Loss, happiness and postpartum depression: The ultimate paradox.

This paper describes a British-based longitudinal qualitative study of postpartum depression over the transition to motherhood. 24 women (aged 21–41 yrs) were interviewed during pregnancy and 1, 3, and 6 mo after the birth. The data were transcribed verbatim and analyzed from a symbolic interactionist perspective to identify themes surrounding the meaning of motherhood and experiences of depression during this time. The findings presented here demonstrate an important paradox in women's experiences: they are happy to be mothers to their children, while unhappy at the losses that early motherhood inflicts upon their lives—losses of autonomy and time, appearance, femininity and sexuality, and occupational identity. It is argued that if these losses were taken seriously and the women encouraged to grieve that postpartum depression would be seen by the women and their partners, family, and friends as a potentially healthy process toward psychological re-integration and personal growth rather than as a pathological response to a "happy event." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Information-seeking and maternal self-definition during the transition to motherhood.

The self-definitional processes accompanying the transition to motherhood were examined in this study. A cross-sectional sample of more than 600 women who were planning to get pregnant within 2 years, pregnant, or in the postpartum stage completed extensive questionnaires pertaining to their experiences of pregnancy and motherhood. On the basis of the assumption of the "self-socialization" perspective that individuals actively construct their identities in response to life transitions, our analyses focused on the role of information-seeking in the developing self-definitions of women becoming mothers. As predicted, (a) women actively sought information in anticipation of a first birth, (b) they used this information to construct identities incorporating motherhood, and (c) after the birth the determinants of their self-definitions shifted from indirect sources of information to direct experiences with child care. Hence, consistent with the self-socialization perspective, information-seeking did play an important role in the women's developing self-conceptions during this life transition. Mechanisms by which information gathered may alter self-conception are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward an understanding of depression from the standpoint of women: Exploring contributions of qualitative research approaches.

Provides an introduction to the special issue of Canadian Psychology on depression in women. "Depression" is recognized as one of the more common mental health problems and also one that is particularly prevalent among women. One major limitation of mainstream theorizing is the taken-for-granted view of depression as a form of internal "psychopathology," a phenomenon which can be understood without regard to sociocultural context. An approach that avoids this limitation is one in which contextual aspects of women's lives are included from the outset by following a research process that begins with the lived experiences of women. A focus on women's experiences also leads to consideration of the contributions of qualitative approaches to research on depression which are compatible with both a feminist standpoint perspective and social constructionist epistemologies. The articles in this special issue are intended to contribute to the development of new knowledge about depression in women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vers une compréhension de la dépression dans la perspective des femmes: Exploration de la contribution des approches de la recherche qualitative.

Provides an introduction to the special issue of Canadian Psychology on depression in women. "Depression" is recognized as one of the more common mental health problems and also one that is particularly prevalent among women. One major limitation of mainstream theorizing is the taken-for-granted view of depression as a form of internal "psychopathology," a phenomenon which can be understood without regard to sociocultural context. An approach that avoids this limitation is one in which contextual aspects of women's lives are included from the outset by following a research process that begins with the lived experiences of women. A focus on women's experiences also leads to consideration of the contributions of qualitative approaches to research on depression which are compatible with both a feminist standpoint perspective and social constructionist epistemologies. The articles in this special issue are intended to contribute to the development of new knowledge about depression in women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why new perspectives are needed for understanding depression in women.

Analyzes limitations of the currently dominant, or mainstream, approaches to understanding and explaining "depression" in women. The often-cited finding that "depression" is a problem particularly afflicting women is one that mainstream theoretical approaches have been unable to explain satisfactorily. Such theories have been critiqued as inherently dualist and reductionist and as employing concepts that are implicitly androcentric. Mainstream theories promote a view of depression as a form of individual disorder or psychopathology, capable of being understood without regard to the broader sociocultural context. Neglected within mainstream theory and research on depression are social-structural and discursive conditions that regulate women's lives and shape their experiences. Research informed by feminist standpoint and social constructionist epistemological perspectives provides one avenue for offsetting the limitations of mainstream approaches. At this juncture, forms of inquiry drawing on qualitative methodologies offer more useful, and potentially more emancipatory, strategies for understanding depression in women than mainstream approaches, because they can more fully acknowledge the lived experiences of women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Your heart is never free": Women in Wales and Ghana talking about distress.

This paper documents women's own constructions of their psychosocial health and the way they trace the problems they experience to the social and material conditions of their lives. The authors report on 2 qualitative studies: one in which 35 women (aged 20–89 yrs) in South Wales were interviewed about their main health concerns and a similar study in Ghana, West Africa which included interviews with 75 women (aged 20–80 yrs). Women's accounts of their distress are set in the context of 3 key issues: money problems, relationships with men, and motherhood. Despite cultural differences in the expression of distress, the common themes point to the influence of gender relations and women's roles in production and social reproduction. The authors argue for greater documentation of the material and social circumstances of women's lives and their effects on women's health. In so doing, it is important to incorporate women's own accounts of their health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychodynamics of postpartum depression.

Although there are numerous articles and books about postpartum depression, few are psychoanalytically informed, and the psychodynamics of women suffering from postpartum depression are overlooked in most of these publications. Psychoanalytic reports concerning postpartum depression are few, but clinical experience and the literature suggest that a triad of three common, specific emotional conflicts is typical of many women who develop postpartum depression. For simplicity, these are dependency conflicts, anger conflicts, and motherhood conflicts. The dependency conflicts typically have a counterdependent form, the conflicts over anger characteristically include a great deal of guilt and inhibition, and there are often problematic identifications with the woman's own mother (and father) with associated conflicts about motherhood. The frequent counterdependent attitude tends to limit participation in extensive psychotherapy, contributing to the paucity of psychoanalytic contributions on this subject. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Getting on with life": Women's experiences and ways of coping with depression.

Explored women's experiences of depression, and in particular how women living in rural communities understand, experience, and cope with feelings of distress unaided by professional help. Participants were 15 women (aged 23–60 yrs) living in rural areas of central New Brunswick who completed a semistructured interview. The purpose of the interview was to explore their experiences of depression and their ways of coping with these experiences. The women's accounts were analyzed using thematic and discourse analysis methods. A central theme revealed in the analysis was that women's understanding of their experiences was interwoven with their attempts to live up to the ideals and practices of the "good" woman. Within this context, depressive experiences were viewed as a taken-for-granted or expected part of their everyday lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Being real and being realistic: chemical abuse prevention, teen counselors, and an ethic of care

This study explored the early motherhood experiences of 79 first-time mothers. All women reported normal pregnancies and deliveries, delivered healthy infants at term, and were surveyed at 6 weeks postpartum using the Inventory of Functional Status After Childbirth. Mothers' written comments were subjected to a content analysis, and much of their commentary revolved around the "conspiracy of silence" that appeared to exist about the realities of motherhood. Most commented that no one had prepared them for the unrelenting demands of infant care, the level of fatigue they would experience, the loss of personal time and space, and the realities of 24-hour-a-day infant care. The women also cited their partners as their main support person during the early weeks of motherhood. Although maternal child health nurses and midwives are well placed to offer prenatal education and long-term professional support postpartum, perhaps what is needed is active, anticipatory preparation for motherhood that begins long before the first pregnancy becomes a reality.     

Maternal representations of past and current attachment relationships, and emotional experience across the transition to motherhood: A longitudinal study.

Sad and anxious feelings are known to increase in the immediate postpartum period, whereas studies on new mothers' other emotional qualities such as anger are scarce. In laboratory studies, attachment security was found to be associated with effective emotion regulation in challenging situations. This study investigated attachment representations of experiences with parents and of current experiences with the partner as predictors of sad, anxious, and angry feelings across the transition to motherhood. Seventy-seven pregnant women in their third trimester were administered the Adult Attachment Interview and the Current Relationship Interview. The Differential Emotions Scale was given in pregnancy and at the infant's ages of 2 weeks, 2, 4, and 6 months, asking both mothers and fathers about maternal emotional experience. Sadness and anxiety increased 2 weeks postpartum and returned to below baseline over the following months, while anger did not change. Contrary to mothers with an insecure representation of their couple relationship, those with a secure representation reported and displayed increased sadness and anxiety 2 weeks after giving birth, from which they quickly recovered. For mothers secure in their representation of past attachment relationships with parents, an increase of low-level anger emerged 4 months postpartum, which did not occur in insecure participants and receded quickly. It can be concluded that secure representations of current and past attachment relationships help new mothers express and recover from negative emotions. These findings further elucidate the associations between attachment status and emotion regulation while adding a couple perspective. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Women's experiences of treatment of depression: Medicalization or empowerment?

An interview study was conducted in which women's experiences of diagnosis and treatment for depression were explored. Nine women (aged 19–66 yrs) who had been diagnosed by a physician participated in the study. Topics explored in the interview included how women came to be diagnosed as depressed, how treatment was experienced, how they understood the causes of their depression, and how being diagnosed had affected their view of themselves and their futures. Analysis involved a thematic approach guided by the topics addressed in the interview. The women's accounts also were analyzed with respect to the themes of medicalization and empowerment. All of the participants gave medicalized accounts of their depressive experiences, which were characterized by biomedical explanations and identification of anti-depressant drugs as beneficial in alleviating their distress. Based on this analysis of the women's accounts, it is concluded that a medicalized understanding and treatment of women's depressive experiences cannot readily co-exist with personal empowerment. Suggestions are made for developing strategies for treatment of women's depressive experiences that offer the benefits of medicalization without precluding the possibility of personal empowerment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding and helping depressed women

A grounded theory study was conducted to examine the process of recovery for women who have been depressed. The purpose of this study was to enhance our understanding of the recovery process of women with depression by exploring the women's experience directly. The study found that the basic social psychological process of women's recovery from depression could be summarized as (re)defining the self. (Re)Defining the self differs significantly from the common conceptualisations of depression recovery, which focus on signs and symptoms without consideration of the woman or the social context in which her life is situated. (Re)Defining the self is a model that considers the woman as a holistic organism existing within a complex network of social interactions. Because (re)defining the self provides a new perspective for understanding women's experience with depression, there are significant implications for the way we provide nursing care. This paper discusses those implications.     

Depressive attributional style and depression following childbirth.

The reformulated learned helplessness model posits that individuals who make internal, stable, and global attributions for undesired outcomes are more likely than others to become depressed when faced with important life events that are perceived as uncontrollable. Two questions arise from the reformulated learned helplessness model within the context of the event of childbirth. The 1st question is whether the relationship between depressive attributional style and concurrent depression found in college undergraduates can be extended to women anticipating the birth of their 1st child. The 2nd question is whether women's prenatal attributional style is predictive of depression in the 1st wk postpartum. 50 pregnant women (mean age 28.85 yrs) completed the Attributional Style Questionnaire and 3 measures of depression during the 3rd trimester of pregnancy and 3 days postpartum. The results provide negligible support for the notion of depressive attributional style as defined by the hypothesis. Depression of clinical severity was reported by 2–6% of Ss during the 3rd trimester and by 10–24% postpartum. (32 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life transitions and mental health in a national cohort of young Australian women.

Young adulthood, a time of major life transitions and risk of poor mental health, may affect emotional well-being throughout adult life. This article uses longitudinal survey data to examine young Australian women's transitions across 4 domains: residential independence, relationships, work and study, and motherhood. Changes over 3 years in health-related quality of life, optimism, depressive symptoms, stress, and life satisfaction, were examined in relation to these transitions among 7,619 young adult participants in the nationally representative Australian Longitudinal Study on Women's Health. Positive changes in mental health occurred for women moving into cohabitation and marriage, whereas reductions were observed among those experiencing marital separation or divorce and those taking on or remaining in traditionally "feminine" roles (out of the workforce, motherhood). The data suggest that women cope well with major life changes at this life stage, but reductions in psychological well-being are associated with some transitions. The findings suggest that preventive interventions to improve women's resilience and coping might target women undergoing these transitions and that social structures may not be providing sufficient support for women making traditional life choices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypothalamic corticotropin-releasing hormone suppression during the postpartum period: implications for the increase in psychiatric manifestations at this time

The third trimester of human pregnancy is characterized by a hyperactive hypothalamic-pituitary-adrenal axis, possibly driven by progressively increasing circulating levels of placental CRH and gradually decreasing levels of CRH-binding protein. The postpartum period, on the other hand, is characterized by an increased vulnerability to psychiatric manifestations (postpartum "blues," depression, and psychosis), a phenomenon compatible with suppressed hypothalamic CRH secretion. To investigate the hypothesis that the postpartum period is associated with suppression of hypothalamic CRH secretion, we studied prospectively 17 healthy euthymic women (mean +/- SE age, 32.0 +/- 1.1 yr) with no prior history of depression, starting at the 20th week of gestation. Psychometric testing was performed monthly during pregnancy and postpartum on day 2 and weeks 2, 3, 6, 8, 12, 16, and 20, whereas serial ovine (o) CRH tests were performed postpartum at 3, 6, and 12 weeks. While pregnant, all 17 subjects remained euthymic; in the postpartum period, 7 women developed the "blues," and 1 developed depression. Overall, the mean plasma ACTH response to an iv bolus of 1 microgram/kg oCRH was markedly blunted at 3 and 6 weeks, but normal at 12 weeks postpartum, whereas the mean plasma cortisol response was at the upper limit of normal at all 3 times. These data are compatible with a suppressed hypothalamic CRH neuron that gradually returns to normal while hypertropic adrenal cortexes are progressively down-sizing. When the postpartum ACTH responses to oCRH were analyzed separately for the euthymic women and the women who had the "blues" or depression, the blunting of ACTH was significantly more severe and long lasting in the latter group; this was observed at all 3 times of testing. We conclude that there is central suppression of hypothalamic CRH secretion in the postpartum, which might explain the increased vulnerability to the affective disorders observed during this period. The suppressed ACTH response to oCRH might serve as a biochemical marker of the postpartum "blues" or depression.     

First-time mothers' expectations of parenthood: What happens when optimistic expectations are not matched by later experiences?

Becoming a parent is a major developmental transition of adulthood. Individuals often have optimistic expectations about parenthood, yet this transition also presents a number of challenges. The authors investigated whether new parents have overly optimistic expectations about parenthood and, if they do, how this influences their adjustment to this role. The sample consisted of 71 first-time mothers who completed questionnaires during pregnancy and at 4 months postpartum. The study assessed women's expectations of caring for their infant and the influence parenthood would have on their well-being and their relationships with others. Most women's expectations were matched or exceeded by their parenting experiences. However, where experiences were negative relative to expectations, there was greater depression symptomatology and poorer relationship adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The double life of Véronique: An inquiry into the existence of woman.

This article is an analysis of the film La Double Vie de Veronique (The Double Life of Véronique; de la Fuente & Kieslowski, 1991) from a Lacanian psychoanalytic perspective. It explores significant differences in the experiences of two women, roles played by the same actress, presented in the film as identical in appearance, living in different places at the same time, and sharing similar life challenges and opportunities. The differences manifest themselves in their relation to the women's remarkable singing ability, their lovers, and familial figures. The early loss of the primary object, the mother, determines both women's being--one of the women more on the side of the normative woman, covering over the loss at the price of death, the other mourning the loss more subtly but no more immune to the forces within her. Both demonstrate Lacan's (1975) axiom that "Woman does not exist," namely, that she lives precariously near the real, on the boundaries of the symbolic and the imaginary. (PsycINFO Database Record (c) 2010 APA, all rights reserved)