1
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Radoš SN, Akik BK, Žutić M, Rodriguez-Muñoz MF, Uriko K, Motrico E, Moreno-Peral P, Apter G, den Berg MLV. Diagnosis of peripartum depression disorder: A state-of-the-art approach from the COST Action Riseup-PPD. Compr Psychiatry 2024; 130:152456. [PMID: 38306851 DOI: 10.1016/j.comppsych.2024.152456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/26/2023] [Accepted: 01/28/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice. METHODS To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis. RESULTS When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications. CONCLUSION There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either "pregnancy onset" or "postpartum onset". Diagnostic criteria for PPD are further discussed.
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Affiliation(s)
- Sandra Nakić Radoš
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | | | - Maja Žutić
- Department of Psychology, Catholic University of Croatia, Zagreb, Croatia
| | - Maria F Rodriguez-Muñoz
- Department of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Kristiina Uriko
- Department of Psychology and Behavioural Sciences, Tallinn University, Tallinn, Estonia
| | - Emma Motrico
- Department of Psychology, Universidad Loyola Andalucia, Seville, Spain
| | - Patricia Moreno-Peral
- Department of Personality, Evaluation and Psychological Treatment, University of Málaga (UMA), Málaga, Spain
| | - Gisèle Apter
- Child and Perinatal Psychiatric Department, Le Havre University Hospital, University Rouen Normandie, Le Havre, France
| | - Mijke Lambregtse-van den Berg
- Departments of Psychiatry and Child & Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands.
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2
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Devouche E, Apter G. [Meeting your baby and becoming a father]. SOINS. PEDIATRIE, PUERICULTURE 2023; 44:12-16. [PMID: 37813515 DOI: 10.1016/j.spp.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
The birth, the moment when the father physically discovers his baby, is essential in the development of fatherhood. Accompanying this encounter during the stay in the postnatal unit leads to a greater commitment to care on the part of the father over the following three months. It therefore seems essential to support him during these first moments, by offering him skin-to-skin contact, for example, or by showing him in practical terms how to provide nursing care for his newborn. Encouraging the development of the father-baby relationship is beneficial for the family alliance that is being built around the cradle.
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Affiliation(s)
- Emmanuel Devouche
- Laboratoire psychopathologie et processus de santé (EA4057), Université Paris Cité, 71 avenue Édouard-Vaillant, 92774 Boulogne-Billancourt cedex, France; Groupe hospitalier du Havre, Université Rouen-Normandie, BP 24, 76083 Le Havre cedex, France.
| | - Gisèle Apter
- Groupe hospitalier du Havre, Université Rouen-Normandie, BP 24, 76083 Le Havre cedex, France
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3
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Gressier F, Glangeaud-Freudenthal NM, Falissard B, Sutter-Dallay AL. Comorbid borderline personality disorders in women with post-partum depression admitted to mother-baby units. J Psychiatr Res 2022; 146:149-155. [PMID: 34982970 DOI: 10.1016/j.jpsychires.2021.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
Borderline personality disorder (BPD) is associated with perinatal depression and parenting difficulties. However, little is known about the characteristics and specific effects of BPD in women with postpartum depression. This study aimed to explore 1) the sociodemographic, mental health characteristics, and motherhood difficulties in women with a major depressive postpartum episode (MDPE) and a comorbid diagnosis of BPD, compared to those with other personality disorders (other PD) or no PD and 2) whether BPD itself may be an independent risk factor for infant neglect in women with a MDPE. 412 women admitted to a Mother and Baby Unit (2001-2010) with a MDPE were involved in this study. Our study showed that women with MDPE-BPD (n = 64) more frequently reported a history of childhood maltreatment, single status, low social support, a history of depression, smoking during pregnancy and suicide attempt during the perinatal period compared to women with other PDs (n = 88) or no PD (n = 260). Women with comorbid BPD had a greater length of stay. Regarding infant care, neglect, abuse, and separation at discharge were more frequent in women with comorbid BPD. Logistic regression was performed to specifically examine whether BPD in women with a MDPE was an independent risk factor for infant neglect during the postpartum period. Comorbid BPD was independently associated with infant neglect (OR = 2.21; CI95% [1.02-4.81]). Our results underline the importance of screening for BPD in women with perinatal depression. Further studies are needed to explore the links between MDPE, BPD, and infant development.
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Affiliation(s)
- Florence Gressier
- CESP, Inserm U1018, University Paris-Saclay, Faculté de Médecine Paris Saclay, Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, 78 rue du Général Leclerc, 94275, Le Kremlin Bicêtre, France.
| | - Nine Mc Glangeaud-Freudenthal
- INSERM Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics (U1153), Paris Descartes University, Paris, France
| | - Bruno Falissard
- Department of Biostatistics, Maison de Solenn, Université Paris Saclay, UVSQ, CESP, Inserm U1018, 97 Bld de Port-Royal, 75679, Paris, Cedex 14, France
| | - Anne-Laure Sutter-Dallay
- Charles Perrens Hospital, Perinatal Psychiatry Network, University Department of Child and Adolescent Psychiatry, Univ. Bordeaux, INSERM, BPH, U1219, F-33000, Bordeaux, France
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4
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Maternal trauma but not perinatal depression predicts infant-parent attachment. Arch Womens Ment Health 2022; 25:215-225. [PMID: 34734355 DOI: 10.1007/s00737-021-01192-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Understanding if maternal depression is a predictor of infant-parent attachment classification is important to furthering knowledge about the early pathways and predictors of socio-emotional development. Yet few studies that have utilised the Strange Situation Procedure, the gold standard for measurement of infant-parent attachment, have examined antenatal depression as a predictor of attachment, and none has also included a measure of maternal trauma. This study uses data on 224 women recruited in early pregnancy and followed up until 12 months postpartum. Maternal depression was measured in pregnancy using the Structured Clinical Interview for the DSM and repeat Edinburgh Postnatal Depression Scale as well as Stressful Life Events scale across pregnancy and postpartum including items on domestic violence. A past history of trauma was measured using the Childhood Trauma Questionnaire. Attachment was measured using the Strange Situation Procedure (SSP) at 12 months postpartum. We found that maternal depression was not associated with insecure or disorganized attachment. However, a maternal history of childhood trauma and current domestic violence both predicted insecure-avoidant attachment at 12 months, whereas increased number of stressful life events prior to conception and in pregnancy was associated with insecure-resistant attachment. Neither trauma, past or current, nor depression predicted disorganized attachment. In the first study to have included measures of antenatal depression, maternal childhood trauma, and current stressful events as predictors of infant attachment measured using the SSP, we found maternal experiences of past and current trauma but not depression were significant predictors of infant-parent attachment security.
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5
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Vitte L, Hauguel C, Benoit V, Genet MC, Letot J, Bruel H, Delaunay F, Le Roux P, Gerardin P, Devouche E, Apter G. Panda Unit, a Mother-Baby Unit Nested in a Neonatal Care Service. Front Psychiatry 2022; 13:889557. [PMID: 36016980 PMCID: PMC9396235 DOI: 10.3389/fpsyt.2022.889557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
The PANDA unit is a full-time mother-baby hospitalization unit based on an original model of care for vulnerable dyads. It is located within a neonatal unit allowing tripartite care (perinatal psychiatry, neonatology and post-natal care). It thus differs from traditional mother-baby units in its close links with the other perinatal care actors, allowing comprehensive health and mental health care in the immediate post-partum period. Patients admitted to the Panda Unit may have been referred during the antenatal period or taken into care in an emergency if the mother's clinical condition requires it, in the aftermath of childbirth. During their stay, the dyads are evaluated daily by a perinatal psychiatrist. This includes assessment of maternal clinical state, the newborn's development and the quality of mother-infant interactions. During the first 6 months of use, 24 dyads have benefited from PANDA care. Three women among 5 were admitted during the antenatal period and almost one-third were aged under 21. The first primary diagnosis during the antepartum was major depressive disorder, two-fold that of personality disorder or bipolar disorder alone. At the end of PANDA stay, close to 3 women among 4 were back to their home with their child, and an out-of-home placement was mandated for 4 infants. PANDA unit is a step toward continuous and comprehensive integrative care. The mother and baby do not leave the maternity ward, and management of mother, baby, and their interactions can start immediately after birth. Considering the importance of the first months of life in the establishment of fundamental links and bonding, PANDA offers an innovative opportunity for what we hope will be both therapeutic and preventive for at-risk dyads. The detection, and ultimately prevention and management of risk of abuse and neglect is another major challenge that this unit hopes to address from the very beginning.
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Affiliation(s)
- Lisa Vitte
- Hospital Group Du Havre, Le Havre, France.,Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Paris, France
| | | | | | - Marie-Camille Genet
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Paris, France.,Service Universitaire de Pédopsychiatrie, Hospital Group Du Havre, Le Havre, France
| | - Jessica Letot
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Paris, France.,Service Universitaire de Pédopsychiatrie, Hospital Group Du Havre, Le Havre, France
| | - Henri Bruel
- Chef de Service Néonatologie, Hospital Group Du Havre, Le Havre, France
| | - Florian Delaunay
- Chef de Pôle Maternité, Hospital Group Du Havre, Le Havre, France
| | - Pascal Le Roux
- Chef de Pôle Pédiatrie, Hospital Group Du Havre, Le Havre, France
| | - Priscille Gerardin
- Faculté de Médecine et de Pharmacie, Université de Rouen, Mont-Saint-Aignan, France
| | - Emmanuel Devouche
- Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Paris, France.,Service Universitaire de Pédopsychiatrie, Hospital Group Du Havre, Le Havre, France
| | - Gisèle Apter
- Service Universitaire de Pédopsychiatrie, Hospital Group Du Havre, Le Havre, France.,Faculté de Médecine et de Pharmacie, Université de Rouen, Mont-Saint-Aignan, France
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6
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Wendelboe KI, Smith-Nielsen J, Stuart AC, Luyten P, Skovgaard Væver M. Factor structure of the parental reflective functioning questionnaire and association with maternal postpartum depression and comorbid symptoms of psychopathology. PLoS One 2021; 16:e0254792. [PMID: 34339422 PMCID: PMC8328297 DOI: 10.1371/journal.pone.0254792] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/04/2021] [Indexed: 02/06/2023] Open
Abstract
Parental reflective functioning (PRF) refers to the parent’s capacity to envision mental states in the infant and in themselves as a parent, and to link such underlying mental process with behavior, which is important for parenting sensitivity and child socio-emotional development. Current findings have linked maternal postpartum depression to impaired reflective skills, imposing a risk on the developing mother–infant relationship, but findings are mixed, and studies have generally used extensive methods for investigating PRF. The present study examined the factor structure and measurement invariance of the Danish version of the 18-item self-report Parental Reflective Functioning Questionnaire (PRFQ) in a sample of mothers with and without diagnosed postpartum depression. Moreover, the association between PRF and maternal postpartum depression in mothers with and without comorbid symptoms of personality disorder and/or clinical levels of psychological distress was investigated. Participants included 423 mothers of infants aged 1–11 months. Confirmatory factor analysis supported a three-factor structure of the PRFQ; however, item loadings suggested that a 15-item version was a more accurate measure of PRF in mothers of infants. Multi-group factor analysis of the 15-item PRFQ infant version indicated measurement invariance among mothers with and without diagnosed postpartum depression. Multinomial logistic regression showed that impaired PRF was associated with maternal psychopathology, although only for mothers with postpartum depression combined with other symptoms of psychopathology. These results provide new evidence for the assessment of maternal self-reported reflective skills as measured by a modified infant version of the PRFQ, as well as a more nuanced understanding of how variance in symptomatology is associated with impaired PRF in mothers in the postpartum period in differing ways.
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Affiliation(s)
- Katrine I. Wendelboe
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Johanne Smith-Nielsen
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Anne C. Stuart
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Mette Skovgaard Væver
- Department of Psychology, Center for Early Intervention and Family Studies, University of Copenhagen, Copenhagen, Denmark
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7
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Stephanie K, Brigitte R. Various mentalizing concepts in mothers with postpartum depression, comorbid anxiety, and personality disorders. Infant Ment Health J 2021; 42:488-501. [PMID: 33759190 DOI: 10.1002/imhj.21914] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mentalization is defined as the human capacity to reflect upon one's own or others' behaviors in terms of underlying mental states and intentions. Several concepts of mentalizing exist, which differ in content, assessment, and clinical prediction. AIMS The present study examines the relationship between the three main concepts of mentalizing, namely, reflective functioning (RF), parental reflective functioning (PRF), and Mind-Mindedness (MM), in mothers with postpartum depression. It was hypothesized that mentalizing concepts differ in their convergent and divergent variance, as well as their clinical validity regarding comorbid anxiety and personality disorders (PDs). METHOD Fifty clinically referred mothers with postpartum depression and infants aged 3-10 months were examined by means of the Reflective Functioning Scale, Parental Reflective Functioning Questionnaire, and Mind-Mindedness Coding-System. RESULTS No significant associations were found between RF and PRF, or between PRF and MM; higher RF was associated with more MM-nonattuned mind-related comments. Increased depression and anxiety were linked to lower PRF in terms of higher PRF-prementalizing. Lower RF, but not PRF, was associated with comorbid PDs. Specifically, obsessive-compulsive PD was associated to considerably fewer MM-nonattuned mind-related comments. CONCLUSION Distinct concepts of mentalizing represent divergent competencies, differentially linked to maternal postpartum psychopathology.
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Affiliation(s)
- Krink Stephanie
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Psychology, University of Münster, Muenster, Germany
| | - Ramsauer Brigitte
- Faculty of medicine, MSH Medical School Hamburg - University of Applied Sciences and Medical University, Hamburg, Germany
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8
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Khalid F, Hirst-Winthrop S. ' Mammy's supposed to be strong and supportive - not sitting in a corner rocking and crying': an interpretative phenomenological analysis of British mothers' experiences of postnatal depression. J Reprod Infant Psychol 2020; 40:299-310. [PMID: 33019805 DOI: 10.1080/02646838.2020.1830540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To gain an in-depth understanding of the lived experience of women with postnatal depression (PND). BACKGROUND Although there is a small body of existing research which explores subjective experience of this phenomenon, relatively little research has been carried out and is prior to the publication of the NICE guidelines for PND in 2007. METHOD Semi-structured interviews were carried out with six mothers (aged 23-40 years), who had taken part in a PND support group. Verbatim transcripts were analysed using Interpretative Phenomenological Analysis (IPA). RESULTS One broad superordinate theme of 'the conflicted mother' emerged from the data, with four corresponding sub-themes (own mother as absent and judgemental; internalised mother; pregnancy on the road to motherhood as an unpleasant stranger; the ideal mother). CONCLUSION It is argued that a broad umbrella construct of 'the conflicted mother' exists in PND experience. This study highlights the importance of the mother's own maternal relationship in living with depression. The authors discuss limitations of the study, make service recommendations to improve current clinical practice for women with PND, and provide future research directions.
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Affiliation(s)
- Farah Khalid
- Department of Behavioural Sciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Sarah Hirst-Winthrop
- UK and Independent Psychological Services Ltd, Formally of Teesside University, Middlesbrough, UK
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9
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Hazell Raine K, Cockshaw W, Boyce P, Thorpe K. Prenatal maternal personality as an early predictor of vulnerable parenting style. Arch Womens Ment Health 2019; 22:799-807. [PMID: 31016471 DOI: 10.1007/s00737-019-00963-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/21/2019] [Indexed: 02/07/2023]
Abstract
Perinatal mental health problems, particularly depression, are prevalent and have been a central focus of prevention initiatives. The greater proportion of ongoing annual perinatal mental health economic cost burdens relate to children. A key linking mechanism is mother-infant relationship quality. Perinatal depression symptoms are typically transient. However, personality style, including interpersonal sensitivity, is a more stable construct and predicts proneness to depression and common mental disorders. Building on our previous work, the objective of the present study is to examine the association between specific dimensions of prenatal interpersonal sensitivity and postpartum mother-infant relationship quality in the context of prenatal depression symptoms. We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Interpersonal sensitivity and depression symptoms were measured at 18 weeks gestation. In a randomly selected 10% subsample of the ALSPAC cohort, mother-infant interaction was measured through standard observation at 12 months postpartum. For the subsample that had complete data at all time points (n = 812), multiple regression models examined prenatal interpersonal sensitivity dimensions predicting postpartum mother-infant relationship quality, accounting for depression symptoms. Two dimensions of maternal interpersonal sensitivity modestly predicted mother-infant relationship quality at 12 months postpartum and remained robust when we controlled for depression symptoms. The interpersonal sensitivity subscales were significantly associated with prenatal depression symptoms but more consistently and robustly predicted postnatal mother-infant interaction quality. The inclusion of personality measures may strengthen prenatal mental health assessment to identify vulnerability to suboptimal mother-infant relationship quality.
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Affiliation(s)
- Karen Hazell Raine
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karen Thorpe
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
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10
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Ramsauer B, Mühlhan C, Lotzin A, Achtergarde S, Mueller J, Krink S, Tharner A, Becker-Stoll F, Nolte T, Romer G. Randomized controlled trial of the Circle of Security-Intensive intervention for mothers with postpartum depression: maternal unresolved attachment moderates changes in sensitivity. Attach Hum Dev 2019; 22:705-726. [PMID: 31726954 DOI: 10.1080/14616734.2019.1689406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Postpartum depression is related to inadequately sensitive caregiving, putting infants at risk for insecure attachment. Therefore, promoting sensitive maternal caregiving and secure child attachment is particularly important in postpartum depressed mothers and their infants. In this randomized-controlled-trial, we evaluated the efficacy of the Circle of Security-Intensive (COS-I)-intervention in supporting maternal sensitivity and mother-infant-attachment compared to treatment-as-usual (TAU) with unresolved-maternal attachment as a moderator of treatment effect. Eligible mothers with infants (N=72) 4-9 months-old were randomly assigned to treatment (n=36 dyads). Infant attachment was rated at follow-up (child age 16-18 months) (Strange-Situation-procedure). Maternal sensitivity was measured at baseline and follow-up (Mini-Maternal-Behavior-Q-sort). Maternal-unresolved-attachment was assessed at baseline (Adult-Attachment-Interview). We found no significant differences between treatments in infant attachment nor changes in mothers' sensitivity. However, in COS-I, unresolved-mothers exhibited significantly more change in sensitivity than non-unresolved-mothers, whereas in TAU, the opposite was true. These findings may help to optimize clinical use of COS-I.
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Affiliation(s)
- Brigitte Ramsauer
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Christine Mühlhan
- Medical School Hamburg MSH, University of Applied Sciences and Medical University , Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Sandra Achtergarde
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Jessica Mueller
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Stephanie Krink
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
| | - Anne Tharner
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam , Amsterdam, The Netherlands
| | | | | | - Georg Romer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Muenster , Muenster, Germany
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11
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Hazell Raine K, Nath S, Howard LM, Cockshaw W, Boyce P, Sawyer E, Thorpe K. Associations between prenatal maternal mental health indices and mother-infant relationship quality 6 to 18 months' postpartum: A systematic review. Infant Ment Health J 2019; 41:24-39. [PMID: 31524300 DOI: 10.1002/imhj.21825] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Maternal mental disorders can significantly impact on children's psychosocial and psychological development, incurring substantial ongoing economic and personal costs. A key mediating mechanism is mother-infant relationship quality (MIRQ). Research studies and perinatal mental health screening initiatives have predominantly focused on depressive symptoms and perinatal depression as predictors of MIRQ. While maternal depression is associated with suboptimal MIRQ, the findings have not been consistent. Personality characteristics are associated with parenting and proneness to depression, presenting a potential addition to prenatal mental health assessment. We conducted a systematic review of studies that have examined the link between prenatal depressive symptoms and/or personality characteristics with postnatal MIRQ. Our findings suggest that both maternal personality traits and depressive symptoms measured in early pregnancy are associated with postnatal MIRQ. A measure of personality characteristics may enhance prenatal mental health assessment, affording opportunities for targeted intervention commencing in pregnancy to improve MIRQ, parenting, maternal mental health outcomes, and infant psychosocial and psychological development, and thereby contributing to the reduction of human and economic cost burdens.
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Affiliation(s)
- Karen Hazell Raine
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Selina Nath
- Section of Women's Mental Health, King's College, London, United Kingdom
| | - Louise M Howard
- Section of Women's Mental Health, King's College, London, United Kingdom
| | - Wendell Cockshaw
- School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Emily Sawyer
- Faculty of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Karen Thorpe
- Institute for Social Science Research, University of Queensland, Queensland, Australia
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12
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Affiliation(s)
- Philip M Boyce
- Westmead Hospital Sydney NSW
- Westmead Clinical SchoolUniversity of Sydney Sydney NSW
| | - Fiona Judd
- University of Melbourne Melbourne VIC
- Child and Adolescent Mental Health Services South Hobart TAS
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13
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Apter G, Bobin A, Genet MC, Gratier M, Devouche E. Update on Mental Health of Infants and Children of Parents Affected With Mental Health Issues. Curr Psychiatry Rep 2017; 19:72. [PMID: 28831672 DOI: 10.1007/s11920-017-0820-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This paper highlights the most recent publications, in the field of psychiatry, on offspring of patients with psychiatric illnesses such as schizophrenia and bipolar disorder, and then summarizes what we know about the progeny of adults with mood disorders, the most prevalent of parental disorders. Studies examining personality disorders and contextual factors such as stress and trauma are examined with a focus on the crucial question of development and attachment status in children. Findings converge to reveal that offspring of parents (generally mothers) with most major psychiatric disorders present a higher risk for all mental disorders, and a wide range of disorders are also found in children, adolescent, and finally adult offspring of mothers with mood and anxiety disorders. Developmental psychopathology and infant and child psychiatry have focused on early relationship formation through social interaction and attachment patterns as pathways affected by vulnerability or resilience factors. First year of life longitudinal studies following mothers and infants has shown that maternal psychopathology is positively correlated with higher risk of attachment issues. It would seem that pathology appears when adaptation to real-life contexts becomes difficult in association with an accumulation of negative individual characteristics and environmental circumstances. We suggest that in order to move forward psychiatry should embrace a developmental cascade model, which posits a cumulative pathway for the emergence of psychopathology in the developing child. We propose that we have sufficient knowledge today to start implementing multilevel approaches to enhance the health and mental health of the next generation.
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Affiliation(s)
- Gisèle Apter
- Erasme Hospital, Psychiatry and Psychopathology Research Institute, 143 Avenue Armand Guillebaud, 92160, Antony, France.
| | - Anne Bobin
- Erasme Hospital, Psychiatry and Psychopathology Research Institute, 143 Avenue Armand Guillebaud, 92160, Antony, France
- EA 3456 - LABORATOIRE ETHOLOGIE COGNITION DEVELOPPEMENT (LECD), Paris Ouest Nanterre University, 200 avenue de la République, 92001, Nanterre Cedex, France
| | - Marie-Camille Genet
- Erasme Hospital, Psychiatry and Psychopathology Research Institute, 143 Avenue Armand Guillebaud, 92160, Antony, France
| | - Maya Gratier
- Erasme Hospital, Psychiatry and Psychopathology Research Institute, 143 Avenue Armand Guillebaud, 92160, Antony, France
- EA 3456 - LABORATOIRE ETHOLOGIE COGNITION DEVELOPPEMENT (LECD), Paris Ouest Nanterre University, 200 avenue de la République, 92001, Nanterre Cedex, France
| | - Emmanuel Devouche
- Erasme Hospital, Psychiatry and Psychopathology Research Institute, 143 Avenue Armand Guillebaud, 92160, Antony, France
- Laboratoire de Psychopathologie et Processus de Santé (EA 4057), Paris Descartes University, 71 avenue Edouard Vaillant, 92774, Boulogne-Billancourt Cedex, France
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Lowenhoff C, Appleton JV, Davison-Fischer J, Pike N. NICE guideline for antenatal and postnatal mental health: The health visitor role. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/johv.2017.5.6.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Catherine Lowenhoff
- PhD student, Department of Psychology, Social Work and Public Health, Oxford Brookes University
| | - Jane V Appleton
- Professor of primary and community care, Oxford Brookes University
| | | | - Nick Pike
- Research visiting fellow in social work, Oxford Brookes University
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15
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Apter G, Devouche E, Garez V, Valente M, Genet MC, Gratier M, Dominguez S, Tronick E. The Still-Face: A Greater Challenge for Infants of Mothers With Borderline Personality Disorder. J Pers Disord 2017; 31:156-169. [PMID: 27088165 DOI: 10.1521/pedi_2016_30_243] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The main aim of this study was to ascertain whether infants as young as 3 months of age, whose mothers suffer from borderline personality disorder (BPD), are already at risk of greater dysregulation than infants of mothers without BPD when faced with a minor stressful experience. Nineteen mothers diagnosed with BPD and 41 controls with no history of psychopathology and their 3-month-old infants were observed using Tronick's Face-to-Face Still-Face paradigm. The authors found that infants whose mothers have BPD express less positive vocalizations and less nonautonomic self-regulation than infants of mothers with no psychopathology. The stress of the Still-Face episode affects their gaze and self-regulation behaviors more strongly than those of infants of controls. The Reunion episode seems particularly challenging for mothers with BPD, who show fewer smiles and an increase in intrusive behavior. Because infants and their mothers with BPD are already dysregulated at 3 months postpartum, envisaging very early intervention seems warranted.
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Affiliation(s)
- G Apter
- Psychiatry and Psychopathology Research Institute, Erasme Hospital, Antony, France.,Paris Diderot University
| | - E Devouche
- Psychiatry and Psychopathology Research Institute, Erasme Hospital, Antony, France.,Paris Descartes University
| | - V Garez
- Psychiatry and Psychopathology Research Institute, Erasme Hospital, Antony, France
| | - M Valente
- Psychiatry and Psychopathology Research Institute, Erasme Hospital, Antony, France
| | - M-C Genet
- Psychiatry and Psychopathology Research Institute, Erasme Hospital, Antony, France
| | - M Gratier
- Psychiatry and Psychopathology Research Institute, Erasme Hospital, Antony, France.,Paris Ouest Nanterre University, Nanterre, France
| | - S Dominguez
- Paris Ouest Nanterre University, Nanterre, France
| | - E Tronick
- Department of Psychology, University of Massachusetts, Boston.,Department of Newborn Medicine, Harvard Medical School, Boston, Massachusetts
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16
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Moraes GPDA, Lorenzo L, Pontes GAR, Montenegro MC, Cantilino A. Screening and diagnosing postpartum depression: when and how? TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 39:54-61. [DOI: 10.1590/2237-6089-2016-0034] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
Abstract Introduction: Prevalence rates of postpartum depression (PPD) vary widely, depending on the methodological parameters used in studies: differences in study populations, diagnostic methods, and postpartum time frame. There is also no consensus on the ideal time to perform screening, on whether PPD can only be diagnosed in the early postnatal period, or on how soon after a delivery depression may be related to it. Objective: To review which instruments have been used over recent years to screen and diagnose PPD and the prevailing periods of diagnosis. Methods: Only articles published within 5 years and related exclusively to screening and diagnosis were selected. The sample comprised 22 articles. Results: The Edinburgh Posnatal Depression Scale (EPDS) was the most common screening tool, used in 68% of the sample (15 articles), followed by the Beck Depression Inventory (BDI-II) (27%, 6 articles), and the Patient Health Questionnaire-9 (PHQ-9) (18%, 4 articles). Screening time frame was reported in 21/22 articles: 0 to 3 months postpartum in 9 (43%), up to 6 months in 4 (19%), and up to 12 months or more in 8 (38%). In short, 13 articles screened during the first 6 months (59%) while only 8 (36%) screened up to 1 year. Conclusion: The most frequent PPD diagnosis tool was the EPDS, but other scales were also used. The most common period for diagnosis was up to 3 months postpartum. However, some researchers diagnosed PPD 12 months or more postpartum. Greater standardization of parameters for investigation of this disease is needed.
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17
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Smith-Nielsen J, Tharner A, Steele H, Cordes K, Mehlhase H, Vaever MS. Postpartum depression and infant-mother attachment security at one year: The impact of co-morbid maternal personality disorders. Infant Behav Dev 2016; 44:148-58. [DOI: 10.1016/j.infbeh.2016.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 05/22/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
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18
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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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Smith-Nielsen J, Steele H, Mehlhase H, Cordes K, Steele M, Harder S, Væver MS. Links Among High EPDS Scores, State of Mind Regarding Attachment, and Symptoms of Personality Disorder. J Pers Disord 2015; 29:771-93. [PMID: 25562537 DOI: 10.1521/pedi_2014_28_173] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Underlying persistent psychological difficulties have been found to moderate potential adverse effects of maternal postpartum depression (PPD) on parenting and infant development. The authors examined whether mothers presenting postpartum depressive symptoms showed higher levels of personality pathology and more insecure state of mind regarding attachment compared to nondepressed mothers. Participants (N = 85) were assessed with the Edinburgh Postnatal Depression Scale (EPDS), the Present State Examination, the Adult Attachment Interview, and the Structured Clinical Interview for DSM-IV Axis II. Mothers with high EPDS scores were more likely to have a preoccupied insecure state of mind and to have personality disorder compared with mothers scoring below clinical cutoff. Furthermore, multiple regression analysis showed that personality disorder and AAI classification were independently related to EPDS score, and that these two factors together accounted for 48% of the variance in EPDS score. Findings are discussed in terms of heterogeneity in PPD populations and underline the importance of examining potential coexisting psychological difficulties when studying PPD.
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20
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Khajehei M. Mental health of perinatal women. World J Obstet Gynecol 2015; 4:46-51. [DOI: 10.5317/wjog.v4.i2.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/06/2015] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
Pregnancy and childbirth are major stressors for some women. They can be followed by deterioration in mental health status and cause mental illnesses during perinatal period. Undetected and untreated perinatal mental illnesses can have negative unexpected impacts on parenting skills of the women and children’s development. Mentally ill mothers may not effectively attend their children’s needs in a timely manner and may experience an unfavourable mother-child attachment affecting the child’s language, social, emotional and cognitive development. The rate of pregnancy and postnatal health complications and interventions is higher among mentally ill women with some certain risk factors. The mentally ill mothers along with their partners need comprehensive support and counselling to be able to care for their infants and establish strong parent-child bond and attachment. Mental health campaigns across the world have endeavoured to increase the knowledge and awareness of the public towards perinatal mental health illnesses. To this aim, a routine screening is recommended in order to identify the women who are at risk of mood or anxiety disorder during perinatal period. The development of knowledge on perinatal mental illnesses among public and the health professionals has resulted in timely recognition and treatment of perinatal mental illnesses. Although great volumes of research show high prevalence of perinatal mental illnesses and their impacts on parenting confidence and competence as well as child’s developmental process, there is still lack of research on various aspects of perinatal mental illnesses. To enable early prevention, diagnosis and intervention, it is crucial to identify families who are at an increased risk of perinatal mental illnesses and provide support and intervention to minimise the adverse outcomes. The children’s needs may not be met by providing treatment to parental mental illnesses alone. It is also important to understand the impact of specific parenting behaviours on child outcomes which is modified by the quality of parenting.
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21
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Kettunen P, Koistinen E, Hintikka J. Is postpartum depression a homogenous disorder: time of onset, severity, symptoms and hopelessness in relation to the course of depression. BMC Pregnancy Childbirth 2014; 14:402. [PMID: 25491477 PMCID: PMC4279462 DOI: 10.1186/s12884-014-0402-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/20/2014] [Indexed: 11/19/2022] Open
Abstract
Background Postpartum depression (PPD) is a common illness, but due to the underlying processes and the diversity of symptoms, some variability is exhibited. The risk of postpartum depression is great if the mother has previously suffered from depression, but there is some evidence that a certain subgroup of women only experience depression during the postpartum period. Methods The study group consisted of 104 mothers with postpartum major depression and a control group of 104 postpartum mothers without depression. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used for data collection. The severity of depression and other mental symptoms were assessed using several validated rating scales. Results A history of past depression (82%), including depression during pregnancy (42%) and during the postpartum period (53%), was very common in those with current PPD. Eighteen per cent of mothers with current PPD had previously not had any depressive episodes and four per cent had experienced depression only during the postpartum period. Therefore, pure PPD was rare. The onset of PPD was usually (84%) within six weeks of childbirth. Obsessive-compulsive symptoms, phobic anxiety, paranoid ideation, depressed mood, diminished pleasure/interest, decreased energy, and psychomotor agitation/retardation were common with all kinds of depression histories. Pure PPD was the most similar to the first depressive episode. Nevertheless, the severity of depression, the level of hopelessness, somatisation, interpersonal sensitivity, anxiety, hostility, psychoticism, sleep disturbance, and suicidal ideation were lower, appetite changed less, and concentration was better than in other recurrent depressions. Conclusions According to this study, PPD is not a homogenous disorder. The time of onset, severity, symptoms, level of hopelessness, and the course of depression vary. Recurrent depression is common. All mothers must be screened during the sixth week postpartum at the latest. Screening alone is not effective; it is also important to give mothers information about PPD and to discuss the symptoms with them in order for them to recognise this disorder and possible new episodes in the future.
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Affiliation(s)
- Pirjo Kettunen
- Department of General Hospital Psychiatry, North Karelia Central Hospital, Joensuu, Finland.
| | - Eeva Koistinen
- Department of Obstetrics and Gynecology, North Karelia Central Hospital, Joensuu, Finland.
| | - Jukka Hintikka
- School of Medicine, University of Tampere, Lahti, Finland. .,Department of Psychiatry, Paijat-Hame Central Hospital, Lahti, Finland.
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Garez V, Apter G, Valente M, Golse B, Devouche E. Genre du bébé et trouble de la personnalité borderline maternel : quel impact sur l’interaction mère-bébé à 3 mois du postpartum ? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.neurenf.2013.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Genet MC, Golse B, Devouche E, Apter G. Psychopathologie, attachement et devenir des enfants de mères présentant un trouble de personnalité borderline/état-limite : une revue de la littérature. PSYCHIATRIE DE L ENFANT 2014. [DOI: 10.3917/psye.571.0259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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