Postpartum depressive symptoms in a family perspective : Some indicators, experiences and consequences

Sammanfattning: Aim: The aim of this thesis was to examine the 1) consequences of maternal depressive symptoms 2-3 months postpartum on parents experiences of parenthood at one year and on parent-child interactions15-18 months postpartum, and the 2) circumstances in the early postpartum, which might predict depressive symptoms 2 months postpartum. Method: A community sample of 574 women was screened for depressive symptoms, using the Edinburgh Postnatal Depression Scale (EPDS) two months postpartum. Forty-two women (7%) showed signs of depression, and 24 of these women and 11 of their partners consented to be videotaped during a parent-child interaction observation at 15-18 months. Twenty-one women showing no signs of depression, and 14 of their partners were selected as a comparison group. At one year, parents reported on their experiences of parenthood. To study early indicators for depressive symptoms parents were approached at the maternity clinic, Karolinska University Hospital, Solna, One hundred and six couples filled out all questionnaires about their maternity blues during a period of five consecutive days in the first week after birth, and additionally completed an EPDS, along with a questionnaire about their bonds to the child. At two months postpartum, follow-up questionnaires about the parents mood and bonding to the child were filled out. Twenty-two mothers showing signs of depression at this occasion were interviewed about their experiences of the first months with the child. Results: The videotaped parent-child interactions15-18 months postpartum showed that children of mothers who demonstrated signs of depression at 2 months exhibited less interest in and attention to an explorative play situation with their mothers. Fathers in the families with a mother showing signs of depression were, however, more positively involved with their children and, in turn, their children showed less negative affect in the interaction with their fathers than children in families where the mother did not show signs of depression. In the interviews with mothers having depressive symptoms at 2 months, it was found that the mothers expressed strong feelings of guilt, failure, and unfulfilled expectations. They struggled with life as it related to the self, with the relations with partner and with the child. At one-year postpartum, women with signs of depression at 2 months, experienced motherhood more stressfully than did mothers without signs of depressive symptoms. However, no difference was found in their respective partners experiences of fatherhood. Severe blues, bonding problems and a partner with depressed mood were found to be early indicators for depressive symptoms in both mothers and fathers. For mothers, previous depression and an emergency Caesarean section were also predictive for depressive symptoms. Conclusions: The results indicate that self-reported depressive mood in mothers might affect the child negatively, but also that fathers might compensate for the mother s mood. Postpartum depressive symptoms still seems to be a hidden condition, since mothers do not easily talk about their feelings. It is important to identify these women early. Thus, to be attentive to severe blues and bonding problems during the first week and to give the mothers an opportunity to speak about their feelings, maybe through active listening without giving advise. This may alleviate depressive symptoms and possibly prevent negative interactions between mother and child in the future.