The Developmental Psychopathology of Perinatal Depression: Implications for Psychosocial Treatment Development and Delivery in Pregnancy

Abstract

Taking a developmental psychopathology perspective, our objective was to identify ways in which psychosocial treatment of depression during pregnancy may be enhanced. We first consider the state of evidence on psychosocial interventions for antenatal depression, next define key developmental psychopathology concepts that are relevant to antenatal depression, and finally discuss implications for clinical practice and research. We found a limited, but promising, evidence base for effective psychosocial interventions for depression during pregnancy. Examining antenatal depression from a developmental psychopathology perspective revealed suggestions for improving treatment. A developmental psychopathology perspective suggests that treatment of depression during pregnancy may be improved by attention to the continuum of depression, from subclinical to severe major depressive disorder; personalized care based on individual women's pattern of risk and resilience factors and correlated risks; consideration of the potential benefits of treating the couple's relationship, the mother's qualities of parenting, and infants' and children's mental health needs; and, including a detailed understanding of the developmental pathways to antenatal depression for each patient in treatment planning. W W WSelon une perspective de psychopathologie développementale, notre objectif était d'identifier des moyens d'améliorer le traitement psychosocial de la dépression durant la grossesse. Nous examinons d'abord l'état des données probantes sur les interventions psychosociales pour la dépression prénatale, puis nous définissons les principaux concepts de la psychopathologie développementale qui concernent la dépression prénatale, et nous discutons enfin des implications pour la pratique clinique et la recherche. Nous avons trouvé une base factuelle limitée, mais prometteuse, pour des interventions psychosociales efficaces pour la dépression durant la grossesse. L'examen de la dépression prénatale dans une perspective de psychopathologie développementale a révélé des pistes pour améliorer le traitement. Une perspective de psychopathologie développementale suggère que le traitement de la dépression durant la grossesse peut être amélioré en portant attention au continuum de la dépression, du trouble subclinique au trouble dépressif majeur grave; par des soins personnalisés basés pour chaque femme sur son modèle de risque, ses facteurs de résilience et les risques corrélés; par la prise en compte des avantages potentiels de traiter la relation du couple, les qualités parentales de la mère, et les besoins de santé mentale des bébés et des enfants; et en incluant une compréhension exhaustive des voies développementales de la dépression prénatale pour chaque patiente dans la planification du traitement.

Maternal programming: Application of a developmental psychopathology perspective

“…Consistent with contemporary symptom-based, dimensional approaches to the study of psychiatric disorders (Cuthbert & Insel, 2013), a developmental psychopathology perspective recognizes that psychopathology occurs on a continuum and that contextual factors are critical in defining boundaries between adaptive and maladaptive development along this continuum. For example, somatic symptoms related to sleep, energy, weight, and appetite that are characteristic of psychopathological conditions in non-perinatal phases can result from normative physiological processes of pregnancy and postpartum (Bernstein et al, 2008;Goodman & Dimidjian, 2012;Howard et al, 2014;Matthey & Ross-Hamid, 2011;Misri et al, 2015;Nylen, Williamson, O'Hara, Watson, & Engeldinger, 2013) and may not necessarily indicate psychopathology. Relatedly, symptoms such as heightened anxiety or preoccupation regarding the infant may be a normative feature of new motherhood and represent a healthy maternal response to the infant initially, promoting vigilance, threat detection, and harm avoidance (Leckman et al, 1999(Leckman et al, , 2004Wisner et al, 1999).…”

An Exploratory Study of Maternal Depressive Symptoms and Infant's Social Skills in Korea: The Mediating Role of Mothers’ Social Interactions with their Infants

“…Among various factors which explain the association of MDSs and adverse outcomes in infancy (e.g., genetic transmission, learning depressive symptoms from depressive mothers, prenatal in utero exposure, attachment, and impaired parenting) (for extensive review, see Goodman & Dimidjian, 2012), research has consistently demonstrated that depressed mothers have difficulties in parenting, especially when they interact with their infants (Dawson et al, 1999;Elgar, Mills, McGrath, Waschbusch, & Brownridge, 2007;Field, 2010;Field et al, 1988;Lovejoy, Graczyk, O'Hare, & Neuman, 2000;Pearson et al, 2012;Tronick & Reck, 2009). Depressed mothers, in comparison to nondepressed mothers, are known to be less likely to have sensitive and responsive interactions with their infants that produce suboptimal developmental outcomes of infants (Reck et al, 2004;Field et al, 2007).…”

“…There has been consensus among researchers that maternal depressive symptoms (MDSs) are a risk factor for a number of developmental delays and problems in infancy and childhood (Beardslee, Versage, & Gladstone, ; Campbell, Cohn, & Meyers, ; Field, , , ; Goodman & Dimidjian, ; Murray & Cooper, ; Tronick & Reck, ). Many empirical findings have suggested that mothers’ social interactions with their infants and children have played a mediating role in the link between MDSs and outcomes of infants and children (Goodman & Gotlib, , ; Pearson et al., ; Tronick & Reck, ).…”

Examination of the completeness of routinely collected antenatal care data in New South Wales

“…Antenatal care enables early detection and treatment of adverse physical 6 and mental health 7 pregnancy related outcomes. The improved data completeness post 2006 demonstrates achievable benefits from well‐founded modification to existing information collection forms.…”