Considering a Relational Model for Depression in Women With Postpartum Depression

Abstract

Purpose To extend testing of a relational theory that a low sense of belonging, delayed or impaired bonding, and loneliness are salient risk factors for postpartum depression (PPD) in women. Methods Data for this theory-testing analysis came from a larger prospective longitudinal cohort study and included women who were retained to the end of the study at the 6 week postpartum interview (n=564). Structural equation modeling was used to test the “fit” of the model and determine significance of direct and indirect paths. Results The model explained 35% of the variance in postpartum depression with impaired bonding and loneliness as the strongest indicators. Lower sense of belonging, less perceived social support from a healthcare practitioner and a partner, and lower parenting sense of competence were additional predictors. Conclusion Study findings challenge current thinking about the relationship between impaired bonding and PPD as this study raises the possibility that impaired bonding is a risk for PPD as opposed to the reverse relationship. The study provided evidence of the importance of healthcare practitioners’ alliance with patients. This paper contributes to advancing the science of women’s mental health in relation to depression by considering additional predictors which might be amenable to intervention.

“You Get Angry Inside Yourself”: Low-Income Adolescent South African Girls’ Subjective Experience of Depression

“…It can thus be concluded that the participants situated depression within the relational domain. A recent study by Lourens and Kruger (2013) conducted in the same community with adult women also found depressed participants to situate their causes and experiences of depression within the relational domain, suggesting the appropriateness of a relational model of depression (Kruse, 2012;Kruse, Williams & Seng, 2014;Lund, Chan & Liang, 2014). Situating depression within the relational domain may hold implications for therapy: situating the cause and existence of depression within the relational domain means that treatment should address this domain.…”

Depressive symptoms during pregnancy and postpartum: a prospective cohort study

“…Therefore, mother and their family members should be educated about problems that they might encounter during the postpartum period, the symptoms of PPD, and where to apply for help when needed. Because, low perceived social support from a healthcare practitioner is reported as a predictor for PPD, supportive relationships with nurses, especially for women at risk of depression, could increase women's sense of control and well‐being and, ultimately, prevent PPD.…”

“…PPD is a debilitating disorder that can affect not only maternal function and overall health but also the health of the infant and the entire family . The negative effects of PPD include poor self‐care, malnutrition, noncompliance with prenatal care, higher rates of tobacco and alcohol use, pregnancy‐related complications such as early gestational age at birth and low birth weight, impaired mother‐infant attachment, lower rates of breastfeeding, marital discord, and poor parenting .…”

“…8 PPD is a debilitating disorder that can affect not only maternal function and overall health but also the health of the infant and the entire family. [9][10][11] The negative effects of PPD include poor self-care, malnutrition, noncompliance with prenatal care, higher rates of tobacco and alcohol use, 11,12 pregnancy-related complications such as early gestational age at birth and low birth weight, 13,14 impaired mother-infant attachment, 14,15 lower rates of breastfeeding, marital discord, and poor parenting. 11,12 However, PPD is still considered as one of the health problem which remains underdiagnosed and untreated in many countries, 7,16 possibly because the postpartum period in which PPD symptoms arise marks a time away from healthcare personnel at the new mother's home.…”

Emotional Rejection of the Infant: Status of the Concept

“…There is conflicting evidence for the association in the community [76,77,78,79,80,81,82,83]. An association could be due to cause or effect [84] or both. Depression and impaired ‘bonding' often have a different severity and timing, and a different response to treatment [85,86,87,88,89].…”