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OBJECTIVE: The objective of the current study was to examine associations between daily subjective stress and relationship satisfaction as a function of two protective factors—partner support and connection (i.e., intimacy, passion, and commitment)—among couples during pregnancy. BACKGROUND: Stress brought into the intimate relationship by each partner is often associated with relational dissatisfaction and discord, referred to as stress spillover. Although much research has focused on risk for poor relational outcomes associated with partner stress, it is equally important to focus on resilience. METHOD: We examined this phenomenon among 154 couples navigating pregnancy. Couples attended an initial laboratory session and then completed daily diary measures from home across 14 days. RESULTS: Multilevel modeling techniques revealed that higher daily subjective stress than usual was negatively associated with relationship satisfaction that day for fathers and mothers, and partner support and connection attenuated this link to a significant degree. As these protective factors increased, the strength of the negative association between daily stress and relationship satisfaction decreased for both parents. Exploratory analyses showed no significant within-person associations between daily stress and next-day relationship satisfaction at any level of support or connection. CONCLUSION: These findings add innovative components to the investigation of the spillover process, including the examination of this process among couples during pregnancy, utilization of daily diary methods to study this phenomenon on a micro-level over time, and identification of protective factors mitigating daily stress spillover.

Despite findings demonstrating the importance of parental present-centered awareness, factors undermining mindful parenting have received less attention. Increasingly, evidence points to parental psychopathology as a salient risk factor for parenting difficulties. Thus, the goal of the present study was to investigate specific dimensions of parental trauma-related distress and general negative affectivity during pregnancy as predictors of mindful parenting during toddler age. Parental psychopathology, parent–infant bonding, and mindful parenting were assessed in a sample of heterosexual couples (N = 159) across four waves of data collection spanning pregnancy to child age two. Data were analyzed using path analysis within a dyadic framework. Results demonstrated the unique impact of maternal trauma-related distress during pregnancy (e.g., intrusions and avoidance) on facets of mindful parenting more than two years later. Further, among both mothers and fathers, general negative affectivity common across internalizing disorders undermined mindful parenting through impaired parent–infant bonding. Findings highlight the need for early intervention efforts that incorporate mindfulness strategies to reduce subthreshold symptoms of prenatal psychopathology, promote healthy bonding, and improve parental awareness and self-regulation, thereby enhancing the overall parent–child relationship.

Purpose The negative impact of stress on the mental health of perinatal women is well-established. Prior research using data from the Pregnancy Risk Assessment Monitoring System (PRAMS) confirms three distinct stress domains: financial, relationship, and trauma. In 2013, an item assessing perceived racial discrimination was added to the Iowa PRAMS. Using the first phase of available data, we examine whether perceived racial discrimination represents an independent stress domain and assess its association with postpartum depressed mood. Methods A principal component analysis of the Iowa PRAMS data (2013–2015: N = 2,805) evaluated stress and perceived racial discrimination. Logistic regression examined the effect of racial discrimination on postpartum depressed mood. Results In Iowa, 4.4% of respondents perceived racial discrimination, with higher rates among non-Hispanic Black women and Hispanic women. The principal component analysis identified five stress domains: financial, relational, traumatic, emotional, and displacement. Perceived racial discrimination did not load onto any of these domains, suggesting that it represents an independent stress component. Logistic regression indicated that those who experienced perceived racial discrimination were twice as likely to have experienced depressed mood. Conclusions Racism, in the form of perceived racial discrimination among pregnant women, is a unique domain of stress that is significantly associated with an increased risk for depressed postpartum mood. Decreasing discrimination's effects on perinatal mental health could begin with ensuring respectful and compassionate health care during pregnancy and the postpartum period.

Objective: The present study examined the protective role of partner support in reducing daily experiential avoidance (EA) associated with trauma symptoms in a sample of 154 couples during pregnancy. Background: Although psychological distress during pregnancy may hinder the developing bond between parents and infants after birth, high quality intimate partner support has the potential to enhance psychological wellbeing during pregnancy, particularly in the context of trauma. Specifically, partner support might mitigate the impact of trauma symptoms on maladaptive coping strategies such as EA by enabling individuals to safely encounter their distress. Method: Participants completed a semi-structured clinical interview of support and a PTSD symptom inventory, followed by home surveys of EA over 14 days. We examined growth trajectories of EA over 14 days using latent trajectory modeling within a dyadic framework. Results: Trauma symptom severity was associated with higher levels of EA across the 2 weeks; however, among women, the impact of trauma symptoms on EA was no longer significant when support from a partner was above average quality or higher. Findings also revealed partner effects; to the extent that women reported higher levels of trauma symptoms, their partners had higher levels of EA. Conclusion: Findings highlight the protective role of high quality support from intimate partners and suggest that trauma-related interventions targeting partner support processes, especially those implemented during pregnancy, might enhance recovery and prevent further distress and dysfunction among pregnant women experiencing trauma symptoms.

Existing research suggests that childbirth may be a significant trigger of posttraumatic stress symptoms (PTSS). The current study examined whether subjective birthing experiences and objective childbirth characteristics mediated the association between predisposing psychosocial factors measured during pregnancy (e.g., fear of childbirth, history of trauma, and social support) and PTSS during the postpartum period. Women were recruited during pregnancy from a large Midwestern hospital. Symptoms of posttraumatic stress, obsessive compulsive disorder (OCD), and depression, as well as PTSS-related risk factors, including social support, lifetime trauma exposure, fear of childbirth, subjective perceptions, and objective characteristics of childbirth, were measured during pregnancy and 4, 8, and 12 weeks postpartum. A path model revealed that subjective perceptions of childbirth mediated the association between fear of childbirth and PTSS at 4 weeks postpartum. Objective childbirth characteristics mediated the association between fear of childbirth and PTSS at 8 weeks postpartum, and there was a direct association between fear of childbirth and PTSS. Subjective perceptions of childbirth also mediated the effect of fear of childbirth on PTSS at 4 weeks postpartum when controlling for OCD symptoms. Further, the direct effect of fear of childbirth on PTSS at 8 weeks postpartum remained significant when controlling for OCD symptoms. The current study emphasizes the importance of fear of childbirth and subjective and objective birthing experiences in predicting postpartum psychopathology. Future research should examine these models in diverse and at-risk samples. Valid assessments and effective interventions for perinatal PTSS should be explored.

Consistent with objectification theory, the primary goal of the present study was to investigate the role of perceived humanization from one’s intimate partner as a predictor of depression (i.e., symptom severity), eating disorders (i.e., body dissatisfaction), and sexual dysfunction (i.e., dissatisfaction with quality of the sexual relationship) during pregnancy through decreased self-objectification. We tested our hypotheses within a dyadic framework, considering the respective contributions of humanization perceived by each partner to self-objectification and well-being in 159 U.S. heterosexual couples. Results converged with research linking partner humanization to lower levels of self-objectification in women. Further, feeling humanized by one’s partner also decreased self-objectification in men. Subsequently, lower levels of self-objectification were associated with lower levels of depressive symptoms and body dissatisfaction for both men and women and higher levels of sexual satisfaction for women. Our study also revealed the complex role of self-objectification in couple relationships: Less self-objectification by women, related to humanization from one’s partner, was associated with fewer depressive symptoms reported by their partners, but less self-objectification by men was, paradoxically, associated with more depressive symptoms reported by their partners. Results have implications for practitioners implementing couple and family interventions with pregnant women and their partners.

Feminist scholars have called for gender researchers to consider gene-environment interactions for gender-imbalanced disorders (Salk and Hyde Psychology of Women Quarterly, 36, 395–411, 2012). Responding to these calls, the present study integrates objectification theory (Fredrickson and Roberts Psychology of Women Quarterly, 21, 173–206, 1997) and genetic research. In the tested model, objectification experiences are associated with disordered eating through body surveillance and body shame, and serotonin transporter (SLC6A4) genotypes (5-HTTLPR and rs25531), serotonin 2A receptor SNP genotypes (HTR2A rs6311), and the epistatic interaction between those genotypes function as moderators. U.S. undergraduate women (n = 526) completed self-reports of objectification, body surveillance, body shame, and disordered eating and donated buccal cells for genetic analyses. The association between objectification and disordered eating was mediated by body shame, but not body surveillance. The paths from objectification to both body surveillance and body shame were moderated by genotypes. The indirect effect of objectification on disordered eating through body shame was only present for SLC6A4 L′ and rs6311 G homozygotes. Our results are consistent with previous evidence that serotonin system genetic variation is associated with disordered eating risk. They provide evidence of a non-deterministic genetic effect that is context-dependent and subtle. These findings also reinforce efforts to develop personalized prevention and treatment approaches for eating disorders.

Objective: Women who have experienced trauma report high rates of heavy episodic drinking (HED) and sleep problems. Prior work suggests that poor sleep exacerbates heavy alcohol use; however, potential mechanisms for this association are unclear. Consistent with the self-medication model, one possibility may be that women with a history of trauma are drinking at increased rates in order to cope with the affective consequences of poor sleep. To examine this possibility, the current study tested the role of drinking to cope motives as a mediator of prospective associations between sleep problems and HED among women who have experienced trauma. Method: Community women reporting a history of trauma (N = 414, Mage = 21.8, 59.9% White, 36.2% Black) completed self-report measures at baseline and 4 month and 8 month follow-ups. Measures of trauma exposure (Life Events Checklist [LEC]) and sleep problems (Cohen-Hoberman Inventory of Physical Symptoms-Revised [CHIPS-R]) were taken from baseline, drinking motives (Revised Drinking Motives Questionnaire) at 4 months, and HED at 8 months. Results: Findings supported an indirect association between sleep problems and later HED through increased drinking to cope motives (b = .05, 95% CI [.018, .108], β = .05). Conclusion: As hypothesized, drinking to cope accounted for associations between sleep problems and later HED. Findings underscore the potential value in addressing drinking to cope motives as a means of reducing HED, particularly among women with a history of trauma who are sleeping poorly. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sleep is a critical health behavior with important implications for child development. This chapter discusses the effects of sleep problems on early child executive functioning (EF), with an emphasis on individual differences that might moderate this relationship. Specifically, we (1) provide a brief background on sleep and EF in early childhood; (2) review literature on the association between sleep and EF; (3) review literature on individual differences in the effects of sleep problems on EF; (4) offer recommendations for future research on moderators of the sleep-EF association, and (5) briefly describe an ongoing study examining the moderators of the sleep-EF association within a longitudinal study from pregnancy to preschool.

Background Home visitation is a popular mechanism for supporting parents and their young children. Breastfeeding is often promoted by home visitors due to its health benefits. However, maternal depression may interfere with breastfeeding. Thus, home visitors may be attempting to encourage health-promoting behaviors like breastfeeding, but maternal depression may interfere with engagement in those behaviors. Method The data for this study were provided by the Des Moines Healthy Start and the Empowerment Family Support Project (DMHSP). We analyzed the relation between depression and breastfeeding for 364 women. Results First, rates of elevated depression scores in this sample of women (8.7%-21.4% of women) were lower than rates of elevated depression scores reported in other studies of women enrolled in home visitation (30%–50% of women). Second, rates of breastfeeding at 3 months postpartum in this sample (56% of women) were higher than rates of breastfeeding reported in the general population (51% of women). Third, Non-Hispanic White women were significantly less likely to breastfeed compared to other racial groups. Fourth, average Edinburgh Postnatal Depression Scale (EPDS) scores during the first 3 months postpartum, but not during pregnancy, were predictive of likelihood to breastfeed at 3 months postpartum, even after accounting for demographic characteristics. Conclusion Addressing maternal depression during the early postpartum period may increase the likelihood of engaging in breastfeeding.

To evaluate how sexual pain influences changes in sexual frequency from the pregnancy to postpartum transition, and to examine how couple’s sexual communication interacts with sexual pain during pregnancy. We explored data following 159 mixed-sex couples across the transition from pregnancy to 6 months postpartum. Couples completed the Relationship Quality Interview and the Marital Satisfaction Inventory-Revised, which assessed their sexual communication, pain and other sexual problems during pregnancy, and frequency of intercourse at pregnancy and postpartum. Overall, couples reported a decline in sexual activity from pregnancy to postpartum. Women’s sexual pain during pregnancy influenced changes in sexual frequency only among couples who reported poorer communication about sex. Among couples reporting sexual pain and good communication, pain did not impact changes in sexual frequency (i.e. they experienced significant declines in sexual activity into the postpartum period, as expected). In contrast, among couples with poor communication, sexual frequency did not significantly decline. Our findings suggest that sexual communication alters the effects of sexual pain on postpartum sexual activity. Future research should examine if sexual communication training during pregnancy improves postpartum sexual wellbeing.

Research demonstrates the central role of mother-child relationships in child socioemotional development; however, families are complex systems and the unique roles of multiple family subsystems in early infant development have received less attention. In the present study, we investigated the role of multiple family relationships (interparental, mother-infant, father-infant), during pregnancy and the first month after childbirth, in infant socioemotional functioning at 6 months. We administered semi-structured interviews during pregnancy to assess multiple qualities of the interparental relationship. At 1 month postpartum, parents completed reports about their feelings and attitudes toward their infant to assess impaired bonding. At 6 months, parents provided reports of child socioemotional functioning. Both mother-infant and father-infant impaired bonding were uniquely associated with infant socioemotional impairment, controlling for prenatal interparental relationship quality. Additionally, multiple dimensions of the interparental relationship (i.e., poor-quality conflict management, inadequate support for fathers, and low levels of respect toward mothers) were associated with infant socioemotional impairment controlling for parent-infant bonding. Results also demonstrated an indirect pathway, such that poor sexual quality during pregnancy was associated with fathers (but not mothers) reporting more impaired bonding with their infants, which was linked to greater infant socioemotional impairment. Results highlight the importance of understanding the broad family environment, prior to and immediately following the birth of the child, to identify at-risk children at the earliest possible stages of intervention.Las investigaciones demuestran el papel fundamental que desempeñan las relaciones entre madre e hijo en el desarrollo socioemocional del niño; sin embargo, las familias son sistemas complejos, y los papeles únicos que desempeñan los múltiples subsistemas familiares en el desarrollo temprano del bebé han recibido menos atención. En el presente estudio, investigamos el papel que desempeñan varias relaciones familiares (interparentales, mamá-bebé, papá-bebé) durante el embarazo y el primer mes después del parto en el funcionamiento socioemocional a los 6 meses. Administramos entrevistas semiestructuradas durante el embarazo para evaluar varias cualidades de la relación interparental. Un mes después del parto, los padres realizaron informes acerca de sus sentimientos y actitudes hacia su bebé para evaluar deficiencias en el vínculo. A los 6 meses, los padres proporcionaron informes del funcionamiento socioemocional del niño. Los vínculos deficientes tanto entre la madre y el bebé como entre el padre y el bebé estuvieron asociados exclusivamente con una deficiencia socioemocional del bebé, teniendo en cuenta la calidad de la relación interparental prenatal. Además, varias dimensiones de la relación interparental (p. ej.: la mala calidad de la gestión de conflictos, el apoyo inadecuado para los papás y los niveles bajos de respeto hacia las mamás) estuvieron asociadas con una deficiencia socioemocional del bebé teniendo en cuenta el vínculo entre los padres y los bebés. Los resultados también demostraron una vía indirecta, por ejemplo, que la mala calidad de vida sexual durante el embarazo estuvo asociada con el informe de los padres (pero no de las madres) de un vínculo más deficiente con sus bebés, el cual estuvo ligado a una mayor deficiencia socioemocional del bebé. Los resultados destacan la importancia de comprender el entorno familiar amplio antes e inmediatamente después del nacimiento del niño a fin de identificar niños en riesgo lo antes posible en las etapas de la intervención.研究证明了母子关系在儿童社会情感发展中的中心作用; 然而，家庭是一个复杂的系统，多个家庭子系统在幼儿早期发育中的独特作用却没有得到足够的重视。在本研究中，我们调查了多种家庭关系(父母间、母亲-婴儿、父亲-婴儿)在怀孕期间和分娩后的第一个月，以及在婴儿6个月的社会情感功能中的作用。我们对父母在怀孕期间进行半结构化访谈，以评估父母间关系的多重品质。在产后1个月，父母完成关于他们对婴儿的感觉和态度的报告，以评估受损的关系。在6个月大时，父母提供关于孩子社会情感功能的报告。在控制产前父母关系质量的前提下，母子关系和父婴关系受损与婴儿社会情感受损有着独特的联系。此外，父母间关系的多个维度(即如冲突管理质量差、对父亲的支持不足、对母亲的尊重程度低)与婴儿社会情感障碍有关，控制了亲子关系。研究结果还显示了一种间接的途径，例如，婴儿更大的社会情感障碍和父母性生活质量有关，怀孕期间不良的性生活质量与父亲(而不是母亲)报告的与婴儿的关系更糟糕有关。结果强调了在孩子出生之前和之后立即了解核心家庭所在的大家庭网路环境的重要性，以便在尽可能早的干预阶段识别出有高危风险的儿童。.

A common topic for advice given to parents after childbirth – both from relationship experts and popular media – is how to “bounce back” to one’s pre-pregnancy sexuality, with warnings that postpartum declines in sexual frequency will take a serious toll on one’s relationship. However, these admonishments may not accurately reflect the ways in which the unique reproductive context of pregnancy and the postpartum transition alter associations between sexual frequency and relationship quality. Evolutionary perspectives on reproductive strategies would suggest that in the postpartum context, decreased sexual activity would help target parental investment in the current offspring (rather than creating new offspring); however, if the parental relationship is lacking in intimacy and support, continued sexual activity may help seal the cracks in the bond. We tested this theory in a longitudinal dyadic study of changes in relationship quality and sexual frequency from pregnancy to 6 months postpartum among 159 heterosexual couples. We found that across three different measures of relationship quality taken from interviews and behavioral observation of couple interactions, higher relationship quality (i.e., greater support, intimacy, and responsiveness) predicted greater decline in sexual frequency whereas sexual frequency remained relatively stable in lower quality relationships. These findings suggest that, during the postpartum transition, decreased sexual frequency may not be a reliable signal of poor relationship quality.

This vignette study examined perceptions of 237 male and female undergraduate students regarding two severity levels (low and high) of other specified (OSFED) and unspecified feeding and eating disorders (UFED) in their male and female peers. Multilevel modeling showed that female characters received stronger endorsements of eating pathology than male characters for similar symptom presentations. College men were more likely than college women to rate female characters as having eating disorders. Gender bias about eating disorders affected men and women differently in this study. Implications for gender-inclusive as well as gender-sensitive eating disorder outreach and prevention are discussed.

It is important to consider trauma-related sequelae in the etiology and maintenance of psychopathology, namely understudied disorders such as those belonging to the Obsessive-Compulsive Spectrum (OCS). This meta-analysis examined the association between past trauma exposure and current severity of OCS disorder symptoms. A systematic literature search was conducted with 24 (N=4557) articles meeting inclusion criteria. A significant overall effect size was obtained (r=0.20), indicating that exposure to past trauma is associated with a higher severity of OCS symptoms, with a stronger association for females (β=0.01, p

Background Weight loss and depressive symptoms are critical head and neck cancer outcomes, yet their relation over the illness course is unclear. Methods Associations between self-reported depressive symptoms and objective weight loss across the year after head and neck cancer diagnosis were examined using growth curve modeling techniques (n = 564). Results A reciprocal covariation pattern emerged–changes in depressive symptoms over time were associated with same-month changes in weight loss (t [1148] = 2.05; p = .041), and changes in weight loss were associated with same-month changes in depressive symptoms (t [556] = 2.43; p = .015). To the extent that depressive symptoms increased, patients lost incrementally more weight than was lost due to the passage of time and vice versa. Results also suggested that pain and eating-related quality of life might explain the reciprocal association between depressive symptoms and weight loss. Conclusion In head and neck cancer, a transactional interplay between depressive symptoms and weight loss unfolds over time. © 2016 Wiley Periodicals, Inc. Head Neck 39: 370–379, 2017

Understanding how couples navigate and negotiate the challenges and demands of pregnancy has important implications for family health. The aim of this study was to apply a multidimensional model of intimate relationship quality in a sample of 154 pregnant, cohabitating couples, to investigate the association between a range of intimate relationship processes (i.e., emotional intimacy, conflict management, sexual quality, received respect and acceptance, and received support) and the global relationship satisfaction of each partner. Semistructured clinical interviews were administered to each partner assessing multiple qualities of the relationship, and participants completed home surveys of global relationship satisfaction each day for 14 days. Results demonstrated that multiple dimensions of the intimate relationship were associated with greater relationship satisfaction. Some processes (e.g., degree of emotional intimacy and closeness, conflict management) had larger effects on relationship satisfaction than others (e.g., quality of the sexual relationship). Furthermore, some processes were more important for maternal than paternal satisfaction (e.g., emotional intimacy, support, respect). Finally, results varied, to some degree, as a function of whether parents were transitioning to parenthood for the first time. We discuss the implications of adopting a multidimensional approach to studying the specific relationship processes associated with global relationship satisfaction and present implications for clinicians working with couples navigating the transition into parenthood.La comprensión de cómo las parejas transitan y negocian los desafíos y las exigencias del embarazo tiene importantes consecuencias para la salud familiar. El objetivo del presente estudio fue aplicar un modelo multidimensional de calidad de las relaciones íntimas en una muestra de 154 parejas convivientes que esperaban un bebé a fin de investigar la asociación entre varios procesos relacionales íntimos (i.e., intimidad emocional, manejo de conflictos, calidad sexual, respeto y aceptación recibidos y apoyo recibido) y la satisfacción general con la relación de cada integrante de la pareja. Se realizaron entrevistas clínicas semiestructuradas a cada integrante de la pareja donde se evaluaron varias cualidades de la relación, y los participantes contestaron encuestas en su hogar sobre la satisfacción general con la relación cada día durante 14 días. Los resultados demostraron que varias dimensiones de la relación íntima estuvieron asociadas con una mayor satisfacción con la relación. Algunos procesos (p. ej.: el grado de intimidad y cercanía emocional, el manejo de conflictos) tuvieron efectos más considerables en la satisfacción con la relación que otros (p. ej.: la calidad de la relación sexual). Además, algunos procesos fueron más importantes para la satisfacción maternal que para la parental (p. ej.: intimidad emocional, apoyo, respeto). Finalmente, los resultados variaron, hasta cierto grado, en función de si los padres estaban atravesando la transición a la paternidad por primera vez. Debatimos las implicancias de adoptar un enfoque multidimensional para estudiar los procesos relacionales específicos asociados con la satisfacción general con la relación y presentamos las consecuencias para los clínicos que trabajan con parejas que atraviesan la transición hacia la paternidad.了解夫妇情侣如何应对和处理怀孕期间的各种挑战和需求对整个家庭的健康状况有重要的启示。本研究旨在应用一种亲密关系质量多维度模型来调查亲密关系处理要素(比如感情亲密关系,冲突管理,性生活质量,受到的尊重和接受程度,受到的支持等)和情侣各自对整体关系满意度之间的联系。受试者是154对怀孕中且生活在一起的夫妇情侣。每个受试者被要求回答半结构化的医用访谈问卷以测试伴侣关系的各种质量,且被要求每日在家完成一份整体关系满意度的调查问卷,持续14天。结果显示多个维度的亲密关系和更满意的伴侣关系有关联。有些要素(比如感情亲密程度和亲近关系,冲突管理)较之于其他要素素(比如性关系质量)对关系的满意度有更大影响。另外,有些要素对母亲的满意度的影响比起对父亲的满意度之影响更重要(比如情感亲密程度,支持,和尊重)。最后,在某种程度上,父母是否第一次体验到为人父母的转变会对结果有不同的影响。我们在文中讨论了使用多维度方法研究特定关系方法与整体关系满意度的意义, 也讨论了此法对治疗师辅助夫妇情侣一起过渡到父母身份的意义。.

Disaster exposure during pregnancy has received limited attention. This study examined the impact of the 2008 Iowa Floods on perinatal maternal depression and well-being, and the role of peritraumatic distress as a possible mechanism explaining this link. Perinatal women (N = 171) completed measures of depressive symptoms and general well-being at 5 timepoints from pregnancy to 30 months postpartum. Objectively assessed prenatal flood exposure was associated with greater depression (r = .15). Further, flood-related peritraumatic distress was uniquely associated with greater depression (r = .23), and was a key mechanism through which flood exposure led to depression. Prenatal flood exposure was also associated with general well-being (r = .18); however, a mechanism other than peritraumatic distress appears to have been responsible for the effect of flood exposure on well-being. We discuss the implications of these findings for informing etiological models and enhancing the efficacy of interventions for maternal psychopathology.

Background Up to 20% of women experience postpartum depression (PPD). PPD is associated with anxiety and poor health-related quality of life (HRQOL). Efficacious treatments are critical; many women with PPD prefer complementary therapies. Thus, the current study examined yoga as a complementary therapy for PPD. Methods Fifty-seven postpartum women with scores ≥12 on the Hamilton Depression Rating Scale were randomly assigned to a yoga ( N = 28) or wait-list control ( N = 29) group. The yoga intervention consisted of 16 classes over 8 weeks. Outcomes were depression, anxiety, and HRQOL. Results The yoga group experienced significantly greater rate of improvement in depression, anxiety, and HRQOL, relative to the control group with moderate to large effects. Reliable Change Index analyses revealed that 78% of women in the yoga group experienced clinically significant change. Conclusion These findings support yoga as a promising complementary therapy for PPD, and warrant large-scale replication studies. Trial Registration http://clinicaltrials.gov/NCT02213601.

Maternal postpartum depression has been linked to later internalizing and externalizing behaviors in offspring; whereas, the consequences of paternal postpartum depression have received little attention. Further, research has produced inconsistent findings regarding mechanisms accounting for the link between postpartum depression and subsequent child behaviors. The purpose of this longitudinal study was to extend previous research by examining simultaneously the unique effects of maternal and paternal postpartum depression on child behaviors, and exploring the potential mediating roles of later depression and interparental conflict. The study included a sample of 199 couples whose index child was an average age of 4.5 months at the postpartum assessment and 45.5 months at the toddlerhood assessment. Findings suggest that both maternal and paternal depression in the postpartum period set the stage for future parental depression and interparental conflict. Parental depression during toddlerhood was associated with child internalizing and externalizing behaviors and represents a primary mechanism through which postpartum depression is linked to child behaviors for both male and female children. Interparental conflict was not a significant mediator, but may have an indirect role in internalizing and externalizing behaviors through its associations with parental depression. Clinical implications include the need for pediatric primary care providers to routinely implement systematic screening practices for parental mental health and to provide referrals to couples and parenting programs when depression is detected.

BACKGROUND: Maternal depression in the postpartum period confers substantial morbidity and mortality, but the definition of postpartum depression remains controversial. We investigated the heterogeneity of symptoms with the aim of identifying clinical subtypes of postpartum depression.METHODS: Data were aggregated from the international perinatal psychiatry consortium Postpartum Depression: Action Towards Causes and Treatment, which represents 19 institutions in seven countries. 17,912 unique subject records with phenotypic data were submitted. We applied latent class analyses in a two-tiered approach to assess the validity of empirically defined subtypes of postpartum depression. Tier one assessed heterogeneity in women with complete data on the Edinburgh postnatal depression scale (EPDS) and tier two in those with postpartum depression case status.FINDINGS: 6556 individuals were assessed in tier one and 4245 in tier two. A final model with three latent classes was optimum for both tiers. The most striking characteristics associated with postpartum depression were severity, timing of onset, comorbid anxiety, and suicidal ideation. Women in class 1 had the least severe symptoms (mean EPDS score 10·5), followed by those in class 2 (mean EPDS score 14·8) and those in class 3 (mean EPDS score 20·1). The most severe symptoms of postpartum depression were significantly associated with poor mood (mean EPDS score 20·1), increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptom onset within 4 weeks postpartum and had more pregnancy complications than in other two classes (69% vs 67% in class 1 and 29% in class 3).INTERPRETATION: PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations.FUNDING: Sources of funding are listed at the end of the article.

BackgroundUniversal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.MethodOrdinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.ResultsEducation, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).ConclusionsInvestigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

A systematic investigation of the role of prenatal partner support in perinatal maternal depression was conducted. Separate facets of partner support were examined (i.e., received support and support adequacy) and a multidimensional model of support was applied to investigate the effects of distinct types of support (i.e., informational, physical comfort, emotional/esteem, and tangible support). Both main and stress-buffering models of partner support were tested in the context of prenatal maternal stress resulting from exposure to a natural disaster. Questionnaire data were analyzed from N=145 partnered women using growth curve analytic techniques. Results indicate that received support interacts with maternal flood stress during pregnancy to weaken the association between stress and trajectories of maternal depression from pregnancy to 30 months postpartum. Support adequacy did not interact with stress, but was associated with levels of depressive symptoms controlling for maternal stress and received support. Results demonstrate the distinct roles of various facets and types of support for a more refined explanatory model of prenatal partner support and perinatal maternal depression. Results inform both main effect and stress buffering models of partner support as they apply to the etiology of perinatal maternal depression, and highlight the importance of promoting partner support during pregnancy that matches support preferences.

BACKGROUND: The perinatal period is a time of high risk for onset of depressive disorders and is associated with substantial morbidity and mortality, including maternal suicide. Perinatal depression comprises a heterogeneous group of clinical subtypes, and further refinement is needed to improve treatment outcomes. We sought to empirically identify and describe clinically relevant phenotypic subtypes of perinatal depression, and further characterise subtypes by time of symptom onset within pregnancy and three post-partum periods.METHODS: Data were assembled from a subset of seven of 19 international sites in the Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. In this analysis, the cohort was restricted to women aged 19-40 years with information about onset of depressive symptoms in the perinatal period and complete prospective data for the 10-item Edinburgh postnatal depression scale (EPDS). Principal components and common factor analysis were used to identify symptom dimensions in the EPDS. The National Institute of Mental Health research domain criteria (RDoC) functional constructs of negative valence and arousal were applied to the EPDS dimensions that reflect states of depressed mood, anhedonia, and anxiety. We used k-means clustering to identify subtypes of women sharing symptom patterns. Univariate and bivariate statistics were used to describe the subtypes.FINDINGS: Data for 663 women were included in these analyses. We found evidence for three underlying dimensions measured by the EPDS: depressed mood, anxiety, and anhedonia. On the basis of these dimensions, we identified five distinct subtypes of perinatal depression: severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia, and resolved depression. These subtypes have clear differences in symptom quality and time of onset. Anxiety and anhedonia emerged as prominent symptom dimensions with post-partum onset and were notably severe.INTERPRETATION: Our findings show that there might be different types and severity of perinatal depression with varying time of onset throughout pregnancy and post partum. These findings support the need for tailored treatments that improve outcomes for women with perinatal depression.FUNDING: Janssen Research & Development.

Background Research suggests that trauma exposure is associated with perinatal depression; however, little is known about the nature of the relation between trauma history and trajectory of depression, as well as the predictive power of trauma history beyond other risk factors. Additionally, more research is needed in at-risk samples that are likely to experience severe traumatic exposure. Methods Secondary data analysis was conducted using demographic and depression data from the Healthy Start and Empowerment Family Support programs in Des Moines, Iowa. Hierarchical linear modeling was used to examine trajectories of perinatal depressive symptoms, from pregnancy to 24 months postpartum, and clarify whether trauma exposure, relationship status, and substance use uniquely contribute to trajectories of symptoms over time. Results On average, depressive symptoms decreased from pregnancy to 24 months postpartum; however, trajectories varied across women. Single relationship status, substance use, and trauma history were each predictors of higher depression levels at several points in time across the observed perinatal period. Single relationship status was also associated with decline in depressive symptoms followed by a rebound of symptoms at 22 months postpartum. Limitations These data were not collected for research purposes and thus did not undergo the rigorous data collection strategies typically implemented in an established research study. Conclusions History of trauma, substance use and single relationship status represent unique risk factors for perinatal depression. For single women, depressive symptoms rebound late in the postpartum period. Single women are at greater risk for substance use and traumatic exposure and represent a sample with cumulative risk. Eliciting social support may be an important intervention for women presenting with these risk factors.

Maternal depression is linked to poor infant and child outcome. In 2001, the U.S. Health Resources and Services Administration required all Healthy Start programs to incorporate maternal-depression screening as part of home visiting services. This article describes the implementation and results of depression screening by the Des Moines Healthy Start Project between 2002 and 2009. The study represents the first longitudinal assessment of the Healthy Start maternal-depression screening initiative.The evaluation assessed staff compliance with a protocol for screening for depression among clients at regular intervals during the prenatal and postnatal periods until the client's child was two years old. Rates of acceptance of referral for treatment and treatment seeking as well as depression outcomes were measured.A total of 1,902 women were served by the Des Moines Healthy Start Project between 2002 and 2009. Compliance with the screening protocol was immediately high and increased significantly over the evaluation period, from 83% in 2002 to 98% in 2009. Of the 573 women who had elevated depression scores but who were not already in treatment, 64% accepted a referral, and 47% reported receiving treatment. Predictors of referral acceptance and treatment included higher depression scores and speaking English as a primary language. Depression severity significantly decreased for women who reported receiving treatment.A federal screening initiative identified a significant number of women who were at risk for maternal depression and connected them with treatment resources. Continuing work should assess the impact of this initiative on outcomes of women and children.

Background The course and predictors of women׳s mood following childbirth have informed clinically significant phenomena, such as postpartum depression (PPD), with some contradictory findings due to methodological limitations. It is important to further investigate mood during this unique period of time to inform assessment and improve interventions. Methods Recently delivered mothers ( n =216) recruited from the maternity unit at a University hospital completed sociodemographic questions and the Daily Experiences Questionnaire (DEQ), a measure of Negative Affect (NA) and Positive Affect (PA), for 10 consecutive days. The Structured Clinical Interview for DSM-IV was administered to assess postpartum depression diagnosis. Results Growth curve modeling (GCM) techniques revealed average trends in mood following delivery. NA changed in a curvilinear fashion with a peak at day 5. PA declined rapidly during the days immediately following delivery and then stabilized. Women diagnosed with PPD experienced higher overall levels of NA and lower levels of PA from delivery to 10 days postpartum. Patterns of mood varied as a function of neuroticism and several well-established sociodemographic variables. Limitations Small sample size and relatively few ethnic minority participants may affect generalizability of the findings. Conclusions NA changed in a pattern consistent with the “peaking phenomenon”. Well-established risk factors of the blues had significant associations with mood from delivery to day 10. Increased understanding into the nature of NA and PA in the early postpartum, and its role in identifying women susceptible to experiencing PPD, can inform screening and therapeutic interventions for PPD.

Objective: We examined the course and predictors of postpartum depression in the 18 months following interpersonal psychotherapy (IPT). Method: We enrolled 120 community women with major depression in a 12-week randomized trial of individual IPT during the postpartum period (O’Hara, Stuart, Gorman, & Wenzel, 2000). At 6, 12, and 18 months posttreatment, women participated in clinical interviews to establish the course of depression over the previous 6 months. We used survival analyses to characterize recovery and recurrence in the follow-up and growth curve modeling techniques to identify predictors of change in depression during the follow-up period. Potential predictors included severity, chronicity, and personal history of depression. Results: Of 35 women who recovered with acute treatment, 20 (57%) achieved sustained recovery during follow-up; average time to recurrence was 33.40 weeks (SD 18.43 weeks). Over 80% of women who did not recover with acute treatment experienced recovery at some point during follow-up; average time to recovery was 28.60 weeks (SD 17.51 weeks). Time depressed each month decreased over the follow-up period. Posttreatment depressive severity and length of the index episode predicted changes in depression over time. Posttreatment depression severity, personal history of depression, and weeks of treatment in the follow-up were significant predictors of time depressed during follow-up. Conclusions: IPT resulted in long-term benefits past the termination of acute treatment, even for women who did not initially recover. Though the vast majority of women who did not recover with acute treatment did recover during the follow-up period, continuation of IPT may accelerate the process.