Expanding the Postpartum Depression Construct

Journal of Human Behavior in the Social Environment, 22:718–732, 2012 Copyright © Taylor & Francis Group, LLC ISSN: 1091-1359 print/1540-3556 online DOI: 10.1080/10911359.2012.692563

Expanding the Postpartum Depression Construct Using a Social Work Paradigm KIM W. BOLAND-PROM Department of Social Work, Governors State University, University Park, Illinois, USA

NANCY MACMULLEN Nursing Department, Governors State University, University Park, Illinois, USA

This paper describes and evaluates current definitions and models of postpartum depression. Research on prevalence, risk and resiliency factors is reviewed. A more comprehensive approach to postpartum mood disorders is proposed. The ‘‘Model Assessing Maternal Adjustment’’ (MAMA) is based on the biopsychosocial approach of social work and can be utilized for both client selfassessment and clinical assessments by professionals across various disciplines. The MAMA approach moves beyond sole focus on depressive symptoms to include anxiety symptoms and bipolar disorders and lengthens the time frame to include the pregnancy through the first year postpartum. KEYWORDS Postpartum depression, perinatal depression, prenatal education, MAMA model Postpartum depression is a term that is variously used to describe women who experience depressive symptoms or clinical depression in the weeks and months after child birth; it is also referred to as minor and major depression, respectively. From a clinical perspective, postpartum depression (PPD) is defined by the American Psychiatric Association in the Diagnostic and Statistical Manual IV (2000) as clinical depression (depression lasting at least 2 weeks) that occurs within 4 weeks after childbirth. In other words, the depression symptoms after childbirth are viewed as identical to those exhibited at other times in women’s lives. The lexicon of PPD includes the concept of ‘‘baby blues.’’ The term of baby blues is used to describe transitory types of symptoms that occur Address correspondence to Kim Boland-Prom, Department of Social Work, Governors State University, University Park, IL 60484-0975, USA. E-mail: [email protected] 718

Postpartum Depression within a Social Work Paradigm

719

within days of delivery (Yalom, Lunde, Moos, & Hamburg, 1968) including tearfulness, anxiety, mood lability, irritability, concentration problems, and headaches that usually occur within 10 days after the birth (Beck, 1991). Based on meta-analysis results of studies in the United States, the baby blues appears to affect 58% to 67% of postpartum women (Beck, 1991). Gaynes and associates (2005) completed a rigorous meta-analysis of studies of major and minor depression and found depression rates during pregnancy ranged from 6.5% to 12.9% and 8.5% to 11% during postpartum time periods. The Centers for Disease Control analyzing 2004–2005 data from 17 states report prevalence rates for PPD ranging from 11.7% (Maine) to 20.4% (New Mexico; Brett, 2008). In addition to the suffering of mothers, PPD has been linked to poor childhood outcomes. PPD then is not only a public health concern but is also arguably a social problem. Despite the fact that social workers provide services to mothers with PPD, the topic is infrequently discussed in the social work literature (Abrams, 2007). It is this paper’s claim that social work perspectives and paradigms can be used to enhance current practice models related to PPD.

PURPOSE The purpose of this paper is fourfold: (1) to discuss the assessment models currently used for PPD, (2) to outline their limitations, (3) to examine the research literature on risk and resiliency factors, and (4) to propose a more comprehensive model of PPD that utilizes social work perspectives. The proposed approach, a model assessing maternal adjustment (MAMA), expands the symptom profile from a sole focus on depression to a focus that includes anxiety symptoms and bipolar disorder. The time frame traditionally used to assess for postpartum adjustment is expanded to include perinatal time frames (pregnancy and after child birth) and more months after child birth.

ASSESSMENT MODELS Medical Model of Postpartum Depression Within the American Psychiatric Association (2000) diagnostic model, postpartum is listed as one possible specifier or description that can be used with the depression diagnosis. Clinicians are expected to differentiate between physiologically normal symptoms, such as fatigue related to child birth and infant care, and depression-related symptoms of lack of energy and interest. Decades of research have failed to find the postpartum time period as posing

720

K. W. Boland-Prom and N. MacMullen

an increased risk for depression (O’Hara, 1984) and studies that have failed to link PPD with biological factors are cited as support for the contention that PPD is not a different type of depression from clinical depression occurring at other times. BIOLOGICAL

ETIOLOGY

A biologic etiology for PPD has long been sought after by researchers in the field. If a biologic explanation for PPD were found, physiologic testing (serum, urine) could be done. Researchers have long tried to establish shifting hormone levels of the postpartum period (estrogen, progresterone, oxytocin) as culprits in PPD. An increase in cortisol levels as a result of increased stress has thought to be responsible for altered mood states. A study by Carroll and colleagues (2007) concluded that increased adrenal cortex secretion of adrenal corticotropic hormone (ACTH) results in increased cortisol levels for many depressed hospitalized patients. The increased cortisol levels are hypothesized to be correlated with PPD. Additionally, Corwin and Pajer (2008) found that for women who develop PPD, there is hypthalamic, pituitary, adrenal (HPA) axis hyperactivity with a resultant increase in ACTH. The resultant increase in ACTH increases the blood levels of cortisol, which is associated with agitation, dysphoria, insomnia, and anorexia. Serotonin another hormone has been associated with PPD when blood levels are decreased (Newport et al., 2004). Maurer-Spurej, Pittendreigh, and Misri (2007) found in their study of a small sample of clinically depressed postpartum patients that serotonin levels were reduced by 50%; these were patients who had either not started treatment with or were not responsive to Paxil, a selective serotonin reuptake inhibitor (SSRI). Further studies are needed to confirm these studies’ conclusions. If replication studies derive the same results, it is hoped that serotonin and ACTH would act as biomarkers for disease diagnosis. Currently, the postpartum shift in hormone levels or increase in cortisol levels have yet to be proven as a cause for PPD (Bloch et al., 2003; Murry & McKinney, 2010a). THE

BLUES–TO-PSYCHOSIS CONTINUUM MODEL

There is a popular model that is used to describe postpartum disorders along a continuum. It begins with baby blues on the mild end of the spectrum, graduating next to PPD and, finally, postpartum psychosis on the extreme end of the spectrum (Kendall-Tacket, 1993; Robinson & Stewart, 1993). The baby blues–to-psychosis model is used in birth education classes, support groups, and clinical treatment. This model offers a framework for qualitatively describing fluctuating moods during an important transition period, offering an accessible conceptual framework for self-assessment, which normalizes subclinical levels of depressive symptoms.


LIMITS

721

OF FREQUENTLY USED MODELS OF POSTPARTUM DEPRESSION

Limitations of these models fall into two major categories: limited time frame and limited mood states. Published research on PPD has frequently included measures during pregnancy and the months after the birth. The concept of perinatal depression, which includes both pregnancy and postpartum time frames, may be more descriptive; it is not commonly used outside the medical field; the concept of perinatal mental health would in fact be more inclusive (Reid, 2009). It is important to lengthen the period of time associated with ‘‘postpartum’’ to reflect that for many women their adjustment to motherhood includes changes during pregnancy and continues beyond the initial weeks and months postpartum. An extended time frame also reflects physiological changes for the mother, dramatic developmental changes for the infant, evolving roles for the parents, and changing family dynamics. Research has demonstrated that adjustment to parenthood is related to different variables at different times (Matthey, Barnett, Ungerer, & Waters, 2000). The idea that postpartum adjustment lasts longer than the medical model of 4 weeks is intuitively appealing when the transition to parenthood is considered within the complexity of family and work life. At a minimum, the transition to parenthood for employed mothers extends beyond maternal leave when mothers must learn to effectively juggle work and family demands. The second challenge is limited mood states. The most common clinical diagnosis for postpartum mothers is depression. Moreover, mood liability is considered only within the first days after delivery as a part of the baby blues. However, anxiety is both a predictor to PPD (Beck, 2001) and can coexist with PPD. The American Psychological Association (APA) notes that women with PPD ‘‘often have severe anxiety and panic attacks (2000, p. 423).’’ The anxiety can be seen in conjunction with depression, or it can be experienced without depression. Furthermore, anxiety symptoms can often be overshadowed or ignored because of co-occurring depression. The blues-to-psychosis model suggests that attention should be focused on depression and psychotic symptoms, both of which can be a manifestation of bipolar disorder (among other causes), yet the model fails to acknowledge this clinical disorder. A PPD framework that describes all the major symptom clusters including anxiety and bipolar disorder would be the more beneficial to women. Including anxiety symptoms within the model can lead to discussions about levels of symptoms ranging from low-level to clinical impairment, in a sense paralleling the blues-to-depression framework. Ultimately, mothers can be empowered with models that view their adjustment to motherhood within the more complex social and environmental contexts in their lives. Models that consider all the time periods (pregnancy, postpartum weeks, and postpartum months) help mothers to recognize the complex process of taking on a new role and making role adjustments.

722


In the next section, the biopsychosocial assessment, a common approach in social work practice, will be discussed for completing an assessment on a pregnant or postpartum woman. Table 1 lists risk and predictive factors for PPD that can be identified during a clinical interview.

BIOPSYCHOSOCIAL FRAMEWORK OF SOCIAL WORK PRACTICE The biopsychosocial and person-in-environment approaches are a foundation for social work practice with individuals and families. Interviewing clients utilizing a standard biopsychosocial format can help identify risk and protective factors related to parental moods.

Biological Domain Information about women’s health would include discussions of their underlying health and the course of pregnancy (and delivery in a postpartum interview) identifying any diagnosed illness, with particular attention to diabetes. Use or dependency on alcohol or illegal drugs and smoking during the third trimester are important risk factors. Additionally, the amount of sleep, nutrition, and eating patterns (disorders) are significant to mothers’ wellbeing. From the environmental domain, there are two important variables that impact the biological domain: medical care (of the woman and her baby) and stress levels. The former, often related to income (poverty) is a significant risk factor for poor health, disparities in health care services, and other related risk factors).

Psychological Domain Within the psychological domain, social workers need to consider a wider variety of moods and clinical syndromes. Prevalence data indicate that depressive symptoms and clinical depression are the most common moodrelated problems reported both during pregnancy and the postpartum period. Moreover, there is some research-based evidence that the cluster of depressive symptoms may vary during pregnancy and later postpartum. Psychomotor symptoms related to restlessness and agitation and problems with concentration and related decision making were pronounced and more frequently reported (Bernstein et al., 2008). ANXIETY Anxiety symptoms commonly co-occur with depression and can be overshadowed by depression. However, anxiety may also occur without depressive symptoms. When discussing anxiety, a full spectrum of anxiety-related

723

Stress Use of alcohol and controlled substances Age of mother PSYCHOLOGICAL Mental health history Current mood disorder symptoms Depression Anxiety and panic Obsessive compulsive disorder Bipolar disorder

General health

BIOLOGICAL Nutrition Sleep

Adult mother Mental health services and plans for care and support throughout pregnancy, delivery and transition time frames. Monitoring of personal symptoms by mother and her support person.

Younger (teenage) maternal age

History or current symptoms: Depression (restlessness, agitation, problems with concentration or decision making), Anxiety (sensitivity, general anxiety, panic attacks, obsessions & compulsions). Mood labiality (baby blues, moods change quickly) Clinically diagnosable mood disorder (present and history) Sense of loss of self and autonomy

(continued)

Good nutrition Adequate medical information and services (personal and prenatal care) Manageable, predictable stress Abstain from use of alcohol or illegal drugs.

Good nutrition Adequate sleep Naps as needed

Protective factors

Eating disorders Inadequate sleep Less than 4 hours night (12–6 a.m.) (Goyal & Lee, 2009) Less than 60 minute daily nap Poor quality of sleep during pregnancy (Skouteris et al., 2008) Underlying illness (i.e., diabetes) History of Premenstrual Syndrome (PMS) and premenstrual dysphoric disorder (Bloch, 2003). High cortical (ACTH) levels Chemical dependency

Risk factors

PERSON

TABLE 1 Biopsychosocial Assessment Model for Perinatal Time Frames: Risk Factors Related to Future Depression

724

Friends

Parents and in-laws

Partner/co-parent

PSYCHOLOGICAL General attitude toward life Trauma history SOCIAL General support network Instrumental Emotional Parenting

TABLE 1 (Continued)

Supportive individuals and groups who can be counted on to help in various ways. Able to ask for things or help People to talk with Individuals respect mother’s decisions and parenting Supportive relationship Partner and mother have a shared vision of their roles and responsibilities as parents

Low, none or the wrong type of support (Dennis & Letourneau, 2007; Reid, 2009). Isolation having to do it all alone without helpful advice or support Criticized for parenting decisions

(continued)

Socialize with other parents with small children Attendance at church few times a month (Mann et al., 2008)

Parent figures are available and responsive to needs of mother and her family.

Resolved prior abuses

Child abuse and neglect history

Absent or not dependable Emotional and physical violence (Ross & Dennis, 2009) Critical of maternal decisions Low partner support Absent or unavailable Not supportive or intrusive Parents critical of mother Isolated from outside support

Optimistic outlook on life

Protective factors

Pessimistic perspective

Risk factors

PERSON

725

Stressful life events

Economic stress

Employer

Culture

SOCIAL Infant

TABLE 1 (Continued)

Employer policies and practices unsupportive of mother or family responsibilities. Threats of loosing job. ENVIROMENT Poverty Financial hardship Unemployment or loss of job Mismatch between women’s wish and actual choice to work or not outside the home. External stressors (baby and others, employment, financial, housing) Child care stressors

Low birth weight infant Infant admitted to NICU Colicky baby Isolation from culturally important supports and traditions.

Risk factors

PERSON

Ability to respond to stress that results in sense of mastery and control

Accessing all economic, medical and social services available

Medical care, information & supportive home health care Support and respite from infant care Observed practices about the transition to parenthood time frame. Attending organized religious activities (Mann et al., 2008). Family leave available Flexible work family policies (i.e., schedule changes and sick leave) Boland-Prom, 2004

Protective factors

726


symptoms from anxiety sensitivity to panic attacks needs to be considered. Anxiety sensitivity, a fear that anxiety-related bodily sensations, has been associated with posttraumatic stress disorder (PTSD; Friarbrother & Woody, 2007). For some mothers, anxiety sensitivity may have an impact on their delivery and recovery experiences. A history of PTSD has also been found related to later PPD (Onoye, Goebert, Morland, Matsu, & Wright, 2009). Anxiety symptoms have been found to be predictive of PPD whereas the reverse has not been found (Misri & Kendrick, 2007). Little is known about panic attacks during pregnancy and postpartum, although some evidence exists of its co-morbidity with depression, and they have been shown to be a predictor of persistent depression (Katon et al., 1994). BIPOLAR

DISORDER

Social workers need to be mindful of possible bipolar symptomology. It may be difficult to determine the difference between an elevated mood (hypomania) of a person with bipolar disorder and the natural exuberance of maternal joy when no previous diagnosis of the disorder has been made. There is a paucity of literature on bipolar disorder during pregnancy and postpartum beyond individual case descriptions and discussions of medical management. However, there is some evidence that postpartum psychosis is usually an expression of bipolar disorder (Sharma, 2005). Social workers who gather historical information about mood state fluctuations of mothers will better understand the postpartum mood within the context of the individual woman’s baseline history. OBSESSIVE

COMPULSIVE DISORDER

There is little published literature on obsessive compulsive disorder (OCD) during pregnancy and postpartum. Overall, the existing literature suggests that OCD symptoms appear to be preexisting for most mothers, remain consistent across pregnancy, and are exacerbated during the postpartum period (Misri, 2007). However, the focus of obsessions and compulsions may differ. Obsessive fears during pregnancy are usually related to germs or contamination to the infant and harm to the fetus or baby (intentional or accidental). Postpartum fears can include fear of separation from the infant and fear of criticism related to mothering. Compulsions during pregnancy can manifest as excessive washing and cleaning, which can continue after delivery. Postpartum compulsions have been reported as predominately avoidant behaviors and excessive checking behaviors. Overall, research has failed to identified a specific time frame for increased risk. As moods, stress levels, and adjustment can fluctuate in part due to life events and sense of support received, it is important to consider each client within the context of their individual lives.


727

SOCIAL Understanding a mother’s social networks and access to social support is important in thorough assessments. Both the availability and the quality of the social support are important. The needs for specific types of support may vary throughout the postpartum time frame. Also in the social domain are characteristics of the babies and their interactions with their mothers.

Support for Mothers Prince and Jacobson (1995) consider the relationship with a partner to be a source of both stress and support and a focus for intervention. Studies that measured social support variables have identified the following risk factors: domestic violence (Brett, 2008); the response toward the pregnancy by the mothers and their partners (Kitamura, Sugawara, Sugawara, Toda, & Shima, 1996); the father’s mental health (Zelkowitz & Milet, 2001); the mother’s relationship with her own mother (Matthey, Barnett, Ungerer, & Waters, 2000); and the marital relationship itself (Whiffen, 1988). When considering primary support from partners and parents, criticism and support for parenting decisions made by the mother may also have an impact. Finally, support from employers related to work and family demands can impact working mothers’ transitions after maternity leaves (Boland-Prom, 2004).

Infant Characteristics Characteristics of children have also been identified as risk factors for PPD. They include the infant’s health and temperament-related variables (Beck, 1996, 2001); infant low birth weight (Brett, 2008; Hay & Kumar, 1995); and child’s difficult behavior (Sharp, Hay, Pawlby, Schmucker, Allen, & Kumar, 1995). Although infant temperament (Bates, Frreland, Lounsbury, 1979) is conceptualized to be identifiable after 6 months of age, the fussiness or ‘‘colicky’’ patterns of the infants can exert a considerable influence on mothers’ sleep, sense of proficiency as a mother, and the relationship between mother and baby. Though the infant’s fussiness may not have a direct impact on mother’s mental health, at the very least this can be a source of increased stress on the mother.

Environmental Variables Studies that measured environmental variables have identified risk factors for PPD. The risk factors include: poverty (Fisher, Feekery, & Rowe-Murray, 2002; Hobfoll, Cameron, Chapman, & Gallagher, 1996; Siefert, Bowman, Heflin, Danzinger, & Williams, 2000); lower income, manual work, and occupational dissatisfaction (Murray, Cox, Chapman, & Jones, 1995); and mothers’ sense of control at work (Boland-Prom, 2004).

728


RISK FACTORS Decades of research on PPD have been compared through meta-analysis and resulted in lists of pregnancy variables that have been found to be the most predictive of the development of depressive symptoms and depression during the postpartum time period. As informative as the rankings of risk factors are, caution is needed as social workers seek to apply the broad risk categories to individual clients. Different risk factors are more predictive during different postpartum time frames. Many of the risk factors may also reflect problems frequently linked to poverty. This section will review a meta-analysis study resulting from a large national study. It is followed by discussion of specific risk and protective factors related to the biopsychosocial assessment model. Beck (2001), in a meta-analysis of 84 studies, found the following predictors of PPD (listed in descending order of their effect sizes): prenatal depression, self-esteem, childcare stress, prenatal anxiety, life stress, social support, marital relationship, history of depression, infant temperament, maternal blues, marital status, socioeconomic status, and unplanned/unwanted pregnancy. Furthermore, the Center for Disease Control conducted a study of women in 17 states (Brett, 2008). The following demographic characteristics were related to PPD in all 17 states: maternal age, marital status, maternal education, tobacco use in the last 3 months, and Medicaid coverage for delivery. In a large majority of the states the following were identified as risk factors during pregnancy for postpartum depressive symptoms: physical abuse (before or during) pregnancy; partner-related stress; traumatic stress; and financial stress. Infants’ low birth weight was related to postpartum depressive symptoms, but two other infant variables were unrelated: premature birth and admission to a neonatal intensive care unit. The CDC report also found different rates of depression for different racial and ethnic groups, with White women demonstrating the lowest prevalence rates.

EXPANDED MODEL: MAMA A new model of perinatal moods (of which PPD is one) based on social work paradigms of person-in-environment and the biopsychosocial perspectives can be useful in education, assessment, and treatment. The proposed approach named MAMA expands the current PPD frameworks in four ways: (1) It views mothers within more-complex personal frameworks (biopsychosocial) and environmental contexts (person in environment); (2) it expands the time frame from pregnancy through the first year after birth; (3) it includes additional moods and symptoms (anxiety, panic, and mood labiality); and (4) it includes other diagnosable clinical disorders (anxiety


729

disorders, panic attacks, bipolar disorder, and so on). The MAMA approach can be useful to social workers as they assess mothers’ risk and resiliency factors and plan targeted interventions. Moreover, the MAMA approach can be intuitively appealing to mothers in their self-assessments (Table 2). Social workers in a wide variety of settings treat mothers with depression. The social work literature provides limited guidance on PPD, but the

TABLE 2 Model Assessing Maternal Adjustment BIOLOGICAL Poor nutrition

Nutrition

Good nutrition

Sleep Health (Mom) Alcohol, illegal drugs, smoking

Optimum sleep Healthy No use

Disturbed sleep Medical risk factors Occasional use

Medical care

Primary and OB care visits

Stress

Low stress

Inconsistent prenatal or postnatal care Manageable stress

Depression Anxiety Mood swings Sense of control Family Social (friends or groups) Work-boss Work-coworkers

Work environment

Health Temperament

PSYCHOLOGICAL Pregnancy blues Depression Postpartum blues Minimal worry Anxious Minimal labiality Labile mood Sense of control Variable control (work and family) SOCIAL Partner present, Inattentive or pushy supportive family Contact with social Access to other parents and support as less previous social than mom desires networks Supportive Some expectations & some flexible Some support— Supportive— practical and possible complaints or emotional support resentments Flexible-family Provide only legally friendly policies required leave BABY Some medical concerns Easy or adaptable Fussy Healthy

Note. Continuum: MINIMUM PROBLEMS $ SEVERE PROBLEMS.

Inadequate nutrition Eating disorders Extreme fatigue Chronic illnesses Chemical dependency Smoking last trimester No access to medical services Extreme stress (interpersonal or environmental) Depression w/psychosis PTSD, Panic attacks or OCD Bipolar disorder Lack of control Abusive, unavailable, critical, or intrusive Isolated from expected social supports Work production primary concern Inflexible—expects demands be met or consequences Hostile work environment penalizes mothers Low birth weight Serious illness Cholicy, unsoothable

730


profession has unique practice approaches that can add to the best-practice models. This paper proposes the MAMA approach, which has utility for professionals, clients, and individuals in their social support networks. It can be used in education efforts with clients. MAMA can be both the basis of a thorough client assessment in multiple disciplines and self-monitoring for mothers at risk for developing depression. This approach can be a platform for instruction in clinical and human development courses. Finally, this approach is an ideal model for the development of an instrument that measures risk and incidence of prenatal depression, moving beyond simple psychological symptoms to more-complex, inclusive mental health symptoms. More research on its application is recommended.

REFERENCES Abrams, L. S., & Curran, L. (2007). Not just a middle-class affliction: Crafting a social work research agenda on postpartum depression. Health & Social Work, 32(4), 289–296. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (IV-TR ed.). Washington, DC: American Psychiatric Press. Bates, J., Freeland, C., & Lounsbury, M. (1979). Measurement of infant difficulties. Child Development, 50, 794–803. Beck, C. (1991). Maternity blues research: A critical review. Issues in Mental Health Nursing, 12, 291–300. doi: 10.3109/01612849109040522 Beck, C. (1996). A meta-analysis of predictors of postpartum depression. Nursing Research, 45(5), 297–303. doi: 10.1097/00006199-199609000-00008 Beck, C. (2001). Predictors of postpartum depression. Nursing Research, 50(5), 275– 285. doi: 10.1097/00006199-200109000-00004 Bernstein, I., Rush, J., Yonkers, K., Carmody, T., Woo, A., McConnell, K. : : : Trivedi, M. (2008). Symptom features of postpartum depression: Are they distinct? Depression and Anxiety, 25, 20–26. doi: 10.1002/da Bloch, M., Daly, R. C., & Rubinow, D.R. (2003). Endocrine factors in the etiology of postpartum depression. Comprehensive Psychiatry, 44(3), 234–246. Boland-Prom, K. (2004). Control and social support variables during pregnancy and the development of depressive symptoms during the postpartum period. Unpublished doctoral dissertation, Portland State University, Portland. Brett, K., Barfield, W., & Williams, C. (2008). Prevalence of self-reported postpartum depressive symptoms—17 states, 2004–2005. Retrieved from www.cdc.gov/ mmwR/preview/mmwrhtml/mm571a1.html Carroll, B. J., Cassidy, F., Naftolowitz, D., Tatham, N. E., Wilshon, W. H., Iranamanesh, A. : : : Veldhuis, J. D. (2007). Pathophysiology of hypercortisolism in depression. Acta Psychiatric Scand. 115(Suppl. 433), 90–103. Corwin, E. J., & Pajer, K. (2008). The psychoneuroimmunology of postpartum depression. Journal of Women’s Health. 17(9), 1529–1534. doi: 10.1089/jwh.2007. 0725


731

Dennis, C.-L., & Letourneau, N. (2007). Global and relationship-specific perceptions of support and the development of postpartum depressive symptomatology. Social Psychiatry and Psychiatric Epidemiology, 42(5), 389–395. Fisher, J., Feekery, C., & Rowe-Murray, H. (2002). Nature, severity and correlates of psychological distress in women admitted to a private mother-baby unit. Journal of Pediatric Child Health, 38, 140–145. doi: 10.1046/j.1440-1754.2002. 00723.x Friarbrother, N., & Woody, S. R. (2007). Fear of childbirth and obstetrical events as predictors of postnatal symptoms of depression and post-traumatic stress disorder. Journal of Psychosomatic Obstetrics and Gynecology, 28(4), 239–242. Gaynes, B., Gavin, N., Meltzer-Brody, S., Lohr, K., Swinson, T., Gartlehner, G. : : : Miller, W. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Rockville, MD: Agency for Healthcare Research and Quality. Goyal, D., Gay, C., & Lee, K. (2009). Fragmented maternal sleep is more strongly correlated with depressive symptoms than infant temperament at three months postpartum. Archives of Women’s Mental Health, 12(4), 229–237. Hay, D., & Kumar, R. (1995). Interpreting the effects of mothers’ postnatal depression on children’s intelligence: A critique and reanalysis. Child Psychiatry and Human Development, 25(3), 165–181. doi: 10.1007/BF02251301 Hobfoll, S., Cameron, R., Chapman, H., & Gallagher, R. (1996). Social support and social coping in couples. In G. Pierce, B. Sarason, & I. Sarason (Eds.), Handbook of social support and the family. New York, NY: Plenum. Katon, W., Lin, E., von Korff, M., Bush, T., Walker, E., Simon, G., & Robinson, P. (1994). The predictors of persistence of depression in primary care. Journal Affective Disorders, 31(2), 81–90. Kendall-Tacket, K. (1993). Postpartum depression: A comprehensive approach for nurses. Newbury Park, CA: Sage. Kitamura, T., Sugawara, M., Sugawara, K., Toda, M. A., & Shima, S. (1996). Psychosocial study of depression in early pregnancy. British Journal of Psychiatry, 168, 732–738. doi: 10.1192/bjp.168.6.732 Mann, J. R., McKeown, R. E., Bacon, J., Vesselinov, R., & Bush, F. (2008). Do Antenatal religious and spiritual factors impact the risk of postpartum depressive symptoms? Journal of Women’s Health, 17(5), 745–755. Matthey, S., Barnett, B., Ungerer, J., & Waters, B. (2000). Paternal and maternal depressed mood during the transition to parenthood. Journal of Affective Disorders, 60, 75–85. doi: 10.1016/S0165-0327(99)00159-7 Maurer-Spurej, A., Pittendreigh, C. & Misri, S. (2007). Platelet serotonin levels support depression scores for women with postpartum depression. Journal of Psychiatry and Neuroscience, 32(1), 23–29. Misri, S., & Kendrick, K. (2007). Obsessive-compulsive disorder in the perinatal period: A review of the literature. Current Psychiatry Reviews, 3(4), 265–270. Murray, D., Cox, J., Chapman, G., & Jones, P. (1995). Childbirth: Life event or start of a long-term difficulty? Further data from the Stoke-on-Trent controlled study of postnatal depression. British Journal of Psychiatry, 166, 595–600. doi: 10. 1192/bjp.166.5.595 Murray, S. S., & McKinney, E. (2010). Foundations of maternal-newborn and women’s health nursing (5th ed.). Missouri: Saunders Elsevier.

732


Newport, D. J., Owens, M. J., Knight, L., Ragan, K., Morgan, N., Nemeroff, C. B. : : : Stowe, Z. N. (2004). Alterations in platelet serotonin transporter binding in women with postpartum onset major depression. Journal of Psychiatric Research, 38, 467–473. O’Hara, M., Neunaber, D., & Zekoski, E. (1984). Prospective study of postpartum depression: Prevalence, course, and predictive factors. Journal of Abnormal Psychology, 93(2), 158–171. Onoye, J. M., Goebert, D., Morland, L., Matsu, C., & Wright, T. (2009). PTSD and postpartum mental health in a sample of Caucasian, Asian, and Pacific Islander women. Archives of Women’s Mental Health, 12(6), 393–400. Prince, S., & Jacobson, N. (1995). Couple and family treatment for depression. In E. Beckman & W. Leber (Eds.), Handbook of depression. New York, NY: Guilford Press. Reid, H., Power, M., & Cheshire, K. (2009). Factors influencing antenatal depression, anxiety and stress. British Journal of Midwifery, 17(8), 501–508. Robinson, G., & Stewart, D. (1993). Postpartum disorders. In Psychological aspects of women’s health care: The interface between psychiatry and obstetrics and gynecology (pp. 115–138). Washington, DC: American Psychiatric Press. Ross, L., & Dennis, C.-L. (2009). The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: A systematic review. Journal of Women’s Health, 18(4), 475–486. Sharma, V. (2005). Bipolar depression: The neglected realm of postpartum disorders. Current Psychiatry Reviews, 1(3), 325–329. doi: 10.1089=jwh.2008.0953 Sharp, D., Hay, D., Pawlby, S., Schmucker, G., Allen, H., & Kumar, R. (1995). The impact of postnatal depression on boys’ intellectual development. Journal of Child Psychology and Psychiatry, 36(8), 1315–1336. doi: 10.1111/j.1469-7610. 1995.tb01666.x Siefert, K., Bowman, P., Heflin, C., Danzinger, S., & Williams, D. (2000). Social and environmental predictors of maternal depression in current and recent welfare recipients. American Journal of Orthopsychiatry, 70(4), 510–522. doi: 10.1037/ h0087688 Skouteris, H., Germano, C., Wertheim, E., Paxton, S., & Milgrom, J. (2008). Sleep quality and depression during pregnancy: A prospective study. Journal of Sleep Research, 17, 217–200. doi: 10.1111/j.1365-2869.2008.00655.x Whiffen, V. (1988). Vulnerability to postpartum depression: A prospective multivariate study. Journal of Abnormal Psychology, 97(4), 467–474. doi: 10.1037/0021843X.97.4.467 Yalom, I., Lunde, D., Moos, R. H., & Hamburg, D. (1968). Postpartum blue syndrome. Archives of General Psychiatry, 18, 16–27. Zelkowitz, P., & Milet, T. (2001). The course of postpartum psychiatric disorders in women and their partners. Journal of Nervous and Mental Diseases, 189(9), 575–582. doi: 10.1097/00005053-200109000-00002

Copyright of Journal of Human Behavior in the Social Environment is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Copyright of Journal of Human Behavior in the Social Environment is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.