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Rahimi H, Mousavi FS, Rahmanian SA, Khalajinia Z, Khavari F. Postpartum depression and its relationship with the positive and negative perfectionism. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:110. [PMID: 38726073 PMCID: PMC11081452 DOI: 10.4103/jehp.jehp_162_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/08/2023] [Indexed: 05/12/2024]
Abstract
BACKGROUND Depression is a common mental disorder after childbirth, which has serious consequences for the mother, baby, and family. A wide range of causes, including some personality traits of mothers, are involved in its etiology. Therefore, this study was conducted aiming to determine the factors related to postpartum depression (PPD) and its relationship with positive and negative perfectionism in Qom, Iran. MATERIALS AND METHODS This cross-sectional analytical study was conducted on 162 mothers who had been referred to health centers in Qom during 6-8 weeks after normal vaginal delivery (NVD) in 2020. After randomly classifying the health centers, the convenience sampling method was carried out. Data collection tools included social-individual information form, Edinburg Postnatal Depression Scale (EPDS), and Positive and Negative Perfectionism Questionnaire of Terry-Short. The data were analyzed using the Chi-square and Pearson correlation tests and multivariate logistic regression analysis. RESULT The prevalence of PPD in this study was 29.6%. The results showed that with the increase in the negative dimension of perfectionism, the chance of PPD in people increases by 14% (OR = 1.14, CI = 1.06-1.21), while there was no significant correlation between the positive dimension of perfectionism and PPD (r = 0.006, P > 0.05). Furthermore, the chance of PPD was higher in student mothers, mothers who had a history of PPD, and unintended pregnancy. Moreover, some factors such as multigravidity, breastfeeding, and not worrying about body image reduce the chance of occurrence. CONCLUSION Since mothers' negative perfectionism is associated with PPD, it is recommended to identify perfectionist individuals during pregnancy and after delivery and provide counseling service to them.
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Affiliation(s)
- Hanieh Rahimi
- Student of Medicine, Student Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sadat Mousavi
- Department of Midwifery, Student Research Committee, Qom University of Medical Sciences, Qom, Iran
| | - Seyyedeh Adeleh Rahmanian
- Master of Midwifery, Shirvan Health and Treatment Network, North Khorasan University of Medical Sciences, Bojnord, Iran
| | - Zohre Khalajinia
- Department of Midwifery, Student Research Committee, Qom University of Medical Sciences, Qom, Iran
| | - Farideh Khavari
- PhD Candidate in Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Rodríguez-Muñoz MF, Chrzan-Dętkoś M, Uka A, García-López HS, Krupelnytska L, Morozova-Larina O, Vavilova A, Molotokas A, Murawska N, Le HN. The impact of the war in Ukraine on the perinatal period: Perinatal mental health for refugee women (pmh-rw) protocol. Front Psychol 2023; 14:1152478. [PMID: 36993880 PMCID: PMC10042139 DOI: 10.3389/fpsyg.2023.1152478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/14/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundThe aim of the Perinatal Mental Health for Refugee Women (PMH-RW) Project is to investigate the impact of the war on perinatal mental health: anxiety, post-traumatic stress, depression, and birth trauma symptoms. It will also evaluate the factors that serve as protective elements for the development of these potential diagnoses (such as personality traits, social support, sociodemographic characteristics, and access to medical/mental health services).MethodAn international observational cohort study with baseline data is being assessed in Ukraine (for internal refugees) and several European Countries (for external refugees). The study includes as participants both pregnant women and those who have recently given birth (with babies up to 1 year old). The assessment includes measures on depression (EPDS), anxiety (GAD-7), experiences during birth (City Birth Questionnaire), post-traumatic stress symptoms [Impact of events scale—revised (PTSD-R)], Personality (10-Item Personality Inventory-TIPI), and a questionnaire for socio-demographic data which also such social support.ConclusionThis study will provide needed information for determining the impact of the Ukrainian Crisis on perinatal mental health by studying potential risk and protective factors. The data collected will be used to inform policymakers with useful information that can be used in the development of plans to protect and promote the mental health of the perinatal refugees impacted by this event. Also, it is our hope that data collected from this study will serve to plant the seeds for further research regarding the impact of the crisis in Ukraine on the offspring and to analyze how these events are affecting further generations.Clinical Trial RegistrationClinicalTrials.gov, Identifier: NCT05654987.
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Affiliation(s)
| | | | - Ana Uka
- Research Center for Sustainable Development and Innovation, Beder University College, Tirana, Albania
| | | | - Liudmyla Krupelnytska
- Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
- *Correspondence: Liudmyla Krupelnytska,
| | | | - Alona Vavilova
- Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | | | | | - Huynh-Nhu Le
- George Washington University, Washington, DC, United States
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Evans C, Kreppner J, Lawrence PJ. The association between maternal perinatal mental health and perfectionism: A systematic review and meta-analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1052-1074. [PMID: 35762187 PMCID: PMC9796248 DOI: 10.1111/bjc.12378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Perfectionism is an important feature of adult psychopathology. In the absence of a prior review of the role of perfectionism in perinatal psychopathology, we aimed to ascertain whether perfectionism was associated with symptoms of maternal perinatal depression and anxiety. METHOD We followed PRISMA guidance (PROSPERO: 42019143369), estimated weighted effect sizes and tested possible moderators: timing (pre or post- natal), scales used to measure constructs, infant gender, temperament and age; and rated study quality. RESULTS Fourteen studies met eligibility criteria. Perfectionism as a whole, and the perfectionistic concerns dimension, were moderately correlated with common maternal perinatal mental health difficulties r = .32 (95% Confidence Interval = 0.23 to 0.42). In sub-group analyses, perfectionistic concerns were associated with depression (r = .35, 95% CI = 0.26-0.43). We found no evidence of significant moderation of associations. LIMITATIONS Included studies had methodological and conceptual limitations. All studies examined depression and two examined anxieties; all examined perfectionistic concerns and four examined perfectionist strivings. CONCLUSIONS Perfectionism, namely perfectionistic concerns, is potentially associated with common maternal perinatal mental health problems. While further research is warranted, identification of perfectionism in the perinatal period may help focus resources for intervention, reducing the prevalence of perinatal mental health difficulties.
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Affiliation(s)
- Clare Evans
- Sussex Partnership NHS Foundation TrustWest SussexUK
| | - Jana Kreppner
- Centre for Innovation in Mental HealthSchool of PsychologyUniversity of SouthamptonSouthamptonUK
| | - Peter J. Lawrence
- Centre for Innovation in Mental HealthSchool of PsychologyUniversity of SouthamptonSouthamptonUK
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Diop S, Turmes L, Specht C, Seehagen S, Juckel G, Mavrogiorgou P. Capacities for meta-cognition, social cognition, and alexithymia in postpartum depression. Psychiatry Res 2022; 309:114430. [PMID: 35134669 DOI: 10.1016/j.psychres.2022.114430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/24/2022]
Abstract
Postpartum depression (PPD), a female-specific disorder, is the most common medical complication associated with childbirth (10-20%). The pathological relevance of emotion processing, meta-cognition, alexithymia, and social cognition to PPD is unclear. We tested 25 mothers with PPD (mean age: 30.72 ± 5.76 years) and 25 healthy mothers (mean age: 32.03 ± 3.54 years) for alexithymia (Toronto Alexithymia Scale) and evaluated cognitive empathy (Faux Pas Test), affective empathy (Interpersonal Reactivity Index), meta-cognition (Meta-Cognitions Questionnaire), sociodemographic and clinical-psychometric characteristics and personality dimensions. Mothers with PPD showed higher levels of neuroticism and more anxiety-depressive characteristics. Their metacognitive abilities were significantly altered and they more often had alexithymia. Significant correlations between alexithymia and meta-cognition, trait anxiety, and neuroticism were found. Alexithymia, neurotic personality traits, and dysfunctional meta-cognition appear more frequently in PPD women than healthy women. Social cognition abilities were not significantly altered. Alexithymia and metacognitive distortions play important roles in the pathogenesis of PPD. Dysfunctional meta-cognition, neuroticism, and alexithymia may be risk factors that should be detected early in expectant mothers to prevent the development of PPD.
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Affiliation(s)
- Shirin Diop
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital Bochum, Alexandrinenstr. 1, Bochum 44791, Germany
| | - Luc Turmes
- Psychotherapy and Psychosomatic Health, LWL Hospital Herten of Psychiatry, Im Schloßpark 20, Herten 45699, Germany
| | - Christina Specht
- Psychotherapy and Psychosomatic Health, LWL Hospital Herten of Psychiatry, Im Schloßpark 20, Herten 45699, Germany
| | - Sabine Seehagen
- Department of Psychology, Ruhr University Bochum, Universitätstr. 150, Bochum 44801, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital Bochum, Alexandrinenstr. 1, Bochum 44791, Germany.
| | - Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital Bochum, Alexandrinenstr. 1, Bochum 44791, Germany
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Personality traits as a risk factor for postpartum depression: A systematic review and meta-analysis. J Affect Disord 2022; 298:577-589. [PMID: 34763034 DOI: 10.1016/j.jad.2021.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Certain personality traits increase vulnerability to depression, but the evidence linking personality and postpartum depression (PPD) is less robust. This systematic review aimed to identify personality traits that increase the risk of PPD. METHODS We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, Scopus, CINAHL, and Cochrane, following the PRISMA guidelines for reporting. We carried out a meta-analysis on the association between neuroticism and PPD. RESULTS A total of 34 studies were analyzed. Of these, 31 considered at least one trait associated with PPD; 10 studies considered at least one trait not associated with PPD. The meta-analysis included 13 studies, concluding that neuroticism was associated with PPD (OR: 1.37; 95%CI: 1.22-1.53; p<0.001). LIMITATIONS Study design and approach to personality assessment influence results. Prospective longitudinal studies of persons with no prior history of mood disorder would provide stronger evidence about whether particular personality traits predict PPD. Most studies reviewed used self-report measures to assess personality. Study design and approach to personality assessment influence results, and indications of publication bias were found. CONCLUSIONS Neuroticism is the personality trait most widely studied in relation to PPD. Our meta-analysis found this trait is strongly related with PPD. Moreover, vulnerable personality style and trait anxiety are also associated with PPD. Screening for these traits might help identify women at risk, improving prevention, early detection, and possibly treatment.
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Bull E, Al-Janabi S, Gittens CB. Are women with traits of perfectionism more likely to develop perinatal depression? A systematic review and meta-analysis. J Affect Disord 2022; 296:67-78. [PMID: 34592658 DOI: 10.1016/j.jad.2021.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
Women who present with a maladaptive form of the perfectionism trait may be vulnerable to perinatal depression (PND). The studies examining this association, though, differ in the specific time-points at which PND is measured, the tool/s used to assess PND and/or perfectionism, and the sample of women used; consequently, extant results reflecting this association can be difficult to integrate and interpret. This systematic review and meta-analysis seeks to clarify the association between PND and perfectionism by surveying literature on the relationship. Literature search strategies were developed using medical subject headings (MeSH) and text words related to PND and perfectionism. Nine electronic databases of published and unpublished literature were searched for relevant studies, which were selected for inclusion in this systematic review and meta-analysis if they contained data on female participants aged 18 or over and pregnant or who were within 12 months post-birth; additionally, studies were included if they contained quantitative reporting of depressive symptoms and trait perfectionism symptoms within the perinatal period (between pregnancy and up to 12 months post-birth). Ten publications were selected for inclusion based on independent review against the selection criteria by the authors. Eight of the 10 publications provided substantial correlational data and were analysed using meta-analytic techniques. All studies showed a significant positive relationship between measures of perfectionism and depression at various time points within the perinatal period (3rd trimester to 12-months postpartum), including concurrently in pregnancy, concurrently in postpartum, and longitudinally between pregnancy and postpartum. Interestingly, however, moderation analyses identified that the relationship between perfectionism and PND in the 3rd trimester may emerge only when a perinatal-specific, but not when a general, depression screening tool is used. These analyses also revealed that the strength of the relationship between perfectionism and PND may increase with length of time postpartum. The findings of this systematic review and meta-analysis, thus, suggest that medical professionals should consider perfectionism when formulating PND prevention strategies and assessing for PND using perinatal-specific screening tools.
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Affiliation(s)
- Emilie Bull
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | - Shahd Al-Janabi
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia.
| | - Catherine B Gittens
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
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Gingras AS, Lessard I, Mallette F, Brassard A, Bernier-Jarry A, Gosselin P, de Pierrepont C. Couple Adaptation to the Birth of a Child: The Roles of Attachment and Perfectionism. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:581-594. [PMID: 32865861 DOI: 10.1111/jmft.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
This study aims to examine two explanatory factors of relationship satisfaction and parental alliance among both parents of a new child, namely romantic attachment and perfectionism. A sample of 80 couples completed individual online questionnaires. Path analyses based on the Actor-Partner Interdependence Model were carried out to explore the actor and partner effects of each explanatory variable (attachment, perfectionism) on both partners' postnatal relationship satisfaction and parental alliance. Results revealed that attachment avoidance is negatively related to each partner's own relationship satisfaction and parental alliance, whereas attachment anxiety is related to their own lower parental alliance. Maladaptive perfectionism is negatively related to each partner's own relationship satisfaction, whereas adaptive perfectionism is positively related to each partner's own relationship satisfaction. These results extend the understanding of the factors contributing to parental and couple adaptation in the postnatal period. They highlight the role of attachment and perfectionism for improving postnatal professionals' interventions.
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Affiliation(s)
| | - Isabelle Lessard
- Department of Psychology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédéric Mallette
- Department of Psychology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Audrey Brassard
- Department of Psychology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Patrick Gosselin
- Department of Psychology, Université de Sherbrooke, Sherbrooke, QC, Canada
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O'Loghlen E, Galligan R. Disordered eating in the postpartum period: Role of psychological distress, body dissatisfaction, dysfunctional maternal beliefs and self-compassion. J Health Psychol 2021; 27:1084-1098. [PMID: 33588637 DOI: 10.1177/1359105321995940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The present cross-sectional study tested the affect regulation model of disordered eating for women in the postpartum period, whereby disordered eating is used to cope with psychological distress. Two hundred and two women who had given birth in the last two years completed an online survey of self-report measures of study variables. Path analyses supported the primary hypothesis: negative affect mediated relationships between body dissatisfaction, dysfunctional maternal beliefs, negative components of self-compassion and disordered eating behaviours, particularly binge eating. Results suggest that negative affect plays a central role in postpartum disordered eating. Interventions to address maladaptive emotion regulation strategies, specifically targeting body image distress and self-critical maternal thoughts may improve eating behaviours for this population.
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Arnold M, Kalibatseva Z. Are "Superwomen" without social support at risk for postpartum depression and anxiety? Women Health 2020; 61:148-159. [PMID: 33164713 DOI: 10.1080/03630242.2020.1844360] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Postpartum depression and anxiety are common among women. Previous research has found perfectionism and the lack of social support to be associated with psychological distress. This study examined (1) social support as a protective factor against postpartum depressive and anxiety symptoms and perfectionism as a risk factor; (2) associations between different types of social support and postpartum depressive and anxiety symptoms; and (3) social support as a moderator between the relationship of perfectionism and postpartum depressive and anxiety symptoms. A total of 596 postpartum participants were included. Participants completed measures on postpartum depression, anxiety, social support, and perfectionism. Multivariate regressions revealed perfectionism was not significantly associated with depressive symptoms but predicted anxiety symptoms. Social support was a significant protective factor against depressive and anxiety symptoms. All support subscales were significantly associated with depressive and anxiety symptoms, with support from friends having the largest effect size (partial η2 = .061). High levels of support significantly moderated the relationship between perfectionism and depressive symptoms, β = .003, 95% CI [.0006, .005], t (592) = 2.53, p = .012, and average and high levels of support significantly moderated the relationship between perfectionism and anxiety symptoms, β = .0023, 95% CI [.0002, .004], t (592) = 2.13, p = .03. These results emphasize the importance of social support for postpartum women's mental health, especially for "Superwomen" with perfectionistic tendencies. Implications for healthcare and policies are discussed.
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Affiliation(s)
- Molly Arnold
- Social and Behavioral Sciences, Stockton University, USA
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Monteiro F, Fonseca A, Pereira M, Canavarro MC. Is positive mental health and the absence of mental illness the same? Factors associated with flourishing and the absence of depressive symptoms in postpartum women. J Clin Psychol 2020; 77:629-645. [PMID: 33098665 DOI: 10.1002/jclp.23081] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Exploring a wide range of factors associated with flourishing and with the absence of depressive symptoms among postpartum women. METHODS A sample of 661 postpartum women completed a set of questionnaires assessing sociodemographic and infant-related data, flourishing, psychological flexibility, self-compassion, resilience, and maternal confidence. RESULTS Younger infant age, higher levels of maternal confidence, and resilience increased the likelihood of flourishing. In turn, higher income, fewer problems with an infant's sleep, perceiving an infant's temperament as easy, and higher psychological flexibility increased the likelihood of not having depressive symptoms. Appraising the support received by others as good and having higher self-compassion increased the likelihood of both outcomes. CONCLUSIONS Our results support positive mental health and mental illness being related but distinct dimensions. Promoting positive mental health in the postpartum period should be an additional goal in public health care as it may efficiently complement the prevention of psychopathology.
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Affiliation(s)
- Fabiana Monteiro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Marco Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria C Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
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Price L, Centifanti L, Slade P. Personality factors and vulnerability to post-traumatic stress responses after childbirth. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:480-502. [PMID: 32808684 DOI: 10.1111/bjc.12262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/18/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate whether levels of perfectionism, organization, and intolerance of uncertainty predispose women to more negative birth experiences and post-partum post-traumatic stress symptoms (PTSS). Birth experience was also examined as a potential moderator of the relationship between levels of the personality traits and post-natal PTSS. DESIGN Prospective survey. METHOD First-time expectant mothers (N = 10,000) were contacted via Emma's Diary during the perinatal period. At 32-42 weeks' gestation, participants completed measures examining the three personality traits and prenatal mood. At 6-12 weeks' post-partum, instruments assessing childbirth experience, birth trauma, PTSS, and post-natal mood were completed. Data from 418 women were analysed. RESULTS Higher perfectionism and intolerance of uncertainty were associated with more negative birth appraisals and PTSS. Organization was unrelated to birth experience or PTSS. In a regression, higher intolerance of uncertainty and perfectionism statistically predicted more negative birth appraisals. Only perfectionism predicted PTSS. Birth experience did not moderate the relationship between perfectionism or intolerance of uncertainty and PTSS. CONCLUSIONS Personality risk factors for negative birth experiences and post-natal PTSS are identifiable prenatally. Maternity care providers could educate women about the unique roles of high perfectionism and intolerance of uncertainty during antenatal birth preparation. PRACTITIONER POINTS Women who expect themselves to be more perfect or who find it more difficult to cope with uncertainty had more negative experiences of childbirth. Women with higher levels of perfectionism were more likely to experience more symptoms of post-traumatic stress during the early post-natal period. Being more perfectionistic continued to have a more negative effect on women's well-being after birth, regardless of whether they had a positive or negative experience of birth. Integrating these findings into antenatal discussion around birth preferences would increase women's awareness of predisposing and obstetric risk factors that partially explain experiences of unsatisfactory births and post-partum post-traumatic stress.
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Affiliation(s)
- Lisa Price
- The Walton Centre NHS Foundation Trust, Cheshire and Merseyside Rehabilitation Network, Elyn Lodge, Seddon Suite, St. Helens Hospital, UK
| | - Luna Centifanti
- Institute of Life and Human Sciences, University of Liverpool, UK
| | - Pauline Slade
- Institute of Life and Human Sciences, University of Liverpool, UK
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Bittner A, Junge-Hoffmeister J, Treichel T, Coenen A, Weidner K. Maladaptive personality styles in a clinical sample of women with postpartum depression. J Affect Disord 2020; 263:318-325. [PMID: 31969261 DOI: 10.1016/j.jad.2019.11.151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/04/2019] [Accepted: 11/30/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Personality traits are associated with the onset and course of postpartum depression. The impact of maladaptive personality traits on mother-child bonding and parenting is less studied. Therefore, the aims of this study are to investigate: a) the frequency of maladaptive personality styles in women with postpartum depression; b) the association between personality styles and the course of maternal psychopathology; and c) the association between personality styles and mother-child bonding and parenting competence. METHODS We examined n = 123 patients of a mother-baby unit with the Personality Style and Disorder Inventory (PSSI) at admission and instruments assessed maternal psychopathological symptoms (BSI), mother-child bonding (PBQ), and parenting sense of competence (PSOC) at admission and discharge. RESULTS Maladaptive personality styles were frequent. Women with postpartum depression had higher scores on the schizoid, avoidant, obsessive-compulsive, negativistic, dependent, borderline, depressive, and self-forgetting PSSI scales than women of the general population. The presence of maladaptive personality styles was associated with higher psychopathology, impaired mother-child bonding, and lower parenting sense of competence at admission. From admission to discharge, women showed significant improvements on psychopathology, bonding and parenting irrespective of the presence of maladaptive personality styles. However, mothers with maladaptive personality styles still had higher psychopathology and impaired mother-child bonding at discharge compared to mothers with normal PSSI scores. LIMITATIONS Data is based upon a clinical sample of women hospitalized in a mother-child unit. Results are not representative for all women with postpartum depression. CONCLUSIONS Our results underline the need for early identification of maladaptive personality styles and for the adequate treatment and monitoring of women with postpartum depression. It can be anticipated that women suffering from maladaptive personality styles will need ongoing care to prevent long-term negative outcomes.
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Affiliation(s)
- Antje Bittner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
| | - Juliane Junge-Hoffmeister
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Tina Treichel
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Anne Coenen
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, D-01307, Dresden, Germany
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Responding to women's needs and preferences in an online program to prevent postpartum depression. Internet Interv 2019; 18:100275. [PMID: 31890624 PMCID: PMC6926164 DOI: 10.1016/j.invent.2019.100275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Global access to adequate resources to address postpartum depression (PPD) are limited and, at times, not reflective of the needs of pregnant women and new mothers. Gathering information about the preferences and needs of women when designing and implementing Internet-based programs is warranted, especially given the diversity of experiences related to childbirth. Thus, the aim of this study was to obtain user feedback on the content, structural, and cultural factors associated with a fully automated online PPD prevention intervention that, like similar programs, suffered from poor adherence and engagement. METHODS Following the completion of the Mothers and Babies Internet Course (eMB), an online prevention of PPD trial, a convenience sampling method was used to invite consenting participants to return to the site. Participants provided anonymous feedback on how to improve and adapt the eMB based on screenshots and video content from the Internet intervention. Demographic information and engagement in the online trial were examined as factors influencing participant responses. RESULTS One hundred nineteen English and Spanish speaking women from 27 countries and territories provided feedback about the eMB. Content-based feedback included requesting additional detail in explanations and simplifying recommended exercises. Structure-based feedback included requests for more visual representations of the materials. In general, participants did not explicitly suggest culturally specific feedback that differed by geographic region, but instead reported similar themes related to motherhood and childrearing. An unexpected finding that only emerged among English-speaking participants was the need for the eMB to address perfectionism and introspection as factors that impact motherhood. Relative to those who did not access the eMB in the parent study, women who did thought the intervention content was acceptable (i.e., no suggested changes) and provided feedback that referenced maternal stress and pregnancy experiences. Age, education, pregnancy status and number of children were not significant factors associated with participants' use of the eMB. CONCLUSIONS Findings from this study offer preliminary information about the needs and preferences of an international sample of childrearing women who access automated Internet interventions to manage mood changes during the perinatal period.
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Elwood J, Murray E, Bell A, Sinclair M, Kernohan WG, Stockdale J. A systematic review investigating if genetic or epigenetic markers are associated with postnatal depression. J Affect Disord 2019; 253:51-62. [PMID: 31029013 DOI: 10.1016/j.jad.2019.04.059] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 03/08/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Postnatal depression (PND) is common, affects the health of the mother, the development of the infant and places a large financial burden on services. Genetic and epigenetic biomarkers for PND could potentially improve the accuracy of current antenatal screening approaches. The aim of this systematic review is to report on the evidence for an association between genetic or epigenetic factors and postnatal depression. METHOD A systematic search of five databases (Medline, EMBASE, PILOT, PsychINFO and SCOPUS) was carried out using the following (MeSh) terms and keywords: postpartum, depression, postnatal depression, genetics, genetic polymorphisms and epigenetics. Inclusion criteria were applied and quality of studies was assessed using guidelines from the HuGE Review Handbook (Little and Higgins, 2006). RESULTS Following removal of duplicate articles, 543 remained; of these 37 met the inclusion criteria. Positive associations have been reported between PND and polymorphisms in the HMNC1, COMT, MAOT, PRKCB, ESR1, SLC6A4 genes in the presence of stressful life events, the BDNF gene when the postnatal period occurs during autumn and winter months and the OXT and OXTR genes in the presence of childhood adversity experienced by the mother. Epigenetic interactions with genotype, estrogen, and childhood adversity were identified that are predictive of PND. LIMITATIONS The number of studies investigating some of the markers was small and grey literature was not included. CONCLUSION This review highlights the importance of examining the interaction between epigenetic, genetic, hormonal and environmental factors in order to fully understand the risk factors for PND and to improve the accuracy of current antenatal and early postnatal screening procedures. Women susceptible to PND appear to have heightened epigenetic sensitivity to the physiological changes of childbirth or to environmental factors conferred by genotype.
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Affiliation(s)
- Judith Elwood
- Centre for Maternal, Fetal and Infant Research Ulster University, Shore Road, Co. Antrim, N. Ireland BT370Q, United Kingdom.
| | - Elaine Murray
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute, Ulster University, United Kingdom
| | - Aleeca Bell
- Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, United States
| | - Marlene Sinclair
- Centre for Maternal, Fetal and Infant Research Ulster University, Shore Road, Co. Antrim, N. Ireland BT370Q, United Kingdom
| | - W George Kernohan
- Managing Chronic Illness Research Centre, Institute of Nursing and Health Research, Ulster University, United Kingdom
| | - Janine Stockdale
- School of Nursing and Midwifery, Queen's University Belfast, United Kingdom
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Fonseca A, Canavarro MC. Cognitive correlates of women's postpartum depression risk and symptoms: the contribution of dysfunctional beliefs and negative thoughts. J Ment Health 2019; 29:614-622. [PMID: 30924704 DOI: 10.1080/09638237.2019.1581331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Despite the extensive research on interpersonal and clinical risk factors for postpartum depression (PPD), there is a paucity of research on the potential role of cognitive variables (dysfunctional beliefs and negative thoughts) as correlates of PPD symptoms.Aims: This exploratory study aimed to understand the cognitive processes of women at a higher risk (i.e. presenting well-established interpersonal and clinical risk factors) for PPD by: (a) comparing women's dysfunctional motherhood-related beliefs and frequency of automatic thoughts, as a function of their levels of PPD risk and symptoms; (b) examining the cognitive correlates of PPD symptoms, controlling for the presence of well-established risk factors.Method: A cross-sectional internet survey comprising 441 postpartum women was conducted.Results: Women presenting high-risk for PPD showed more dysfunctional motherhood-related attitudes (p < 0.001), more frequent negative thoughts (p < 0.001) and less frequent positive thoughts (p < 0.001) than low-risk women. More dysfunctional beliefs related to maternal responsibility, more frequent negative thoughts related with personal maladjustment and with the metacognitive appraisal of the thoughts' content, and less frequent positive thoughts were found to be significantly associated with PPD symptoms.Conclusion: The inclusion of cognitive variables in risk assessment and preventive efforts for PPD may hold potential to increase its clinical efficacy.
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Affiliation(s)
- Ana Fonseca
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Kofman YB, Eng ZE, Busse D, Godkin S, Campos B, Sandman CA, Wing D, Yim IS. Cortisol reactivity and depressive symptoms in pregnancy: The moderating role of perceived social support and neuroticism. Biol Psychol 2019; 147:107656. [PMID: 30703466 DOI: 10.1016/j.biopsycho.2019.01.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/09/2019] [Accepted: 01/26/2019] [Indexed: 01/17/2023]
Abstract
Perinatal depression negatively impacts mother-infant health and well-being. Previous work has linked cortisol reactivity to perinatal depressive symptoms, but moderating effects including social support and neuroticism, have not been studied. Forty-nine pregnant women (9-30 weeks' gestational age; GA) provided saliva samples in response to the Trier Social Stress Test (TSST) and to awakening (cortisol awakening response, CAR), and completed questionnaires on perceived social support, personality, and depressive symptoms. Two hierarchical logistic regressions, one including the TSST response and one including the CAR as predictor variables, suggest that cortisol reactivity, social support from the baby's father, and neuroticism contribute to depressive symptoms, controlling for GA (both p < .01). Significant statistical interactions among predictors of pregnancy depressive symptoms were, however, only found in the model using the CAR. Findings highlight the importance of considering biopsychosocial interactions in studies predicting perinatal depressive symptoms.
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Affiliation(s)
- Yasmin B Kofman
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Zoe E Eng
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - David Busse
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Sophia Godkin
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA
| | - Belinda Campos
- Department of Chicano and Latino Studies, University of California, Irvine, 3151 Social Science Plaza, Irvine, CA 92697-5100, USA
| | - Curt A Sandman
- Department of Psychiatry and Human Behavior, University of California, Early Human and Lifespan Development Program, 1 University Drive, Orange, CA 92866, USA
| | - Deborah Wing
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of California, Irvine, 333 City Blvd. West, Suite 1400, Orange CA 92868, USA
| | - Ilona S Yim
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA 92697-7085, USA.
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Padoa T, Berle D, Roberts L. Comparative Social Media Use and the Mental Health of Mothers With High Levels of Perfectionism. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018. [DOI: 10.1521/jscp.2018.37.7.514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Social media is thought to communicate idealized images and discourses of motherhood. As such, it may present as a risk factor for poor mental health in mothers who strive for perfection and compare themselves to the ideals presented on social media. The present study examined the influence of Facebook and In-stagram on the relationship between perfectionism in mothers and their mental health. A sample of 201 mothers completed an online survey. Two dimensions of perfectionism were assessed: Self-Orientated Parenting Perfectionism (SOPP) and Societal-Prescribed Parenting Perfectionism (SPPP). Mediation models were conducted to examine social media frequency and social comparison respectively on the relationship between perfectionism and maternal mental health. Results revealed that for mothers with SOPP, the process of social comparison with other mothers on social media contributed to symptoms of anxiety and depression. The amount of time engaging in social media however, had no impact. In contrast, for mothers with SPPP, the amount of time spent on Facebook contributed to symptoms of depression and anxiety, while the process of social comparison led to anxiety symptoms alone. Social comparison appears to be important for perfectionistic mothers who use social media, as this may contribute to negative mental health outcomes.
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Affiliation(s)
- Tricia Padoa
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - David Berle
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- School of Psychiatry, UNSW Sydney, Australia
| | - Lynette Roberts
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
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Lowndes TA, Egan SJ, McEvoy PM. Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial. Cogn Behav Ther 2018; 48:106-120. [DOI: 10.1080/16506073.2018.1490810] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Sarah J. Egan
- School of Psychology, Curtin University, Perth, Australia
| | - Peter M. McEvoy
- School of Psychology, Curtin University, Perth, Australia
- Centre for Clinical Interventions, Perth, Australia
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The mediating role of intolerance of uncertainty on the relationships between perfectionism dimensions and psychological adjustment/maladjustment among mothers. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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McEvoy K, Osborne LM, Nanavati J, Payne JL. Reproductive Affective Disorders: a Review of the Genetic Evidence for Premenstrual Dysphoric Disorder and Postpartum Depression. Curr Psychiatry Rep 2017; 19:94. [PMID: 29082433 DOI: 10.1007/s11920-017-0852-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to review and summarize the literature exploring the genetic basis for premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD). RECENT FINDINGS There is more evidence for a genetic basis for PPD than for PMDD, but only when PPD is defined as beginning in the immediate postpartum time period. Familial, genome-wide linkage and association studies, and candidate gene studies, most in the past 10 years, have examined the genetic etiology of reproductive affective disorders, including PMDD and PPD. The most commonly studied genes include SERT, COMT, MAOA, BDNF, and ESR1 and 2. This qualitative review of the recent literature finds limited evidence so far for the genetic basis for PMDD, with both familial and candidate gene studies having negative or conflicting results. Evidence is stronger for the genetic basis for PPD, with positive associations found in family studies and in several genes associated with major depression as well as genes involved in estrogen signaling but only when PPD onset is shortly after delivery. Epigenetic biomarkers on genes responsive to estrogen have also been found to predict PPD. Our findings underscore the need for additional studies with larger samples, as well as the crucial importance of timing in the definition of PPD for genetic studies.
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Affiliation(s)
- Katherine McEvoy
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Lauren M Osborne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Julie Nanavati
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA
| | - Jennifer L Payne
- Department of Psychiatry, Women's Mood Disorders Center, Johns Hopkins School of Medicine, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA.
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21
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A longitudinal investigation of perfectionism and repetitive negative thinking in perinatal depression. Behav Res Ther 2017; 97:26-32. [DOI: 10.1016/j.brat.2017.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 05/31/2017] [Accepted: 06/26/2017] [Indexed: 11/17/2022]
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22
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Fonseca A, Canavarro MC. Exploring the paths between dysfunctional attitudes towards motherhood and postpartum depressive symptoms: The moderating role of self-compassion. Clin Psychol Psychother 2017; 25:e96-e106. [PMID: 28960625 DOI: 10.1002/cpp.2145] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 08/21/2017] [Accepted: 08/30/2017] [Indexed: 11/11/2022]
Abstract
Better understanding how cognitive processes operate to influence women's depressive symptoms during the postpartum period is crucial for informing preventive and treatment approaches. The present study aimed to examine the relationship between women's dysfunctional attitudes towards motherhood and depressive symptoms, considering the mediating role of negative automatic thoughts and the moderating role of self-compassion. A sample of 387 women in the postpartum period cross-sectionally answered a set of questionnaires to assess dysfunctional attitudes towards motherhood, negative automatic thoughts (general and postpartum-specific), depressive symptoms, and self-compassion. Women with clinically significant depressive symptoms presented more dysfunctional attitudes towards motherhood, more frequent negative thoughts, and lower self-compassion. More dysfunctional beliefs about others' judgments and about maternal responsibility were associated with higher depressive symptoms, and this effect occurred through both general and postpartum-specific thoughts related to the metacognitive appraisal of the thought content. Moreover, these relationships occurred only when women presented low or moderate levels of self-compassion. These results highlight the need to comprehensively assess women's cognitive variables during the postpartum period with appropriate measures, for the early identification of women with more dysfunctional beliefs about motherhood, who may be at higher risk of depression. Moreover, preventive/treatment approaches should aim not only to challenge women's preexisting dysfunctional beliefs but also to promote a more self-compassionate attitude towards themselves.
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Affiliation(s)
- Ana Fonseca
- Cognitive-Behavorial Center for Research and Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Cognitive-Behavorial Center for Research and Intervention (CINEICC) of the Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Sylvén S, Thomopoulos T, Kollia N, Jonsson M, Skalkidou A. Correlates of Postpartum Depression in First Time Mothers Without Previous Psychiatric Contact. Eur Psychiatry 2016; 40:4-12. [DOI: 10.1016/j.eurpsy.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/08/2016] [Accepted: 07/10/2016] [Indexed: 10/20/2022] Open
Abstract
AbstractBackgroundPostpartum depression (PPD) is a common disorder after childbirth. The strongest known predictors are a history of depression and/or a history of PPD. However, for a significant proportion of women, PPD constitutes their first depressive episode. This study aimed to gain further insight into the risk factors for PPD in first time mothers without previous psychiatric contact.MethodsWomen delivering in Uppsala University Hospital, Sweden, from May 2006 to June 2007, were asked to participate and filled out questionnaires five days and six weeks postpartum, containing inter alia the Edinburgh Postnatal Depression Scale (EPDS). Univariate logistic regression models, as well as a path analysis, were performed to unveil the complex interplay between the study variables.ResultsOf the 653 participating primiparas, 10.3% and 6.4% reported depressive symptoms (EPDS ≥ 12 points) five days and six weeks postpartum, respectively. In the path analysis, a positive association between anxiety proneness and depressive symptoms at five days and six weeks postpartum was identified. For depressive symptoms six weeks after delivery, additional risk factors were detected, namely depressive symptoms five days postpartum and subjective experience of problems with the baby. Caesarean section and assisted vaginal delivery were associated with fewer depressive symptoms at 6 six weeks postpartum.ConclusionsIdentification of anxiety proneness, delivery mode and problems with the baby as risk factors for self-reported depressive symptoms postpartum in this group of primiparas can be important in helping health care professionals identify women at increased risk of affective disorders in the perinatal period, and provide a base for early intervention.
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Hain S, Schermelleh-Engel K, Freitag C, Louwen F, Oddo S. Development of a Short Form of the Personality Styles and Disorder Inventory (PSDI-6). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2016. [DOI: 10.1027/1015-5759/a000260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract. The original Personality Styles and Disorder Inventory (PSDI) consists of 140 items capturing the non-pathological equivalents of 14 personality disorders (PDs) listed in DSM-III-R, DSM-IV-TR, and ICD-10. Because the DSM-5 proposes only six PDs in its research section and completing the PSDI is very time-consuming, a questionnaire capturing these six PDs with a smaller number of items would be desirable. Therefore, the short version PSDI-6 measuring each of the six PDs with six items was developed. Methods: Items were selected by means of exploratory and confirmatory factor analysis (CFA), using a calibration sample of nonclinical pregnant women. Measurement invariance of the PSDI-6 was demonstrated by CFA of multisample models in two independent samples. The PSDI-6 demonstrated acceptable internal consistency, factorial validity, and factorial invariance. Correlations with perfectionism, anxiety, and depression provided preliminary evidence of convergent and discriminant validity. Because our sample was limited to pregnant women, further studies should investigate the PSDI-6 in other clinical contexts.
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Affiliation(s)
- Sarah Hain
- Goethe University, Institute of Psychology, Department of Psychological Research Methods and Evaluation, Frankfurt/Main, Germany
| | - Karin Schermelleh-Engel
- Goethe University, Institute of Psychology, Department of Psychological Research Methods and Evaluation, Frankfurt/Main, Germany
| | - Christine Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt/Main, Germany
| | - Frank Louwen
- Division Obstetrics and Fetomaternal Medicine, University Hospital Frankfurt/Main, Germany
| | - Silvia Oddo
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt/Main, Germany
- Division Obstetrics and Fetomaternal Medicine, University Hospital Frankfurt/Main, Germany
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25
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Luo X, Stavrakakis N, Penninx BW, Bosker FJ, Nolen WA, Boomsma DI, de Geus EJ, Smit JH, Snieder H, Nolte IM, Hartman CA. Does refining the phenotype improve replication rates? A review and replication of candidate gene studies on Major Depressive Disorder and Chronic Major Depressive Disorder. Am J Med Genet B Neuropsychiatr Genet 2016; 171B:215-36. [PMID: 26566975 DOI: 10.1002/ajmg.b.32396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022]
Abstract
Replication has been poor for previously reported candidate genes involved in Major Depressive Disorder (MDD). One possible reason is phenotypic and genetic heterogeneity. The present study replicated genetic associations with MDD as defined in DSM-IV and with a more narrowly defined MDD subtype with a chronic and severe course. We first conducted a systematic review of genetic association studies on MDD published between September 2007 and June 2012 to identify all reported candidate genes. Genetic associations were then tested for all identified single nucleotide polymorphisms (SNPs) and the entire genes using data from the GAIN genome-wide association study (MDD: n = 1,352; chronic MDD subsample: n = 225; controls: n = 1,649). The 1,000 Genomes database was used as reference for imputation. From 157 studies identified inthe literature, 81 studies reported significant associations with MDD, involving 245 polymorphisms in 97 candidate genes, from which we were able to investigate 185 SNPs in 89 genes. We replicated nine candidate SNPs in eight genes for MDD and six in five genes for chronic MDD. However, these were not more than expected by chance. At gene level, we replicated 18 genes for MDD and 17 genes for chronic MDD, both significantly more than expected by chance. We showed that replication rates were improved for MDD compared to a previous, highly similar, replication study based on studies published before 2007. Effect sizes of the SNPs and replication rates of the candidate genes were improved in the chronic subsample compared to the full sample. Nonetheless, replication rates were still poor.
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Affiliation(s)
- Xiaochen Luo
- Interdisciplinary Centre Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nikolaos Stavrakakis
- Interdisciplinary Centre Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda W Penninx
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Department of Psychiatry, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Fokko J Bosker
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Willem A Nolen
- Interdisciplinary Centre Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Eco J de Geus
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Johan H Smit
- Department of Psychiatry, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ilja M Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Catharina A Hartman
- Interdisciplinary Centre Psychopathology and Emotion Regulation (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Oddo-Sommerfeld S, Hain S, Louwen F, Schermelleh-Engel K. Longitudinal effects of dysfunctional perfectionism and avoidant personality style on postpartum mental disorders: Pathways through antepartum depression and anxiety. J Affect Disord 2016; 191:280-8. [PMID: 26688497 DOI: 10.1016/j.jad.2015.11.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 11/17/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is first evidence that some personality characteristics raise the risk of postpartum depression (PPD). The present longitudinal study investigates whether dysfunctional perfectionism and avoidant personality style predict PPD, postpartum anxiety (PPA) and bonding impairment (BI) directly or indirectly through antepartum anxiety (APA) and antepartum depression (APD). METHODS Pregnant women were recruited in two obstetric departments in Germany. The assessment occurred at two measurement time points: In the third trimester of pregnancy (N=297) and twelve weeks postpartum (N=266). Six questionnaires were administered during pregnancy: perfectionism, personality styles, anxiety, and depression. Postpartum, data on PPA, PPD and BI were collected. We conducted two path analyses in order to examine direct and indirect effects of the two personality characteristics on postpartum disorders. RESULTS Testing for direct effects of dysfunctional perfectionism and avoidant personality style on PPD, PPA, and BI did not yield significant results. Instead, significant indirect effects were found: PPD, PPA, and BI were influenced indirectly by dysfunctional perfectionism and avoidant personality style via APD and APA. This model explained high portions of the variance of PPD, PPA, and impaired bonding. Each of the two personality characteristics explained a unique part of the outcome measures. The influence on BI was mediated by PPD. APD affected PPD and PPA more strongly than APA. LIMITATION Path models with manifest (observed) variables may lead to measurement errors. Self-rating questionnaires may raise the problem of social desirability. CONCLUSION Dysfunctional perfectionism and avoidant personality style are significant risk factors for PPD, PPA, and BI. Screenings of both variables, as well as of APA and APD, which mediated the effect of personality traits on postpartum syndromes, are necessary.
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Affiliation(s)
- Silvia Oddo-Sommerfeld
- University Hospital of Frankfurt Division of Obstetrics and Fetomaternal Medicine Theodor-Stern-Kai, 7, 60590 Frankfurt, Germany.
| | - Sarah Hain
- University Hospital of Frankfurt Division of Obstetrics and Fetomaternal Medicine Theodor-Stern-Kai, 7, 60590 Frankfurt, Germany; University of Frankfurt Institute of Psychology PEG, Theodor-W.-Adorno-Platz, 6, 60629 Frankfurt am Main, Germany
| | - Frank Louwen
- University Hospital of Frankfurt Division of Obstetrics and Fetomaternal Medicine Theodor-Stern-Kai, 7, 60590 Frankfurt, Germany
| | - Karin Schermelleh-Engel
- University of Frankfurt Institute of Psychology PEG, Theodor-W.-Adorno-Platz, 6, 60629 Frankfurt am Main, Germany
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Abstract
This article is part of a Special Issue "Parental Care". The postpartum period involves some truly transformational changes in females' socioemotional behaviors. For most female laboratory rodents and women, these changes include an improvement in their affective state, which has positive consequences for their ability to sensitively care for their offspring. There is heterogeneity among females in the likelihood of this positive affective change, though, and some women experience elevated anxiety or depression (or in rodents anxiety- or depression-related behaviors) after giving birth. We aim to contribute to the understanding of this heterogeneity in maternal affectivity by reviewing selected components of the scientific literatures on laboratory rodents and humans examining how mothers' physical contact with her infants, genetics, history of anxiety and depression and early-life and recent-life experiences contribute to individual differences in postpartum affective states. These studies together indicate that multiple biological and environmental factors beyond female maternal state shape affective responses during the postpartum period, and probably do so in an interactive manner. Furthermore, the similar capacity of some of these factors to modulate anxiety and depression in human and rodent mothers suggests cross-species conservation of mechanisms regulating postpartum affectivity.
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Affiliation(s)
- Daniella Agrati
- Department of Physiology and Nutrition, Facultad de Ciencias, Universidad de la Republica, Montevideo, Uruguay.
| | - Joseph S Lonstein
- Neuroscience Program & Department of Psychology, Michigan State University, East Lansing, MI 48824, USA
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Martin-Santos R, Egmond E, Cavero M, Mariño Z, Subira S, Navines R, Forns X, Valdes M. Chronic hepatitis C, depression and gender: a state of art. ADVANCES IN DUAL DIAGNOSIS 2015. [DOI: 10.1108/add-05-2015-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose
– The purpose of this paper is to provide a comprehensive overview of the current knowledge regarding chronic hepatitis C (CHC) infection, antiviral therapy, depression, and gender.
Design/methodology/approach
– CHC and its treatment options were reviewed examining their relationship with depression and gender.
Findings
– CHC is a high prevalent chronic infection worldwide, being similar in men and women. However, the infection shows many gender differences in terms of innate response, genetic variability (i.e. IL-28B), route of transmission (i.e. intravenous drug use), disease progression (i.e. fibrosis), lifetime period (i.e. pregnancy), and risk factors (i.e. HIV). Both the hepatitis C infection and antiviral treatment (especially when using the pro-inflammatory cytokine interferon α), are highly associated with depression, where female gender constitutes a risk factor. It seems that the new direct-acting antiviral combinations produce fewer neuropsychiatric side effects. In fact, the presence of depression at baseline is no longer a limitation for the initiation of antiviral treatment. Antidepressant drugs have been recommended as current depression and prophylactic treatment in risk subgroups. However, caution should be exercised due to the risk of drug-drug interactions with some antiviral drugs. Women should be counselled prenatal, during and after pregnancy, taking into account the clinical situation, and the available evidence of the risks and benefits of antiviral and antidepressant treatments. Multidisciplinary approach shows cost-efficacy results.
Originality/value
– The paper clarifies the complex management of CHC therapy and the importance of individualizing treatment. The results also underline the need for an integrated multidisciplinary approach.
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Iliadis SI, Koulouris P, Gingnell M, Sylvén SM, Sundström-Poromaa I, Ekselius L, Papadopoulos FC, Skalkidou A. Personality and risk for postpartum depressive symptoms. Arch Womens Ment Health 2015; 18:539-46. [PMID: 25369905 DOI: 10.1007/s00737-014-0478-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/18/2014] [Indexed: 11/24/2022]
Abstract
Postpartum depression (PPD) is a common childbirth complication, affecting 10-15 % of newly delivered mothers. This study aims to assess the association between personality factors and PPD. All pregnant women during the period September 2009 to September 2010, undergoing a routine ultrasound at Uppsala University Hospital, were invited to participate in the BASIC study, a prospective study designed to investigate maternal well-being. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) while the Depression Self-Rating Scale (DSRS) was used as a diagnostic tool for major depression. Personality traits were evaluated using the Swedish Universities Scale of Personality (SSP). One thousand thirty-seven non-depressed pregnant women were included in the study. Non-depressed women reporting high levels of neuroticism in late pregnancy were at high risk of developing postpartum depressive symptoms (PPDSs) at 6 weeks and 6 months after delivery, even after adjustment for confounders (adjusted odds ratio (aOR) = 3.4, 95 % confidence interval (CI) 1.8-6.5 and adjusted odds ratio (aOR) = 3.9, 95 % CI 1.9-7.9). The same was true for a DSRS-based diagnosis of major depression at 6 months postpartum. Somatic trait anxiety and psychic trait anxiety were associated with increased risk for PPDS at 6 weeks (aOR = 2.1, 95 % CI 1.2-3.5 and aOR = 1.9, 95 % CI 1.1-3.1), while high scores of mistrust were associated with a twofold increased risk for PPDS at 6 months postpartum (aOR 1.9, 95 % CI 1.1-3.4). Non-depressed pregnant women with high neuroticism scores have an almost fourfold increased risk to develop depressive symptoms postpartum, and the association remains robust even after controlling for most known confounders. Clinically, this could be of importance for health care professionals working with pregnant and newly delivered women.
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Affiliation(s)
- S I Iliadis
- Department of Women's and Children's Health, Uppsala University, Uppsala University Hospital, 751 85, Uppsala, Sweden,
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The Influence of genetic factors on peripartum depression: A systematic review. J Affect Disord 2015; 172:265-73. [PMID: 25451426 DOI: 10.1016/j.jad.2014.10.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/07/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND This systematic review aimed to explore the potential influence of genetic factors on the symptoms of peripartum depression and to critically analyze the methodologies employed by the examined studies. METHODS A systematic review of the literature indexed prior to July 2014 identified 200 articles. After applying the inclusion and exclusion criteria, 39 papers were included. RESULTS The papers predominantly featured a molecular genetic approach (n=35), and the majority examined polymorphisms (n=27). Most studies used samples of Caucasians living in high income countries. The results suggest that the influence of genetic factors become more consistent when methodological variations among the studies are considered. Environmental stressors are also important variables that influence the relationship between genetic factors and peripartum depressive states. In addition, differences in the influence of genetic factors were observed depending upon the precise time point during pregnancy or the postpartum period that was examined in the studies. The late stages of pregnancy and the early postpartum period were times of greater genetic vulnerability. LIMITATIONS This study was limited by the small number of papers reviewed and by the lack of information regarding whether the effects of genetics on peripartum depression are specific to certain ethnicities and/or stressors. CONCLUSIONS Genetic studies of perinatal depression reinforce a pathophysiological role of the hormonal changes inherent in the childbirth period. However, the distinction between depressive episodes that begin during pregnancy from those that begin during the postpartum period can still be useful to improve our understanding of the physiopathology of depressive disorders.
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Was hält Schwangere gesund? Protektive Faktoren für postpartale Depression. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2013. [DOI: 10.13109/zptm.2013.59.4.391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sweeney AC, Fingerhut R. Examining relationships between body dissatisfaction, maladaptive perfectionism, and postpartum depression symptoms. J Obstet Gynecol Neonatal Nurs 2013; 42:551-61. [PMID: 24004109 DOI: 10.1111/1552-6909.12236] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore body dissatisfaction and maladaptive perfectionism as risk factors for postpartum depression symptomatology. DESIGN Prospective, cohort design. SETTING Urban and suburban hospital-based obstetrician and midwifery offices. PARTICIPANTS Forty-six (46) adult ethnically diverse pregnant women with gestational age greater than or equal to 28 weeks. METHOD Body dissatisfaction and maladaptive perfectionism were assessed in the offices of health care providers during the third trimester of pregnancy. Postpartum depression symptomatology was assessed at least 2 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS) via postal mail or e-mail. RESULTS Body dissatisfaction predicted postpartum depression symptoms, even after controlling for previously established risk factors. No main effect emerged between maladaptive perfectionism and postpartum depression symptoms. CONCLUSIONS Body dissatisfaction in the third trimester of pregnancy serves as a risk factor for postpartum depression. Therefore, assessment of body image during the third trimester of pregnancy may help health care providers identify women at risk of postpartum depression. Body dissatisfaction also may be an important target for postpartum depression prevention and treatment programs.
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The role of perfectionism in postpartum depression and symptomatology. Arch Womens Ment Health 2012; 15:459-68. [PMID: 23053217 DOI: 10.1007/s00737-012-0310-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 09/19/2012] [Indexed: 01/03/2023]
Abstract
The role of perfectionism as a correlate and as a predictor of perinatal depressive symptomatology and disorder was examined. Three-hundred and eighty-six pregnant women (mean age = 30.08 years; SD = 4.205; range = 19-44) completed the Portuguese versions of the Multidimensional Perfectionism Scale, Beck Depression Inventory-II/BDI-II and three questions evaluating anxiety trait, life stress and social support perception. Diagnoses of depression were obtained using the Portuguese version of the Diagnostic Interview for Genetic Studies/OPCRIT system. Women who were depressed in pregnancy (ICD-10/DSM-IV) were excluded from the analyses. Self-Oriented Perfectionism and Socially Prescribed Perfectionism subcomponents (Conditional Acceptance and Others' High Standards) were significant correlates of depressive symptomatology/BDI-II in pregnancy. Others' High Standards was a significant predictor of postpartum depressive symptomatology/BDI-II, after controlling the other independent variables (depressive symptomatology and trait anxiety in pregnancy, life stress and social support perception in postpartum). None of the perfectionism subscales predicted postpartum depressive disorder (ICD-10/DSM-IV). Self-Oriented Perfectionism was an important correlate of depressive symptomatology in pregnancy and Others' High Standards and Conditional Acceptance were significant correlates of perinatal depressive symptomatology. Others' High Standards accounted for 0.8 % of the depressive symptomatology variance in postpartum after controlling the effect for other depressive symptomatology correlates. Perfectionism was not a risk factor for postpartum depressive disorder. Our findings improve the knowledge regarding the risk factors implicated in the development of postpartum depressive symptomatology/disorder, which is of utmost importance to develop adequate prevention and intervention strategies.
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