Postpartum exuberance: Not all women in a highly positive emotional state in the postpartum period are denying depression and distress

The question addressed in this study was whether or not mothers who scored low on self-report depression scales—so-called “deniers”—were denying their symptoms and suffering from an illusion of mental health. The findings did not support the interpretation that low-scoring mothers were denying other symptoms. Rather, low-scoring mothers: 1) experienced a wide range of emotions and similar levels of positive emotions compared to mid-symptom mothers; 2) changed their reported levels of depressive symptoms over the course of the study; 3) reported a variety of symptoms at levels similar to those of mothers in the mid symptom range; and 4) were affected negatively by having a diagnosis of depression, in a manner similar to mothers in the mid and high symptom groups. Furthermore, low symptom mothers consistently reported the most positive profiles of maternal adaptation with higher levels of maternal self-esteem and a high ratio of self-reported positive to negative affect. Thus, they appeared to be experiencing a heretofore underdescribed highly positive normal postpartum state that we have labeled “postpartum exuberance.” Postpartum exuberance, as well as a compromise of affective functioning associated with any lifetime diagnosis of depression regardless of the mothers' current level of depressive symptoms, highlights the complexity of emotional reactivity during the postpartum period. © 1997 Michigan Association for Infant Mental Health     

Interactions between depressed and nondepressed Latina mothers and their premature infants

The impact of depression upon mother–infant interaction was studied longitudinally in a sample of very low income, immigrant Latina mothers with premature, very low birth weight infants. Both maternal characteristics and infant characteristics were examined using a rating scale which measured feeding interactions. Results indicate that mothers who were depressed at one month did not interact differently with their premature infants than nondepressed mothers. In addition, infants of mothers who were depressed at one month did not interact differently with their mothers than infants of nondepressed mothers. There were no differences between groups of mothers who remained depressed across the one-year period and groups whose scores reflected no depression or changes in depression levels. These findings challenge previous assumptions about interactions between depressed mother–infant dyads. Results indicate the need to broaden study attention to include socioeconomic, cultural, and life circumstances of families that may have greater impact on child outcomes than single assessments of maternal depression. Such studies may lead to changes in the way services are delivered and the types of interventions provided to non-mainstream families. © 1997 Michigan Association for Infant Mental Health     

Asian Indian Immigrant and White American Maternal Emotion Socialization and Child Socio-Emotional Functioning

Previous research provides an inadequate account of parental emotion socialization and its relation to child functioning among ethnic minority groups in the United States. This study compared reports of Asian Indian immigrant and White American mothers’ emotion socialization and examined relations between mothers’ emotion socialization and child outcomes in these two groups. Indian immigrant (n = 34) and White American (n = 38) mothers completed measures of child behavior problems and social competence, as well as self-report measures of two types of emotion socialization, responses to children’s negative emotions and emotion expressivity. Children completed a self-report measure of social competence. Results revealed that Indian immigrant mothers were more likely than White American mothers to report responding nonsupportively to their children’s negative emotions. However, reports of mothers’ nonsupportive responses were not related to child outcomes in the Indian immigrant group. In the White American group, reports of mothers’ nonsupportive responses were positively related to child behavior problems. Mothers’ self-reported negative emotion expressivity was positively related to child behavior problems and negatively related to mother-rated child social competence for Indian immigrants, while no significant relation was found between mothers’ negative emotion expressivity and child outcomes for White Americans. Moderation analyses were performed with these variables but were nonsignificant. Results are discussed in the context of cultural influences on emotion socialization and subsequent impact on child functioning.     

Multimethod assessment of depression in sexually abused girls

This study measured depression in sexually abused Black girls using the Children's Depression Inventory (Kovacs & A. T. Beck, 1977), the Internalization scale of the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and the Rorschach Depression Index (Exner, 1986). There were no significant correlations between these self-report, behavior observation (by parental report), and projective measures. The abused subjects had high scores on the behavior observation and Rorschach scales. Consistent with past research, negative results were obtained with the self-report instrument. We suggest that the low scores on self-report measures of distress produced by sexually abused children may be the result of guardedness or defensiveness rather than a genuinely low level of dysphoria in this population. There were no significant relations between abuse characteristics and scores on the depression measures. Scores on Rorschach measures of organizational activity (Zf) and available coping resources (EA) were generally positively related to depression within the abuse group and negatively related to depression within the control group.     

Multimethod Assessment of Depression in Sexually Abused Girls

This study measured depression in sexually abused Black girls using the Children's Depression Inventory (Kovacs & A. T. Beck, 1977), the Internalization scale of the Child Behavior Checklist (Achenbach & Edelbrock, 1983), and the Rorschach Depression Index (Exner, 1986). There were no significant correlations between these self-report, behavior observation (by parental report), and projective measures. The abused subjects had high scores on the behavior observation and Rorschach scales. Consistent with past research, negative results were obtained with the self-report instrument. We suggest that the low scores on self-report measures of distress produced by sexually abused children may be the result of guardedness or defensiveness rather than a genuinely low level of dysphoria in this population. There were no significant relations between abuse characteristics and scores on the depression measures. Scores on Rorschach measures of organizational activity (Zf) and available coping resources (EA) were generally positively related to depression within the abuse group and negatively related to depression within the control group.     

Authenticity as a Mediator of the Relation Between Child Maltreatment and Negative Outcomes for College Women

The goal of this cross-sectional study was to determine if authenticity in relationships mediated the relation between early childhood maltreatment and negative outcomes (depression, low self-esteem, and traumatic symptoms). An ethnically diverse sample of female college students (N = 257, M age = 19.74) completed self-report questionnaires related to early childhood maltreatment, negative outcomes, and authenticity in relationships. Approximately 30% of participants experienced childhood maltreatment including physical maltreatment, emotional maltreatment, or both. Results from multiple mediation analyses indicated that, when controlling for physical maltreatment, authenticity in close relationships significantly partially mediated the relation between emotional maltreatment and depression, self-esteem, and traumatic symptoms (p < .05). However, when controlling for emotional maltreatment, physical maltreatment did not significantly predict any of the outcome variables, so physical maltreatment was not significantly mediated by authenticity in relationships. These results have important clinical implications for women who experience negative mental health outcomes as a result of childhood maltreatment.     

WOMEN'S PSYCHOLOGICAL ADJUSTMENT FOLLOWING EMERGENCY CESAREAN VERSUS VAGINAL DELIVERY

The present study was designed to investigate possible differences in psychological adjustment and satisfaction between women delivering vaginally and those delivering by emergency cesarean section. Women's satisfaction with the birth experience was distinguished from postpartum psychological adjustment, as measured by depression, anxiety, and confidence in mothering ability. Twenty-two women who delivered vaginally and twenty-two women who delivered by emergency cesarean section were selected according to stringent criteria, to control for factors known to be associated with positive cesarean outcomes. Significant differences were found in level of satisfaction, with cesarean mothers reporting less satisfaction with the delivery than vaginal mothers. However, no differences were found between the groups on the three measures of psychological adjustment. Under optimal conditions, cesarean deliveries are not associated with adverse early postpartum psychological adjustment.     

An exploration of the impact of invalid MMPI-2 protocols on collateral self-report measure scores

Although a number of studies have examined the impact of invalid MMPI-2 (Butcher et al., 2001) response styles on MMPI-2 scale scores, limited research has specifically explored the effects that such response styles might have on conjointly administered collateral self-report measures. This study explored the potential impact of 2 invalidating response styles detected by the Validity scales of the MMPI-2, overreporting and underreporting, on scores of collateral self-report measures administered conjointly with the MMPI-2. The final group of participants included in analyses was 1,112 college students from a Midwestern university who completed all measures as part of a larger study. Results of t-test analyses suggested that if either over- or underreporting was indicated by the MMPI-2 Validity scales, the scores of most conjointly administered collateral measures were also significantly impacted. Overall, it appeared that test-takers who were identified as either over- or underreporting relied on such a response style across measures. Limitations and suggestions for future study are discussed.     

Effects of extended father-infant contact during the newborn period

Studies within the past decade have suggested that extended contact between mothers and newborns may have positive effects on later parent-infant interaction and may impact favorably upon the establishment of the mother-to-infant attachment bond. The present study was designed to determine whether similar extended contact effects occur for fathers. The results indicated that a group of fathers who attended their infants' births and received extended postpartum hospital contact with their infants engaged in greater amounts of en face behavior and vocalization with their infants and were more involved in infant caretaking responsibilities at 6 weeks postpartum and had higher self-esteem scores following the births compared to another group of fathers who attended their infants' births but received traditional amounts of hospital contact. Although there were more behavioral similarities than differences between the two groups of fathers, positive effects were found on behavioral measures, standardized psychometric measures, and on self-report questionnaires. The results indicated that extended contact effects are at least as salient with fathers as with mothers.     

Bidirectional Effects of Positive Affect,Warmth, and Interactions Between Mothers With and Without Symptoms of Depression and Their Toddlers

Maternal depression has negative implications for parenting and child outcomes, but it is also important to understand the daily transactional interactions that occur between mothers varying in symptoms of depression and their children. The current study aimed to examine immediate bidirectional effects between maternal warmth and positive affect and toddler affect in a sample of mothers varying in symptoms of depression. Ninety-one mothers and their 24-month-old toddlers completed a laboratory free-play/clean-up task. Mothers rated their symptoms of depression using the CES-D, and maternal warmth and positive affect and toddler positive and negative affect were observationally coded from a free-play and clean-up laboratory task. Sequential analyses indicated that mothers with no or mild symptoms of depression exhibited mutual positive affect with their children, but mothers with more severe symptoms of depression did not. Mothers with higher symptoms of depression displayed a decrease in warmth concurrent with toddlers’ positive affect. Further, unlike dyads in which mothers had higher symptoms of depression, dyads of mothers with lower symptoms appeared to exhibit some covariation in positive affect across the episode. These results provide evidence that even in non-clinical samples, affective manifestations of mothers’ subthreshold levels of depression may have negative immediate effects on toddlers’ emotions, and that mothers without symptoms of depression may have more reciprocal affective exchanges with their toddlers.     

Depressive Attributional Style: The Role of Self-Esteem

Two studies evaluate the role of self-esteem in the depressive attributional style. In the first study, college students completed four measures of depression, four measures of self-esteem, and the Attributional Style Questionnaire (ASQ). Regression analyses revealed that across measures, self-esteem was a better predictor of attributional style for negative events than was depression. In study two, psychiatric inpatients completed a measure of self-esteem, a measure of depression, and the ASQ. In this clinical sample, self-esteem and depression were highly correlated and both predicted ASQ scores. But when variation in depth of depression and social desirability were removed statistically from the association between self-esteem and attributions for negative outcomes, there remained a significant association between self-esteem and internal, stable, and global attributions for negative outcomes. Controlling for the variation in self-esteem eliminated the relation between depression and depressive attributional style. These findings demonstrate the importance of self-esteem in depressive attributional style in both normal and clinical populations, as well as potential differences in the relations among self-esteem, depression, and attributional style in clinical versus normal samples.     

Maternal Depression,Maternal Expressed Emotion,and Youth Psychopathology

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors–maternal depression within the child’s lifetime and maternal EE–in a study of children at risk for depression. One hundred and seventy-one youth, ages 8–12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist–Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children’s own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers’ reports of children’s Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers’ reports of children’s Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children’s depression diagnoses.     

A Direct Method of Assessing Underlying Cognitive Risk for Adolescent Depression

An enduring tendency towards negative thinking is thought to increase vulnerability for future depression. However, it has not been possible to assess this tendency in non-depressed mood states. We examined if response latency to endorse dysfunctional attitudes is associated with depressive outcomes in a longitudinal study. A sample of young people at familial risk of depression (N?=?252, aged 10–19, 56.3 % female) completed a computer-administered dysfunctional attitude scale. The main outcome measure was the difference in reaction time to agree versus disagree with dysfunctional attitudes. Cross-sectional differences between current and previous depression and no psychiatric disorder groups as well as longitudinal associations with depressive symptoms were examined. Young people with current and previous depression were quicker to agree with dysfunctional attitudes than those without disorder. In young people free from depressive disorder, faster agreements with dysfunctional attitudes were specifically associated with increased depressive symptoms over time. Self-reported dysfunctional attitudes did not differentiate the formerly depressed and no disorder groups and showed a longitudinal association with depressive symptoms for older adolescents only. Reaction time to endorse dysfunctional attitudes may indicate changes in affective processing that represent an early risk for future depression that is not indexed by self-report measures of negative thought.     

Measuring abuse stress and negative cognitive appraisals in child sexual abuse: Validity data on two new scales

The validity of two measures assessing degree of stress associated with child sexual abuse was examined in a sample of 48 girls who had been sexually abused. The Checklist of Sexual Abuse and Related Stressors (C-SARS) assessed negative life events that were part of or were related to the abuse, and the Negative Appraisals of Sexual Abuse Scale (NASAS) assessed negative cognitive appraisals of threat, harm, or loss associated with the abuse. Total scores for victim reports of both stressful events and negative appraisals were positively and significantly related to two other measures of abuse severity: therapist ratings of abuse stress and the number of types of sexual abuse reported. Stressful event scores were also related to aggressive behavior problems, sexual concerns, and total symptom scores on the Child Behavior Checklist. Negative cognitive appraisal scores were related to victims' self-reports of depression, anxiety, and posttraumatic stress symptoms, and to parent reports of child depression and total symptoms. Regression analyses indicated that there were significant effects of negative appraisals on internalizing symptoms when controlling for the level of stressful events experienced. The results suggest that negative life events and negative appraisals associated with sexual abuse are valid constructs that help account for variability in mental health outcomes among child victims. The implications of these results and future research directions in examining variable outcomes among sexual abuse victims are discussed.     

Convergence among multiple methods of measuring positivity and negativity in the family environment: relation to depression in mothers and their children

The present study addressed the following questions: (a) To what extent do different methods of measuring the family environment converge onto a single latent construct? (b) How are the constructs of positive and of negative family environment related? (c) Do the associations among various methods of measuring the family environment differ as a function of children's gender or of risk? and (d) How are the latent constructs of family environment related to depression in mothers and their children? Participants were 240 children (mean age = 11.86 years, SD = 0.57) and their mothers, who varied with regard to their history of depression. Family environment was measured with self-report questionnaires completed separately by mothers and by children, observations of mother-child interactions, and a 5-min speech sample of each mother talking about her child. Confirmatory factor analyses revealed that different methods for assessment of the family environment converged and that the constructs of positive and of negative family environments were significantly related to each other and to depression in both mothers and their children. These findings may help inform future intervention efforts by highlighting specific parenting dimensions that are strongly associated with maternal and with child depression.     

Expectations and attributions in social anxiety disorder: diagnostic distinctions and relationship to general anxiety and depression

Contemporary cognitive models suggest that social anxiety disorder arises from a number of cognitive factors, including tendencies to form pessimistic (rather than optimistic) attributions and expectations for socially-related events. These models also assume that the strengths of such attributions and expectations are more closely linked with social anxiety than with general anxiety or depression. To test these assumptions, a battery of self-report measures was completed by participants with a primary diagnosis of generalized social anxiety disorder (n = 75), panic disorder with agoraphobia (n = 44), or post-traumatic stress disorder (n = 59). To examine differences on these cognitive variables, group comparisons were performed controlling for general anxiety, depression and medication status. Social anxiety disorder, compared with panic disorder with agoraphobia and post-traumatic stress disorder, was characterized by lower expectations for positive social events and higher expectations for negative social events. There was no difference among the groups on expectations for non-social positive or negative events. Stable and global attributions for social negative events were more closely associated with social anxiety disorder than with panic disorder with agoraphobia and post-traumatic stress disorder. Correlational analyses also revealed specific relationships among social-cognitive measures and social anxiety, even after controlling for general anxiety and depression. The results are consistent with cognitive models of social anxiety disorder.     

Self-Report,Peer-Report,and Teacher-Report Measures of Childhood Depression: An Analysis by Item

We explored the low correlation among different types of childhood depression measures at the item level. The items from the Children's Depression Inventory (CDI), Peer Nomination Inventory of Depression (PNID), and the Child Behavior Checklist-Teacher Report Form (CBCL-T) were combined, and both first- and second-order factor analyses were conducted. Results indicate that self-report, peer-report, and teacher-report assessments of depression measure generally uncorrelated constructs. Second-order analysis suggests that depression as a global construct is being measured to some degree by items from all three instruments. Canonical analysis was employed to identify items that best predicted CDI, PNID, and CBL-T summary scores simultaneously. Also, the relationship between specific items with similar content was investigated. Results from these analyses generally supported a conclusion that the three types of measures yield scores that are primarily independent and that the use of summary scores is not masking stronger relationships within measures. These findings have implications for clinical practice and construct elaboration.     

Self-report, peer-report, and teacher-report measures of childhood depression: an analysis by item.

We explored the low correlation among different types of childhood depression measures at the item level. The items from the Children's Depression Inventory (CDI), Peer Nomination Inventory of Depression (PNID), and the Child Behavior Checklist-Teacher Report Form (CBCL-T) were combined, and both first- and second-order factor analyses were conducted. Results indicate that self-report, peer-report, and teacher-report assessments of depression measure generally uncorrelated constructs. Second-order analysis suggests that depression as a global construct is being measured to some degree by items from all three instruments. Canonical analysis was employed to identify items that best predicted CDI, PNID, and CBL-T summary scores simultaneously. Also, the relationship between specific items with similar content was investigated. Results from these analyses generally supported a conclusion that the three types of measures yield scores that are primarily independent and that the use of summary scores is not masking stronger relationships within measures. These findings have implications for clinical practice and construct elaboration.     

Responsiveness of measures of attentional bias to clinical change in social phobia

This study examined responsiveness of the dot probe measure of attentional bias to standard cognitive-behaviour group therapy (CBGT) for social phobia. People who met criteria for social phobia were randomly allocated to either an immediate treatment condition or a waiting list control (WLC). All participants completed self-report measures of social anxiety, depression, and anxiety sensitivity, a verbal dot probe and a facial dot-probe task before and after eight weeks of standard CBGT was undertaken by the treatment group. On the first measurement occasion the two groups had similar scores on all measures. On the second measurement occasion the self-report scores for the CBGT group were lower than those of the WLC group. Performance on the dot-probe tasks for the CBGT group had also changed. The treatment group appeared to direct their attention away from social threat words and threatening faces after CBGT.     

Mediation analyses of Internet-facilitated cognitive behavioral intervention for maternal depression

This study evaluated the putative mediating mechanisms of an Internet-facilitated cognitive-behavioral therapy (CBT) intervention for depression tailored to economically disadvantaged mothers of preschool-age children. The CBT mediators were tested across two previously published randomized controlled trials which included the same measures of behavioral activation, negative thinking, and savoring of positive events. Trial 1 included 70 mothers with elevated depressive symptoms who were randomized to either the eight-session, Internet-facilitated intervention (Mom-Net) or to treatment as usual. Trial 2 included 266 mothers with elevated depressive symptoms who were randomized to either Mom-Net or to a motivational interviewing and referral to services condition. Simple mediation models tested each putative mediator independently followed by tests of multiple mediation that simultaneously included all three mediators in the model to assess the salient contributions of each mediator. The pattern of results for the mediating effects were systematically replicated across the two trials and suggest that behavioral activation and negative thinking are salient mediators of the Mom-Net intervention; significant mediating effects for savoring were obtained only in the simple mediation models and were not obtained in the multiple mediation models.