Psychological factors associated with persistent postnatal depression: past and current relationships, defence styles and the mediating role of insecure attachment style

BACKGROUND

This study prospectively investigated the factors underlying the maintenance and persistence of postnatal depression beyond the first year after birth.

METHOD

One hundred primiparous women who were admitted to a parentcraft hospital for a week were assessed after discharge at 4 and 12 months postpartum. Various measures of mood, interpersonal relationships and defence styles were administered at 4 months and the relation between these measures and clinically elevated symptoms of depression at 12 months was examined.

RESULTS

At 12 months, 30% of all mothers and 60% of those diagnosed depressed at 4 months continued to report clinically significant levels of depressive symptomatology. The strongest predictor of depression at 12 months was severity of symptoms at 4 months, and women from a non-English speaking background were significantly more likely to remain depressed. Reports of low maternal care in childhood, marital dissatisfaction at 4 months, an attachment style characterised by anxiety over relationships and immature defence styles were significant predictors of clinically elevated depression scale scores at 12 months. Furthermore, an insecure attachment style was shown to mediate the effect of low maternal care in childhood, while other cognitive and interpersonal factors appeared to contribute additively in maintaining depressive symptoms.

LIMITATIONS

Self-report measures were used to measure insecure attachment styles and depression at 12 months.

CONCLUSIONS

Findings demonstrate that both childhood and concurrent relationship difficulties contribute to the maintenance of postpartum depression. Interventions for persistent depression need to address relationship difficulties as well as depressive symptomatology.

Drug-induced extrapyramidal reactions

A child with psychotic symptoms and attention-deficit hyperactivity disorder who developed extrapyramidal symptoms while on a combination of risperidone, methylphenidate, sertraline, tropisetron and ketorolac is described herein. The extrapyramidal symptoms resolved with the administration of benztropine, an anticholinergic drug. Successful treatment of his psychosis was achieved by decreasing the dose of risperidone, followed by slow upward titration.

Postnatal depression, anxiety and unsettled infant behaviour

OBJECTIVE

This study compares maternal mood, marital satisfaction and infant temperament in 128 mothers admitted to the residential care unit of a parentcraft hospital and 58 mothers in a demographically matched group.

METHOD

Mothers were recruited from the residential care unit of a parentcraft hospital (Tresillian Family Care Centres) and a comparison group from a private obstetric practice in the same demographic area. Both groups completed self-report questionnaires on depression, anxiety and marital adjustment, while mothers in the residential care group also received a structured diagnostic interview for depression (CIDI).

RESULTS

Sixty-two per cent of mothers in the residential care group met diagnostic criteria for a major depressive episode occurring since childbirth and a further 13% met DSM-IV research criteria for minor depression. The residential care group also scored significantly higher on both state and trait anxiety and rated their infants as significantly more temperamentally difficult than did the comparison group.

CONCLUSIONS

This study replicates a previous Australian finding of a high incidence of maternal mood disorders in mothers admitted to parentcraft hospitals. Acknowledgement of the close association between maternal mood state and unsettled infant behaviour facilitates an integrated multidisciplinary approach offering appropriate management for both mothers and infants. Residential care units may be ideally suited to provide such early intervention strategies in a non-stigmatizing environment, but provision of adequate staff support, mental health consultation, education and skills in managing mental health problems in these settings is important.