Motherhood: A Discrepancy Theory

Exploring the roles of human values and self-discrepancies in postnatal depression in first-time mothers

OBJECTIVES

Postnatal depression is the most prevalent psychopathology experienced within the perinatal period and has been associated with a range of adverse outcomes for both mother and infant. In the present research, we combine two influential theories, Schwartz's theory of human values and Higgins' self-discrepancy theory (SDT), to test new hypotheses about postnatal depression.

METHODS

We recruited 80 first-time mothers who had given birth within the last 6 months and who self-reported experiencing low mood or postnatal depression. Participants anonymously completed measures of postnatal depression, value importance, self-discrepancies, and subjective value fulfillment.

RESULTS

Contrary to our hypotheses, actual-ought self-discrepancies, but not actual-ideal self-discrepancies, predicted postnatal depression. Interestingly however, self-discrepancies were negatively correlated with value fulfillment. The findings within this study diverge from the relation predicted within SDT and highlight how motherhood may represent a unique circumstance, in which the "ideal self" has evolved to become a self that one feels morally obligated to embody. Further exploratory analyses revealed that depression was predicted by the difference between value fulfillment and value importance in conservation values, but not by differences between value fulfillment and value importance regarding any of the other value types.

DISCUSSION

We discuss potential impact on discourses around motherhood, alongside clinical implications for practitioners who work with mothers during the perinatal period.

Theory Development Strategies for Middle-Range Theories

The purpose of this article is to present an analysis on the theory development strategies that have been used to develop middle-range theories through an integrated literature review and to provide directions for future theoretical development in nursing. First, theory development strategies that have been suggested and used in nursing are briefly discussed. Second, the methods used for the analysis are described. Then, 4 themes reflecting the theory development strategies that have been used to develop middle-range theories are discussed. Finally, suggestions for future theoretical development in nursing are made on the basis of the findings.

Breastmilk Pumping for the Mental Health of the NICU Mother

Objective

While much is known about breastfeeding and postpartum depression, little is known about breast milk pumping's impact on postpartum depression among mothers with infants in the neonatal intensive care unit (NICU).

Methods

Thirty-two mothers of infants admitted to a Level III NICU between February and July 2017 were screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS). They were also surveyed for current breastmilk pumping activities and demographic factors. Multivariable logistic regression was used to assess the associations between postpartum depression and breast milk pumping, adjusting for confounding variables.

Results

After controlling for confounding variables, mothers who did not pump breast milk (relative to mothers who did) were 11 times more likely to have lower EPDS depression scores indicative of probable postpartum depression (OR = 11.7, p-value .05).

Conclusions

Our results suggest a significant reduction in probable postpartum depression among NICU mothers who express breastmilk.

Case Report of the Incidence of Maternal Depression at a Community Level III, 39-Bed NICU

Postpartum depression (PPD) is a vastly undetected, underdiagnosed, and untreated mental health concern for all mothers with infants. Having an infant in the neonatal intensive care unit (NICU) has an even higher impact on mothers’ mental health, predisposing them to a higher rate of PPD. The aim of this project was to identify the incidence of PPD in a Level III NICU to determine appropriate intervention strategies. All mothers with NICU infants 14 to 20 days were invited to complete the 10-question Edinburgh Postnatal Depression Screening (EPDS). The EPDS was scored, and a NICU social worker discussed the results and offered resources for those with scores of ≥10. The incidence of positive screens at our institution was 71.9% for an EPDS score with a cutoff ≥10, and 50% for an EPDS score with a cutoff ≥13. Simple strategies, including routine screening, PPD groups, and NICU support groups, were implemented. All NICUs should know the incidence of mothers’ PPD. Acting on this information flows downstream to improving the health of the infant and family.