The role of anxiety and other factors in predicting postnatal fatigue : from birth to 6 months

Objective: to explore the role of anxiety and other factors in predicting postnatal fatigue from birth to 6 months. Design: a prospective longitudinal correlational survey design. Setting: Canberra, Australian Capital Territory, Australia. Participants: 504 well women, 233 primipara and 271 multipara, aged 20-40 years who gave birth during the study period. Measurement: the Postpartum Fatigue Scale, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the Support Behavior Inventory were used to measure the relationship between the predictive factors and the intensity of fatigue at the various time points. Findings: an explanatory model of fatigue development was applied to all participants, and then to primiparas and multiparas, explaining 27-44% of the variance in fatigue from 1 to 24 weeks in the total sample (p>.001). State anxiety was a consistently strong predictor of fatigue intensity across time and group. Key conclusions and implications for practice: the contribution that state anxiety made to the development of fatigue in this group of low risk women highlights the importance of assessing symptoms of anxiety in all childbearing women. Focusing on depressive symptoms limits the extent to which anxiety symptoms, which occur in parallel with depressive symptoms, are addressed. Anxiety is a normal response to the changes in roles and responsibilities that occur following birth. However the belief that all new mothers worry excessively and that anxiety is not as harmful as depression may have influenced the way midwives and maternal child health nurses view postnatal anxiety. Assessment of anxiety, and use of interventions such as cognitive and behavioural strategies and self-care practices, can be used to assist women to reduce anxiety levels.