MEDIATING ROLE OF POSTPARTUM DEPRESSION BETWEEN PERCEIVED SPOUSAL SUPPORT AND POSTPARTUM MATERNAL BONDING
AbstractBackground: The present study intended to examine the direct effects of perceived spousal support and postpartum depression on postpartum maternal bonding. Furthermore, it also explored the mediating role of postpartum depression between perceived spousal support and postpartum maternal bonding. Methods: This study was based on a cross-sectional survey research design. A purposive sample of 170 women who were already diagnosed by the doctor/psychiatrist as suffering from postpartum depression was recruited from different hospitals of Gujrat district. Urdu translated versions of The Marital Empathy Scale, Postpartum Bonding Questionnaire, and the Edinburgh Postnatal Depression Scale were used to measure the focal constructs of the study. Results: IBM Amos was used to test the proposed model of the present study. Path analysis revealed that perceived spousal support had negative significant direct effects on postpartum depression and postpartum maternal bonding. Postpartum depression had significant positive direct effect on postpartum maternal bonding. Finally, the significant indirect effect of perceived spousal support through postpartum depression on postpartum maternal bonding was negative. Conclusion: The mediation found in the present study suggested that perceived spousal support reduced the postpartum depression, which in turn, lowered the chances of dysfunctional postpartum maternal bonding with the baby. Implications of the study along with the recommendations for future studies have been reflected upon. Keywords: Postpartum depression; postpartum maternal bonding; perceived spousal support
Beck C.T., Watson-Driscoll J. Postpartum mood and anxiety disorders: A clinician's guide. Boston. Jones & Bartlett Learning. 2006.
Wilkinson R.B., Mulcahy R. Attachment and interpersonal relationships in postnatal depression. Journal of Reproductive and Infant Psychology. 2010; 28: 252–265.
Gulamani S., Shaikh K., Chagani J. Postpartum depression in Pakistan: A neglected issue. Nursing for women’s health. 2013;17(2): 147-152.
Rahman, A. Challenges and opportunities in developing a psychological intervention for perinatal depression in rural Pakistan—A multi-method study. Archives of Women’s Mental Health. 2007;10: 211–219.
Ashman S.B., Dawson G., Panagiotides H. Trajectories of maternal depression over 7 years: relations with child psychophysiology and behavior and role of contextual risks. Journal of psychopathology. 2008; 20(1): 55-77. doi: 10.1017/S0954579408000035.
Chojenta C., Loxton D., Lucke, J. How do previous mental health, social support, and stressful life events contribute to postnatal depression in a representative sample of Australian women? Journal of midwifery & women’s health. 2012; 57(2):145–150.
Lakey B., Cassady P. B. Cognitive processes in perceived social support. Journal of personality and social psychology. 1990; 59(2): 337-343.
Romito P., Saurel-Cubizolles M. J, Lelong N. What makes new mothers unhappy: psychological distress one year after birth in Italy and France. Social science. 1999; 49: 1651–61.
Mauthner N. S. Re-assessing the importance and role of the marital relationship in postnatal depression: Methodological and theoretical implications. Journal of reproductive and infant psychology. 1998; 16(2-3):157-175.
Leahy-Warren P., McCarthy G., Corcoran, P. First-time mothers: Social support, maternal parental self-efficacy and postnatal depression. Journal of clinical nursing. 2012; 21(34): 388–397. doi:10.1111/j.1365-2702.2011.03701.x.
Beck C. T. A meta-analysis of predictors of postpartum depression. Nursing research. 1996; 45: 297-303.
Stapleton L., Schetter C., Westling E., Rini C., Glynn L. M., Hobel C. J., Sandman, C. A. Perceived partner support in pregnancy predicts lower maternal and infant distress. Journal of family psychology. 2012; 26(3): 453–463.
Kalar M. U., Fatima I., Nabila K., Zainab A., Wardah G., Zara R., Jafri F. Prevalence and predictors of postnatal depression in mothers of Karachi. international journal of collaborative research on internal medicine and public health. 2012; 4(5): 830–839.
Rahman A., Iqbal Z., Harrington R. Life events, social support and depression in childbirth perspective from a rural community in developing world. Psychological medicine. 2003; 33(7): 1161–1167.
Hasin S. D., Goodwin D. R., Stinson S. F., Grant F. B. Epidemiology of major depressive disorder. Archives of general psychiatry. 2005; 62: 1097–1106.
Bjerke S. E. Y., Vangen S., Nordhagen R., Ytterdahl T., Magnus P., Stray-Pedersen, B. Postpartum depression among Pakistani women in Norway: Prevalence and risk factors. Journal of maternal-fetal and neonatal medicine. 2008; 21(12): 889–894.
Hasin, S.D., Goodwin, D.R., Stinson, S.F., & Grant, F.B., (2005). Epidemiology of major depressive disorder. Archives of General Psychiatry, 62, 1097–1106.
Kalyani G. H. S., Saeed K., Rehman I. U., & Mubbashar M. H. Incidence of depressive illness in Pakistani women during postnatal period. Journal of college professors of surgery Pakistan. 2001; 11(4): 246–248.
Khooharo Y., Majeed T., Das C., Majjed N., Majeed N., Choudhry A. M. Associated risk factors for postpartum depression presenting at a teaching hospital. Annals of King Edward medical university. 2010; 16(2): 87–90.
Rahman A., Creed F. Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: Prospective study from Rawalpindi, Pakistan. Journal of affective disorders. 2007; 100: 115–121.
Ugarriza D., Brown S., Chang-Martinez C. Anglo-American mothers and the prevention of postpartum depression. Issues in mental health nursing. 2007; 28(7): 781–798.
Brown J., Harris S., Woods E., Burman M., Cox, J. Longitudinal study of depressive symptoms and social support in adolescent mothers. Maternal and child health journal. 2012; 16(4): 894–901.
Chien L., Tai C., Yeh M. Domestic decision-making power, social support, and postpartum depression symptoms among immigrant and native women in Taiwan. Nursing research. 2012; 61(2): 103–110. doi.org/10.1097/nnr.0b013e31824482b6
Edwards R. C., Thullen M. J., Isarowong N., Shiu C., Henson L., Hans S. L. Supportive relationships and the trajectory of depressive symptoms among young, african american mothers. Journal of family psychology. 2012; 26(4): 585–594. doi.org/10.1037/a0029053.
Fowles E. R., Hsiu-Rong C., Milles S. Postpartum health promotion interventions: A systematic review. Nursing research. 2012; 61(4): 269–282. doi; org/10.1097/nnr.0b013e3182556d29.
Paulson J., Dauber S., Leiferman J. Individual and combined effects of postpartum depression in mothers and fathers on parenting behavior. Journal of social and clinical psychology. 2006; 118: 659–668.
Leerkes E. M., Crockenberg S. C. The development of maternal self-efficacy an impact on maternal behavior. Infancy. 2002; 3: 227-247. doi:10.1207/S15327078IN0302.
Goodman S. H. Depression in mothers. Annual Review of Clinical Psychology. The Journal of clinical psychology. 2007; 3: 107–35.
Feldman R. Parent–infant synchrony and the construction of shared timing: physiological precursors, developmental outcomes and risk conditions. Journal of Child Psychology and Psychiatry. 2007; 48: 329–354.
Beck C. T. A meta-analysis of predictors of postpartum depression. Nursing research. 1996; 45: 297-303.
Moehler E., Brunner R., Wiebel A., Reck C., Resch F. Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother-child bonding. Women's mental health. 2006; 9: 273–278.
Edhborg M., Nasreen H., Kabir Z. Impact of postpartum depressive and anxiety symptoms on mothers' emotional tie to their infants 2–3 months postpartum: A population-based study from rural Bangladesh. Archives of Women's Mental Health. 2011;14(4): 307–316.
Liberto T. Screening for depression and help-seeking in postpartum women during well-baby pediatric visits: An integrated review. Journal of Pediatric Healthcare. 2012; 26(2): 109–117.
Patel M., Bailey R. K., Jabeen S., Ali S., Barker N. C., Osiezagha K. Postpartum depression: A review. Journal of health care for the poor & underserved. 2012; 23(2): 534–542.
Murray L., Cooper P.J. The role of infant and maternal factors in postpartum depression, mother–infant interactions and infant outcomes. Postpartum Depression and Child Development, New York, Guilford Press. 1998.
Stein A, Arteche A, Lehtonen A. Interpretation of infant facial expression in the context of maternal postnatal depression. Infant behavior. 2010; 33: 273–8.
Arteche A., Joormann J., Harvey A. The effects of postnatal maternal depression and anxiety on the processing of infant faces. Journal of affect disorder. 2011; 133: 197–203.
Gil S., Teissèdre F., Chambres P. The evaluation of emotional facial expressions in early postpartum depression mood: a difference between adult and baby faces? Psychiatry revelation. 2011; 186(2-3): 281–286.
Cox J. L., Holden J. M., Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British journal of psychiatry. 1987; 150: 782-786.
Schuster T. L., Kessler R. C., Aseltine R. H. Supportive interactions, negative interactions, and depressive mood. American journal of community psychology. 1990; 18: 423-438.
Brockington I. F, Oates J., George S., Turner D., Vostanis P., Sullivan M., Loh C., Murdoch C. A screening questionnaire for mother-infant bonding disorders. Archives of women's mental health. 2001; 3: 133–140
Weis K., Lederman R. P. Prenatal spousal military deployment and maternal prenatal adaptation as predictors of postpartum maternal-infant attachment. Southern Online Journal of Nursing Research. 2010; 10(3).
Richman J. A., Raskin V. D., Gaines, C. Gender roles, social support, and postpartum depressive symptomatology. The benefits of caring. Journal of Mental Disorder. 1991; 179: 139-147.
Forman D. N., Videbech P., Hedegaard M., Salvig J. D., Secher N. J. Postpartum depression: identification of women at risk. British journal of obstetrics & gynecology. 2000; 107: 1210-1217.
Rahman A., Malik A., Skkander S., Roberts C., Creed, F. Cognitive behavior therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: A cluster-randomized controlled trial. Lancet. 2008; 372(13): 902–909.