Access Type

Open Access Dissertation

Date of Award

January 2020

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nursing

First Advisor

Nancy Hauff

Abstract

Purpose and Background/Significance: The transition from “woman” to “mother” is a significant life event and can be extremely stressful when merged with the transition from ‘local’ to ‘immigrant’. The development of mother-infant bonding is considered a critical process in the postpartum period. Immigrant women have higher rates of PPD compared with women in their native countries. Among the general population, PPD is strongly associated with lower quality mother-infant bonding. Social support can play a central role in lowering the levels of PPD, and may contribute to higher quality of mother-infant bonding. Moreover, limited data suggests that acculturative stress is found to be related to an increased PPD among immigrant women. However, no published studies have examined the predictors of mother-infant bonding among U.S. immigrant women of Arabic descent. Additionally, no published research has examined the relationships of PPD, acculturative stress, social support and mother-infant bonding among U.S. immigrant women of Arabic descent. Therefore, the purpose of this study was to examine the effect of PPD, acculturative stress, and social support on mother-infant bonding among U.S. immigrant women of Arabic descent.

Theoretical/ conceptual framework: This study was guided by Roy’s Adaptation Model. The model concepts of RAM utilized in this study include the focal and contextual environmental stimuli, self-concept as an adaptive mode, and adaptation. In the present study, the main concepts were acculturative stress, social support, PPD, and mother-infant bonding. The focal stimulus is childbirth and the contextual stimuli is acculturative stress and social support. PPD is considered a self-concept adaptive mode. Finally, adaptation which is mother-infant bonding.

Method: This study utilized a non-experimental, cross-sectional, correlational, descriptive design. A convenience sample of 95 postpartum U.S. immigrant women of Arabic descent was enrolled in this study. Participants completed five instruments including: (1) the Edinburgh Postnatal Depression Scale (EPDS), (2) the Multidimensional Acculturative Stress Inventory (MASI), (3) the Multidimensional Scale of Perceived Social Support (MSPSS), (4) the Postpartum Bonding Questionnaire (PBQ), and (5) a sociodemographic tool developed by the investigator. The data were analyzed using correlational and multiple linear regression analyses.

Results: Women ranged in age from 20-43 years with mean age = 30 years and were between 1-12 months postpartum with mean 5.5 months postpartum. The average length of stay in the U. S. ranged from one to 31 years (mean = 10.19 years, SD= 7.18). The participant’s mean age at the time of immigration to U.S was 19.6 years (SD= 9.18). The average woman completed a high school education (mean=12 years, SD=3.5). Eighty percent of the women preferred to be interviewed in Arabic, and (91%) had an annual family income of <$40,000, and 90.5% were not employed.

Aim 1: There was a negative relationship among PPD and mother-infant bonding. PPD was significantly correlated with mother-infant bonding, that is higher levels of PPD symptoms related to poor mother-infant bonding (r=.55, p= .000). Social support was significantly related to mother-infant bonding (r= -.29, p= .005), and acculturative stress was significantly correlated with mother-infant bonding, with higher levels of acculturative stress being related to poor mother-infant bonding (r=.37, p= .000).

Aim 2: Multiple linear regression analyses were used to identify the effect of acculturative stress on the relationship between PPD and mother-infant bonding. A series of linear models were used to examine the relationship between (a) PPD and acculturative stress, (b) PPD and mother infant bonding, and (c) acculturative stress and PPD on mother-infant bonding. PPD was significantly associated with acculturative stress (β= .32, t= 3.27, p= .002), and significantly associated with mother-infant bonding (β= .55, t= 6.28, p= .000). When examining the relationships among acculturative stress, PPD, and mother-infant bonding, both PPD (β= 45, t= 5.33, p= .000), and acculturative stress were statistically significant (β= .22, t= -2.41, p= .018). Therefore, acculturative stress mediates PPD and mother-infant bonding.

Aim 3: Multiple regression equation was conducted to test the interaction between social support, PPD and mother-infant bonding. PPD, social support, and the interaction between PPD and social support were not statistically significant. Therefore, social support did not moderate PPD and mother-infant bonding

Conclusions: PPD, acculturative stress, and social support were associated with mother-infant bonding among U.S. immigrant women of Arabic descent. Social support did not moderate the association between PPD and mother-infant bonding, while acculturative stress mediated the association between PPD and mother-infant bonding. Future studies with larger samples in different settings are needed to provide validity to the results of this study and to provide a better understanding of the factors that might impact mother-infant bonding among immigrant women of Arab descent. Longitudinal studies and using observational methods are recommended to be used in assessing the mother-infant bonding because they provide objective details of the relationship, as well as, using a diagnostic assessment for measuring PPD. Nurses and other health care providers should be aware of life stressors including acculturative stress that may influence the mother-infant bonding among U.S. immigrant women of Arabic descent. Therefore, is screening those women prenatally for acculturative stress, depression, and bonding are needed

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