Health-Related Quality of Life Among Chinese Pregnant Women in the Third Trimester Based on Theory of Unpleasant Symptoms: A Complex Network Analysis

Abstract

Health-related quality of life (HRQOL) is the result of complex interactions between many different factors. But few studies to date have explored the structure of HRQOL. This study aimed to investigate the complex inter-relationship between HRQOL and influencing factors using network analysis. In all, 624 Chinese pregnant women in third trimester were recruited through recruiting sampling. We used regularized network analysis to create a complex network. The relationship with mother-in-law was the most central node followed by relationship with partner. We found the comorbidity of anxiety and depressive symptoms using network analysis. Physical- and mental-related quality of life were a “bridge node” connecting psychological factors with physiologic factors. The present network analysis highlights the strong link between relationship with mother-in-law or partner and HRQOL, which is also a unique phenomenon under Chinese culture. This analysis provides key variables for future intervention or improvement of pregnant women’ HRQOL.

Keywords

pregnant women health-related quality of life complex network analysis

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References

Angel Oviedo-Caro

Bueno-Antequera

Munguia-Izquierdo

. (2018). Explanatory factors and levels of health-related quality of life among healthy pregnant women at midpregnancy: A cross-sectional study of The PregnActive Project. Journal of Advanced Nursing, 74(12), 2766–2776. https://doi.org/10.1111/jan.13787

Bai

Korfage

I. J.

Hafkamp-De

G. E.

Jaddoe

Eva

Hein

Jodi

(2016). Associations between nausea, vomiting, fatigue and health-related quality of life of women in early pregnancy: The generation R study. PLoS One, 11(11), e0166133. https://doi.org/10.1371/journal.pone.0166133

Blakeman

J. R.

(2019). An integrative review of the theory of unpleasant symptoms. Journal of Advanced Nursing, 75(5), 946–961. https://doi.org/10.1111/jan.13906

Borsboom

Cramer

A. O. J.

(2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9(1), 91–121. https://doi.org/10.1146/annurev-clinpsy-050212-185608

Buysse

D. J.

Iii

Monk

T. H.

Berman

S. R.

Kupfer

D. J.

(1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213. https://doi.org.10.1016/0165-1781(89)90047-4

Chang

S. R.

Chen

K. H.

Lin

M. I.

Lin

H. H.

Huang

L. H.

Lin

W. A.

(2014). A repeated measures study of changes in health-related quality of life during pregnancy and the relationship with obstetric factors. Journal of Advanced Nursing, 70(10), 2245–2256. https://doi.org/10.1111/jan.12374

Chang

S. R.

Kenney

N. J.

Chao

(2010). Transformation in self-identity amongst Taiwanese women in late pregnancy: A qualitative study. International Journal of Nursing Studies, 47(1), 60–66. https://doi.org.10.1016/j.ijnurstu.2009.06.007

Chen

(2004). The division of labor between generations of women in rural China. Social Science Research, 33(4), 557–580. https://doi.org/10.1016/j.ssresearch.2003.09.005

Chen

(2008). Extended Bayesian information criteria for model selection with large model spaces. Biometrika, 95(3), 759–771. https://doi.org/10.1093/biomet/asn034

10.

Chen

X. P.

Chen

C. C.

(2004). On the Intricacies of the Chinese Guanxi: A process model of guanxi development. Asia Pacific Journal of Management, 21(3), 305–324. https://doi.org/10.1023/B:APJM.0000036465.19102.d5

11.

Cheung

F. M.

Tang

(2017). Women’s lives in contemporary Chinese societies. In Brown

Gielen

Gibbons

Kuriansky

(Eds.), Women’s Evolving Lives (pp. 19–38). Springer. https://doi.org.10.1007/978-3-319-58008-1_2

12.

Chow

S. C.

Shao

Wang

Lokhnygina

(2017). Sample size calculations in clinical research (3rd ed.). CRC Press. https://doi.org/10.1201/9781315183084

13.

Cohen

Kamarck

Mermelstein

(1983). A global measure of perceived stress. Journal of Health & Social Behavior, 24(4), 385–396. https://doi.org/10.2307/2136404

14.

Costantini

Epskamp

Borsboom

Perugini

Mottus

Waldorp

L. J.

Cramer

(2015). State of the aRt personality research: A tutorial on network analysis of personality data in R. Journal of Research in Personality, 54, 13–29. https://doi.org/10.1016/j.jrp.2014.07.003

15.

Cox

J. L.

Holden

J. M.

Sagovsky

(1987). Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. British Journal of Psychiatry the Journal of Mental Science, 150(6), 782–786. https://doi.org/10.1192/bjp.150.6.782

16.

Cuthbert

B. N.

(2014). The RDoC framework: Facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry, 13(1), 28–35. https://doi.org/10.1002/wps.20087

17.

Diemer

M. A.

Mistry

R. S.

Wadsworth

M. E.

López

Reimers

(2012). Best practices in conceptualizing and measuring social class in psychological research. Analyses of Social Issues and Public Policy, 13(1), 77–113. https://doi.org/10.1111/asap.12001

18.

Duan

Y. F.

Wang

Jiang

Yang

Z. Y.

(2018). Prevalence of calf muscle cramps and influencing factors for pregnant women in China during 2010–2012. Zhonghua yu fang yi xue za zhi Chinese Journal of Preventive Medicine, 52(1), 14–20. https://doi.org/10.3760/cma.j.issn.0253-9624.2018.01.004

19.

Eom

C. -S.

Shin

D. W.

Kim

S. Y.

Yang

H. K.

H. S.

Kweon

S. S.

Kang

Y. S.

Kim

J. H.

Cho

B. L.

Park

J. -H.

(2013). Impact of perceived social support on the mental health and health-related quality of life in cancer patients: results from a nationwide, multicenter survey in South Korea. Psycho-Oncology, 22(6), 1283–1290. https://doi.org/10.1002/pon.3133

20.

Epskamp

Borsboom

Fried

E. I.

(2016). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50(1), 195–212. https://doi.org/10.3758/s13428-017-0862-1

21.

Estebsari

Kandi

Z. R. K.

Bahabadi

F. J.

Filabadi

Z. R.

Estebsari

Mostafaei

(2020). Health-related quality of life and related factors among pregnant women. Journal of Education and Health Promotion, 9(1), 299. https://doi.org/10.4103/jehp.jehp_307_20

22.

Feng

Zhao

You

(2012). Social support mediates the impact of emotional intelligence on mental distress and life satisfaction in Chinese young adults. Personality & Individual Differences, 53(4), 513–517. https://doi.org/10.1016/j.paid.2012.04.021

23.

Fereshte

Rezaei

Zahra

B. M.

Hamid

(2013). Prevalence of sleep disorders in the pregnant women. Rayesh, 12(6), 629–635.

24.

Friedman

(2014). Glasso: Graphical lasso-estimation of Gaussian graphical models. http://www-stat.stanford.edu/~tibs/glasso

25.

Gandek

Ware

J. E.

Aaronson

N. K.

Apolone

Bjorner

J. B.

Brazier

J. E.

Bullinger

Kaasa

Leplege

Prieto

Sullivan

(1998). Cross-validation of item selection and scoring for the SF-12 health survey in nine countries: Results from the IQOLA project. International quality of life assessment. Journal of Clinical Epidemiology, 51(11), 1171–1178. https://doi.org/10.1016/S0895-4356(98)00109-7

26.

Glover

(2014). Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Practice & Research: Clinical Obstetrics & Gynaecology, 28(1), 25–35. https://doi.org/10.1016/j.bpobgyn.2013.08.017

27.

Haslbeck

Waldorp

L. J.

(2015). Mgm: Estimating time-varying mixed graphical models in high-dimensional data. Journal of Statistical Software, 93(1), 1–46. https://doi.org/10.18637/jss.v093.i08

28.

Hevey

(2018). Network analysis: A brief overview and tutorial. Health Psychology and Behavioral Medicine, 6(1), 301–328. https://doi.org/10.1080/21642850.2018.1521283

29.

Holt-Lunstad

Smith

T. B.

Layton

J. B.

(2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), 1–20. https://doi.org/10.1371/journal.pmed.1000316

30.

Iwanowicz-Palus

Zarajczyk

Pita

Bień

(2019). Quality of life, social support, acceptance of illness, and self-efficacy among pregnant women with hyperglycemia. International Journal of Environmental Research and Public Health, 16(20), 3941. https://doi.org/10.3390/ijerph16203941

31.

Jing-Li

Hao

J. H.

Tao

F. B.

(2011). Influencing factors of pregnancy-related anxiety in first trimester of pregnancy. Chinese Journal of Public Health, 27, 969–971.

32.

Kai

W. L.

Ching

S. M.

Fan

K. H.

Ramachandran

Devaraj

N. K.

(2020). Factors associated with poor-to-moderate quality of life among pregnant women with gestational diabetes mellitus: A cross-sectional study in Malaysia. Quality of Life Research, 29(10), 2725–2736. https://doi.org/10.1007/s11136-020-02532-3

33.

Kane

S. C.

Costa

F. S.

Brennecke

(2014). First Trimester biomarkers in the prediction of later pregnancy complications. BioMed Research International, 12, 807196. https://doi.org/10.1155/2014/807196

34.

Kefiyalew

Zemene

Asres

Gedefaw

(2014). Anemia among pregnant women in Southeast Ethiopia: Prevalence, severity and associated risk factors. BMC Research Notes, 7, 771. https://doi.org/10.1186/1756-0500-7-771

35.

Kessler

R. C.

Nelson

C. B.

Mcgonagle

K. A.

Liu

Swartz

Blazer

D. G.

(1996). Comorbidity of DSM-III-R major depressive disorder in the general population: Results from the US National comorbidity survey. British Journal of Psychiatry Supplement, 168(30), 17–30. https://doi.org/10.1192/S0007125000298371

36.

Lain

S. J.

Ford

J. B.

Hadfield

R. M.

Roberts

C. L.

(2010). A prevalence survey of every-day activities in pregnancy. BMC Pregnancy Childbirth, 10(1), 41. https://doi.org/10.1186/1471-2393-10-41

37.

Lam

C. L.

Tse

E. Y.

Gandek

(2005). Is the standard SF-12 health survey valid and equivalent for a Chinese population? Quality of Life Research, 14, 539–547. https://doi.org/10.1007/s11136-004-0704-3

38.

Lee

D. T. S.

Yip

S. K.

Chiu

H. F. K.

Leung

T. Y. S.

Chung

T. K. H.

(1998). Detecting postnatal depression in Chinese women: Validation of the Chinese version of the Edinburgh postnatal depression scale. The British Journal of Psychiatry, 172(5), 433–437. https://doi.org/10.1192/bjp.172.5.433

39.

Lee

Crockett

M. S.

(1994). Effect of assertiveness training on levels of stress and assertiveness experienced by nurses in Taiwan, Republic of China. Issues in Mental Health Nursing, 15(4), 419–432. https://doi.org/10.3109/01612849409006918

40.

Lee

S. E.

Vincent

Finnegan

(2017). An analysis and evaluation of the theory of unpleasant symptoms. Advances in Nursing Science, 40(1), E16–E39. https://doi.org/10.1097/ANS.0000000000000141

41.

Lenz

E. R.

Pugh

L. C.

Milligan

R. A.

Gift

Suppe

(1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14–27. https://doi.org/10.1097/00012272-199703000-00003

42.

Lenz

E. R.

Pugh

Milligan

R. A.

(2013). Theory of unpleasant symptoms. Middle range theories: Application to nursing research. Wolters Kluwer.

43.

Leung

D. Y.

Lam

T. H.

Chan

S. S.

(2010). Three versions of perceived stress scale: Validation in a sample of Chinese cardiac patients who smoke. BMC Public Health, 10(1), 513–519. https://doi.org/10.1186/1471-2458-10-513

44.

Sun

Duan

(2020). Role of psychotherapy on antenatal depression, anxiety, and maternal quality of life: A meta-analysis. Medicine, 99(27), e20947. https://doi.org/10.1097/MD.0000000000020947

45.

Bao

Zhou

Chen

Luo

(2021). Culture-related health disparities in quality of life: Assessment of instrument dimensions among Chinese. Frontiers in Public Health, 9, 663904. https://doi.org/10.3389/fpubh.2021.663904

46.

Liu

X. C.

Tang

M. Q.

(1996). Reliability and validity of the Pittsburgh sleep quality index. Chinese Journal of Psychiatry, 29(2), 103–107.

47.

Lopes-Junior

L. C.

de Omena Bomfim

Nascimento

L. C.

Pereira-da-Silva

de Lima

R. A. G.

(2015). Theory of unpleasant symptoms: support for the management of symptoms in children and adolescents with cancer. Revista Gaúcha de Enfermagem, 36(3), 109–112. https://doi.org/10.1590/1983-1447.2015.03.51465

48.

Maslow

A. H.

(1958). A dynamic theory of human motivation. In Stacey

C. L.

DeMartino

(Eds.), Understanding human motivation (pp. 26–47). Howard Allen Publishers. https://doi.org/10.1037/11305-004

49.

Mazúchová

KelÍková

Dubovická

(2017). Measuring women’s quality of life during pregnancy. Kontakt, 20(1), 31–36. https://doi.org/10.1016/j.kontakt.2017.11.004

50.

Miller

A. H.

(1998). Neuroendocrine and immune system interactions in stress and depression. Psychiatric Clinics of North America, 21(2), 443–463. https://doi.org/10.1016/S0193-953X(05)70015-0

51.

Mirghafourvand

Mohammad-Alizadeh-Charandabi

Jafarabadi

M. A.

Shiri

Ghanbari-Homayi

(2016). Feasibility, reliability, and validity of the Iranian version of the quality of life questionnaire for pregnancy. Iranian Red Crescent Medical Journal, 18(9), e35382. https://doi.org/10.5812/ircmj.35382

52.

Mogren

I. M.

Pohjanen

A. I.

(2005). Low back pain and pelvic pain during pregnancy: Prevalence and risk factors. Spine, 30(8), 983–991. https://doi.org/10.1097/01.brs.0000158957.42198.8e

53.

Nasreen

H. E.

Rahman

A. J.

Mohd

R. R.

Mira

Rosnah

Maigun

(2018). Prevalence and determinants of antepartum depressive and anxiety symptoms in expectant mothers and fathers: Results from a perinatal psychiatric morbidity cohort study in the east and west coasts of Malaysia. BMC Psychiatry, 18(1), 195. https://doi.org/10.1186/s12888-018-1781-0

54.

Nilsson

(2006). Social capital and quality of life in old age: Results from a cross-sectional study in rural Bangladesh. Journal of Aging & Health, 18(3), 419–434. https://doi.org/10.1177/0898264306286198

55.

Okonofua

F. E.

Ntoimo

Ogu

R. N.

(2017). Women’s perceptions of reasons for maternal deaths: Implications for policies and programs for preventing maternal deaths in low-income countries. Health Care for Women International, 39(1), 95–109. https://doi.org/10.1080/07399332.2017.1365868

56.

Park

Chesla

(2007). Revisiting Confucianism as a conceptual framework for Asian family study. Journal of Family Nursing, 13(3), 293–311. https://doi.org/10.1177/1074840707304400

57.

Pereira Calou

C. G.

de Oliveira

M. F.

Costa Carvalho

F. H.

Lessa Soares

P. R. A.

Bezerra

R. A.

Mendes de Lima

S. K.

Antezana

F. J.

de Souza Aquino

Moura Barbosa Castro

R. C.

Bezerra Pinheiro

A. K

. (2018). Maternal predictors related to quality of life in pregnant women in the Northeast of Brazil. Health and Quality of Life Outcomes, 16(1), 1–10. https://doi.org/10.1186/s12955-018-0917-8

58.

Ren

(2010). Measurement methodology on social economic status index of students. Journal of Educational Studies, 6, 77–82.

59.

Shefaly

Yin

Esperanza

D. N.

Chan

Y. H.

Tam

Seng

C. Y.

(2018). Prevalence and incidence of postpartum depression among healthy mothers: A systematic review and meta-analysis. Journal of Psychiatric Research, 104, 235–248. https://doi.org/10.1016/j.jpsychires.2018.08.001

60.

Solmi

Koyanagi

Thompson

Fornaro

Correll

C. U.

Veronese

(2019). Network analysis of the relationship between depressive symptoms, demographics, nutrition, quality of life and medical condition factors in the Osteoarthritis Initiative database cohort of elderly North-American adults with or at risk for osteoarthritis. Epidemiology and Psychiatric Sciences, 29, e14. https://doi.org/10.1017/S204579601800077X

61.

Tan

J. X.

Kraus

M. W.

(2015). Lay theories about social class buffer lower-class individuals against poor self-rated health and negative affect. Personality and Social Psychology Bulletin, 41(3), 446–461. https://doi.org/10.1177/0146167215569705

62.

Tang

C. S.

Lai

B. P.

(2008). A review of empirical literature on the prevalence and risk markers of male-on-female intimate partner violence in contemporary China. Aggression and Violent Behavior, 13(1), 1359–1789. https://doi.org/10.1016/j.avb.2007.06.001

63.

Tsai

S. Y.

Lee

P. L.

Lin

J. W.

Lee

C. N.

(2016). Cross-sectional and longitudinal associations between sleep and health-related quality of life in pregnant women: A prospective observational study. International Journal of Nursing Studies, 56, 45–53. https://doi.org/10.1016/j.ijnurstu.2016.01.001

64.

VanderDrift

L. E.

Vanable

P. A.

Bonafide

K. E.

Brown

J. L.

Bostwick

R. A.

Carey

M. P.

(2017). Using actor-partner interdependence modeling to understand HPV vaccine acceptance. PLoS One, 12(7), 1–15. https://doi.org/10.1371/journal.pone.0181662

65.

Wang

S. Y.

Jiang

X. Y.

Jan

W. C.

Chen

C. H.

(2003). A comparative study of postnatal depression and its predictors in Taiwan and mainland China. American Journal of Obstetrics & Gynecology, 189(5), 1407–1412. https://doi.org/10.1067/S0002-9378(03)00673-2

66.

Wang

Y. L.

Yang

X. Y.

Chen

(2021). Community identity as a mediator of the relationship between socioeconomic status and altruistic behavior in Chinese residents. Journal of Community and Applied Social Psychology, 31(1), 26–38. https://doi.org/10.1002/casp.2476

67.

Ware

J. E.

Kosinski

M. A.

Keller

S. D.

(1998). SF-12: How to score the SF-12 physical and mental health summary scales. In Michalos

A. C.

(Ed.) Encyclopedia of Quality of Life and Well-Being Research (pp. 258–311). Springer. https://doi.org/10.1007/978-94-007-0753-5_2698

68.

Xiao

L. M.

Tao

F. B.

Jing-Li

(2012). Development and reliability evaluation of a pregnancy-related anxiety questionnaire. Chinese Journal of Public Health, 28(3), 275–277.

69.

Xiao

Chan

C. W. H.

Xiao

Wong

C. L.

Chow

K. M.

(2021). Development of a nurse-led educational intervention program in managing the nutrition impact symptom cluster in patients with nasopharyngeal carcinoma following the medical research council framework. Asia-Pacific Journal of Oncology Nursing, 8(6), 653–661. https://doi.org/10.4103/apjon.apjon-2141

70.

Ying

Yin

(2011). Maternal, obstetric variables, perceived stress and health-related quality of life among pregnant women in Macao, China. Midwifery, 27(5), 668–673. https://doi.org/10.1016/j.midw.2010.02.008

71.

Zhang

Gao

Kong

Qin

Cao

Mei

(2019). Relations between Stress and Quality of Life among Women in late pregnancy: The parallel mediating role of depressive symptoms and sleep quality. Psychiatry Investigation, 16(5), 363–369. https://doi.org/10.30773/pi.2019.02.14

72.

Zimet

G. D.

Powell

S. S.

Farley

G. K.

Werkman

Berkoff

K. A.

(1990). Psychometric characteristics of the multidimensional scale of perceived social support. Journal of Personality Assessment, 55(3), 610–617. https://doi.org/10.1080/00223891.1990.9674095