論文の公開元へSocial Isolation among Mothers Caring for Infants in Japan: Findings from the Nationwide Survey of Healthy Parents and Children 21
概要
Objective
Social isolation has been identified as a risk factor for morbidity and mortality for a nu mber of diseases. Therefore, preventing social isolation is one of the key challenges that public health faces.Social isolation can occur in any age group; however, child-rearing i solation of mothers with infants is a pressing issue in Japan. In fact, it is addressed as a major issue in three maternal and child health policies in Japan: countermeasures again st adverse effects of the relationship between parents and children, child abuse, and birt h rate decline. The lack of social support has been shown to be associated with maternal stress and depres sion and not adopting safe practices for the prevention of childhood injury. Moreover, chi ld-rearing isolation represents a risk factor for child abuse, which has a deleterious imp act on children’s development. In Japan, socially isolated mothers with 6-month-old infan ts spent JPY 4,186 (Japanese yen; around USD 35) more per month on child-rearing costs com pared to non-isolated mothers, which suggested parenting costs are higher due to lack of s ocial support for mothers. Therefore, from a public health perspective, understanding the current situation regarding child-rearing isolation and its related factors is critical. However, to date, few studies in Japan have examined child-rearing isolation nationwide. This study aimed to identify the prevalence of child-rearing isolation and the related sociodemographic factors among mothers in Japan using data from the Final Survey of Healthy Parents and Children21.
Methods
Participants: Mothers of young children attending their health checkups. Participants were residents of 472 municipalities that had been identified as targets of the Final Survey o f Healthy Parents and Children 21 and were also the parents of children scheduled for chil d health checkups during the survey period. Municipalities were divided into quartiles by population, and participants were randomly selected from each group. In total, 89,404 prin t questionnaires were mailed to the identified number of participants in each municipality. Surveys were collected from 75,622 parents whose children were receiving health checkups during the survey period: 3-4-month checkup, n = 20,729; 18-month checkup, n = 27,922; 3-y ear checkup, n = 26,971 (response rate = 84.6%).
Statistical Analysis: Multivariate logistic regression models assessed the association bet ween child-rearing isolation and socio-demographic variables. Data from 69,337 women were analyzed. Further, for sensitivity analysis, we accounted for missing data with the multip le imputation by chained equations (MICE).
Results
Mothers who experienced child-rearing isolation comprised 0.2% of all participants. Mothers who were 35- to 39-years-old at childbirth (OR = 1.6, CI[1.0, 2.4], p = .036), unemployed (OR = 1.7, CI[1.3, 2.4], p = .001), experienced financial difficulty (OR = 1.8, CI[1.3, 2.5], p< .001), had husbands with limited participation in child-rearing (OR = 5.7, CI[4.2, 7.9], p< .001), lived in special wards in Tokyo Metropolis (OR = 4.2, CI[2.2, 8.3], p < .001), had child abuse concerns (OR = 2.1, CI [1.5, 2.9], p < .001), and had no time to relax with their child (OR = 4.5, CI [3.1-6.7], p < .001) exhibited higher odds ratio for child-rearing isolation, compared to those who did not. There were statistically significant differences in most variables between those who were and those who were not included in this analysis. However, in the sensitivity analysis, there were small differences between the results of the analysis of the complete data and those of the MICE. (imputed data sample size 75,622).
Discussion
Findings showed that spousal support and community support may play an important role in preventing mothers with infants from becoming isolated in child care. While spousal support is the most important source of support for mothers, it can be inferred that if the source of support is limited to the spouse, mothers can easily become isolated when they cannot rely on their spouse. It is important to create a supportive environment in the community in order to prevent mothers of infants who are likely to leave their families due to marriage and childbirth from becoming isolated from their blood and work relationships. The results of this study also suggest that community characteristics and place of residence are factors associated with child care isolation among mothers with infants. In cities that are considered to be at high risk of childcare isolation, community support for childcare, such as encouragement from local people and creating an environment where mothers can easily participate in community activities, will be more important. We hope that the results of this study will contribute to future maternal and child health care activities in municipalities.
Conclusions
We examined the characteristics of mothers reporting child-rearing isolation and the associated factors using data from a large-scale, nationwide survey in Japan. Child-rearing isolation was found to be associated with advanced age at childbirth, unemployment, financial difficulties, lack of husband’s participation in child-rearing, anxiety about child-rearing: concerns about abusing own child, no time to relax with child, and living in Tokyo’s special wards.
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