Social support for postpartum women and associated factors including online support to reduce stress and depression amidst COVID-19: Results of an online survey in Thailand

PLOS ONE RESEARCH ARTICLE Social support for postpartum women and associated factors including online support to reduce stress and depression amidst COVID19: Results of an online survey in Thailand Soo Jung Kim1, Yin Min Aye ID2, Danipa Panyarachun3, Seo Ah Hong ID2,4*, YanShing Chang ID5* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Public Health Sciences, Seoul National University, Seoul, Republic of Korea, 2 ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand, 3 Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand, 4 Institute for Health and Society, Hanyang University, Seoul, Republic of Korea, 5 Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, United Kingdom * (SAH); (YSC) OPEN ACCESS Citation: Kim SJ, Aye YM, Panyarachun D, Hong SA, Chang Y-S (2023) Social support for postpartum women and associated factors including online support to reduce stress and depression amidst COVID-19: Results of an online survey in Thailand. PLoS ONE 18(7): e0289250. https://doi.org/10.1371/journal.pone.0289250 Editor: Ephraim Kumi Senkyire, Ghana Health Service (GHS) / African Forum for Primary Health Care (AfroPHC) / Liverpool School of Tropical Medicine (LSTM), GHANA Received: March 21, 2023 Accepted: July 13, 2023 Published: July 27, 2023 Copyright: © 2023 Kim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and Supporting Information file. Funding: This research project was supported by Mahidol University (MU-GPI 02/2564). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Abstract Background Social support for postpartum women helps mothers to recover from childbirth and fosters healthy infant development. However, the impacts of reduced interpersonal interactions inflicted by the COVID-19 outbreak on available social support for postpartum women have received little attention. Therefore, this study aimed to examine the levels of social support provided to postpartum women and associated factors in Thailand during the COVID-19 pandemic. Methods A cross-sectional study was conducted from July to October 2021 using an anonymous online questionnaire. The responses of 840 eligible women up to six months postpartum in Thailand were obtained. The maternity social support scale was used to measure social support. Multivariate logistic regression was used to analyse the factors associated with social support among postpartum women. Results About 57% of women reported to receive high support. Women in the high social support group were more likely to be married (aOR:2.70; 95% CI:1.57–4.66), have a university education or above (1.88; 1.35–2.64), have an intended pregnancy (2.06; 1.34–3.16), good health (2.01; 1.44–2.81), good sleep quality (1.62; 1.14–2.31), receive counsel from peers or family (1.56; 1.13–2.16), and use internet or social media to reduce stress and depression (1.51; 1.08–2.11). Meanwhile, women in the high social support group were significantly less likely to feed complementary foods to infants within 24 hours of completing the survey (0.28; 0.15–0.52). PLOS ONE | https://doi.org/10.1371/journal.pone.0289250 July 27, 2023 1 / 14 PLOS ONE Competing interests: The authors have declared that no competing interests exist. COVID-19 postnatal social support in Thailand Conclusions The results of this study indicated that more than half of the women reported high support and illustrated the important role played by family, peers, and professionals as well as online and remote channels in providing postpartum informational and emotional support during the pandemic. Online platforms and remote support may be considered to provide social support to postpartum women during a pandemic such as COVID-19. Introduction According to House [1], social support refers to the material and immaterial aspects found in social relationships, such as empathy, physical assistance, beneficial information, and feedback. When women recover from the childbirth experience and start nurturing their newborn over the postpartum period [2], social support aids women in their recovery, prevents possible mental disorders and stress after childbirth [3, 4], and contributes to positive parenting [5] and bonding between the women and their newborns [6]. Postpartum women have faced changes in the provision of maternal social support since the onset of the coronavirus disease (COVID-19), resulting in increased anxieties and worries [7]. Some studies reported that more support was provided by family members who spent more time at home due to home-working or restricted outdoor movements [8]. On the other hand, some women experienced reduced social support due to fewer visits from family and peers [9]. A rise in domestic conflict and violence involving postpartum women was reported in households during the pandemic [10]. Such conflicting results concerning the availability of social support for postpartum women during the pandemic period require further attention. To our knowledge, research relating to maternal social support during the COVID-19 pandemic conducted in China [8], Japan [11], and the United States (US) [12], tended to focus on the relationship between COVID-19 and postpartum depression or mental distress. Moreover, no studies had specifically focused on levels of social support in association with sources of support for postpartum women during the COVID-19 pandemic in low and middle-income countries (LMICs), including Thailand, where the pandemic had a greater effect on less stable national economies with limited healthcare professionals and equipment compared to highincome countries with better resources [13]. To better understand social support among postpartum mothers during the COVID-19 pandemic, it is critical to understand the associated factors, including support received, support needed, and sources of supportive information. Previous studies have shown that sociodemographic factors such as older infant age [14], marital status [15], low income [15], and less education [16] were associated with low maternal social support. Furthermore, it has been reported that high social support may improve sleep quality [17] and play a role in infant feeding practice [10]. Meanwhile, women’s approaches to acquiring the necessary health information and emotional support during the ongoing challenges of COVID-19 are critical to understanding the sources of social support for postpartum women. Social support can come from various sources such as family, peers, and healthcare providers [18], all of whom have been affected (...truncated)