Controlled prospective study of postpartum mood disorders: Psychological, environmental, and hormonal variables.

Demographic, psychiatric, social, cognitive, and life stress variables were used to determine the etiology of depression in childbearing (CB; n?=?182) and nonchildbearing (NCB; n?=?179) women. Hormonal variables in postpartum depression were also evaluated. In the CB group predictors of depression diagnosis were previous depression, depression during pregnancy, and a Vulnerability (V)?×?Life Stress (LS) interaction; predictors of depressive symptomatology were previous depression, depressive symptoms during pregnancy, life events, and V?×?LS. Only estradiol was associated with postpartum depression diagnosis. In the NCB group V?×?LS was the only predictor of depression diagnosis; depressive symptoms during pregnancy and life events were predictors of depressive symptomatology. Previous findings about depression vulnerability were replicated. The significant V?×?LS interactions support the vulnerability-stress model of postpartum depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective study of postpartum depression: Prevalence, course, and predictive factors.

[Correction Notice: An erratum for this article was reported in Vol 94(2) of Journal of Abnormal Psychology (see record 2008-10964-001). Much of the data reported in Tables 4 and 5 are incorrect. Most of the errors are small and they do not affect the p values shown in the tables, with three exceptions which are provided in the erratum.] 99 women (mean age 26.5 yrs) were followed from the 2nd trimester of pregnancy until about 6 mo postpartum. Depression diagnostic and severity assessments were conducted during pregnancy and after delivery. Instruments included the Beck Depression Inventory and an interview adapted from the Schedule of Affective Disorders and Schizophrenia. Depression severity decreased steadily from the 2nd trimester until 9 wks postpartum. Approximately 9% of the Ss during pregnancy and 12% of the Ss during the postpartum period were diagnosed as having a major or minor depression. A model of depression was constructed to account for both postpartum depression symptomatology and the syndrome of postpartum depression. Predictor variables (e.g., prepartum depression symptomatology, obstetric risk factors) accounted for about 50% of the variance in depressive symptomatology. Predictor variables (e.g., depression history, stressful childcare events) accounted for about 30% of the variance in diagnostic status. Findings underscore the importance of studying changes in depression diagnostic status as well as changes in level of depressive symptomatology in prospective studies. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Prospective study of postpartum depression: Prevalence, course, and predictive factors": Correction.

Reports an error in "Prospective study of postpartum depression: Prevalence, course, and predictive factors" by Michael W. O'Hara, Danny J. Neunaber and Ellen M. Zekoski (Journal of Abnormal Psychology, 1984[May], Vol 93[2], 158-171). Much of the data reported in Tables 4 and 5 are incorrect. Most of the errors are small and they do not affect the p values shown in the tables, with three exceptions which are provided in the erratum. (The following abstract of the original article appeared in record 1984-23277-001.) 99 women (mean age 26.5 yrs) were followed from the 2nd trimester of pregnancy until about 6 mo postpartum. Depression diagnostic and severity assessments were conducted during pregnancy and after delivery. Instruments included the Beck Depression Inventory and an interview adapted from the Schedule of Affective Disorders and Schizophrenia. Depression severity decreased steadily from the 2nd trimester until 9 wks postpartum. Approximately 9% of the Ss during pregnancy and 12% of the Ss during the postpartum period were diagnosed as having a major or minor depression. A model of depression was constructed to account for both postpartum depression symptomatology and the syndrome of postpartum depression. Predictor variables (e.g., prepartum depression symptomatology, obstetric risk factors) accounted for about 50% of the variance in depressive symptomatology. Predictor variables (e.g., depression history, stressful childcare events) accounted for about 30% of the variance in diagnostic status. Findings underscore the importance of studying changes in depression diagnostic status as well as changes in level of depressive symptomatology in prospective studies. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonpsychotic postpartum depression among adolescent mothers.

This study examined the extent to which childbearing increases vulnerability to clinical depression and depressive symptomatology among primiparous adolescent girls (ages 14 to 18). Childbearing Ss (n?=?128) were assessed during pregnancy, 6 weeks postpartum, and 1 year postpartum. Matched nonchildbearing Ss (n?=?114) were assessed at corresponding time points. Six weeks postpartum, 6% of the childbearing adolescents met Research Diagnostic Criteria for major depression and 20% for minor depression. These rates were not significantly different from those found for nonchildbearing Ss (4% major depression, 10% minor depression). However, higher rates of somatic symptoms of depression were found among the childbearing Ss than among the nonchildbearing Ss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum.

Examined the prevalence of depression in a heterogeneous sample of 360 pregnant women. Subjects were assessed with respect to both depressive symptomatology and diagnostic status during pregnancy and after delivery. At both assessments, approximately 25% of the sample reported elevated levels of depressive symptomatology. In contrast, 10% of the women met diagnostic criteria for depression during pregnancy, and 6.8% were depressed postpartum. However, only half of the cases of postpartum depression were new onset (3.4%); the remaining women receiving a diagnosis in the postpartum had also been depressed during pregnancy. Finally, depression during pregnancy was related to different sociodemographic variables than was postpartum depression, suggesting that depression at these two times may be associated with different psychological or etiological factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with a diagnosis of multiple sclerosis.

Examined the relation between coping and depression in 38 women and 12 men (aged 21–58 yrs) recently diagnosed with multiple sclerosis (MS). A semistructured interview was used to assess how Ss coped with the onset of disabling illness, and to assess depressive symptomatology. According to Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria, 18 Ss were diagnosed with major depression, 11 Ss were diagnosed with adjustment disorder with depressed mood, and 21 Ss did not satisfy the criteria for any affective disorder. Interview results indicate that nondepressed Ss were more likely to use present focus and avoidance/denial strategies to deal with illness onset than Ss with major depression or adjustment disorder. Discussion addresses why these strategies may be an adaptive means of dealing with the onset of MS. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vulnerability to postpartum depression: A prospective multivariate study.

A sample of 115 primiparous women was assessed during pregnancy and the postpartum to identify the predictors and correlates of postpartum depression. The variables considered were marital adjustment, attributional style, life stress, maternal expectations for and perceptions of infant behavior, and blues symptoms. The data obtained at each assessment were submitted to principal-components analyses to identify variable clusters or constructs, which were used to predict both depressive symptom levels and a diagnosis of depression. Concurrently, symptoms and diagnosis were related to mothers' perceptions of their infants as temperamentally difficult. Prospectively, depressive symptomatology was predicted by low marital adjustment and depressed mood during pregnancy, optimistic expectations for infants, prepartum life stress, and early postpartum symptoms of anxiety and cognitive impairment. Although diagnostic status was related to a subset of these variables, results indicate that depressive symptom levels and diagnosis are not synonymous measures of the construct "postpartum depression." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship adjustment, depression, and anxiety during pregnancy and the postpartum period.

The associations between relationship adjustment and symptoms of depression and anxiety were evaluated in a sample of pregnant married or cohabiting women (N = 113) who were at risk for perinatal depression because of a prior history of major depression. Women completed self-report measures of relationship adjustment, depressive symptoms, and anxiety symptoms monthly during pregnancy and for the first six months following the birth of their child. Multilevel modeling was used to examine concurrent and time-lagged within-subjects effects for relationship adjustment and depressive and anxiety symptoms. Results revealed that (a) relationship adjustment was associated with both depressive symptoms and anxiety symptoms in concurrent analyses; (b) relationship adjustment was predictive of subsequent anxiety symptoms but not subsequent depressive symptoms in lagged analyses; and (c) depressive symptoms were predictive of subsequent relationship adjustment in lagged analyses with symptoms of depression and anxiety examined simultaneously. These results support the continued investigation into the cross-sectional and longitudinal associations between relationship functioning and depressive and anxiety symptoms in women during pregnancy and the postpartum period. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Blood pressure lowering effect of low intensity aerobic training in elderly hypertensive patients

OBJECTIVE: The prevalence and etiology of pre- and postpartum depressive symptoms in women in a variety of family forms have been well documented, but relatively little research has been conducted on the adjustment of their male partners. The authors' goals in this study were 1) to estimate rates of depression during the pregnancy and 8 weeks following the birth of a child in a large representative community sample of fathers in different family structures and 2) to explore the role of stressful life events, social and emotional support, the quality of the partner relationship, and socioeconomic circumstances. METHOD: This study describes the relations of family setting and other correlates to men's depressive symptoms during the pregnancies (18 weeks gestation, on average) and 8 weeks after the births of children for 7,018 partners of female participants in the Avon Longitudinal Study of Pregnancy and Childhood. RESULTS: Men living in stepfamilies had-significantly higher levels of depressive symptoms before and after the birth than did men in more traditional families. The effect of stepfamily status on depression was mediated by education, life events, social support, social network, and level of aggression in the partnership. CONCLUSIONS: There are similarities in the patterns and correlates of depression after the birth of a child for men and women. These findings point to the importance of family and partnership ecology in the adjustment of men before and after the birth of a child.     

Social support, life events, and depressive symptoms: A 1-year prospective study.

Examined associations between life events, social support, and depressive symptoms in a sample of 709 married women. Ss were administered the SCL-90, a life events scale, a social support scale, and a marital conflict scale in 1981 and again 1 yr later. For a sample of 473 Ss who initially were relatively asymptomatic and reported nonconflicted marital relationships, life events and social support were significant prospective predictors of depressive symptomatology (assessed 1 yr later). In contrast, identical analyses performed on the full, unselected sample yielded discrepant, likely misleading, results. The implications of these findings for the longitudinal study of dynamically interactive processes are discussed. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional style and depression in rheumatoid arthritis: The moderating role of perceived illness control.

Examined the moderating influence of perceived daily illness control on the relationship between disease-unrelated causal attributions and Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) depressive symptomatology in a sample of 58 patients (aged 25–75 yrs) with rheumatoid arthritis (RA). Eight of the Ss met DSM-IV criteria for major depression. All Ss completed paper-and-pencil instruments measuring depression, attributional style, arthritis-specific helplessness, disease severity and pain and disability. As predicted, attribution?×? perceived control interactions contributed significant variance to depression, after controlling for disease variables and arthritis helplessness. Specifically, internal and global attributions for negative events were associated with increased levels of depression under conditions of decreased perceived illness control. The findings provide support for examining general attributional style in studies of depression in RA and for cognitive diathesis-stress conceptualizations of adjustment to chronic illness. Clinical implications of the results for cognitive-behavioral treatment approaches in RA are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief cognitive-behavioral depression prevention program for high-risk adolescents outperforms two alternative interventions: A randomized efficacy trial.

In this depression prevention trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater reductions in depressive symptoms than did supportive-expressive, bibliotherapy, and assessment-only participants at posttest, though only the difference compared with assessment controls was significant at 6-month follow-up. CB participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than did participants in all 3 other conditions. Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than did assessment-only controls at certain follow-up assessments but produced no effects for social adjustment and substance use. CB, supportive-expressive, and bibliotherapy participants showed a significantly lower risk for major depression onset over the 6-month follow-up than did assessment-only controls. The evidence that this brief CB intervention reduced risk for future depression onset and outperformed alternative interventions for certain ecologically important outcomes suggests that this intervention may have clinical utility. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal follow-up of unipolar depressives: An investigation of predictors of relapse.

Conducted longitudinal interval follow-up evaluations, using the method described by R. Shapiro and M. Keller (unpublished), with 113 19–60 yr old unipolar depressives who had completed a cognitive-behavioral intervention in an examination of 1- to 3-yr outcomes and risk factors for relapse. Ss were administered the Beck Depression Inventory, the Schedule for Affective Disorders and Schizophrenia, and a life satisfaction scale. 59, 28, and 26 Ss were assigned to major depressive, intermittent depressive, and double depressive categories, respectively, according to pretreatment symptomatology and the Research Diagnostic Criteria. Results indicate that the recovery rate of the major depressives (75%) was significantly higher than that of the intermittent depressives (43%) or that of the superimposed depressives (27%). Significant predictors of relapse, accounting for 38% of the variance, included the number of previous episodes of depression, family history, poor health, history of depression in 1st-degree relatives, dissatisfaction with major life roles, depression level at entry to the study, and age. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective investigation of postpartum depression: Factors involved in onset and recovery.

We examined the role of a number of psychosocial variables in the onset of postpartum depression and in recovery from depression that occurs during pregnancy. Women (N?=?730) were recruited during pregnancy and were followed through 1 mo postpartum. They were assessed on demographic variables and on measures of depressive symptomatology and diagnostic status, perceived stress, marital satisfaction, perceptions of their own parents, dysfunctional cognitions, and coping style. Onset of depression in the postpartum was predicted by the levels during pregnancy of depressive symptomatology and perceived maternal and paternal care during childhood. In contrast, recovery in the postpartum from depression during pregnancy was not predicted by the variables examined in this study. These results are discussed with reference to previous investigations that have examined depression that occurs outside the context of childbirth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized controlled trial of a preventive intervention for perinatal depression in high-risk Latinas.

Objective: A randomized controlled trial was conducted to evaluate the efficacy of a cognitive–behavioral (CBT) intervention to prevent perinatal depression in high-risk Latinas. Method: A sample of 217 participants, predominantly low-income Central American immigrants who met demographic and depression risk criteria, were randomized into usual care (UC; n = 105) or an 8-week CBT group intervention during pregnancy and 3 individual booster sessions during postpartum (n = 112). Participants completed measures assessing depressive symptoms (Center for Epidemiological Studies Depression Scale at baseline; Beck Depression Inventory, Second Edition [BDI–II]) and major depressive episodes (Mood Screener) at 5 time points throughout the perinatal period. Results: Intent-to-treat analyses indicated that intervention participants had significantly lower depressive symptoms and fewer cases of moderate depression (BDI–II ≥ 20) at Time 2 than UC participants. These effects were stronger for women who fully participated in the intervention (≥4 classes). The cumulative incidence of major depressive episodes was not significantly different between the intervention (7.8%) and UC (9.6%) groups. Conclusions: A CBT intervention for low-income, high-risk Latinas reduced depressive symptoms during pregnancy but not during the postpartum period. Low levels of depressive symptoms and lower than expected rates of clinical depression in both groups may partially be due to methodological issues. As perinatal depression is a significant public health problem, more work is needed to prevent perinatal depression in low-income, ethnically diverse women. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults.

Compared the effects of 2 psychotherapies based on divergent conceptualizations of depression in later life. 75 older adults diagnosed with major depressive disorder were assigned randomly to problem-solving therapy (PST), reminiscence therapy (RT), or a waiting-list control (WLC) condition. Participants in PST and RT were provided with 12 weekly sessions of group treatment. Dependent measures, taken at baseline, posttreatment, and 3-mo follow-up, included self-report and observer-based assessments of depressive symptomatology. At posttreatment, both the PST and the RT conditions produced significant reductions in depressive symptoms, compared with the WLC group, and PST Ss experienced significantly less depression than RT Ss. Moreover, a significantly greater proportion of Ss in PST vs RT demonstrated sufficient positive change to warrant classification of their depression as improved or in remission at the posttreatment and follow-up evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thyroid and adrenal measures during late pregnancy and the puerperium in women who have been major depressed or who become dysphoric postpartum

Prior studies of thyroid, adrenal and mood measures during pregnancy and the puerperium, which we review, have not examined hormone-mood relationships over the full peripartum period during which hormone levels change nor have they compared prior depression history with hormone changes. In a pilot study we measured thyroid and adrenal hormones as well as mood at 38 weeks of pregnancy, and 1, 3, 6, 9 and 12 weeks postpartum in 12 women with major depression history and 14 women with negative psychiatric history. Subjects with prior depressions had significantly higher T3, T4, TSH and cortisol levels during the puerperium. Subjects with higher levels of postpartum dysphoria had lower T4 and free T4 levels as well as higher T3 uptake at 38 weeks of pregnancy and higher cortisol levels during the puerperium. The pathophysiological implications of these findings are discussed.     

Stress, psychosocial resources, and depressive symptomatology during pregnancy in low-income, inner-city women.

The authors examined the prospective influence of stress, self-esteem, and social support on the postpartum depressive symptoms of 191 inner-city women (139 European Americans and 52 African Americans) over 3 waves of data collection. Depressive symptomatology was measured by multiple indicators, including self-report and clinical scales. Women became less depressed as they move from prenatal to postpartum stages and adjusted to their pregnancy and its consequences. LISREL and regression analyses indicated that stress was related to increased depression, whereas greater income and social support were related to decreased depression. Self-esteem was related to lower depression at the prenatal and postpartum periods but not to change in depression from the prenatal to the postpartum period. The results also indicated that self-esteem and social support did not have additional stress-buffering effects over and above their direct effects on depression. Finally, African American women did not differ from European American women terms of depression or in terms of how they were impacted by stress or psychosocial resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression among African Americans, Latinos, and Caucasians with spinal cord injury: A exploratory study.

Objective: Explored the relationship between depression and racial–ethnic group membership among people with spinal cord injury (SCI). No literature exists on this topic, and research on related areas reveals variable findings with regard to ethnic–racial differences in depression. Study Design: During their annual physical exams at an SCI clinic in Southern California, 171 Ss with SCI completed the Older Adult Health and Mood Questionnaire, a clinically validated measure of depressive symptomatology. Participants: Forty-six Caucasians, 28 African Americans, and 97 Latinos over 21 years of age with either tetraplegia or paraplegia. Main Outcome Measures: Depression scores, diagnoses, and item clusters. 42% of the Ss reported clinically significant symptomatology; 18% reported possible major depression. Latino Ss reported higher overall depression scores than either African American or Caucasian Ss, who did not differ from each other. Latinos also had a greater prevalence of possible major depression, along with higher item clusters reflecting loss of pleasure and greater feelings of hopelessness and fatigue. Conclusions: These findings suggest a need for routine screening for depression after SCI, particularly among individuals from Latino backgrounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premorbid and symptomatic characteristics of schizophrenics from families with high and low levels of expressed emotion.

Measures of intrafamilial expressed emotion (EE) have been found to predict relapse in schizophrenic patients, but the relationship between EE and other prognostic indicators has not been fully determined. In the present study, 42 18–41 yr old recently episodic schizophrenic patients from high- and low-EE homes were contrasted on a battery of symptomatology and social adjustment measures (e.g., Brief Psychiatric Rating Scale, Hopkins Symptom Checklist), which were administered during the hospitalization period and shortly after discharge. In addition, because the high-EE designation is based on the presence of either parental criticism, emotional overinvolvement, or both attributes, Ss from high-EE subgroups were contrasted as well. Results indicate that high- and low-EE Ss were indiscriminable on measures of symptomatology and social adjustment. However, when the high-EE group was divided into subtypes, notable intergroup differences emerged: Ss from emotionally overinvolved families were characterized by poorer premorbid adjustment and greater residual symptomatology at discharge than Ss from critical families. The implications of these findings for the predictive utility of the EE construct and other prognostic indicators are discussed. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)