Conceptualizing postpartum depression: examining cognitive styles, perceptions of loss, and relationship maladjustment to test the distinction hypothesis
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Is postpartum depression (PPD) a distinct syndrome from depression that occurs at other times in women’s lives? How might certain vulnerabilities increase the risk of PPD and enhance our understanding of PPD etiology and phenomenology? The current study sought to answer these questions using a cross-sectional survey with a sample of 67 participants comprising two groups of mothers: postpartum depressed (n = 37) and nonpostpartum depressed (n = 30). Between subjects comparisons revealed that relative to nonpostpartum depressed women, women with PPD had more unrealistic expectations for motherhood, less consistent and confidently defined self-concept, and higher depression severity based on a measure of postpartum symptomatology, lending support to the "distinction hypothesis." The study also evaluated a cognitive diathesis-stress model for PPD. Different best fit models were identified for each type of maladjustment: symptomatology versus relationship maladjustment (partner, mother, or baby). State anxiety and unrealistic expectations predicted PPD symptoms, and self-concept clarity emerged as a consistent predictor of relationship maladjustment. Active and passive facets of perfectionistic self-presentation were predictors of maladjustment particular to partner relationship. Different levels of each cognitive vulnerability revealed vulnerability versus resiliency effects. Models with interactions between cognitive vulnerability and two types of loss, interpersonal and independent, confirmed the important role of self-categorized perceptions of loss as moderator in the prediction of maladjustment. Significant interactions between maladaptive independent goal orientation, self-criticism, and independent loss in prediction of depression, the "match hypothesis", was confirmed for both groups of mothers. The more powerful negative impact of self-criticism, compared to interpersonal goal orientation, on PPD was confirmed, and the impact of adaptive independent goal orientation, self-efficacy, on NPP MDD was demonstrated. Unique conceptualization of PPD was supported with exploratory investigation of prediction models for nonpostpartum depression in mothers. The discussion considered implications for tailored prevention and treatment, and women’s and societal perceptions of experiences of PPD. Namely, traditional interventions such as IPT and CBT were supported, and flexible approaches and aspects of treatment such as in-home visits, enlisting close others, facilitating adaptive vulnerability, relying on a range of health professionals, and early screening for psychological vulnerabilities in medical visits were recommended.