Depression during and following pregnancy: quality of family relationships

Fifty-four primiparous women were administered the Zung Self-rating Depression Scale and the Objective Social Perception Inventory during the last trimester of pregnancy. Four to 8 weeks postpartum, they again responded to the SRDS. A poor relationship with the husband, as rated during pregnancy, was significantly associated with depression during pregnancy and was also predictive of depression after childbirth. No parallel association between relationship with the mother and depression pre- or postpartum was noted.     

Problem-Solving Appraisal and the Prediction of Depression During Pregnancy and in the Postpartum Period

Based on the presumed mood-regulatory properties of the problem orientation component delineated in the social problem-solving model, a positive problem orientation was predicted to influence ongoing levels of positive and negative affect during pregnancy. Higher levels of positive affect and lower levels of negative affect would then in turn predict depression during pregnancy and in the postpartum period. This hypothesis was tested in 100 women. Path analyses supported the predicted relation of the problem orientation components to trait affectivity, and indirectly to peripartum and postpartum depression. Trait negative and positive affectivity was also associated with peripartum depression, and indirectly with postpartum depression, as expected. Implications for the integrated social problem-solving model are discussed. Recommendations for assessment and counseling interventions with expectant women are offered.     

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.     

Affect expression in prenatally psychotropic exposed and nonexposed mother–infant dyads

This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant–mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother–infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal–infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics. ©2002 Michigan Association for Infant Mental Health.     

MATERNITY LEAVE AND WOMEN'S MENTAL HEALTH

The Wisconsin Maternity Leave and Health Study addresses an important policy issue, parental leave, by investigating the work status, maternity leave, and mental health of 570 women. In the longitudinal design, the women, all of whom were living with a husband or partner, were interviewed during the fifth month of pregnancy, 1 month postpartum, and 4 months postpartum. At 4 months postpartum, full-time workers, part-time workers, and homemakers did not differ in depression or anger, but full-time workers showed elevated anxiety compared with the other two groups. In multiple regression analyses, length of leave interacted significantly with marital concerns when predicting depression; women who took a short leave (6 weeks or less) and were high on marital concerns had the highest depression scores. Short maternity leave can be conceptualized as a risk factor that, when combined with other risk factors such as marital concerns, places women at greater risk for depression.     

Maternal depression: A review of relevant treatment approaches for mothers and infants

The negative impact of postpartum depression on the mother‐infant relationship and infant development more generally has been well documented. Compared to infants of nondepressed mothers, infants of depressed mothers have been shown to be less securely attached to their caregivers and often have cognitive, emotional, and behavioral deficits that persist well into childhood. Recent evidence has suggested that reduction of maternal depressive symptoms may itself not be sufficient to prevent negative effects on children. Rather, treatments that target the mother‐infant relationship may have great potential in providing a buffer against the potentially damaging effects of postpartum depression. Based on our review of several treatment‐outcome studies, we conclude that mother‐infant psychotherapies and home‐based interventions are generally efficacious in their goal of ameliorating detrimental consequences for children of depressed mothers. Nonetheless, the field must continue to investigate the extent to which treatment gains are maintained over time and the mechanisms by which protective effects occur. It is likely that the most efficacious treatment approaches will be those that address the needs of the mother, the infant, and their relationship.     

Hope,Social Support,and Postpartum Depression: Disentangling the Mediating Effects of Negative Affectivity

We examined the potentially mediating effects of negative affectivity (NA) on the hope–depression relationship among a sample of postpartum women. We also assessed the social support reported by these women and examined the possible mediating effects of NA on the social support–postpartum depression relationship. Correlational analyses of data obtained from women (N = 98) who had given birth in the previous 6 months revealed that NA did not mediate either hope or social support in the prediction of postpartum depression. Hope accounted for a significant degree of variance in postpartum depression. These data suggest that hope has palliative effects among women following childbirth and these effects are not nullified or explained by emotional predispositions.     

Maternal perinatal mental health: Associations with bonding,mindfulness, and self-criticism at 18 months’ postpartum

The perinatal period is a time of significant transition for women, with changes in maternal mental health from pregnancy to 18 months’ postpartum. This study specifically analyzes maternal self-criticism and mindfulness during pregnancy and at 18 months’ postpartum, and their associations with bonding. A longitudinal study (30 weeks’ gestation–18 months’ postpartum) assessed 32 mother–infant dyads, examining changes in maternal depression, anxiety, self-criticism, and mindfulness. In addition, associations between maternal variables during pregnancy and bonding were investigated. Maternal depression and self-criticism significantly increased from pregnancy to postpartum. Maternal anxiety, self-criticism, and facets of mindfulness during pregnancy were also associated with mother–infant bonding at 18 months. Maternal mental health during pregnancy is subject to change postchildbirth. The lack of control and autonomy accompanying motherhood may result in an increase in self-criticism during this period. Such feelings may elevate a woman's vulnerability to postpartum depression and have consequences for later maternal bonding. Early identification of at-risk mothers is important to increase likelihood of positive outcomes.     

Rated helpfulness and partner-reported smoking cessation support across the pregnancy-postpartum continuum.

Support interventions have not changed smoking cessation rates significantly. The pregnancy-postpartum continuum presents a unique opportunity to examine patterns of support. Expectant couples (N = 477) were surveyed twice during pregnancy and 3 times postpartum. Partners reported positive and negative smoking-specific support; women reported the helpfulness of partner support. Linear trends suggest that women viewed support as more helpful during pregnancy than during postpartum. Partners' provision of positive support across the continuum depended on their smoking; provision of negative support depended on women's smoking. Partners who smoked provided lower levels of both positive and negative support, especially postpartum. Women who smoked throughout the pregnancy perceived their partner's negative support as helpful. Implications are that partners who smoke may need help staying engaged in the support process. Partners may provide negative support in response to women's smoking cues. Women who are struggling with cessation may not view negative support as negative.     

Trait Forgiveness and Dyadic Adjustment Predict Postnatal Depression

The birth of a first child can be stressful on intimate partner relationships and the women having their first child. Conflict can occur, and hurts might be experienced, which could lead to post-partum depression. Thus, capacity for forgiveness with specific hurts might affect post-partum depression. We investigated women having their first child (N?=?52), and examined whether dyadic adjustment, trait forgiveness, and situational forgiving during pregnancy predicted postpartum depression. This study found that marital forgiveness predicted lower levels of depression above and beyond the effects of general dyadic adjustment. Dyadic adjustment and trait forgiveness predicted postpartum depression while situational forgiving was mixed. Postpartum depression researchers are encouraged to consider the inclusion of positive psychology variables, such as forgiveness, in future research studies.     

TRANSITION TO PARENTHOOD AND MENTAL HEALTH IN FIRST‐TIME PARENTS

This study aimed to examine the transition to parenthood and mental health in first‐time parents in detail and explore any differences in this transition in the context of parental gender and postpartum mental health. Semistructured clinical interviews (Birmingham Interview for Maternal Mental Health) were carried out with 46 women and 40 men, 5 months after birth. Parents were assessed on pre‐ and postpartum anxiety, depression, and postpartum posttraumatic stress disorder (PTSD), and a range of adjustment and relationship variables. One fourth of the men and women reported anxiety in pregnancy, reducing to 21% of women and 8% of men after birth. Pregnancy and postpartum depression rates were roughly equal, with 11% of women and 8% of men reporting depression. Postpartum PTSD was experienced by 5% of parents. Postpartum mental health problems were significantly associated with postpartum sleep deprivation (odds ratio [OR] = 7.5), complications in labor (OR = 5.1), lack of postpartum partner support (OR = 8.0), feelings of parental unworthiness (OR = 8.3), and anger toward the infant (OR = 4.4). Few gender differences were found for these variables. This study thus highlights the importance of focusing interventions on strengthening the couple's relationship and avoiding postnatal sleep deprivation, and to address parents’ feelings of parental unworthiness and feelings of anger toward their baby.     

First-time parents' expectations about the division of childcare and play

The current study examines violated expectations regarding the division of childcare and play in first-time parents during the initial transition to parenthood. The study's goal was threefold: (a) to compare prenatal expectations with the reported postpartum division of childcare and play, (b) to compare the influence of the reported division versus violated expectations on postpartum relationship satisfaction and depression, and (c) to examine the role of persistent violations of expectations on these outcomes. Couples expecting their first child were interviewed during the third trimester of pregnancy and at 1 and 4 months postpartum. Results indicated both mothers and fathers have unrealistic expectations during pregnancy; interestingly, the direction violation was opposite but converging for mothers and fathers. As found in prior research, mothers experienced unmet expectations with fathers doing less than mothers expected. Fathers, on the other hand, experienced overmet expectations with mothers doing more than fathers expected. Violated expectations were also a stronger predictor of depression and relationship satisfaction than the reported division, although again in opposite directions for mothers and fathers. Unmet expectations were negative for mothers, while overmet expectations with regard to childcare tasks were beneficial for fathers. The one caveat was for fathers' overmet expectations with play; in this case, a mother playing with the baby more than a father expected was related to less relationship satisfaction. A similar pattern of results was found for mothers and fathers with persistent violations. This study highlights the importance of understanding violated expectations in both mothers and fathers, as well as examining play separately from childcare.     

Perceived partner support in pregnancy predicts lower maternal and infant distress

Maternal postpartum emotional distress is quite common and can pose significant risk to mothers and infants. The current study investigated mothers' relationships with their partners during pregnancy and tested the hypotheses that perception of prenatal partner support is a significant predictor of changes in maternal emotional distress from midpregnancy to postpartum, and contributes to maternal ratings of infant distress to novelty. Using a prospective longitudinal design, 272 adult pregnant women were interviewed regarding their partner support, relationship satisfaction, and interpersonal security (attachment style and willingness to seek out support), and they completed standardized measures of prenatal symptoms of depression and anxiety (distress). At 6 to 8 weeks' postpartum, mothers reported these symptoms again and completed measures of their infants' temperament. Structural equation modeling (SEM) was used to test direct and indirect contributions of partner support, relationship satisfaction, and interpersonal security to maternal and infant postpartum distress. Mothers who perceived stronger social support from their partners midpregnancy had lower emotional distress postpartum after controlling for their distress in early pregnancy, and their infants were reported to be less distressed in response to novelty. Partner support mediated the effects of mothers' interpersonal security and relationship satisfaction on maternal and infant outcomes. A high-quality, supportive partner relationship during pregnancy may contribute to improved maternal and infant well-being postpartum, indicating a potential role for partner relationships in mental health interventions, with possible benefits for infants as well.     

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     

Prevalence of mood symptoms and depressions during pregnancy: implications for clinical practice and research

A review of the literature demonstrates that the incidence of new mental disorders and their prevalence during pregnancy is similar to the 12-month incidence of mental disorders in women during other periods of their lives. The prevalence of severe mood, behavior, and cognitive symptoms during pregnancy is rather high. Severe mental symptoms during pregnancy have been reported to be associated with an increased rate of complications during pregnancy and delivery, preterm deliveries, low birth weight, a higher rate of postpartum depression, and a longer-term impact on the offspring's development. Several pre-pregnancy risk factors to develop dysphoric symptoms have been reported, but their utility for primiparous women with no previous history of mental disorders is unclear. The association of mental symptoms with general symptoms and biological changes during pregnancy is also unclear. Given the short- and long-term impact of dysphoric symptoms and stress during pregnancy on mother and child, efficacious, efficient, and safe prevention and treatment modalities are essential and achievable. Clarification of the nature and phenotyping of mental and general symptoms during pregnancy is an important step for the development of effective interventions.     

Influences of maternal postpartum depression on fathers and on father–infant interaction

Maternal postpartum depression (PPD) has been shown to negatively influence mother–infant interaction; however, little research has explored how fathers and father–infant interaction are affected when a mother is depressed. This study examined the influence of maternal PPD on fathers and identified maternal and paternal factors associated with father–infant interaction in families with depressed as compared with nondepressed mothers. A convenience sample of 128 mother–father–infant triads, approximately half of which included women with significant symptoms of PPD at screening, were recruited from a screening sample of 790 postpartum women. Mothers and fathers completed measures of depression, marital satisfaction, and parenting stress at 2 to 3 months' postpartum and were each videotaped interacting with their infants. Results indicate that maternal PPD is associated with increased paternal depression and higher paternal parenting stress. Partners of depressed women demonstrated less optimal interaction with their infants, indicating that fathers do not compensate for the negative effects of maternal depression on the child. Although mother–infant interaction did not influence father–infant interaction, how the mother felt about her relationship with the infant did, even more so than maternal depression. The links between maternal PPD, fathers, and father–infant interaction indicate a need for further understanding of the reciprocal influences between mothers, fathers, and infants.     

Changes in the marital relationship during the transition to first time motherhood: effects of violated expectations concerning division of household labor

This research combined cross-sectional and longitudinal analyses to evaluate the hypothesis that violated expectations with respect to sharing child care and housekeeping responsibilities contribute to women's dissatisfactions with their marital relationships after the birth of their first child. The cross-sectional sample consisted of 670 women who completed questionnaires at one of six phases in relation to birth. The longitudinal sample consisted of 48 women who filled out questionnaires late in pregnancy and at three periods postpartum. The results showed, consistent with previous findings, that women reported less positive feelings about their husbands during the postpartum period than during pregnancy, and that women reported doing much more of the housework and child care than they had expected. Moreover, regression analyses indicated, as predicted, that violated expectations concerning division of labor were related to negative feelings postpartum concerning some aspects of the marital relationship. Additional findings suggested that the negative implications of the birth of a baby for the marital relationship may not be as great as has been emphasized in previous literature, and that expectancy violations affect some parts of the relationship but not necessarily the core affective feeling.     

产后抑郁相关危险因素分析

本文通过分析引发产后抑郁的相关危险因素及其对健康的影响,为探索干预措施提供依据。危险因素重要性的分析显示“夫妻关系不佳”位居危险因素之首;产妇的性格特征和孕期心理状态是产后抑郁发生的重要心理影响因素。因此,丈夫角色不容忽视,社会支持系统的建立意义重大,干预效果显著的因素应作为研究重点。     

Parenting stress and depressive symptoms in postpartum mothers: Bidirectional or unidirectional effects?

Despite the consistent link between parenting stress and postpartum depressive symptoms, few studies have explored the relationships longitudinally. The purpose of this study was to test bidirectional and unidirectional models of depressive symptoms and parenting stress. Uniquely, three specific domains of parenting stress were examined: parental distress, difficult child stress, and parent–child dysfunctional interaction (PCDI). One hundred and five women completed the Beck Depression Inventory and the Parenting Stress Index – Short Form at 3, 7, and 14 months after giving birth. Structural equation modeling revealed that total parenting stress predicted later depressive symptoms, however, there were different patterns between postpartum depressive symptoms and different types of parenting stress. A unidirectional model of parental distress predicting depressive symptoms best fit the data, with significant stability paths but non-significant cross-lagged paths. A unidirectional model of depressive symptoms predicted significant later difficult child stress. No model fit well with PCDI. Future research should continue to explore the specific nature of the associations of postpartum depression and different types of parenting stress on infant development and the infant–mother relationship.     

Infant Developmental Outcomes: A Family Systems Perspective

The aim of the current study was to examine whether parental mental health, parent–infant relationship, infant characteristics and couple's relationship factors were associated with the infant's development. Forty‐two families took part at three time points. The first, at 3 months postpartum, involved a video recorded observation (CARE‐index) of parent–infant interactions. At 5 months postpartum, in‐depth clinical interviews (the Birmingham Interview of Maternal Mental Health) assessed parental mental health and parental perceptions of their relationship with their infant, their partner and their infant's characteristics. Finally, the Bayley Scales III was carried out 17 months postpartum to assess the infants' cognitive, language and motor development. A higher mother–infant relationship quality was significantly associated with more optimal language development, whilst a higher father–infant relationship quality was associated with more advanced motor development. Additionally, maternal postnatal post‐traumatic stress disorder had a negative impact on the infant's cognitive development, whilst maternal prenatal depression was associated with a less optimal infant's language development. The largest prediction was afforded by parental perceptions of their infant's characteristics. The findings indicate that such perceptions may be crucial for the infant's development and imply that negative internal parental perceptions should be considered when assessing risk factors or designing interventions to prevent negative child outcomes. Copyright © 2013 John Wiley & Sons, Ltd.