Association between Support and Maternal Stress at ...

Social Work Research Advance Access published January 14, 2015

Association between Support and Maternal Stress at One Year Postpartum: Does Type Matter? McClain Sampson, Yolanda Villarreal, and Yolanda Padilla Left untreated, maternal parenting stress in the first year postpartum can have serious long-term consequences for both the mother and her child. Although studies have shown that perceived support can ameliorate maternal stress, more research is needed on whether the type of support matters when measured among a diverse sample of new mothers. Data from the Fragile Families and Child Wellbeing Study (N = 2,412) were used to examine effects of four types of perceived support on maternal parenting stress and to test a moderating effect of education. Multivariate analyses of variance and ordinary least squares regression found direct effects of partner support. Emotional support from fathers was most ameliorative for a mother’s stress regardless of education, race, or marital status. Predominantly, the association between support and stress did not differ by educational attainment. Implications for policy, research, and practice that buffer parenting stress for mothers of differing demographics are discussed. KEY WORDS:

first year postpartum; parenting stress; partner support; prevention; social support

ositive maternal mental health in the first year postpartum enhances infant emotional attachment and positive mother–child interaction (Grace, Evindar, & Stewart, 2003; Martins & Gaffan, 2000; O’Hara, 2009). Yet the first year after childbirth is often a time of emotional upheaval during which a mother’s mental health may be compromised. In this first year of a child’s life mothers are at increased risk for chronic stress, anxiety, and depression (Mulsow, Caldera, Pursley, Reifman, & Huston, 2002; Woolhouse, Brown, Krastev, Perlen, & Gunn, 2009). Maternal parenting stress, an adverse psychological reaction to the demands of parenting, can impair the way a mother responds to her child (Hammen, Hazel, Brennan, & Najman, 2012). Chronic parenting stress can result in negative feelings about one’s self and one’s child, less life satisfaction, parent–infant conflict, and even an increased risk of child abuse (Crnic & Low, 2002; Pereira et al., 2012; Sparks, Hunter, Backman, Morgan, & Ross, 2012). Having a stressed mother can result in maladaptive coping strategies for children during the toddler and schoolage years. Thus, early interventions are needed for stressed mothers (Cappa, Begle, Conger, Dumas, & Conger, 2011). Moreover, a mother’s parenting stress in early child-rearing years can have long-lasting effects on her own mental health. Recent research shows that

P

doi: 10.1093/swr/svu031

© 2015 National Association of Social Workers

child rearing–related stressors during the infancy period predict elevated symptoms of maternal depression and anxiety throughout the entire child-rearing period (Skipstein, Janson, Kjeldsen, Nilsen, & Mathiesen, 2012). Consequently, exploration of what affects a mother’s parenting stress postpartum could inform prevention efforts that promote positive and stable maternal and child mental health. Social support in first year postpartum has been identified as one important factor affecting parenting stress levels and the long-term mental health functioning of a mother (Mistry, Stevens, Sareen, De Vogli, & Halfon, 2007; Skipstein et al., 2012). However, some important gaps remain in the literature regarding the association between support and maternal stress and warrant more research. First, although early research suggests that all forms of social support buffer stress (Adamakos et al., 1986; Crnic & Greenberg, 1990; Crnic, Greenberg, Robinson, & Ragozin, 1983), more recent studies indicate that the effect of support may be temporal and that certain types of support may be more helpful than others for mothers of infants (Mulsow et al., 2002; Skipstein et al., 2012). Early stages of motherhood are often characterized by self-doubt, physical recovery, and transitioning to new roles. The demands in first year postpartum may result in more social isolation than in later years of child rearing (KendallTackett, 2005). Thus, the first year postpartum may

1

come with different emotional demands than subsequent years and therefore may be a time when some types of support help more than others. Many studies on maternal mental health do not focus exclusively on the first year postpartum, yet this is a time of increased emotional and physical demands for the mother. Second, it is possible that whether a type of support lowers stress depends on a mother’s level of educational attainment. Studies among higher educated mothers (at least high school degree or more) show positive direct and indirect effects of social support on the mother’s parenting stress level (Crnic et al., 1983; Hung, 2006; Mulsow et al., 2002). However, research among samples of less educated mothers indicates that social support can often aggravate maternal parenting stress (Belle, 1982; Jackson, 1998; Raikes & Thompson, 2005). These conflicting findings have left us with a picture of lower educated mothers being different than higher educated mothers when it comes to the benefits of social support. Cohen, Mermelstein, Kamarck, and Hoberman (1985) argued that support is most effective when the type of support matches the type of need. Conceivably, less educated mothers with fewer resources may feel most supported by tangible support such as offers of financial help. Experience of material hardship (Gershoff, Aber, Raver, & Lennon, 2007), chronic stressors (Zayas, Cunningham, McKee, & Jankowski, 2002), and frequent changes in family structure (Cooper, McLanahan, Meadows, & BrooksGunn, 2009) are sometimes the most prescient stressors for mothers with less than high school education. Hashima and Amato (1994) found that perception of financial or housing support had stronger effects among lower educated, lower socioeconomic parents. The researchers speculated it was because the lower socioeconomic parents were more prone to crises that necessitated certain types of assistance from others. Therefore, support for meeting basic needs may be the most effective to lower parenting stress when one has less education and fewer economic resources. In contrast, higher educated mothers may be most preoccupied by meta-issues, such as not feeling supported by society, family, and partner (Guendouzi, 2006; Johnston & Swanson, 2006). Higher educated mothers are more likely to garner financial and social resources before childbearing than less educated mothers who tend to give birth at younger ages (Ellwood & Jencks, 2004). Higher levels of education

2

are also positively correlated with more social support, which in turn is associated with better mental health (Ross & Mirowsky, 1999). Therefore, higher educated mothers may not be affected by perceiving they have financial help because their basic needs have been met. It may be that emotional support from their partner and support of the way they mother would have a stronger effect on lowering stress than it would for a mother with fewer resources who is more preoccupied with issues related to material hardship. Educational attainment is also discussed in current research as a proxy for income (Grzywacz & Butler, 2005; McLanahan, 2004) because of the resources it confers. Educational attainment may be an especially relevant indicator of resources for mothers of infants, given that only about 57% of women with an infant are in the workforce by one year postpartum (U.S. Bureau of Labor Statistics, 2014) and may not maintain a consistent household income in early child rearing. HYPOTHESIS

To our knowledge, no in-depth examination has been conducted to assess the influences of different types of support on maternal stress in the first year postpartum. Consequently, this study examines the association between four types of social support and maternal parenting stress among mothers of infants. It also investigates whether maternal education level moderates this association. Types of Support

The term “social support” is often used as a label for many different types of support. In this article, we focus on one type of support from friends and kin and three types of support from the biological father of the child. Specifically, we look at financial or child care support from friends and kin and emotional, household, and parenting appraisal support from the partner. Friends and Kin Support. Traditionally, social support shows positive effects for a mother’s parenting stress (Adamakos et al., 1986;Crnic & Greenberg, 1990). However, older studies typically used homogenous samples of mostly white, married mothers. Research among mothers of low socioeconomic status and varying marital status reveals contrasting findings. Tangible support such as lending money may actually exacerbate stress for mothers with fewer resources. A study by Meadows (2009) found that although perceptions of financial or child care

Social Work Research

support alleviated some maternal stress, when the actual receipt of support fell short of the mother’s anticipated support, it resulted in more stress. Jackson (1998) found that anticipation of financial or child care support exacerbated negative maternal mood among a sample of 188 single, low-income, low–educational attainment black mothers. Jackson (1998) speculated that outside assistance may burden, hassle, or even threaten the authority and parenting skills of low-income mothers. It may be that financial or child care support from friends and family comes with a set of expectations that something be repaid, which may be stressful when one has no tangible resources to repay the debt. Partner Support. Earlier research in family stress purports that support from the husband is one of the most important predictors of a first-time mother’s mental health (Belsky, 1984; Cowan et al., 1985). Currently, there is limited exploration of various types of support from the biological father who the mother is romantically involved with but not married to. The presence of a partner may not be a guarantee for helpful support. For example, a mother may feel unsupported because she does not have help around the house or with the responsibility of the child. Extrapolating from the findings of Meadows (2011)and Jackson (1998), mothers whose partners have fewer financial and education resources may report low levels of support and high levels of stress. A more critical analysis of partner support from biological fathers is therefore warranted. Although a study by Mulsow and colleagues (2002) is often cited as evidence that partner support lowers stress for mothers, the authors looked exclusively at emotional support and did not measure other types of partner support. Their results found that levels of emotional support from the husband were highest and the effect of support was strongest during the first year postpartum. Their sample comprised mostly white, married mothers with an average 14 years of education. The findings from the Mulsow et al. (2002) study are helpful in understanding the influence of a husband’s emotional support for mothers during the first year postpartum, but results should be seen within the context of the homogenous sample. Meadows (2011) found that increased level of emotional support at the time of childbirth by the biological father has cumulative effects so that even years after the child is born, support has an ameliorative effect on mental distress. This type of support may be particularly important

for mothers during the first year postpartum according to studies by Paris, Gemborys, Kaufman, and Whitehill (2007)and Guendouzi (2006), which found that although mothers felt isolated and overwhelmed at times, the ability to talk to someone provided stress relief. An often overlooked type of partner support is the amount of encouragement and positive feedback a mother receives about her mothering practices. Dennis and Ross (2006) found that higher levels of appraisal support, having a partner that agrees with the mothering choices and affirms that she is a good mother, were associated with lower levels of depressive symptoms for mothers during the first year postpartum. Feeling reinforced as a mother helps manage the stress of parenting (Mulsow et al., 2002), whereas feeling incompetent as a mother leads to more maternal parenting stress (Deater-Deckard, 1998; Mulsow et al., 2002; Östberg & Hagekull, 2000). METHOD

Our research was guided by two broad questions: (1) How do four types of social support affect maternal stress at one year postpartum? and (2) Does maternal educational attainment moderate the association between type of support and stress? We used data from the Fragile Families and Child Wellbeing Study (FFCWS), a longitudinal birth cohort study that followed nearly 5,000 mothers and children from 1998 to 2000. The analytic sample for this secondary analysis included only mothers who had some form of romantic involvement with the biological father at one year follow-up. This decision was made in an effort to have the cleanest measure of partner support—some participants answered that they had a partner but identified both the biological father and another man as partner, and others did not answer the partner support questions. Casewise deletion was used to select cases with no missing data for the stress and support variables. There were no significant differences between the missing and nonmissing cases. The final sample for our analysis consisted of 2,412 mothers. Measures

For the dependent variable of maternal stress, we constructed a variable that was created by calculating a mean for the sum of the responses to four statements in the survey (Cooper et al., 2009; Osborne, 2004). Responses to these four statements were gathered at one year postpartum:

Sampson, Villarreal and Padilla / Association between Support and Maternal Stress at One Year Postpartum: Does Type Matter?

3

Table 1: Description of Variables of Different Types of Support Independent Variables

Friends and kin support

Emotional support

Household support

Parenting appraisal support

Definition

Three questions capture general social support: (1) If you need help during the next year, could you count on someone to loan you $200? (2) Is there someone you could count on to provide you with a place to live? (3) Is there someone you could count on to help you with emergency child care? All three variables are dichotomous in the original study and were recoded so that 0 = no and 1 = yes for the friends and kin variable. Also, we reconstructed the variable to be continuous so that we could determine a mean. We did this by summing the answers to the three questions so that each case had a number between 0 and 3, with 3 representing “yes” to all three questions. Mean score of responses to five questions on a Likert-type scale. The responses were reverse coded (3 = often, 2 = sometimes, and 1 = never). Questions asked whether the mother’s partner (1) is willing to compromise during an argument, (2) expresses love and affection, (3) encourages or helps with things that are important, (4) listens when you need someone to talk to, and (5) understands your hurts and joys. Mean score of answers to four questions on a Likert-type scale, with 1 = often, 2 = sometimes, 3 = rarely, 4 = never. The items were recoded so that higher scores represent father helping often and low scores represent father rarely or never helping. The questions were (1) How often does he look after child when you need to do things? (2) How often does he run errands for you like picking things up from the store? (3) How often does he fix things around your home, paint, or help make it look nicer in other ways? (4) How often does he take child places he/she needs to go, such as to daycare or to the doctor? Mean score of answers to four questions on a Likert-type scale: How often does the father (or current partner) (1) respect schedules/rules you make for child, (2) support you in the way you want to raise child, (3) talk with you about problems that come up raising child, and (4) can you count on father (or current partner) to watch child for a few hours?

1. Being a parent is harder than I thought it would be. 2. I feel trapped by my responsibilities as a parent. 3. I find that taking care of my child(ren) is much more work than pleasure. 4. I often feel tired, worn out, or exhausted from raising a family. Responses were given on a four-point Likert-type scale and higher scores, which indicated agreement, represented higher stress (M = 2.11). Social Support. Four measures of social support that exist in the FFCWS data set were used in the current study. The four variables for the different types of support are described in depth in Table 1. Friends and kin support was constructed from three questions that asked if the mother felt she could borrow money, get child care, or get help with housing from her friends or kin. The questions had a dichotomous yes/no answer option. We collapsed data to create a dichotomous measure of friends and kin support with 0 = no and 1 = yes. For the multivariate analysis of variance (MANOVA) to explore differences in levels of support by level of education, we needed a continuous measure of friends and kin support. We created this by summing the answers to the three questions so that each case had a number between 0 and 3, with 3 = yes to all three questions. The other three support variables are continuous and represent measures of partner support.

4

Emotional support assesses the degree to which a mother feels heard and understood. Parenting appraisal assesses the degree to which a mother feels that her partner supports the way she parents by upholding her rules and schedules. Household support represents how much the partner helps around the house and helps with taking children to appointments. For all measures of support, higher scores represent higher support. Fragile Families reports that many measures overlap with those used in other large-scale studies such as the Infant Health and Development Program, Early Head Start, the Teenage Parent Demonstration, and the Early Childhood Longitudinal Study—Birth Cohort 2000 (Fragile Families and Child Wellbeing Study, 2007). Other Variables that May Influence Support and Stress. Many studies on maternal parenting stress do not account for background characteristics beyond age, income, and education. The large data set of FFCWS allowed us to use a broad range of control variables: mother’s age, education, race or ethnicity, depression, anxiety, first birth, relationship status, material hardship, father’s education level, father’s work status, and child temperament. Depression is likely to exacerbate stress and may also affect the amount of support the mother receives (Skipstein et al., 2012). Measured at one year follow-up, the FFCWS data set maternal depression and maternal anxiety measures were based on the Composite International Diagnostic Interview-Short


Form (Walters, Kessler, Nelson, & Mroczek, 2002). The measure of depression reflects a conservative estimate of the probability of a major depressive disorder (MDD) as evidenced by high a number of depressive symptoms in the previous two weeks. In the original survey, if the participant answered with a 3 or more on a scale from 0 to 8, the case was coded as yes for likelihood of MDD. It is represented by a dichotomous variable, 0 = no, 1 = yes. Anxiety is one of the most common presenting problems of maternal morbidity (Dennis, 2003) and likely an antecedent of stress. Probability of generalized anxiety disorder is represented by a dichotomous variable (0 = no, 1 = yes) (Berger Cardoso, Padilla, & Sampson, 2010). Experience of material hardship may affect maternal stress (Gershoff et al., 2007). Prior analysis of the FFCWS data reveals that even just one experience of material hardship items on the survey is positively associated with decreased maternal mood (Heflin & Iceland, 2009). A dichotomous variable was created to control for hardship at one year postpartum. A positive score for material hardship indicated one or more hardships in the past year (for example, not being able to pay rent, staying at a shelter, unable to pay for needed medical service). We controlled for a few partner-related characteristics that may affect the support they provide. Lower educated mothers tend to be with lower educated partners (Cherlin, 2005), and lower levels of education may be associated with lower support. The existing data only have a measure of father’s educational attainment relative to the mother’s level. We used these data to capture whether the father has more, less, or equal education to the mother. Whether or not a father works may affect the level of tension in the household and his parenting behaviors (Whitbeck et al., 1997), which may in turn affect both the level of support he can provide and a mother’s stress level. Father’s work status was assessed at baseline with a question, “Is the father of the baby currently employed, going to school or not working?” Research shows that child temperament is likely to influence maternal stress (Mulsow et al., 2002; Östberg & Hagekull, 2000). The existing data had variables that relate to a mother’s perception of child temperament measured at one year followup. For child fussiness we constructed a new variable from questions in the survey that were taken from a pre-existing scale called the Emotionality,

Activity, and Sociability Temperament Survey for Children (Mathiesen & Tambs, 1999). Scores are continuous, and higher scores represent more child fussiness. Analysis

Analyses of variance (ANOVAs) and MANOVAs were used to examine differences in support across mother’s educational level. Using the Bonferroni method, each ANOVA was tested at the .01 level. Post hoc analyses were conducted to determine which level of education affected which type of support most strongly. Post hoc results were interpreted using the Dunnett’s C test (Green & Salkind, 2008; Hair, Black, Babin, Anderson, & Tatham, 2006). Each pairwise comparison was tested at the .05 divided by 4 or the .01 level. To investigate how different types of support affect stress we used ordinary least squares regression (OLS). In the final model of the OLS, we tested for first-order interaction terms between education level and type of support (level of education × type of support). Continuous variables (three measures of partner support) were centered to decrease the chance of multicollinearity (Keith, 2006). RESULTS

Sample Characteristics

Table 2 shows the results of the ANOVA. Among the entire sample (N = 2,412), most participants were non-Hispanic black (42%) and the average age was almost 26. Most had a high school degree or less (57%). Only 35% were married, and roughly 62% were either living with the biological father or sometimes cohabitating. Their average stress score was 2.11 on a scale from 1 to 4, with a score of 4 representing highest possible level of maternal stress. This was the first biological child for 63% of the sample. Table 3 shows the results of levels of the MANOVA to examine support across various educational groups. A significant main effect of maternal educational attainment on support was found [Wilk’s lambda = .961, F(8, 12,635), p < .001]. At one year postpartum, mothers with college education had higher levels of all types of support except household. Household support measured the mother’s perception that the father of the child will help around the house and with errands. Mothers with lowest levels of education reported lowest social support from kin and friends. This means that the least educated mothers felt less confident that they could obtain a


5

loan, find a place to live, or obtain emergency child care if necessary.

Table 2: Descriptives of Variables among All Mothers (N = 2,412) M (SD)

Variable

Dependent variable Maternal parenting stress (1–4) Support variables Emotional support (1–3) Household (1–3) Parenting appraisal (1–3) Friends and kin (yes) Mother characteristics Education Less than high school High school degree Some college College degree or more Mother’s age* (years) Race* Non-Hispanic white Non-Hispanic black Hispanic Other Depressive symptoms Anxiety symptoms Contextual characteristics Relationship status* Married Cohabitating Visit Friends First child Experience of material hardship Father’s education level* (%) Equal to mother’s education level Lower than mother’s education level Higher than mother’s education level Father working* Child characteristics Child fussiness (1–5)

%

Regression Results

2.11 (0.63)

2.66 (0.36) 2.49 (0.49) 2.78 (0.33) 82.0

27.6 29.5 27.4 15.5 25.9 27.6 42.2 26.2 3.9 10.4 2.9

35.4 41.5 20.6 1.3 62.8 41.6

65.0 17.2 17.8 84.5 2.74 (1.01)

*p < .10.

Table 4 presents the unstandardized parameter estimates for a series of OLS regression models showing the effects of support and education on maternal parenting stress at one year postpartum. Model 1 examined the bivariate associations between four types of support and maternal parenting stress. All forms of support made a significant contribution and were associated with lower stress levels ( p < .05 for all). Model 2 added maternal educational attainment (four levels of education with the reference group as less than high school) to investigate the continuing influence of support on stress when controlling for education. Even though education, net of support, made a significant contribution to stress, it did not change the significance of support variables. Having a high school degree or having some years of college was associated with lower maternal stress one year postpartum (b = –.08, p = .015; b = –.08, p = .013). Having a college degree or more years of education did not make a significant contribution to maternal stress when support was held constant in the model. Model 3 estimated the associations between social support and stress, controlling for education, mother’s age, race or ethnicity (non-Hispanic white, nonHispanic black, Hispanic, other), first birth, relationship status at baseline, mother’s depression and anxiety levels, child temperament, father’s education level, father’s work status, and material hardship. Mothers who scored positive for MDD at one year postpartum were significantly more stressed than mothers without probability of scoring positive for MDD (b = .12, p < .05). Mothers who reported having a child with a fussy temperament were more stressed than mothers who reported low levels of child fussiness (b = .10, p < .001). All three forms of partner

Table 3: Differences in Means and Standard Errors of Perceived Support across Education Levels Education Level

Less than high school (n = 664) High school (n = 710) Some college (n = 662) College degree or more (n = 374)

Emotional M (SE)

Parenting Appraisal M (SE)

Household M (SE)

Friends and Kin M (SE)

2.62 (.01) 2.67 (.01) 2.67 (.01) 2.72a (.02)

2.77b (.01) 2.77b (.01) 2.77b (.01) 2.84 (.02)

2.45 (.02) 2.50 (.02) 2.51 (.02) 2.50 (.03)

2.50 (.03) 2.68ab (.03) 2.77ab (.03) 2.88a (.04)

Note: All differences at the .01 level. A continuous measure of general social support was used for the purpose of this analysis (0–3, with 3 being highest level of support). a Denotes significant difference from less than high school category. b Denotes significant difference from college.

6


Table 4: Results of Ordinary Least Squares Models Predicting Maternal Stress One Year Postpartum (N = 2,412)

Variable Support from father Emotional support (1–3) Parenting appraisal support (1–3) Household sSupport (1–3) Friends and kin support (medium to high expected) Education (less than high school) High school Some college College degree or more Control variables Mother’s age (years) Race/ethnicity (non-Hispanic white) Non-Hispanic black Hispanic Other Depressive symptoms Anxiety symptoms Relationship status (married) Cohabiting Visiting Not visiting/friends First child Experience of material hardship Father’s education (less than moms) Equal to moms More than moms Father working Child characteristics Child fussiness (1–5) Interaction terms (less than HS is reference category for education variables) High school × emotional support High school × household support High school × mothering support High school × social support Some college × emotional support Some college × household support Some college × mothering support Some college × social support College × emotional support College × household support College × mothering support College × social support Constant Adjusted R 2

Model 1

Model 2

Model 3

Model 4

B

SE

B

SE

B

SE

B

SE

–0.24*** –0.15*** –0.09** –0.10**

0.04 0.04 0.03 0.03

–0.23*** –0.16*** –0.09** –0.09**

0.04 0.05 0.03 0.03

–0.20*** –0.13** –0.09** –0.05

0.04 0.05 0.03 0.03

–0.23** 0.00 –0.09* –0.03

0.08 0.08 0.05 0.05

–0.08** –0.08** –0.04

0.03 0.03 0.04

–0.10** –0.10** –0.06

0.04 0.04 0.06

–0.08 –0.09 –0.07

0.07 0.08 0.13

0.00

0.00

0.00

0.00

0.01 –0.03 0.07 0.12** 0.02

0.03 0.04 0.07 0.04 0.08

0.01 –0.03 0.08 0.12** 0.03

0.03 0.04 0.07 0.04 0.08

–0.02 –0.06 0.13 –0.00 0.02

0.03 0.04 0.11 0.03 0.03

–0.02 –0.06 0.13 –0.01 0.03

0.03 0.04 0.11 0.03 0.03

0.03 –0.02 0.04

0.04 0.05 0.04

0.03 –0.02 0.05

0.04 0.05 0.04

0.10***

3.46*** 0.059*

3.51*** 0.062**

0.01

2.94*** 0.090**

0.10***

0.01

0.05 0.10 –0.30** –0.03 0.07 –0.02 –0.20 –0.03 –0.04 –0.12 0.10 0.01 2.64*** 0.091**

0.11 0.08 0.11 0.08 0.11 0.08 0.12 0.09 0.14 0.10 0.17 0.13

Note: Reference categories for dichotomous variables are in parentheses. Cell entries reflect unstandardized regression coefficients. Data are unweighted. *p < .10. **p < .05. ***p < .001.

support continued to make a significant contribution to lower stress ( p < .05), but the support

from kin and friends lost significance. The categories of high school and some college continued to


7

make a significant contribution (p = .011) to lower stress. Mothers with high school and some college were significantly less stressed than the reference group of mothers with less than high school (p < .05 for both). Parenting stress levels among mothers with college degrees did not differ significantly than among the least educated. Emotional support by the partner made the strongest contribution (b = .20) to lowered stress even when demographics, depression, child temperament, and a variety of other factors were held constant. Model 4 estimated a potential moderating effect of education on association between support and maternal parenting stress at one year postpartum. The change in the adjusted R 2 was minimal (.09 to .091). This indicates that the effect of support does not depend on educational attainment. Overall, all forms of partner support contributed to lower maternal stress, with understanding and empathy making the greatest contribution to lower stress. DISCUSSION

The current study aimed to provide an in-depth examination of the association of different types of support and maternal stress in a diverse sample of mothers during their first year postpartum. Our main finding was that all types of partner support lower stress for these mothers, with emotional support (that is, feeling that your partner understands, listens, and empathizes) being the strongest contributor to lower stress. This finding was consistent with previous research on the importance of partner support (Dennis & Ross, 2006; Meadows, 2011). What is unique about our findings is that they represent a sample of mostly unmarried mothers of various education levels. Emotional support from the biological father helped to lower stress for mothers during the first year postpartum even if the father was unemployed, living outside the house, or less educated than the mother. This finding extends the research by adding an important piece about the significance of father involvement with the mother during the postpartum time. In a review of literature on father involvement, Lamb (2008) argued that although research shows the importance of emotional involvement by fathers in relation to maternal mental health, emotional contribution of fathers is largely overlooked in the literature. Our finding that emotional support had a significant effect on lowering stress in the first year postpartum has relevant practice implications. Social workers

8

strive to integrate empathy into their own work and are well poised to teach others how to practice and cultivate empathy in their own lives (Gerdes & Segal, 2011).Social workers who work with expectant couples could facilitate groups or individual sessions about stressors and the benefit of partner support. Research shows that increasing awareness of the benefit of empathy helps fathers provide effective support. Diemer (1997) found that fathers who attended a perinatal course that included “father-focused” materials had higher levels of social networks, higher emotional support for mom, and increased conflict resolution skills compared with fathers who attended regular childbirth class. Unwed, urban fathers who received education about the importance of their emotional support had partners who were less stressed than the mothers whose partners did not receive the fathering-specific educational materials (Westney, Cole, & Munford, 1988). Most information we have on research about father involvement narrowly defines involvement as time spent with children or housework (Lamb, 2008), but our findings indicate the importance of focusing on the emotional contribution of the biological father. Prior literature on parenting stress states that any type of social support will aid in reducing maternal stress (Adamakos et al., 1986; Crnic & Greenberg, 1990; Crnic & Low, 2002), but these studies did not exclusively focus on stress at one year postpartum. In our analysis, financial, housing, or child care support from kin and friends lost its effect when all sociodemographics were held constant. One potential explanation for the lack of relationship between kin and friend support and maternal stress may be that most of the older studies on the effects of social support and maternal parenting stress were conducted among homogenous samples of mothers who were likely white and married, thus limiting our understanding of how support may influence stress among mothers of differing backgrounds. Moreover, given that 82% of mothers in the current study reported medium to high levels of expected social support, it is possible that these mothers were able to get financial, housing, or child care help when needed, making these stressors less relevant. It may be that this type of support is only influential when it is lacking and affecting functioning. It also may be that this type of support is more readily available when the child is still in infancy. Mothers of toddlers or older children may not have as many offers for babysitting.


We investigated a moderating effect of education based on conflicting findings about the effect of support depending on mother’s educational attainment. Our statistical analysis did not reveal interaction effects except for one type of support and one level of education. Based on this, we conclude that overall, effect of support does not depend on a mother’s educational status. Partner support lowered stress for all mothers, and educational level was negatively correlated with stress levels. A mother’s level of education had direct effects on lowered stress even when controlling for several factors. Prior research shows that less education is associated with more parenting stress (Gershoff et al., 2007). Given this, it would seem that higher educated mothers would have more resources and less stress. However, we found that mothers who had attended college did not have significantly lower stress levels than lower educated mothers even when controlling for support, marital status, age, and all other variables. This initial finding may be in line with other research that finds women who delay childbirth until their mid-thirties tend to have higher stress than their younger peers because of increased demands to multitask work and family and meet high expectations of parenting (Bianchi, 2011). Unmarried mothers with higher education may be especially susceptible to parenting-related stress because of financial burden and time demands with school, work, and parenting (Goldrick-Rab & Sorenson, 2010). This may be relevant to our study population, who are mostly unmarried mothers. The finding may also be specific to the Fragile Families sample and should be further explored in different data sets. Likelihood of developing MDD (measured by number of symptoms in past two weeks) and having a fussy child predicted increased stress at one year postpartum. This finding was not surprising, given that stress and depression are often associated (Skipstein et al., 2012). This information is useful when considering mental health screening in the prenatal phase. Presence of depression may make upcoming parenting stress even more difficult to manage. Research indicates that an increase in parenting self-efficacy can influence a parent’s competence and reaction to their child’s behavior (Jones & Prinz, 2005). Attending parenting classes and developing relationships with positive parenting role models may help teach effective coping skills during stressful moments of the first year postpartum.

These types of supports benefit both the mother and the infant. LIMITATIONS

The present study has a number of limitations. Given that this was a secondary analysis, we were limited by available data. First, the study is limited by our measurement of maternal stress. This variable lacks a cutoff score, which results in limited knowledge of the maximum stress experienced. We were also limited in number of types and sources of support available. It would be beneficial to explore the contribution of emotional support from family or friends. Because of the limited measures of support it is difficult to flesh out the effect of various types of support and sources of support. In addition, the study sample excluded mothers not romantically involved with their child’s father. This exclusion was based on the need for robust measures of partner support. Preliminary analysis revealed that some mothers answered questions pertaining to the father of the child only, the partner only, or neither. Moreover, it would have been ideal to control for income in the analysis, but it was not included because of the prohibitive amount of missing data. The measure of material hardship was dichotomous, thus we were not able to see variability in the degree to how much material hardship affects stress. In addition, we only controlled for difficult child temperament; existing research also shows that a mother’s stress level can influence how difficult she perceives her baby to be (Mäntymaa, Puura, Luoma, Salmelin, & Tamminen, 2006). CONCLUSION

Stress is a known predictor of postpartum depression and anxiety (O’Hara, 2009). Early interventions to help mothers build supportive relationships may deter more severe psychological distress. Prenatal and early postpartum may be “teachable moments” when parents are open to behavior change for the sake of the child. Fathers may be especially amenable to education regarding how to communicate support with their child’s mother. Social workers can help family functioning by raising awareness among potential mothers and fathers about the importance of emotional support during the transition to motherhood. REFERENCES Adamakos, H., Ryan, K., Ullman, D., Pascoe, J., Diaz, R., & Chessare, J. (1986). Maternal social support as a


9

predictor of mother-child stress and stimulation. Child Abuse & Neglect, 10, 463–470. Belle, D. (1982). Social ties and social support. In D. Belle (Ed.), Lives in stress: Women and depression ( pp. 133–144). Beverly Hills, CA: Sage Publications. Belsky, J. (1984). The determinants of parenting. Child Development, 55, 83–96. Berger Cardoso, J., Padilla, Y. C., & Sampson, M. (2010). Racial & ethnic variation in the predictors of maternal parenting stress. Journal of Social Service Research, 36, 429–444. Bianchi, S. (2011). Family change and time allocation in American families. Annals of the American Academy of Political and Social Science, 638, 21–44. Cappa, K. A., Begle, A. M., Conger, J. C., Dumas, J. E., & Conger, A. J. (2011). Bidirectional relationships between parenting stress and child competence: Findings from the pace study. Journal of Child and Family Studies, 20, 334–342. Cherlin, A. (2005). American marriage in the early twenty-first century. Future of Children, 15(2), 33–55. Cohen, S., Mermelstein, R., Kamarck, T., & Hoberman, H. M. (1985). Measuring the functional components of social support. In I. G. Sarason & B. R. Sarason (Eds.), Social support: Theory, research and applications ( pp. 73–94). Boston: Martinus Nijhoff. Cooper, C., McLanahan, S., Meadows, S., & Brooks-Gunn, J. (2009). Family structure transitions and maternal parenting stress. Journal of Marriage and Family, 71, 558–574. Cowan, C., Cowan, P., Heming, G., Garrett, E., Coysh, W., Curtis-Boles, H., et al. (1985). Transitions to parenthood: His, hers, and theirs. Journal of Family Issues, 6, 451–481. Crnic, K. A., & Greenberg, M. (1990). Minor parenting stress with young children. Child Development, 54, 209–217. Crnic, K. A., Greenberg, M. T., Robinson, N. M., & Ragozin, A. S. (1983). Maternal stress and social support: Effects on the mother-infant relationship from birth to eighteen months. Child Development, 54, 209–217. Crnic, K. A., & Low, C. (2002). Everyday stresses and parenting. In M. H. Bornstein (Ed.), Handbook of parenting: Practical issues in parenting (2nd ed., vol. 5, pp. 243–269). Mahwah, NJ: Lawrence Erlbaum Associates. Deater-Deckard, K. (1998). Parenting stress and child adjustment: Some old hypotheses and new questions. Clinical Psychology: Science and Practice, 5, 314–322. Dennis, C. L. (2003). Detection, prevention, and treatment of postpartum depression. In D. E. Stewart, E. Robertson, C.-L. Dennis, S. L. Grace, & T. Wallington (Eds.). Postpartum depression: Literature review of risk factors and interventions ( pp. 71–196). Toronto: Toronto Public Place. Retrieved from http:// www.who.int/mental_health/prevention/suicide/ lit_review_postpartum_depression.pdf Dennis, C. L., & Ross, L. (2006). Women’s perception of partner support and conflict in the development of postpartum depressive symptoms. Journal of Advanced Nursing, 56, 588–599. Diemer, G. A. (1997). Expectant fathers: Influence of perinatal education on stress, coping, and spousal relations. Research in Nursing & Health, 20(4), 281–293. Ellwood, D., & Jencks, C. (2004). The uneven spread of single-parent families: What do we know? Where do we look for answers? In K. M. Neckerman (Ed.), Social inequality ( pp. 3–77). New York: Russell Sage Foundation. Fragile Families and Child Wellbeing Study. (2007). Fragile Families and Child Wellbeing study documentation.

10

Retrieved from http://www.fragilefamilies.princeton .edu/documentation.asp#oneyear Gerdes, K. E., & Segal, E. (2011). Importance of empathy for social work practice: Integrating new science. Social Work, 56, 141–148. Gershoff, E., Aber, J. L., Raver, C. C., & Lennon, M. C. (2007). Income is not enough: Incorporating material hardship into models of income associations with parenting and child development. Child Development, 78(1), 70–95. Goldrick-Rab, S., & Sorenson, K. (2010). Unmarried parents in college. Fragile Families Journal, 20(2), 179–203. Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Women’s Mental Health, 6, 263–274. Green, S. B., & Salkind, N. J. (2008). Using SPSS for Windows and Macintosh: Analyzing and understanding data (5th ed.). Englewood Cliffs, NJ: Prentice Hall. Grzywacz, J., & Butler, A. (2005). The impact of job characteristics on work-to-family facilitation: Testing a theory and distinguishing a construct. Journal of Occupational Health Psychology, 10(2), 97–109. Guendouzi, J. (2006). “The guilt thing”: Balancing domestic and professional roles. Journal of Marriage and Family, 68, 901–999. Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (2006). Multivariate data analysis (6th ed.). Englewood Cliffs, NJ: Prentice Hall. Hammen, C., Hazel, N. A., Brennan, P. A., & Najman, J. (2012). Intergenerational transmission and continuity of stress and depression: Depressed women and their offspring in 20 years of follow-up. Pyschological Medicine, 42, 931–942. Hashima, P. Y., & Amato, P. R. (1994). Poverty, social support, and parental behavior. Child Development, 65, 394–403. Heflin, C. M., & Iceland, J. (2009). Poverty, material hardship and depression. Social Science Quarterly, 90, 1051–1071. Hung, C.-H. (2006). Correlates of first-time mothers’ postpartum stress. Kaohsiung Journal of Medical Science, 22, 500–506. Jackson, A. P. (1998). The role of social support in parenting for low-income, single, black mothers. Social Service Review, 72, 365–378. Johnston, D. D., & Swanson, D. H. (2006). Constructing the “good mother”: The expectations of mothering ideologies by work status. Sex Roles, 54, 509–519. Jones, T. L., & Prinz, R. J. (2005). Potential roles of parental self-efficacy in parent and child adjustment: A review. Clinical Psychology Review, 25, 341–363. Keith, T. Z. (2006). Multiple regression and beyond. Boston: Pearson. Kendall-Tackett, K. A. (2005). The hidden feelings of motherhood: Coping with mothering stress, depression and burnout. Amarillo, TX: Pharmasoft Publishing. Lamb, M. (2008). The history of research on father involvement: An overview. Marriage & Family Review, 29(2–3), 23–42. Mäntymaa, M., Puura, K., Luoma, I., Salmelin, R. K., & Tamminen, T. (2006). Mother’s early perception of her infant’s difficult temperament, parenting stress and early mother-infant interaction. Nordic Journal of Psychiatry, 60, 379–386. Martins, C., & Gaffan, E. A. (2000). Effects of early maternal depression on patterns of infant-mother attachment: A meta-analytic investigation. Journal of Child Psychology and Psychiatry, 41, 737–746. Mathiesen, K. S., & Tambs, K. (1999). The EAS temperament questionnaire—Factor structure, age trends,


reliability, and stability in a Norwegian sample. Journal of Child Psychology & Psychiatry, 40, 431–439. McLanahan, S. (2004). Diverging destinies: How children are faring under the second demographic transition. Demography, 41, 607–627. Meadows, S. O. (2009). Is it there when you need it? Mismatch in perception of future availability and subsequent receipt of household social support. Journal of Family Issues, 30, 1070–1097. Meadows, S. O. (2011). The association between perceptions of social support and maternal mental health: A cumulative perspective. Journal of Family Issues, 32(2), 181–208. Mistry, R., Stevens, G. D., Sareen, H., De Vogli, R., & Halfon, N. (2007). Parenting-related stressors and self-reported mental health of mothers with young children. American Journal of Public Health, 97, 1261–1268. Mulsow, M., Caldera, Y. M., Pursley, M., Reifman, A., & Huston, A. C. (2002). Multilevel factors influencing maternal stress during the first three years. Journal of Marriage and Family, 64, 944–956. O’Hara, M. W. (2009). Postpartum depression: What we know. Journal of Clinical Psychology, 65, 1258–1269. Osborne, C. (2004). Maternal stress and mothering behaviors in stable and unstable families (Fragile Families Working Paper #03-08-FF, rev. ed.). Princeton, NJ: Center for Research on Child Wellbeing. Östberg, M., & Hagekull, B. (2000). A structural modeling approach to the understanding of parenting stress. Journal of Clinical Child Psychology, 29, 615–625. Paris, R., Gemborys, M. K., Kaufman, P. H., & Whitehill, D. (2007). Reaching isolated new mothers: Insights from a home visiting program using paraprofessionals. Families in Society, 88, 616–626. Pereira, J., Vickers, K., Atkinson, L., Gonzalez, A., Wekerle, C., & Levitan, R. (2012). Parenting stress mediates between maternal maltreatment history and maternal sensitivity in a community sample. Child Abuse & Neglect, 36, 433–437. Raikes, H. A., & Thompson, R. (2005). Efficacy and social support as predictors of parenting stress among families in poverty. Infant Mental Health Journal, 23, 177–190. Ross, C. E., & Mirowsky, J. (1999). Refining the association between education and health: The effects of quantity, credential and selectivity. Demography, 36, 445–460. Skipstein, A., Janson, H., Kjeldsen, A., Nilsen, W., & Mathiesen, K. S. (2012). Trajectories of maternal symptoms of depression and anxiety over 13 years: The influence of stress, social support, and maternal temperament. BMC Public Health, 12, 1120. doi:10.1186/1471-2458-12-1120 Sparks, T., Hunter, S., Backman, T., Morgan, G., & Ross, R. (2012). Maternal parenting stress and mothers’ reports of their infants’ mastery motivation. Infant Behavioral Development, 35(1), 167–173. U.S. Bureau of Labor Statistics. (2014, April 25). Employment characteristics of families summary [News release]. Retrieved from http://www.bls.gov/news.release/ famee.nr0.htm Walters, E. E., Kessler, R. C., Nelson, C. B., & Mroczek, D. (2002). Scoring the World Health Organization’s Composite International Diagnostic Interview Short Form (CIDI-SF). Retrieved from http://www3.who .int/cidi/CIDISFScoringMemo-12-03-02.pdf Westney, O. E., Cole, O. J., & Munford, T. L. (1988). The effects of prenatal education intervention on unwed prospective adolescent fathers. Journal of Adolescent Health Care, 9(3), 214–218. Whitbeck, L. B., Simons, R. L., Conger, R. D., Wickrama, K.A.S., Ackley, K. A., & Elder, G. H. Jr. (1997). The

effects of parents’ working conditions and family economic hardship on parenting behaviors and children’s self-efficacy. Social Psychology Quarterly, 60, 291–303. Woolhouse, H., Brown, S., Krastev, A., Perlen, S., & Gunn, J. (2009). Seeking help for anxiety and depression after childbirth: Results of the Maternal Health Study. Archives of Women’s Mental Health, 12(75), 75–83. Zayas, L. H., Cunningham, M., McKee, M. D., & Jankowski, K.R.B. (2002). Depression and negative life events among pregnant African American and Hispanic women. Women’s Health Issues, 12(1), 16–22.

McClain Sampson, PhD, is assistant professor, and Yolanda Villarreal, MSW, is a doctoral student, Graduate College of Social Work, University of Houston. Yolanda Padilla, PhD, is professor of social work and women’s studies, University of Texas at Austin. Address correspondence to McClain Sampson, Graduate College of Social Work, University of Houston, 110HA Social Work Building, Houston, TX 77204; e-mail: [email protected]. Original manuscript received October 10, 2013 Final revision received March 13, 2014 Accepted March 24, 2014


11