.
authors.forename: D
authors.initials: D
authors.lastname: Bick
authors.affiliation: Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, United Kingdom.
authors.forename: Ar
authors.initials: A
authors.lastname: Syngelaki
authors.affiliation: Department of Psychiatry, School of Medicine, University of Pennsylvania, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: Tsopelas
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Crete.
authors.forename: P
authors.initials: P
authors.lastname: Bitsios
authors.affiliation: Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens.
authors.forename: E T
authors.initials: ET
authors.lastname: Petridou
authors.affiliation: Department of Psychiatry, School of Medicine, University of Pennsylvania, USA.|Department of Psychiatry and Behavioral Sciences, University of Crete.
authors.forename: Al N
authors.initials: AN
authors.lastname: Vgontzas
authors.affiliation: Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion.|Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.
authors.forename: Chr
authors.initials: C
authors.lastname: Lionis
mesh_terms: D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology*; D042241:Early Diagnosis; D061345:Early Medical Intervention; D005260:Female; D006115:Greece; D006801:Humans; D008403:Mass Screening; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012307:Risk Factors; D020377:Self Efficacy; D057566:Self Report; D012944:Social Support; D013223:Statistics as Topic; D011795:Surveys and Questionnaires