Assessing postpartum depression: Evidences for the need of multiple methods

IntroductionDifferent methods and instruments are frequently used to measure postpartum depression (PPD) in research, e.g. PPD-specific scales, DSM-based diagnostic interviews and rating scales assessing general depression. However, it is unsure whether these measures would lead to the same results, e.g. in the identification of “depressed” women or in their relations to third variables.Objective(s)We compared different measures of PPD and their relations with a third variable, namely the mothers’ marital satisfaction.MethodWe recruited 65 mothers to take part in a study about the impact of PPD on the development of early family relations. Maternal PPD was assessed with multiple methods (i) a PPD-specific scale, (ii) a DSM-based diagnostic interviews and (iii) a rating scale designed to assess the severity of depressive symptoms. We assessed mothers’ marital satisfaction with the Marital Adjustment Test (MAT).ResultsResults showed weak overlap between PPD-specific scale and DSM-based diagnosis of PPD, and modest correlations between the PPD-specific scale and the general depression rating scale. Only the score on the PPD-specific scale could predict marital satisfaction.ConclusionAs we found discrepancies between different measures of PPD, we suggest being cautious in the choice of measures and using multiple methods to measure PPD in a comprehensive way.     

Is the Effect of Postpartum Depression on Mother-Infant Bonding Universal?

PurposeAlthough the negative consequences of maternal depression on infants has been documented in several Western societies, similar studies have not been conducted in Middle-Eastern countries where cultural norms and traditions may differ. The main objective of this study was to determine the risk factors for postpartum depression (PPD) and its relationship to mother −infant bonding in a Lebanese population.MethodsOne hundred and fifty participants were administered the Edinburgh Postpartum Depression Scale (EPDS), and the social support scale at 2–3 days postpartum. At 10–12 weeks mother–infant bonding using the Postpartum Bonding Questionnaire (PBQ) and depression using the Beck Inventory (BDI-II) were assessed during a telephone interview.ResultsThe prevalence of depression was 19% with an average score of 10.9 ± 6.02 on the EPDS. At 10–12 weeks 2.7% of the whole sample was depressed with an average score of 18.60 ± 16.87 on the BDI-II. Risk factors of PPD on the EPDS were; history of alcohol use, complications during pregnancy, not a good marital relationship, baby admitted to an intensive care unit, history of depression and low social support. Risk factors for impaired bonding were age, history of depression, BDI-II scores above 20 and low social support. The multiple regression analysis found that impaired bonding was associated with older age, history of depression and low social support, which explained 39% of the variance, F = 7.12, p = 0.02.ConclusionThe prevalence of PPD was higher than previously reported at day 2–3 post-delivery, but lower at 10–12 weeks postpartum. Impaired mother- infant bonding was associated older mothers, history of depression, low social support and BDI-II scores above 20 which should alert practitioner to assessing these factors in post-partum mothers.     

A Tricky Object to Classify: Evidence,Postpartum Depression and the DSM‐IV

The concept of evidence has become central in Western healthcare systems; however, few investigations have studied how the shift toward specific definitions of evidence actually occurred in practice. This paper examines a historical case in psychiatry where the debate about how to define evidence was of central importance to nosological decision making. During the fourth revision of the Diagnostic andStatistical Manual of Mental Disorders a controversial decision was made to exclude postpartum depression (PPD) as a distinct disorder from the manual. On the basis of archival and interview data, I argue that the fundamental issues driving this decision were related to questions about what constituted suitable hierarchies of evidence and appropriate definitions of evidence. Further, although potentially buttressed by the evidence‐based medicine movement, this shift toward a reliance on particular kinds of empirical evidence occurred when the dominant paradigm in A merican psychiatry changed from a psychodynamic approach to a research‐based medical model.     

产后抑郁的预测因素及神经生理机制

产后抑郁是产后时期出现的抑郁症状,对女性及其后代甚至家人都会造成严重的负面影响。产后抑郁稳定的预测因素是遗传基因、依恋风格、童年负性生活经历和激素水平的变化;涉及的脑区和神经网络集中在前额叶皮层、扣带回、杏仁核和海马等脑区及相应神经网络。未来应在探索综合的预测模型、男性伴侣的对照试验和基于大脑可塑性特征的干预模式等方面展开深入研究。     

Transdiagnostic model of psychological factors and sex differences in depression in a large sample of Ecuador

Background/ObjectiveDepression represents a leading cause of disability and a major contributor to the overall global burden of disease with women systematically reporting a higher prevalence than men. This study aimed to examine the predictive value and relation of three transdiagnostic psychological factors (perceived stress, psychological inflexibility and loneliness) on depression and its sex differences for the general population in a large sample of Ecuador.MethodA non-probabilistic and non-clinical sample of 16.074 people from across Ecuador were online surveyed using a cross-sectional design. The structural equation model was based on scores from standardized questionnaires as measures of depression, psychological perceived stress, psychological inflexibility, and loneliness.ResultsWomen reported significantly higher levels of depression, mediated by differences in perceived stress, psychological inflexibility and loneliness. Perceived stress was the most important predictor of depression and mediated the effect of loneliness on depression. Complementarily, psychological inflexibility partially mediated the effect of perceived stress and loneliness on depression. The overall model accounted for the 78% of the total variance in depression.ConclusionsResults of this study provide a novel and robust transdiagnostic model of sex differences on depression and insights on how to design effective programs for preventing depression targeting modifiable transdiagnostic risk factors.     

Research & clinical exchange

Abstract

Question: I once heard Carl Whitaker say at a workshop that one of the greatest myths about marriage is the idea that “I didn't marry your family, I married you.” This makes me wonder when it would be appropriate to involve the families of the two people planning to get married, when the couple goes for premarital counseling.     

Perceived Stigma of Postpartum Depression Symptoms in Low-Risk First-Time Parents: Gender Differences in a Dual-Pathway Model

Although postpartum depression (PPD) symptoms are fairly common among new mothers and fathers, new parents still perceive a stigma associated with having the “baby blues.” Research has extensively examined the role of perceived stigma on help-seeking for clinical PPD, but little is known about the process of perceived stigma in new parents. We examined the role of perceived stigma in postpartum depressive symptoms using the dual-pathway model (Mickelson and Williams 2008). Specifically, we tested whether internalized stigma would influence PPD symptoms through parenting efficacy, whereas experienced stigma would influence PPD symptoms through indirect support-seeking. We also examined whether the internalized pathway was stronger for fathers while mothers would utilize both pathways. Using longitudinal data from a community sample of first-time parents in the United States, we found parenting efficacy was a mediator between internalized stigma and PPD symptoms for mothers and experienced stigma and PPD symptoms for fathers; indirect support-seeking was only a cross-sectional mediator for mothers between internalized stigma and PPD symptoms. Understanding how new mothers and fathers perceive the stigma attached to PPD symptoms and the process by which it impacts symptom reporting can help to improve interventions aimed at new parents.     

Postpartum depression and infant-mother attachment security at one year: The impact of co-morbid maternal personality disorders

Previous studies on effects of postpartum depression (PPD) on infant-mother attachment have been divergent. This may be due to not taking into account the effects of stable difficulties not specific for depression, such as maternal personality disorder (PD).Mothers (N = 80) were recruited for a longitudinal study either during pregnancy (comparison group) or eight weeks postpartum (clinical group). Infants of mothers with depressive symptoms only or in combination with a PD diagnosis were compared with infants of mothers with no psychopathology. Depression and PD were assessed using self-report and clinical interviews. Infant-mother attachment was assessed when infants were 13 months using Strange Situation Procedure (SSP). Attachment (in)security was calculated as a continuous score based on the four interactive behavioral scales of the SSP, and the conventional scale for attachment disorganization was used.PPD was associated with attachment insecurity only if the mother also had a PD diagnosis. Infants of PPD mothers without co-morbid PD did not differ from infants of mothers with no psychopathology. These results suggest that co-existing PD may be crucial in understanding how PPD impacts on parenting and infant social-emotional development. Stable underlying factors may magnify or buffer effects of PPD on parenting and child outcomes.     

Transhumanism and Roman Catholicism: Imagined and Real Tensions

Abstract

Transhumanists have asserted that religious people would both oppose life extension and allowing people with extended lives to die. In this paper, coming from a Roman Catholic perspective, I refute four myths associated with these claims: that the Church materially opposes life extension, that it conceptually opposes the very idea of life extension, that it opposes human genetic manipulation, and that it opposes letting people die in hospitals. I then propose that there are four real tensions that are much more significant: that material immortality is highly improbable, that injustice and inequality are major concerns, that transhuman omnipotence is impossible, and that utopianism is extremely dangerous.     

Teaching Clinical Psychology Trainees about Weight Bias

Abstract

As an assistant professor who teaches clinical psychology trainees about social aspects of behavior, I devote one week to the topic of weight bias. In this class, I rely on the research literature to challenge common myths about “obesity,” demonstrate the pervasiveness and harm of weight bias, and offer recommendations to trainees to apply to their own professional and personal lives. I encourage trainees to shift focus from weight and weight loss to health and well-being and to engage in self-reflection on the role of weight bias in their interactions with others. Here, I describe my weight bias seminar and outline common questions and my responses to them (e.g., Do you actually believe that “obese” people can be healthy?). Weight bias is a neglected topic in most clinical psychology training programs. Weight bias must be addressed in clinical psychology programs to produce culturally competent graduates who are aware of diversity issues.     

Network-level dynamics underlying a combined rTMS and psychotherapy treatment for major depressive disorder: An exploratory network analysis

BackgroundDespite the growing use of repetitive transcranial magnetic stimulation (rTMS) as a treatment for depression, there is a limited understanding of the mechanisms of action and how potential treatment-related brain changes help to characterize treatment response. To address this gap in understanding we investigated the effects of an approach combining rTMS with simultaneous psychotherapy on global functional connectivity.MethodWe compared task-related functional connectomes based on an idiographic goal priming task tied to emotional regulation acquired before and after simultaneous rTMS/psychotherapy treatment for patients with major depressive disorders and compared these changes to normative connectivity patterns from a set of healthy volunteers (HV) performing the same task.ResultsAt baseline, compared to HVs, patients demonstrated hyperconnectivity of the DMN, cerebellum and limbic system, and hypoconnectivity of the fronto-parietal dorsal-attention network and visual cortex. Simultaneous rTMS/psychotherapy helped to normalize these differences, which were reduced after treatment. This finding suggests that the rTMS/therapy treatment regularizes connectivity patterns in both hyperactive and hypoactive brain networks.ConclusionsThese results help to link treatment to a comprehensive model of the neurocircuitry underlying depression and pave the way for future studies using network-guided principles to significantly improve rTMS efficacy for depression.     

Differentiating anxiety and depression: the State-Trait Anxiety-Depression Inventory

ABSTRACT

The differentiation of trait anxiety and depression in nonclinical and clinical populations is addressed. Following the tripartite model, it is assumed that anxiety and depression share a large portion of negative affectivity (NA), but differ with respect to bodily hyperarousal (specific to anxiety) and anhedonia (lack of positive affect; specific to depression). In contrast to the tripartite model, NA is subdivided into worry (characteristic for anxiety) and dysthymia (characteristic for depression), which leads to a four-variable model of anxiety and depression encompassing emotionality, worry, dysthymia, and anhedonia. Item-level confirmatory factor analyses and latent class cluster analysis based on a large nation-wide representative German sample (N?=?3150) substantiate the construct validity of the model. Further evidence concerning convergent and discriminant validity with respect to related constructs is obtained in two smaller nonclinical and clinical samples. Factors influencing the association between components of anxiety and depression are discussed.     

Does Postpartum Depression Affect Parental Embodied Mentalizing in Mothers With 4-Months old Infants?

Parental Embodied Mentalizing (PEM) regards parents’ nonverbal capacity to understand the infant’s bodily manifested mental states and adjust his or her own movements accordingly. Little is known about how mothers suffering from postpartum depression (PPD) mentalize the infant on an embodied level. The aims of the present study were to investigate whether mothers meeting criteria for a PPD diagnosis differ from non-clinical mothers in regard to their PEM capacities and whether the severity of depressive symptoms was associated with PEM in mothers meeting criteria for a PPD diagnosis compared to non-clinical mothers.10-minute long lab-based face-to-face interactions were coded with the PEM coding scheme at 4-months postpartum in mother-infant dyads with mothers meeting criteria for a PPD diagnosis (n = 29) and non-clinical mothers (n = 51).Results showed that mothers with and without a PPD diagnosis differ in their capacity to mentalize on an embodied level, but only when controlling for scores on the Edinburgh Postnatal Depression Scale (EPDS). However, more depressive symptoms as measured with the EPDS was not in itself associated with lower PEM in either group. This finding may indicate the presence of a threshold effect, i.e. that maternal PEM may be affected only when a certain degree of severity and duration in depressive symptoms is beyond a certain threshold. The importance of the findings in regard to the assessment of depression as well as more clinical perspectives are discussed.     

REACTING TO CONSECRATING SCIENCE: WHAT MIGHT AMATEURS DO?

In Consecrating Science: Wonder, Knowledge, and the Natural World, Lisa H. Sideris makes a compelling case that a new cosmology movement advocates for a new, universal, creation story grounded in the sciences. She fears the new story reinforces elite power structures and anthropocentrism and thus environmental degradation. Alternatively, she promotes genuine wonder which occurs in experiences of the natural world. As Sideris focuses on the likely logical outcome of the assumptions and arguments of the new cosmologies, she does not investigate whether and how people react to these new myths. I suggest that methods of documentary studies, applied to popular book reviews on Amazon and Goodreads, shed light on the ramifications of the new cosmologies among the general public. While many reviewers exhibit attitudes and behaviors that would concern Sideris, responses are far from univocal. Using this case as a guide, I suggest that attention to the experience of laypeople could contribute productively to religion and science research in general.     

Distress tolerance as a mechanism of mindfulness for depression and anxiety: Cross-sectional and diary evidence

BackgroundBoth trait and state mindfulness are associated with less depression and anxiety, but the mechanisms remain unknown. Distress tolerance, an important transdiagnostic factor of emotional disorders, may mediate the relationship between mindfulness and depression/anxiety.MethodStudy 1 examined the mediation model at the between-person level in a large cross-sectional sample (n = 905). In Study 2, a daily diary study (n = 110) was conducted to examine within-person changes. Participants were invited to complete daily diaries measuring daily mindfulness, distress tolerance, depression and anxiety for 14 consecutive days.ResultsIn Study 1, results of simple mediation analyses indicated that distress tolerance mediated the relationship between mindfulness and depression/anxiety at the between-person level. In Study 2, results of multilevel mediation analyses indicated that, in both the concurrent model and time-lagged model, daily distress tolerance mediated the effects of daily mindfulness on daily depression/anxiety at both the within- and between-person level.ConclusionsDistress tolerance is a mechanism underlying the relationship between mindfulness and depression/anxiety. Individuals with high or fluctuating depression and anxiety may benefit from short-term or long-term mindfulness training to increase distress tolerance.     

The relationship between childhood abuse and depression in a sample of Chinese people who use methamphetamine

Background/ObjectivePrevious studies have shown that childhood abuse is associated with symptoms of depression. This study aims to examine the prevalence of childhood abuse or neglect and its correlation with depression among a sample of Chinese people who use methamphetamine.MethodPeople who use methamphetamine (MA) (N = 1,173) were recruited from government-operated drug rehabilitation centres in Anhui province, China. Participants were assessed using the short form of Childhood Trauma Questionnaire and the Beck Depression Inventory-II for childhood abuse or neglect and depression symptoms.ResultsA total of 44.6% of people who use MA reported moderate/severe childhood abuse or neglect, and 56.9% of this sample were diagnosed with depression. Emotional abuse, sexual abuse, emotional neglect and physical neglect were revealed to increase the risk of depression. Multivariable regression analyses showed that depression scores were significantly predicted by gender, duration of drug use, sexual abuse and emotional neglect (model R² = .08, p < .001). The interaction between emotional neglect and duration of drug use on the depression was statistically significant.ConclusionsThese analyses indicate that sexual abuse and emotional neglect increase the severity of depression in individuals who use MA in drug rehabilitation centres of China.     

Persian tales on the couch: Notes on folktales as the mirror of the contemporary cultural struggles with gender and sexuality

Abstract

This paper presents a report on our psychoanalytic investigation of cultural folktales, myths, and fables, in which we study, primarily, the extent to which such narratives lurk behind contemporary representations of men and women. Our aim is to identify the multiple narrative structures that form the core plots and storylines of these tales. Following Roland Barthes’ work on mythologies, we want to decode the tales’ ideological components by deciphering the axiomatic assumptions these tales make about the nature of perceived social reality. This represents an attempt to study a mind that is derived from the text. More specifically, we study narratives whose storylines revolve around the struggle between men and women in order to identify the culture’s core concerns about and preoccupations with the relationship between the sexes. We believe that cultural myths or folktales are a royal road to a nation’s collective conscience, and include gendered patterns of defenses, obsessions, fears, and paranoia.     

Value-based choice: An integrative,neuroscience-informed model of health goals

Objective: Traditional models of health behaviour focus on the roles of cognitive, personality and social-cognitive constructs (e.g. executive function, grit, self-efficacy), and give less attention to the process by which these constructs interact in the moment that a health-relevant choice is made. Health psychology needs a process-focused account of how various factors are integrated to produce the decisions that determine health behaviour.

Design: I present an integrative value-based choice model of health behaviour, which characterises the mechanism by which a variety of factors come together to determine behaviour. This model imports knowledge from research on behavioural economics and neuroscience about how choices are made to the study of health behaviour, and uses that knowledge to generate novel predictions about how to change health behaviour. I describe anomalies in value-based choice that can be exploited for health promotion, and review neuroimaging evidence about the involvement of midline dopamine structures in tracking and integrating value-related information during choice. I highlight how this knowledge can bring insights to health psychology using illustrative case of healthy eating.

Conclusion: Value-based choice is a viable model for health behaviour and opens new avenues for mechanism-focused intervention.     

Virtual Reality as a Selfobject Function: Towards Reclaiming Unlived Potentialities

ABSTRACT

In this article, I illustrate how virtual reality may promote reclaiming unlived potentialities, unconscious or disavowed. Using Kohut’s concept of the Virtual Self, I suggest that virtual aspects of the self, its potential capability, are unconscious (or unknown) until met by someone or something that promotes their transformation into a conscious state of mind and supports their realization. In this sense, the virtual experiences of the self are drawn from the preconscious. Three vignettes demonstrate the transformative potential of virtual experiences when they are perceived as recognizing, and responsive to, the Self’s needs. Two vignettes are drawn from ancient myths and illuminate how the virtual zone has inspired transformation and expansion of self awareness already in ancient times. A third vignette is presented to illustrate how, at the advent of social media, disavowed and dissociated needs are channeled into cyberspace as communications that are unconsciously geared to reclaim unlived potentialities. Cyber reality converses with conventional reality and, thus, is appreciated as a mode of psychic advance toward a new kind of self consciousness.