Prospective investigation of postpartum depression: factors involved in onset and recovery

We examined the role of a number of psychosocial variables in the onset of postpartum depression and in recovery from depression that occurs during pregnancy. Women (N = 730) were recruited during pregnancy and were followed through 1 month postpartum. They were assessed on demographic variables and on measures of depressive symptomatology and diagnostic status, perceived stress, marital satisfaction, perceptions of their own parents, dysfunctional cognitions, and coping style. Onset of depression in the postpartum was predicted by the levels during pregnancy of depressive symptomatology and perceived maternal and paternal care during childhood. In contrast, recovery in the postpartum from depression during pregnancy was not predicted by the variables examined in this study. These results are discussed with reference to previous investigations that have examined depression that occurs outside the context of childbirth.     

Longitudinal Study of Life Events,Well-Being,Emotional Regulation and Depressive Symptomatology

Etiological research regarding adolescent depression is relatively recent and longitudinal studies are needed to explicate the mechanisms by which risk and protective factors impact the development of depression. This investigation evaluated the effects of time 1 predictors (e.g., depressive symptoms, life events, subjective well-being, and emotion regulation strategies) on depressive symptoms assessed at time 2 (1 year later). The sample comprised 182 Portuguese adolescents, aged 12–16. Time 1 depressive symptoms and psychological well-being were significant predictors of time 2 depressive symptoms. Time 1 rumination predicted time 2 depressive symptoms, but time 2 brooding mediated this effect. Time 1 life events did not predict time 2 depressive symptomatology. This study identified several factors that seem to play an important role in the development of depressive symptomatology. Previous depressive symptomatology and well-being had a significant effect in this process and the relationship between rumination in time 1 and depressive symptoms at time 2 (1 year later) was fully mediated by brooding at time 2. Given these results, implications for prevention and treatment of depression include addressing risk factors like early depressive symptoms, rumination and brooding, and increasing the protective effect of psychological well-being.     

Femininity and work plans protect women against postpartum dysphoria

This study examined contributions of the following variables to postpartum depressive symptomatology: level of antepartum depression, loss of social reinforcement, assertiveness, sex-role orientation, and work plans. The Beck Depression Inventory (BDI), Pleasant Events Schedule (PES), Assertion Inventory, and Bem Sex Role Inventory (BSRI) were administered to 69 women during the eighth month of pregnancy. One month after delivery, subjects were administered the PES, postdelivery questionnaire, and BDI. A hierarchical regression analysis revealed that antepartum BDI scores predicted postpartum depressive symptomatology, and BSRI Femininity scores and work plans were significant negative predictors. A one-way analysis of variance of sex role orientation on postpartum BDI scores showed that undifferentiated women reported more depression than other sex role groups.     

Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants

Although maternal attachment is an important predictor of infant attachment security and other developmental outcomes, little is known about the formation of maternal attachment in the first few months of the infant's life, particularly among ethnic minority mothers. The current study examined the predictors of postpartum maternal attachment in a sample of 217 Latina women enrolled in a perinatal depression prevention trial. Mothers’ attachment to their infants was measured at 6-8 weeks postpartum using the Maternal Postnatal Attachment Scale. A variety of predictors of early attachment were explored including: depressive symptoms during pregnancy, pregnancy intention, feelings about the pregnancy, and the quality of the partner relationship. The strongest predictor of lower maternal attachment was depressive symptoms late in pregnancy; pregnancy intention was marginally predictive of attachment, with lower scores being associated with unwanted pregnancies. The study fills a critical gap in our understanding of the role of depressive symptoms during pregnancy in shaping mothers’ early attachment to their infants.     

Postpartum Daily Stress,Relationship Quality,and Depressive Symptoms

This study explored the relationships among daily stresses, specifically interpersonal conflict, the quality of supportive spousal relationships, and the experience of postpartum depressive symptoms. In our sample of 51 women nearly 30% reported symptoms consistent with postpartum depression. Using regression analysis and controlling for depression during pregnancy, results suggested that arguments with family members and the depth of the spousal relationship acted as significant predictors of the severity of reported postpartum depressive symptoms. Results of the regression were in the expected direction, but due to the small sample size, the findings should be interpreted with caution. Post-hoc analyses were conducted separating the women into three groups based on their depression scores. Therapeutic interventions to reduce postpartum depressive symptoms are considered. An erratum to this article can be found at     

Negative life events and substance use moderate cognitive behavioral adolescent depression prevention intervention

Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n?=?173) in which adolescents (M age =?15.5, SD =?1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.     

Social support and postpartum depressive symptomatology: The mediating role of maternal self‐efficacy

Research shows that social support and maternal self‐efficacy are inversely related to postpartum depression; however, little is known about the mechanisms by which these variables impact on depressive symptomatology. This study uses path analysis to examine the proposal that maternal self‐efficacy mediates the effects of social support on postpartum depressive symptomatology. Primiparous women (n=247) completed questionnaires during their last trimester and then again at 4 weeks' postpartum (n=192) . It was hypothesized that higher levels of parental support, partner support, and maternal self‐efficacy would be associated with lower levels of depressive symptomatology postpartum and that the relationship between social support and depressive symptomatology would be mediated by maternal self‐efficacy. Results indicated that as expected, higher parental support and maternal self‐efficacy were associated with lower levels of depressive symptomatology postpartum. Partner support was found to be unrelated to both depressive symptomatology and maternal self‐efficacy. Results from the path analysis supported the mediation model. Findings suggest that parental support lowers depressive symptomatology by the enhancement of maternal self‐efficacy.     

Negative Life Events and Substance Use Moderate Cognitive Behavioral Adolescent Depression Prevention Intervention

Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n = 173) in which adolescents (M age = 15.5, SD = 1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.     

Role of psychosocial risk factors in predicting maternal and paternal depressive symptomatology during pregnancy

The aim of the present study was to investigate the role of several psychosocial risk factors in predicting depressive symptomatology during pregnancy in mothers and fathers, respectively. A total of 146 primiparous mothers and 105 primiparous fathers reporting a psychosocial risk condition were recruited independently from maternity and child health services, during the second trimester of pregnancy. All parents were evaluated for depressive symptomatology, anxiety, and perceived social support. Two hierarchical multiple regression analyses were performed to determine the role of psychosocial factors in predicting depressive symptomatology during pregnancy, in mothers and fathers. Marital dissatisfaction, personal history of depression, and personal trait anxiety were identified as significant predictors of depressive symptomatology during pregnancy, both in mothers and in fathers. Family history of substance abuse, conflictual relationship with the parents in the past year, and bereavement in the past year were identified as significant factors contributing to elevated depressive symptoms during pregnancy in mothers, but not fathers. In this study, several psychosocial risk factors were consistently related to an increase in maternal and paternal depressive symptoms during pregnancy; some of these factors seem to be specifically related to maternal depressive mood.     

Social Support and Postpartum Depression Revisited: The Traditional Female Role as Moderator among Mexican Women

Women who lack social support tend to have a higher risk of postpartum depression. The present study examined the traditional female role, understood here as the adoption of passive and submissive traits specific to Mexican women, as another risk factor for postpartum depressive symptomatology that interacts with social support. Using two waves of data from a longitudinal study of 210 adult Mexican women (20–44 years-old, M _age = 29.50 years, SD = 6.34), we found that lacking social support during the third trimester of their pregnancy was associated with greater depressive symptoms at 6 months in the postpartum, although this relationship depended on the level of endorsement of the traditional female role during pregnancy. Lower social support during pregnancy predicted greater postpartum depressive symptoms for women with higher endorsement of the traditional female role, even when accounting for prenatal depressive symptoms. These results suggest that Mexican women’s experience of social support may depend on their individual adherence to gender roles. Understanding the association between women’s traditional roles and social support in the risk for postpartum depression can improve prevention and educational programs for women at risk.     

Social support, stress, and depressive symptoms among the elderly: test of a process model.

Effects of social support, negative life events, and daily hassles on depressive symptoms were assessed in 301 adults aged 65 or older, in person 3 times at 6-month intervals and by mail questionnaires every month over a 12-month period. Initial social support predicted severity of depressive symptoms 12 months later. Social support and initial levels of depressive symptomatology predicted number of daily hassles but not number of major life events. Effects of social support, depression, and major life events on the incidence of daily hassles remained significant without the inclusion of hassles reflecting depressive symptomatology or problems in relationships or whose content overlapped with major life events. Daily hassles mediated the effects of major life events on subsequent depression. Results did not differ for men and women. Implications for models of the relations among social support, stress, and depression are discussed.     

Nonpsychotic postpartum depression among adolescent mothers

This study examined the extent to which childbearing increases vulnerability to clinical depression and depressive symptomatology among primiparous adolescent girls (ages 14 to 18). Childbearing Ss (n = 128) were assessed during pregnancy, 6 weeks postpartum, and 1 year postpartum. Matched nonchildbearing Ss (n = 114) were assessed at corresponding time points. Six weeks postpartum, 6% of the childbearing adolescents met Research Diagnostic Criteria for major depression and 20% for minor depression. These rates were not significantly different from those found for nonchildbearing Ss (4% major depression, 10% minor depression). However, higher rates of somatic symptoms of depression were found among the childbearing Ss than among the nonchildbearing Ss.     

The relationships between negative life events, perceived support in the school environment and depressive symptoms among Norwegian senior high school students: a prospective study

The present study prospectively explored the main and interactive effect of negative life events and social support from teachers and classroom peers on depressive symptoms in a sample of 198 (111 females, 87 males) students in a Norwegian senior high school. In the longitudinal multivariate analyses, self-reported depressive symptom levels at time-point two (T₂) were predicted by initial levels of depressive symptomatology, teacher support, and gender. Support from classroom peers at time-point one (T₁) was not associated with symptoms of depression at (T₂). Multivariate cross-sectional analysis also detected a significant positive association between negative life events and depressive symptoms. Finally, results suggest that perceived teacher support may buffer against negative life events leading to symptoms of depression.     

Correlates of gender role orientation during pregnancy and the postpartum

This study was designed to examine the relationship between gender role orientation and psychological adjustment during pregnancy and the postpartum period in a large sample of French-speaking Caucasian mothers. Gender role was assessed with the Bem Sex Role Inventory, which classifies subjects into four categories: androgynous, masculine, feminine, and undifferentiated. A discriminant analysis showed a relationship between androgyny and the following measures of psychological adaptation: self-esteem, satisfaction with social support, and level of apprehension toward perinatal stressors. The masculine gender role was linked with self-esteem, work involvement, age, and severity of perinatal stress. No relationship was found between gender role and the level of antenatal or postnatal depressive symptomatology. Stress, marital support, and social support were among the predictors of postpartum depression, which underlined the importance of taking these variables into account when studying the well-being of mothers during the postnatal period. Results are discussed in light of previous literature on the association between gender role and motherhood. The limitations of Bem's model and inventory are also considered.     

Parenting Competency Across Pregnancy and Postpartum Among Urban Minority Women

Taking a life-course perspective, we explored the sense of parenting efficacy during the pregnancy-postpartum transition among a group under-represented in much of adult developmental research, minority women. Our intent was to describe the women's report of parenting competency in a major life transition occurring within the context of an impoverished urban environment. We also explored associations with depression, social support, and life events. One hundred and eighty-two African-American and Hispanic mothers at community health centers in low-income urban areas completed measures early in the third trimester and again at 3 months postpartum. Across time, the levels of reported parental efficacy and satisfaction increased while depressive symptoms decreased. Negative life events and levels of depressive symptomatology differentially influenced women's experience of parenting satisfaction and efficacy feelings before and after their babies were born.     

Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.

The authors examined the prospective influence of stress, self-esteem, and social support on the postpartum depressive symptoms of 191 inner-city women (139 European Americans and 52 African Americans) over 3 waves of data collection. Depressive symptomatology was measured by multiple indicators, including self-report and clinical scales. Women became less depressed as they move from prenatal to postpartum stages and adjusted to their pregnancy and its consequences. LISREL and regression analyses indicated that stress was related to increased depression, whereas greater income and social support were related to decreased depression. Self-esteem was related to lower depression at the prenatal and postpartum periods but not to change in depression from the prenatal to the postpartum period. The results also indicated that self-esteem and social support did not have additional stress-buffering effects over and above their direct effects on depression. Finally, African American women did not differ from European American women terms of depression or in terms of how they were impacted by stress or psychosocial resources.     

Application of a stress and coping model to antenatal depressive symptomatology

This study examined the utility of a stress/coping model of antenatal depressive symptomatology. The direct and moderating effects of appraisal, coping resources and coping strategies on depression were explored. A total of 242 primiparous women completed questionnaires during the third trimester of pregnancy. Predictors included life events, coping resources (social support, quality of women's earlier relationships with parents), appraisal (threat, self-efficacy) and coping strategies (wishful thinking, positive reappraisal, problem solving, emotional approach). Results of regression analyses indicated that higher depression was related to higher stressful life events, threat appraisal and wishful thinking coping, and lower positive reappraisal coping. The expected stress exacerbation effects of wishful thinking on depression were supported. There was no support for the expected stress buffering effects of coping resources and coping strategies on depression. Findings provide preliminary support for the use of a stress/coping model to guide future research into psychosocial predictors of antenatal depression.     

Personality,life events and the course of anxiety and depression

Using data from the Netherlands Study of Depression and Anxiety, we examined among 1322 participants with a DSM‐IV diagnosis of depression or anxiety: (i) whether positive and negative life events influence 1‐year course of anxiety and depressive symptoms; (ii) whether personality traits (neuroticism and extraversion) predict symptom course and moderate the impact of life events on symptom course; and (iii) whether life events mediate relationships of neuroticism and extraversion with symptom course. Negative life events were predictive of both anxiety and depressive symptoms, while positive life events predicted the course of depressive symptoms only. Personality traits had significant predictive and moderating effects on symptom course, though these effects were rather small. Copyright © 2011 John Wiley & Sons, Ltd.     

Stress, depressive symptoms, and smoking cessation among pregnant women.

Perceived stress and depressive symptoms were examined as correlates and predictors of smoking cessation during pregnancy in a sample of 819 pregnant smokers (454 baseline smokers and 365 baseline quitters). Women who quit early in pregnancy had lower levels of stress and depressive symptoms than baseline smokers. Adjusting for level of addiction and other demographic factors related to stress and depressive symptoms eliminated the significant association between depressive symptoms and smoking cessation. Lower levels of stress and depressive symptoms were not predictive of cessation in later pregnancy. Prenatal healthcare providers should continue to assess level of addiction and provide targeted intensive cessation interventions. Interventions that reduce stress and depression may also be of benefit to women who are continuing smokers in early pregnancy.     

Perfectionism,life events,and depressive symptoms: A test of a diathesis-stress model

The present research tested the hypothesis that perfectionists who experience stress are vulnerable to depression, in part because negative life events represent a failure to maintain control over negative outcomes. In Study 1, 215 subjects completed the Multidimensional Perfectionism Scale (MPS) and control measures. The MPS assesses self-oriented, other-oriented, and socially prescribed perfectionism. It was confirmed that self-oriented and other-oriented perfectionism were associated with both higher desire for control and greater perceived personal control. Study 2 examined whether trait levels of perfectionism moderate the link between life stress and symptoms of depression. In addition, prospective analyses investigated whether perfectionism accounts for changes in levels of depressive symptomatology over time. Two samples comprised of 374 students (Sample 1) and 173 students (Sample 2) completed the MPS and measures of major life stress and depression symptoms. Subjects in Sample 2 completed these measures at two timepoints separated by a three-month interval. Regression analyses indicated that self-oriented perfectionism and life stress interact significantly to produce higher levels of depressive symptomatology. Moreover, in Sample 2, self-oriented perfectionism at Time 1 was associated with increases in depression symptoms three months later for those individuals who had experienced a major life event. The results provide support for diathesis-stress models, which maintain that perfectionists exposed to life stress are vulnerable to symptoms of depression. The results are discussed in terms of their implications for the study of personality, stress, and vulnerability to symptoms of depression. This research was supported by grants #410-89-0335, #410-91-8056, and #410-93-1256 from the Social Sciences and Humanities Research Council of Canada awarded to the authors.