Does Perceived Quality of Care Moderate Postpartum Depression? A Secondary Analysis of a Two-Stage Survey
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Does Perceived Quality of Care Moderate Postpartum Depression? A Secondary Analysis of a Two‑Stage Survey Bridget Frese Hutchens1 · Margaret L. Holland2 · Tanya Tanner3 · Holly Powell Kennedy2 Accepted: 10 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Objective The purpose of this study was to examine if women’s perceptions of the quality of hospital care during childbirth moderate their risks for symptoms of postpartum depression (PPD). Methods This cross-sectional secondary analysis analyzed data from the Listening to Mothers III (2013) series surveys with a weighted sample size of 1057 of women surveyed from across the United States. PPD symptoms were defined according the Patient Health Questionnaire-2. Associations between risk factors and PPD symptoms were tested using logistic regressions with the moderating variable of perceived quality of care then added to models with significant risk factors. Results Of the 22 potential risk factors for PPD symptoms, 10 were found to be significantly associated with PPD symptoms in this sample of women. Very good perceived quality of care moderated the following risk factors for PPD symptoms in a protective direction: relationship status (p = 0.01), pre-pregnancy BMI (p = 0.02), and pain that interfered with routine activities 2 months postpartum (p = 0.003). Conclusions These findings suggest risk factors for PPD symptoms are moderated by perceived quality of care and therefore, maternity providers can influence women’s psychological wellbeing postpartum by providing very good perceived quality of care during the hospital stay for birth. However, these findings should be interpreted cautiously due to a lack of a direct, proven relationship between provider action and women’s perceived quality of care. Keywords Postpartum depression · Risk factors · Quality of care · Moderation · Mental health
Significance There exists extensive research on risk factors for PPD symptoms. However, maternity care providers have limited ability to modify most of the previously identified risk factors. This study adds to the existing literature by examining not only identifying risk factors for PPD but also exploring Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10995-020-03103-1) contains supplementary material, which is available to authorized users. * Bridget Frese Hutchens [email protected] 1
Hahn School of Nursing and Health Science, University of San Diego, 5998 Alcala Park, San Diego, CA 92110, USA
2
Yale School of Nursing, 400 West Campus Dr., Orange, CT 06477, USA
3
Frontier Nursing University, 2050 Lexington Rd, Versailles, KY 40383, USA
whether these risk factors are moderated by perceived quality of care which maternity care providers have greater ability to modify. Our findings suggest that perceived quality of care does moderate risk factors for PPD and therefore, suggest that maternity care providers can influence women’s psychological wellbeing by wo
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