Stressful life events occurring during pregnancy and the postpartum period have consistently been identified as a risk factor for perinatal mood and anxiety disorders.  While we have instruments to assess for stressful life events and to measure perceived stress, such as the well-established Holmes and Rahe Stress Scale, these tools do not necessarily assess factors specific to pregnant and postpartum women.  For example, these scales do not address breastfeeding problems, sleep deprivation, and childcare issues, all of which are clearly important sources of stress in this population.

To develop a brief self-report assessment of stressors during the postpartum period, researchers performed a cross-sectional study of a sample of 138 women at Massachusetts General Hospital at their 6-week postpartum visit.  The participants were surveyed regarding potential stressors.  In terms of designing a tool for assessing postpartum stressors, items were eliminated based on low relevance and/or low endorsement.

Not so surprisingly, the three most commonly endorsed items (i.e. rated as moderately or very stressful) were lack of sleep (48.2 %), breastfeeding (40.1 %), and being a mother (34.6 %).  Based on these data, the researchers developed the Postpartum Stressors Scale (PPSS), a 9-item scale where the various stressors fell into three basic categories:

Baby Care: Breastfeeding, being a mother, having a fussy baby, and lack of sleep, accounted for 63.2% of the variance in total PPSS scores.

Well-Being: Relationship with spouse/partner, financial worries, concerns about one’s own health, and concerns about physical appearance or weight, accounted for explained 16.8 % of the total variance.

Work Problems: Explained 11.7 % of the total variance.

The authors notes that if additional research in larger and more diverse samples of women supports the external validity of this measure in other populations, the PPSS could easily be incorporated into the 6-week postpartum visit in order to identify women at risk for postpartum depression.  What is also attractive about this scale is that it identifies specific stressors and may help healthcare providers to more clearly understand why a patient may be feeling distressed or overwhelmed and would help the clinician to make a targeted referral (e.g., lactation consultant, parenting classes, counseling, community resources).

  POSTPARTUM STRESSORS SCALE

Please rate how stressful each of the following has been for you since you had your baby:
Not at all

stressful

A little

Stressful

Moderately stressfulVery stressful
Relationship with spouse/partner
Breastfeeding
Being a mother
Fussy baby
Financial worries
Work problems
Concerns about own health
Concerns about physical appearance (weight, shape)
Lack of sleep
1
1
1
1
1
1
1
1

1

2
2
2
2
2
2
2
2

2

3
3
3
3
3
3
3
3

3

4
4
4
4
4
4
4
4

4

 

 

Ruta Nonacs, MD PhD

Park ER, Psaros C, Traeger L, Stagg A, Jacquart J, Willett J, Alert MD, LaRoche KL, Ecker JL.  Development of a Postpartum Stressor Measure.  Matern Child Health J. 2015 Oct;19(10):2094-101.