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Concerns, social support, and health-related quality of life of mothers

ProQuest Dissertations and Theses, 2009
Dissertation
Author: Susan B Coyle
Abstract:
Mothers are primary caregivers and gatekeepers for family health yet little is known about the nature and level of maternal concern, social support, and health-related quality of life for mothers across the maternal continuum. This research was designed to examine the relationship between maternal concerns and health-related quality of life, describe the impact of social support on this relationship, identify the relationship between sociodemographic factors and concern, social support and HRQOL, and identify differences in these variables among categories of mothers. Participants were 238 mothers from Maryland, West Virginia, and Pennsylvania who completed a mail survey. The sample was composed primarily of married women with at least some college or technical training who were the biological mothers of one or two children, working full-time, and living in families with incomes at or above $45,000. All participants completed the Everyday Stressors Index, the Medical Outcomes Study Social Support Survey, and the Medical Outcomes Study Short Form 36 version 2® (SF-36v2). Mothers of children of all ages reported a low level of concern and moderate level of social support; level of maternal concern demonstrated a small to moderate negative relationship with HRQOL and was the strongest predictor of HRQOL compared to sociodemographic factors and social support. Social support did not moderate the relationship between maternal concerns and HRQOL and demonstrated a minimal mediating influence on the relationship between concern and the mental health subscale of the SF36v2®. Income and education were the sole sociodemographic predictors of HRQOL. There were no significant differences in concern, social support or HRQOL among four groups of mothers categorized by age of oldest child living at home. Participant scores on the mental health subscales of the SF-36v2 differed significantly from gender and age-matched national norms. Results indicate the need to focus attention on the mental health needs of mothers of children of all ages. Recommendations for nursing practice include periodic screening for changes in mental health and education, anticipatory guidance, and advocacy efforts to assist mothers to cope with commonly identified concerns. Recommendations for nursing research include longitudinal studies that pair self-report data with neurohormonal markers.

v TABLE OF CONTENTS

Chapter 1: Introduction of the Problem..........................................................................................1 Significance.................................................................................................................................3 Aims............................................................................................................................................5 Chapter 2: Review of the Literature................................................................................................7 Theoretical Framework...............................................................................................................7 Review of the literature.............................................................................................................11 Maternal concerns as causal antecedents..............................................................................11 Social support as a mediating process..................................................................................14 Health-related quality of life as an effect..............................................................................21 Chapter 3: Methodology..............................................................................................................28 Purpose......................................................................................................................................28 Sample.......................................................................................................................................29 Variables...................................................................................................................................29 Concerns...............................................................................................................................29 Social support........................................................................................................................33 Health-related quality of life.................................................................................................36 Sociodemographic variables.................................................................................................41 Procedure..................................................................................................................................43 Data Collection.....................................................................................................................43 Data Analysis........................................................................................................................44 Chapter 4: Results........................................................................................................................48 Treatment of data......................................................................................................................48 Sample descriptives..................................................................................................................49 Findings.....................................................................................................................................51 Chapter 5: Discussion...................................................................................................................64 Maternal concern and HRQOL.................................................................................................64 Sociodemographic factors.........................................................................................................67 Social support............................................................................................................................67 Stages of motherhood...............................................................................................................68 Limitations................................................................................................................................69 Implications...............................................................................................................................70 References.....................................................................................................................................75 MOS Social Support Survey.........................................................................................................88 Medical Outcomes Study SF-36...................................................................................................89

vi LIST OF TABLES

Table 1 SF-36v2® Subscale Score Interpretations (adapted from Ware et al., 2007, pp. 12-13) 38 Table 2 Sample descriptives.........................................................................................................50 Table 3 Concerns identified by mothers.......................................................................................52 Table 4 MOS SF-36v2® subscale Cronbach alpha coefficients..................................................54 Table 5 Central tendency and distribution for MOS SF-36 subscales..........................................55 Table 6 Comparison of sample means with SF-36 gender-by-age norms...................................56 Table 7 Correlations between maternal concern (ESI) and HRQOL subscales...........................57 Table 8 MOS-SSS Results............................................................................................................59 Table 9 Regression analyses to test the mediating effect of social support on the relationship...61 Table 10 Multivariate Analysis of Variance of Maternal Concern, Social Support, and HRQOL by Stage of Motherhood........................................................................................................62

vii

LIST OF FIGURES

Figure 1. Theoretical Framework for Transaction between Mother and Environment...............10

viii APPENDICES

Appendix A Maternal concerns by frequency (total sample)....................................................95 Appendix B Maternal concerns by intensity (total sample).......................................................97 Appendix C Intercorrelations.....................................................................................................98 Appendix D Summary of Hierarchichal Regression Analysis for Predicting Physical Functioning ..........................................................................................................99 Appendix E Summary of Hierarchical Regression Analysis for Predicting Role-Physical....101 Appendix F Summary of Hierarchical Regression Analysis for Predicting Bodily Pain........103 Appendix G Summary of Hierarchical Regression Analysis for Predicting General Health..105 Appendix H Summary of Hierarchical Regression Analysis for Predicting Vitality..............107 Appendix I Summary of Hierarchical Regression Analysis for Predicting Social Functioning .............................................................................................................................................109 Appendix J Summary of Hierarchical Regression Analysis for Predicting Role-Emotional.111 Appendix K Summary of Hierarchical Regression Analysis for Predicting Mental Health...113 Appendix L Measures of Central Tendency for Variables by Group......................................115 Appendix M Recruitment flyer..................................................................................................116

Concerns, social support, and HRQOL 1 Chapter 1: Introduction of the Problem

The U. S. Census Bureau (2005) estimates that there are 82.5 million mothers of all ages in the United States. Four million women give birth annually and 82% of U.S. women between ages 40 and 44 are mothers (U.S. Census, 2005). Despite myriad social changes spanning the last 40 years, women continue to be the primary caregivers for children. The process of mothering is essential to the growth and development of children but places additional demands on mothers. Responsibilities inherent in the maternal role result in unique concerns for women who are mothers. Because the process of mothering takes place in a social/environmental context, it is possible that the impact of these concerns may be influenced by resources including social support. Successfully coping with or resolving these concerns contributes to the positive health- related quality of life of mothers. Mothering has been viewed as both a process and a social institution. Mothering as process serves as a source of satisfaction, creativity, and personal growth. Early researchers conceptualized mothering as task-oriented and focused on the activities required to nurture and care for young children (Arendell, 2000; Collins, 1992; Ruddick, 1989; Rubin, 1976). More recently, the process of mothering has been described in terms of personal experience, growth, and relationships (Barlow & Cairns, 1997; Kittay, 1999; O’Reilly, 2004). The process of mothering has also been conceptualized as a process of adaptation during which multiple conflicting demands are balanced or coordinated (Burkholder, 2003; Oberman & Josselson, 1996). Mothering as a social institution is often labeled “motherhood” and is conceptualized as limiting or restrictive to women. Early feminist views of biologic motherhood as a source of oppression (Firestone, 1970) evolved into views that re-endorsed the importance of motherhood.

Concerns, social support, and HRQOL 2 Recent research has revealed that although the process of mothering can be rewarding and fulfilling, the social institution of motherhood is characterized by increasing demands, changes, responsibilities, and even losses (Hartrick, 1996; Jackson & Mannix, 2003; Keating-Lefler & Wilson, 2004; McBride & Shore, 2001; Wuest, 2001). The work of second wave feminist scholars focused on the needs of mothers. Theorists encouraged mothers to examine their needs and expectations and to re-evaluate their life choices and assumptions about mothering (Benjamin, 1995; Maushart, 1999; McBride, 1973). Modern societal ideology continues to define motherhood as child-centered, emotionally charged, self-sacrificing, and labor intensive (Hays, 1996). The maternal role places stress on women in the form of demands and concerns. Becoming a mother has been identified as a major life transition and a source of stress (Mercer, 2004; Stevens & Meleis, 1991; Wijnberg & Reding, 1999). The process of becoming a mother does not end with the birth of a child; it is a non-linear process that continues across a women’s life span and requires her to continually acquire new knowledge and develop new skills (Mercer, 2004). Maternal concerns can be physical, emotional, or social and arise from a mother’s changing sense of self and from changes in her children, her relationships, and her social environment. Unresolved maternal concerns have the potential to interfere with maternal health and have been linked to negative physical and emotional outcomes in mothers (Peden, Rayens, Hall, & Grant, 2005; Stuart & Garrison, 2002; Urizar, Hurtz, Albright, Ahn, Atienza, & Kine, 2005) Mothering takes place in the context of family and community so women who mother may experience some form of social support. Broadly defined as physical and emotional assistance, social support has been conceptualized in multiple ways – by its source, its nature,

Concerns, social support, and HRQOL 3 and its objectivity (Underwood, 2000). Generally viewed as a positive force, social support has been divided into four categories – emotional, informational, instrumental, and affirmational (Underwood, 2000). Social support has been examined as part of the larger stress and coping framework and identified as a coping resource; conversely, social support has also been viewed as reciprocal and a potential source of stress (Tilden & Galyen, 1987). Research has resulted in models in which social support exerts direct, moderating, or mediating effects on the process of stress and coping (Cairney, Boyle, Offord, & Racine, 2003; Gee & Rhodes, 2003; Hung & Chung, 2001; Kivijarvi, Raiha, Virtanen, Lertola, & Piha, 2004; Silver, Heneghan, Bauman, & Stein, 2006). Although the impact of maternal concerns may be buffered by available social support, mothers need optimal biopsychosocial health to respond adequately to the demands of mothering. Historically, research related to maternal health has focused on the reproductive process, transition to motherhood, and maternal depression (Gennaro, Brooten, Roncoli, & Kumar, 1993; Gjerdingen, Froberg, & Kochevar, 1991; Majewski, 1986; Pridham & Chang, 1992). The concept of health related quality of life broadens that perspective to encompass physical, psychological, and social aspects of health that include physical functioning, psychological adjustment, social functioning, relationships, and sense of well-being. Over the past decade, research examining the health-related quality of life of mothers has focused primarily on mothers coping with depression, poverty, and children with illness or disability (Coyle, 2007b). Significance

The process of mothering cannot be separated from its product – the healthy growth and development of women and children. Mothers are women with multiple, alternate identities and

Concerns, social support, and HRQOL 4 their growth and development may not always synchronize with the growth and development of their children. Mothers play a critical role in society; they provide the physical care and emotional support needed for children to develop into healthy adults who can function successfully in society. Through their relationships with their children they communicate social norms and influence social behaviors (Van Lerberghe, Manuel, Matthews, & Wolfheim, 2005). They shape life values, health beliefs, and lifestyle behaviors; they function as the gatekeepers of child and family health (Clark, 1995; Maynard, Galuska, Blanck, & Serdula, 2003; Pack, Krisnamurthy, Cottrell, D’Alessandri, & Burns, 2005). When the mother-child relationship is affected by changes in maternal health, children suffer. Poor maternal health decreases the frequency of maternal-child interaction and contributes to altered social competence (Clark & Ladd, 2000; Horodynski & Gibbons, 2004). Negative changes in maternal health have been associated with changes in the level of health care provided to young children (Chung, McCollum, Elo, Lee, & Culhane, 2004; Minkovitz, Strobino, Scharfstein, Hou, Miller, & Mistry, 2005); maternal stress has been linked to behavior problems in pre-school aged children (Walker & Cheng, 2007). In the worst case, an unhealthy mother-child relationship contributes to child abuse (Featherstone, 1999) and infanticide (Smithey, 2001). Knowledge about maternal concerns, social support and health related quality of life is significant to nurses because they encounter mothers in a variety of health care settings and at multiple times across the life span. From preconception through delivery, nurses safeguard maternal and infant health. In the immediate postpartum phase, nurses support the development of the early mother-child dyad and the new family. Across the many transitions of parenting, nurses provide anticipatory guidance, health education, and emotional support. In each of these

Concerns, social support, and HRQOL 5 situations, the goal is to help mothers toward optimal health and to foster health in their children and families. An understanding of the mother’s perception of her physical, mental, and social well-being (her health-related quality of life) is necessary for nurses to achieve this goal. Nurses have traditionally been responsible for supporting the mother-child relationship and the needs of mothers, children, and families are increasingly complex in today’s rapidly changing social environment. Knowledge about concerns of mothers and the availability and role of social support assists nurses to provide individualized care. This same knowledge contributes to comprehensive assessment, enables nurses to anticipate periods of increased concerns, and facilitates the planning and implementation of preventive and restorative interventions. Because mothers are the gatekeepers of family health, knowing their concerns provides insights into the health needs of the family system. Knowledge about maternal health- related quality of life enables nurses to broaden their understanding of maternal health beyond reproductive health and to focus on a mother’s ability to function physically, emotionally, and socially. At the policy level, nurses can use empirical evidence related to maternal concerns, social support, and health-related quality of life to advocate for societal and policy change and to give “voice” to a population that is sometimes silent. Aims

Given the knowledge of the impact of mothering and maternal health on the growth and development of both women and children, the aims of this study were to: 1. describe the relationship between maternal concerns and health-related quality of life in mothers of children from birth to age 18 2. describe the relationship between selected sociodemographic factors (maternal age, age of oldest child living at home, number of children, number of years between children,

Concerns, social support, and HRQOL 6 marital status, employment, education level, family income, and family size) and maternal concern, social support, and health related quality of life in mothers of children from birth to age 18. 3. describe the moderating and mediating effects of social support on the relationship between maternal concern and health related quality of life in mothers of children from birth to age 18. 4. examine the differences in maternal concern, social support, and health-related quality of life at different stages of motherhood.

Concerns, social support, and HRQOL 7

Chapter 2: Review of the Literature

This chapter will introduce the theoretical framework used to guide this research and review the literature related to maternal concerns, social support, and health-related quality of life. In each section of the review of literature, findings of individual studies are followed by an analysis of the body of research. Theoretical Framework

The Transactional Theory of Stress and Coping (TTSC) (Lazarus & Folkman, 1984) was the theoretical framework selected to guide this study. The TTSC was developed in the late 1960s and early 1970s to explain the stress response from a multi-faceted perspective that focused on the transaction between an individual and her environment. It was expanded into what the original authors call a “metatheory” (Lazarus & Folkman, 1987, p. 141) that included two main constructs (appraisal and coping) and three variables – transaction, process, and emotion. The transaction was the “dynamic interplay” of the variables of person and environment. Process connoted both change and stability in appraisal and coping over time or in different contexts. Emotion was viewed from a systems perspective that incorporated three key variables of the TTSC - causal antecedents, mediating processes, and outcomes (Lazarus & Folkman, 1987). The model guiding this research is shown in Figure 1. Causal antecedents are personal or environmental characteristics that influence the emotion process. They are the initial elements in the model and influence the mediating processes of primary appraisal, secondary appraisal, and coping. Because the process of emotion is recursive, causal antecedents can be impacted by the outcomes of the process. Personal causal antecedents include values, beliefs, goals, self-esteem, and self-efficacy. Environmental causal

Concerns, social support, and HRQOL 8 antecedents include demands and resources. In this study, the environmental causal antecedent of maternal concerns acted as the stressor and multiple sociodemographic factors (maternal age, number of children, age of oldest child living at home, number of years between children, relationship with child, marital status, employment, level of education, family income, and family size) and stages of motherhood were examined as personal antecedents. In the framework, there are three mediating processes – primary appraisal, secondary appraisal, and coping. Primary appraisal is the individual evaluation of the harm, threat, or challenge in the event or situation causing stress; secondary appraisal is the individual determination of what actions can be taken (or might work) in response to the harm, threat, or challenge. Coping is categorized as problem or emotion-focused and includes the use of social support. In this study, perceived social support, as an element of coping, was examined as the variable mediating or moderating the relationship between maternal concerns and health-related quality of life. In the model, outcomes are classified as either immediate or long-term effects. Immediate effects include affect, physiological changes, and the quality of outcome of the stressful encounter. Long-term effects include psychological well-being, somatic health or illness, and social functioning. In this study, health-related quality of life was the outcome measure. The TTSC was selected as the framework for this inquiry because its transactional approach captured the complexity of the process of mothering. Mothers face complex demands, participate in multiple relationships, and respond to multiple changes in their environment. The TTSC views emotion from a systems perspective; this research incorporated elements of each of the subsystems. Finally, the TTSC is based on appraisal – an individual’s evaluation of the significance of an event to her well-being. Mothering is a personal process unique to each

Concerns, social support, and HRQOL 9 individual mother. It was important that the framework guiding this research include and respect this subjective evaluation.

Concerns, social support, and HRQOL 10 Figure 1. Theoretical Framework for Transaction between Mother and Environment

Causal antecedents Mediating processes Personal

Sociodemographic factors Stage of motherhood

Environmental

Maternal demands Psychological well-being Somatic health Social functioning

Health-related quality of life Coping

Perceived Social support Adapted from Lazarus, R. S., & Folkman, S. (1987). Transactional theory and research on emotions and coping. European Journal of Personality, 1, 141-169. Effects

Concerns, social support, and HRQOL 11 Review of the literature Maternal concerns as causal antecedents

In the Transactional Theory of Stress and Coping, environmental variables, including demands and resources, are the initial elements in the stress process. One potential demand or stressor for mothers is their level of concern. Bernal and Meleis (1995) identified generalized worry as a daily stressor for mothers. McBride and Shore (2001) found that, despite widespread research about becoming a mother, little was known about the full range of maternal concerns across the mothering career. A concern has been defined as a question, problem, or source of worry to a mother (Sheil, Bull, Moxon, Muehl, Kroening, Peterson-Palmberg, & Kelber, 1995) and as a matter of interest, importance, or consequence (Niska, Lia-Hoagberg, & Snyder, 1997). Mothers experience biopsychosocial concerns about themselves, their children, their partners and families, and their environment. Concerns for self Maternal concerns about self include concerns about physical health in the form of returning to a pre-conception state of health, coping with chronic illness or disability, drug or alcohol addiction, and experiencing fatigue (Keating-Lefler, Campbell-Grossman, Fleck, & Westfall, 2004; Sheil et al., 1995; Sheppard & Watkins, 2000). Psychosocial concerns for self include coping with the overwhelming nature of parenting (Jackson & Mannix, 2003) and feelings of social disenchantment, isolation, and loneliness (Sheppard & Watkins, 2000). Loss of freedom, and contradicting feelings of fear, hope and frustration have been cited as concerns (Keating-Lefler et al., 2004) and time pressures and work-related tensions have also been reported (Beeber & Miles, 2003; Sheil et al., 1995; Symon et al., 2002). Additional psychosocial

Concerns, social support, and HRQOL 12 concerns include how becoming a mother might change a woman’s life (Keating-Lefler et al., 2004), returning to work (Kaitz, 2007), and feeling depressed (Sheil et al., 1995). Concerns about child Maternal concerns about the child’s physical condition include general health and well- being (Jackson & Mannix, 2003; Sachs, Hall, Lutenbacher, & Rayens, 1999), providing good physical care (Akister & Johnson, 2004; McCune, Richardson, & Powell, 1984), and safety (Sheil et al., 1995). In addition, mothers report concerns about normal growth and development (Sheil et al., 1995), recognizing signs of illness (Sheil et al., 1995), and nutrition and diet (McCune et al., 1984). Psychosocial concerns include dealing with disruptive behaviors (Akister & Johnson, 2004; Jackson & Mannix, 2003; McCune et al., 1984; Sheppard & Watkins, 2000), bullying (Akister & Johnson, 2004), and mental health (Akister & Johnson, 2004, Sheppard & Watkins, 2000). For mothers of older children, peer pressure, dealing with children’s increasing demands for autonomy, and mental health issues have been identified (Diem, 2000; Jackson & Mannix, 2003). Concerns about partner or family Maternal concerns related to partners focus on the quality of their relationship and parenting practices. Concerns about the relationship with partner include the duration of the relationship, the ability to find time together, and sexual relations (Keating-Lefler at al., 2004; Sheil, 1995; Symon et al., 2002). Concerns about parenting practices include the quality of the partner’s parenting practices (Sheil et al., 1995), the process of co-parenting (Sheppard & Watkins, 2000) and parental disagreements (Akister & Johnson, 2004; Jackson & Mannix, 2003). Strained relationships (Stevens & Meleis, 1991; Wijnberg & Reding, 1999) and fear that

Concerns, social support, and HRQOL 13 the child’s father would not provide support or might hurt the baby (Combs-Orme et al, 2004) were cited as additional concerns about partners. Maternal concerns about family have also been documented in the literature. Common concerns are changes in the family’s lifestyle (Sheil et al., 1995) and financial security (Keating- Lefler et al., 2004; Sachs, Hall, Lutenbacher, & Rayens, 1999; Sheil et al., 1995). Additional concerns related to family include the ability to continue to provide for the infant’s needs (Niska et al., 1997), finding time for other family members (Symon et al., 2002; Hiser, 1991), and child abuse (Akister & Johnson, 2004; Fox, Bruce, & Combs-Orme, 2000; Niska et al., 1997). Concerns related to environment Various authors describe maternal concerns related to the community. Availability of community resources is a frequently reported concern (Keating-Lefler et al, 2004; Beeber & Miles, 2003; Sachs et al., 1999; Sheil et al., 1995). Day care is reported as a concern of mothers working outside the home (Kaitz, 2007; Stevens & Meleis, 1991; Wijnberg & Reding, 1999). Additional concerns include racial intolerance (Akister & Johnson, 2004) and changes in relationships with friends (Keating-Lefler et al, 2004; Sheil et al., 1995). Analysis of the research findings Although multiple concerns of mothers have been identified in the scientific literature, the body of knowledge is incomplete. The majority of research has been designed to focus on concerns in the first year postpartum. Limited studies have been identified that focused on the pre-school period (Miles Holditch-Davis, & Shepherd, 1998; Beeber & Miles, 2003), children under the age of 16 (Stuart & Garrison, 2002; Wijnberg & Reding, 1999), and adolescent and adult children (Jackson & Mannix, 2003). Absent from the research are studies that examine differences in the nature, frequency, and intensity of concerns at different points in time across

Concerns, social support, and HRQOL 14 the maternal experience. The majority of research examined concerns of mothers considered to be at higher risk – low income mothers, adolescent mothers, or the mothers of children with special needs. While these groups have been documented to be more highly vulnerable, there may also be normative concerns inherent in the maternal role. Some programs of research (for example, Peden et al., 2005) utilize a cumulative level of concern rather than identifying the nature and frequency of individual concerns. Although this methodology facilitates the examination of relationships between maternal concerns and other variables (e.g., depression, negative thinking, health behaviors), it does not provide the data needed to inform decisions or guide interventions in clinical practice. Social support as a mediating process

In the model for this research, the relationship between stress and effect is mediated by the process of coping. Lazarus and Folkman (1987) identified social support as part of the coping process. The concept of social support and its effect on stress have been widely researched since the 1970s. Multiple definitions of social support appear in the scientific literature. Cobb (1976) defined social support as information that causes an individual to feel cared for, loved, esteemed, valued, and part of a network of mutual commitment and aid. Kahn and Antonucci (1980) defined social support as interpersonal transactions involving affect, affirmation, and aid. Frey (1989) defined social support as an exchange of positive emotions, social integration, emotional concern, and direct assistance. In addition to multiple definitions, multiple conceptualizations of social support have emerged. One of these conceptualizations was by form of social support. House (1981) identified four forms: instrumental, information, emotional, and appraisal. Barrera and Ainsley (1983) proposed six forms – material aid, physical assistance, intimate interaction, guidance, feedback, and social participation. Underwood (2000)

Concerns, social support, and HRQOL 15 suggested that emotional, informational, instrumental, and affirmational support were categories common to all conceptualizations by form. A second conceptualization was by source of support. Sources of social support generally included family, friends, lay individuals and professionals. Conceptualizations crossed the spectrum from the availability of a single individual to the extent and composition of an individual’s social network. The final conceptualization included satisfaction, cost, and reciprocity. Although social support was generally perceived and portrayed as positive, selected research results indicated that social support could be associated with added demands and cost (Norwood, 1996; Stewart & Tilden, 1995). Beeber and Canuso (2005) suggested a comprehensive conceptualization of social support that included structure (the nature of the social network), function (the type of support and how it is provided), and satisfaction (the cost, conflict, and effectiveness of the support). The role of social support in the process of stress and coping has also been widely researched. Models for direct, mediating, and moderating effects on stress and coping have been proposed and examined. In the main or direct effect model, increased social support is associated with improved health at all stress levels. In the mediation model, increased social support intervenes indirectly to reduce the impact of stress on the health outcome; in the buffering (moderating) model, social support exerts a protective effect at the time the stressor is introduced. Gore (1978) differentiated between the additive and buffering models of social support. In the additive model, social support impacts the health outcome in conditions of high and low stress; in the buffering model, social support impacts the health outcome only in the condition of high stress.

Concerns, social support, and HRQOL 16 For the purposes of this research, the review of the literature was limited to theoretical articles and empirical studies that examined social support in mothers. The body of knowledge presented here reflects research and thought from the fields of nursing, medicine, public health, psychology, and sociology that were published in the past decade. Characteristics of social support in mothers Research conducted in the past decade has identified multiple characteristics of social support in mothers. Hung (2005) found relatively high mean scores for social support in Taiwanese mothers who experienced a normal delivery. Perceived social support was reported to be lower in single mothers than in mothers who were married (Cairney, Boyle, Offord, & Racine, 2002); 42% of inner city mothers reported little or no social support (Silver, Heneghan, Bauman, & Stein, 2006). Mother’s mothers and husbands were found to be the primary sources of support in first-time mothers (Weiss, 2005). Direct effects of social support Research results document associations between social support and multiple aspects of health. Several studies document the relationship between higher levels of social support and lower levels of stress, increased hardiness, or decreased mental health symptoms. Ben-Zur, Duvdevany, and Lury (2005) identified a moderate, negative correlation between social support and stress. Weiss (2002) reported that higher levels of social support were associated with lower levels of depression in a study of mothers of children with autism. In a study of 279 inner city mothers of children ages 6 months to 3 years, Silver and associates (2006) identified a significant relationship between low levels of social support and depression. Hung and Chung (2001) found significant differences in social support in mothers according to level of psychiatric morbidity.

Full document contains 125 pages
Abstract: Mothers are primary caregivers and gatekeepers for family health yet little is known about the nature and level of maternal concern, social support, and health-related quality of life for mothers across the maternal continuum. This research was designed to examine the relationship between maternal concerns and health-related quality of life, describe the impact of social support on this relationship, identify the relationship between sociodemographic factors and concern, social support and HRQOL, and identify differences in these variables among categories of mothers. Participants were 238 mothers from Maryland, West Virginia, and Pennsylvania who completed a mail survey. The sample was composed primarily of married women with at least some college or technical training who were the biological mothers of one or two children, working full-time, and living in families with incomes at or above $45,000. All participants completed the Everyday Stressors Index, the Medical Outcomes Study Social Support Survey, and the Medical Outcomes Study Short Form 36 version 2® (SF-36v2). Mothers of children of all ages reported a low level of concern and moderate level of social support; level of maternal concern demonstrated a small to moderate negative relationship with HRQOL and was the strongest predictor of HRQOL compared to sociodemographic factors and social support. Social support did not moderate the relationship between maternal concerns and HRQOL and demonstrated a minimal mediating influence on the relationship between concern and the mental health subscale of the SF36v2®. Income and education were the sole sociodemographic predictors of HRQOL. There were no significant differences in concern, social support or HRQOL among four groups of mothers categorized by age of oldest child living at home. Participant scores on the mental health subscales of the SF-36v2 differed significantly from gender and age-matched national norms. Results indicate the need to focus attention on the mental health needs of mothers of children of all ages. Recommendations for nursing practice include periodic screening for changes in mental health and education, anticipatory guidance, and advocacy efforts to assist mothers to cope with commonly identified concerns. Recommendations for nursing research include longitudinal studies that pair self-report data with neurohormonal markers.