Identifying risk factors for postpartum depressive symptoms: the importance of social support, self-efficacy, and emotion regulation
Appears in the following Collection
- Psykologisk institutt 
AbstractAs many as 10-15% of new mothers experience severe emotional distress frequently labelled postpartum depression (PPD) (Brockington, 2004; O’Hara & Swain, 1996). The consequences of postpartum depressive symptoms can be serious for the mother, her child and family. Indeed, women who suffer from PPD are less capable of carrying out maternal duties, which may influence the child’s cognitive, and socioemotional development (Goodman, Brogan, Lynch & Shielding, 1993), as well as the infant’s attachment style (Bonari, Bennett, Einarson, & Koren, 2004). Typically, studies emphasize risk factors for PPD that are hard to modify such as a personal history of previously experienced depression, family history of depression, negative life events, certain baby characteristics, and demographics such as parity (Munk-Olsen, Munk Laursen, Bøcker Pedersen, Mors, & Mortensen, 2006) and age (Beck, 2001; Glavin, Smith, & Sørum, 2009; O’Hara & Swain, 1996).
In line with a more preventative framework, the overall aim of this thesis was to investigate the contribution of psychological variables on postpartum depressive symptoms (as measured by the EPDS). We explored in a cross-sectional study how general self-efficacy, breastfeeding self-efficacy and various dimensions of social support predicted postpartum depressive symptoms. The relation between breastfeeding self-efficacy, emotion regulation strategies, various dimensions of social support and postpartum depressive symptoms were further explored in a longitudinal study. In addition, we were interested in a deeper understanding of how first-time mothers experienced the postpartum period and what they regarded as important psychological variables in relation to well-being and depressive symptoms. These questions were explored in a separate qualitative study of first-time mothers.
Results from the cross-sectional study illustrated how higher levels of general self-efficacy and breastfeeding self-efficacy correlated with lower postpartum depressive symptoms. In terms of social support, perceived available support was found to be inversely related to depressive symptoms postpartum. Findings from the longitudinal study suggested that mothers with high breastfeeding self-efficacy tended to have low scores on the EPDS at all three time points. Two of the four social support scales were significantly related to the rate of EPDS scores; perceived available support and need for support. High perceived available support was related to less symptoms of postpartum depression, while high need for support was related to higher depression scores. Cognitive emotion regulation strategies were related with EPDS total scores as expected from theory. That is, while rumination, blaming oneself, and catastrophizing were all significantly related to higher levels of depressive symptoms postpartum, positive reinterpretation and concentrating on planning predicted lower postpartum depression scores. Interestingly, social support and managing breastfeeding stood out as important factors with regards to well-being and depressive symptoms in the qualitative interviews as well. In addition, we found that women varied in how they approached motherhood. These approaches, which we named (in line with how the mother themselves talked about it) ‘controlled’ and ‘relaxed’ influenced how the mothers had envisioned the postpartum period and their need for mastery. Type and specificity of expectations as well as a high need for mastery were related to subjective feelings of depressed mood and well-being.
In summary, our findings demonstrate the importance of psychological variables as risk factors of postpartum depressive symptoms.
List of papers. Paper I is removed from the thesis due to copyright restrictions.
Paper I: Haga, S.M., Slinning, K., Kraft, P., Kalkvik, H. & Staff, A. Depressive symptoms in postpartum women: the role of breastfeeding self-efficacy and social support. Submitted, not yet published.
Paper II: Haga, S.M., Lynne, A., Slinning, K., & Kraft, P. A qualitative study of depressive symptoms and well-being among first-time mothers. Submitted version. The definitive version is available at www3.interscience.wiley.com Scandinavian Journal of Caring Sciences, 2011 Article first published online: 28 NOV 2011. doi:10.1111/j.1471-6712.2011.00950.x
Paper III: Haga, S.M., Ulleberg, P., Slinning, K., Kraft, P., Steen T., & Staff, A. A longitudinal study of postpartum depression: Multilevel growth curve analyses of emotion regulation strategies, breastfeeding self-efficacy and social support. Arch Womens Ment Health. 2012 Jun;15(3):175-84. The original publication is available at www.springerlink.com. doi:10.1007/s00737-012-0274-2