催产素对产后抑郁症患者母性行为的调节作用

产后抑郁症是指女性分娩后一段时间内出现的严重抑郁发作现象。研究表明, 催产素不仅参与分娩过程和正常的母性行为表达, 也在调节产后抑郁的发病及患者的母性行为中起到了重要的作用。产后抑郁症患者的情绪和认知功能受损, 这可能导致了母性行为表达质量的下降; 催产素可以通过中脑边缘多巴胺系统来调控母性行为, 作用于内侧视前区(MPOA)来激活中脑腹侧被盖区(VTA)-伏隔核(NAc)环路从而影响伏隔核内多巴胺的分泌; 催产素对产后抑郁症中母性行为的调节机制可能是通过调节五羟色胺系统的功能来发挥抗焦虑作用, 也可能是通过与其它激素的交互作用来加速母性行为的表达。未来研究进一步明确催产素在中枢神经环路中的功能差异, 以及社会支持对产后抑郁症患者催产素的使用带来的影响。     

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。     

Effects of male postpartum depression on father–infant interaction: The mediating role of face processing

It is estimated that postpartum depression affects up to 25% of men. Despite such high prevalence, the majority of studies on postpartum depression are focused on mothers, and the role of paternal depression and its effects on infant development have been overlooked by researchers and clinicians. The present study aimed to fill this gap by investigating the effect of paternal postpartum depression on father–infant interactions. In addition, we examined whether differences in face recognition mediated the effects of paternal postpartum depression on father–infant interactions. A total of 61 father–infant dyads (17 postpartum depression, 44 controls) took part in the study. Results revealed that compared to controls, fathers with postpartum depression had a worse pattern of interaction with their infants on measures of responsiveness, mood, and sensitivity; they also had greater difficulty in recognizing happy adult faces, but greater facility in recognizing sad adult faces. Depressed fathers attributed greater intensities to sad adult and infant faces. The tendency to attribute greater intensity to sad adult faces was confirmed as a partial mediator of the effect of paternal postpartum depression on measures of father responsiveness and as a full mediator of the effects of paternal depression on father sensitivity. Clinical implications and suggestions for further studies are discussed.     

Negative emotional responses to motherhood-related support receipt during pregnancy predict postpartum depressive symptoms

Background and Objectives: Prenatal stress increases risk for postpartum depression. While social support availability may attenuate this risk, little research has examined support receipt during pregnancy, which has been linked to increased distress in other domains. This study assesses the implications of motherhood-related and motherhood-unrelated support receipt for daily distress during pregnancy and tests whether negative responsiveness to motherhood-related support predicts postpartum depression risk. Design and Method: Thirty-one pregnant women were recruited from the community for a 3-wave study (beginning at approximately 26 weeks gestation, 34 weeks gestation, and 4 weeks postpartum). Each wave included a survey of general characteristics (e.g. depressive symptoms) and a two-week diary period measuring mood, stress, and support. Results: A multilevel model analysis suggested that motherhood-related support predicted greater increases in daily distress than motherhood-unrelated support. Follow-up regression analysis showed that those who responded more negatively to motherhood-related support reported higher postpartum depressive symptoms. Conclusions: Although preliminary due to the sample size, the results suggest that how women interpret and respond to support may contribute to postpartum depression risk. Future research should focus on how mothers can more positively construe the support they receive in addition to how to increase the support available to them.     

UNDERSTANDING THE CONNECTION BETWEEN ATTACHMENT TRAUMA AND MATERNAL SELF‐EFFICACY IN DEPRESSED MOTHERS

Maternal self‐efficacy predicts sensitive and responsive caregiving. Low maternal self‐efficacy is associated with a higher incidence of postpartum depression. Maternal self‐efficacy and postpartum depression can both be buffered by social support. Maternal self‐efficacy and postpartum depression have both been linked independently, albeit in separate studies, to the experience of violent trauma, childhood maltreatment, and spousal abuse. This study proposed a model in which postpartum depression mediates the relation between attachment trauma and maternal self‐efficacy, with emotional support as a moderator. Participants were 278 first‐time mothers of infants under 14 months. Cross‐sectional data were collected online. Mothers completed questionnaires on attachment trauma, maternal self‐efficacy, postpartum depression, and emotional support. A moderated mediation model was tested in a structural equation modeling framework using Mplus’ estimate of indirect effects. Postpartum depression fully mediated the relation between trauma and maternal self‐efficacy. Emotional support moderated only the pathway between postpartum depression and maternal self‐efficacy. Attachment trauma's implications for maternal self‐efficacy should be understood in the context of overall mental health. Mothers at the greatest risk for low maternal self‐efficacy related to attachment trauma also are those suffering from postpartum depression. Emotional support buffered mothers from postpartum depression, though, which has implications for intervention and future research.     

The neurobiology of postpartum depression

Postpartum psychiatric changes can range from maternity blues to psychosis. Causality is still undetermined, but explanations for these disturbances often focus on hormonal changes and dysregulation. Researchers have begun the process of delineating what neurobiological factors may be associated with depressive disorders in pregnancy and the postpartum. This article reviews the current literature on the roles of gonadal and pituitary hormones in the psychopathophysiology of postpartum mood disorders. Other biological factors, such as biogenic amines, neuroactive steroids, cholesterol, and fatty acids, are also discussed. The potential benefits of neuroimaging to aid in understanding neuropsychiatric changes that occur in the context of postpartum depression are also considered.     

A Counselor's Primer on Postpartum Depression

Women are more likely than men to experience depression, and they are particularly vulnerable to depression during the postpartum period. Postpartum depression is distinguished from normal postpartum adjustment, postpartum blues, and postpartum psychosis. Biological, psychodynamic, and diathesis-stress perspectives on postpartum depression are described. Counselors are encouraged to fashion individualized treatments for postpartum depression that are matched to the stressors and vulnerabilities of their clients.     

Mother's prenatal and postpartum depression symptoms and infant's sleep problems at 6 months

Mother's prenatal and postpartum depression have been associated with infant's sleep problems. This study aimed to analyze (a) the effects of mother's prenatal and postpartum depression symptoms, including the effects of prenatal and postpartum anxiety and depression scores of the Edinburgh Postnatal Depression Scale (EPDS), on infant's sleep problems at 6 months, and (b) the interaction effect between mother's prenatal and postpartum depression symptoms and infant's sex on infant's sleep problems at 6 months. The sample was comprised of 164 mother–infant dyads whose mothers completed measures of depression at the third trimester of pregnancy, 2 weeks, 3 and 6 months postpartum and a measure of infant's sleep problems at 6 months (CSHQ-I). Mother's prenatal depression symptoms, specifically depression scores of the EPDS, predicted more infant's sleep anxiety and daytime sleepiness, while mother's depression symptoms at 2 weeks postpartum, specifically anxiety scores of the EPDS, predicted more bedtime resistance and CSHQ-I total scores at 6 months. Boys of mothers with more prenatal depression symptoms presented more sleep anxiety at 6 months. Both mother's prenatal and early postpartum depression symptoms have a negative effect on the emergence of infant's sleep problems. Additionally, boys seem more vulnerable to mother's prenatal depression symptoms.     

Prospective study of postpartum depression: 4 1/2-year follow-up of women and children

The consequences of maternal postpartum depression for mothers and children were investigated in a 4 1/2-year follow-up study, which included 70 of 99 women who had participated in an earlier study of postpartum depression. Information about maternal adjustment and depression during the follow-up period and child adjustment at age 4 1/2 years was obtained. Women who had experienced a postpartum depression were predicted to be at increased risk for subsequent depression and poor adjustment of their child. Postpartum depression was directly related to subsequent depression but not child problems. Later depression was related to child problems at 4 1/2 years. We concluded that postpartum depression may increase risk for later maternal depression and in turn increases risk for child behavior problems. Intervening with women who have experienced a postpartum depression may reduce likelihood of future depressions and child behavior problems.     

IMPACT OF MATERNAL DEPRESSION ON PREGNANCIES AND ON EARLY ATTACHMENT

The relatively high prevalence and duration of depression in the prenatal and postpartum periods reinforce the need for better understanding of maternal depression. The purpose of this article is to explore the main effects of depression to pregnancies’ outcome and to early attachment reviewing research from the last decade and to find the best way to prevent the negative effects of maternal depression to infants. Recent studies have reported significant associations between maternal depression and several adverse obstetric, fetal, and neonatal outcomes. Antenatal depression has been associated with shorter gestation and lower birth weight, with consequences for infant development. A number of studies have demonstrated an association between prenatal depression and attachment difficulties, which seems to play an important mediating role in the development of further adverse outcomes for children. This review reveals some potential risks of untreated depression during the antenatal and postnatal periods, with possibly significant implications for practice and further research. Considering the high prevalence of depression, antenatal detection of depressive symptoms and intervention before childbirth has huge importance in prevention. Early interventions also may need to focus on mother–infant interactions as a key factor of later child development.     

Be a Mom: Formative Evaluation of a Web-Based Psychological Intervention to Prevent Postpartum Depression

A formative evaluation (consisting of two phases: a scoping literature review and a focus group with mental health professionals) was conducted to inform the design of a web-based intervention to prevent postpartum depression, in terms of its characteristics and content: the Be a Mom program. The results showed that the web-based intervention should be short-term, delivered postnatally, and grounded in cognitive-behavior therapy principles. Moreover, the intervention should include weekly sessions targeting basic contents: motherhood changes, reorganizations and emotional experience; cognitions, self-criticism, and self-compassion; parenting values, social support, and assertive communication skills; couple relationship, negotiation and conflict resolution skills; and postpartum depression signs and professional help-seeking. These results may improve the Be a Mom’s adequacy, implementation success, and effectiveness.     

Do postpartum anxiety and breastfeeding self-efficacy and bonding at early postpartum predict postpartum depression and the breastfeeding method?

We investigated whether postpartum anxiety (PPA) and breastfeeding self-efficacy and bonding at the early postpartum period can be used to predict postpartum depression and the breastfeeding method, and we sought to identify factors related to postpartum depression. Of the 510 eligible women, 185 (36%) returned the questionnaire on all three occasions (1 day, 3 days, and 1 month after childbirth). The mothers' progress on the State-Trait Anxiety Inventory (STAI), Breastfeeding Self-Efficacy Scale Short Form (BFSES-SF), and Postnatal Bonding Questionnaire (PBQ) was observed over three periods. A repeated-measures ANOVA revealed that the mothers at high risk of developing postpartum depression (PPD) were those who did not show an increase in BFSES-SF score at early postpartum, and mothers whose bonding disorders have deteriorated rapidly. The results of the logistic regression analysis revealed a significant difference in employment as a factor related to postpartum depression. Compared to Regular, Part-time status was 4.4 times more likely and Unemployed status was 2.3 times more likely to cause postpartum depression. For the early detection of PPD, it is necessary to identify (1) mothers who do not show an increase in the BFSES-SF score, (2) mothers whose bonding disorders have deteriorated rapidly, and (3) part-time or unemployed mothers as characteristic of postpartum depression.     

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.     

Adult attachment styles,self‐esteem,and depressive symptoms: A comparison between postpartum and nonpostpartum women in Korea

Life stress related to child bearing has been suggested to increase the risk of maternal depression in vulnerable women who have an insecure relationship. This study examined the relationship between adult attachment security and maternal depression in postpartum women as compared to nonpostpartum women. A total of 254 Korean women were recruited from pediatric hospitals, of whom 119 were in the postpartum period. Participants completed the Relationship Questionnaire, the Beck Depression Inventory, and the Rosenberg Self‐Esteem Scale. Both preoccupied and fearful attachment styles were associated with low self‐esteem and higher levels of depressive symptoms, but a dismissing attachment style was not related to self‐esteem and depression severity. Low self‐esteem was found to mediate the relation between insecure attachment and depression severity; however, this mediating effect differed depending on the insecure attachment style. For preoccupied attachment, the role of self‐esteem as a mediator was observed only in postpartum women, not in nonpostpartum women (moderated mediation). In contrast, for fearful attachment, the mediating effects emerged in both groups. The results highlight the fact that there is a complex mechanism behind the link between interpersonal relationships and risk of maternal depression.     

Congruence of the Marital Relationship During Transition to Parenthood: A Study with Couples Who Conceived Spontaneously or Through Assisted Reproductive Technologies

In this study we examined the congruence between partners’ perceptions of their marital relationship during the transition to parenthood and the effect of depression during pregnancy on couples’ congruence during the early postpartum period. Thirty-one couples who conceived spontaneously, along with thirty-five who conceived through assisted reproductive technologies (ART), provided data on their marital relationship and depression at their 24th pregnancy week and four months after the partum. All couples reported a decrease in marital congruence. Couples who conceived through ART reported lower marital congruence. For these subjects, women’s depression was associated with lower congruence. Interventions that focus on strengthening the marital relationship across the transition to parenthood should assess and promote couples’ congruence.     

Stress and support as related to postpartum paternal mental health and perceptions of the infant

This study examined the relationship of stress and social support to psychological adjustment, attitudes towards the parental role, and perceptions of infant behavior in two groups of fathers: an index group of 50 men whose wives had a diagnosed postpartum depression, and a control group of 50 men whose wives had no such disorder. Fathers with more stress and less support had higher levels of psychological symptomatology. Index fathers reported more stress, particularly from work and economic pressures. Index fathers were also less likely than controls to report support from in-laws, other relatives, and friends. Stress, but not support, was associated with more negative perceptions of the marriage, the parental role, and infant behavior. Work-related stress was most likely to have an impact on paternal attitudes. These findings suggest the need to adopt a family focus when studying postpartum depression. © 1997 Michigan Association for Infant Mental Healt     

Critical Factors Associated with Early Postpartum Depression among Turkish Women

The main objective of this study was to examine the associated factors of the early postpartum depression, in a Turkish sample of 151 postnatal women. Besides positive and negative affect and marital adjustment measures, demographic and labor related variables, which may affect the postpartum depression, were also included into the study. To reveal the critical factors associated with the early postnatal depressive mood, a regression analysis was conducted. After controlling for the variance accounted for by age and number of children, negative affect and marital maladjustment measures were found to be significant associates of postpartum depression. These findings are discussed in the light of the literature.This work has been supported by the Turkish Academy of Sciences, in the framework of the Young Scientist Award Program. (TG-TUBA-GEBIP/2002-1-11).     

Prenatal depression effects on early development: A review

This review of recent research on prenatal depression suggests that it is a strong predictor of postpartum depression and is more common than postpartum depression. Prenatal depression has been associated with excessive activity and growth delays in the fetus as well as prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate. Infants of depressed mothers have difficult temperament, and later in development attentional, emotional and behavioral problems have been noted during childhood and adolescence, as well as chronic illnesses in adulthood. Several variables have confounded the effects of prenatal depression including comorbid anxiety and anger as well as stressful life events. Potential mediating variables are low prenatal maternal dopamine and serotonin levels and elevated cortisol and norepinephrine. The associated intrauterine artery resistance may limit blood flow, oxygen and nutrients to the fetus. Some studies also suggest the heritability of developmental problems for the children of prenatally depressed mothers, including ADHD and antisocial behavior. Multivariate, longitudinal research is needed to disentangle these confounding and mediating variables.     

产后抑郁症相关因素及防治

产后抑郁症是产妇常见的心理行为异常,严重危害产妇的身心健康,其病因复杂。用系统论方法分析产后抑郁症相关因素,论述产后抑郁症发生是由多方面因素引起,而各因素之间是相互制约、相互作用的。因此,防治产后抑郁症应从整体考虑,多种方法综合应用,以期达到最佳防治效果。     

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.