Predicting the Origins of Post-Partum Depression Through the Use of Mental Representations
Publication Date:December 1994
Both the incidence and scope of post-partum affective disorders are more pervasive than previously assumed. Several etiological factors have been implicated but none has fully explained the origins of the condition. This paper proposes that post-partum depression may be predicted from the expectant mother's representations of her own caregiver. Deficits in representational ability may prevent the caregiver from envisioning herself as a competent mother capable of forging an adaptive relationship with the infant. Previewing-a developmental process that predicts maturational change -may enhance the mother's ability to represent adaptive interaction. Previewing techniques may be used to overcome the negative representations associated with post-partum depression, enabling the mother to establish a secure attachment relationship with the infant. This discussion highlights the representational deficits that may contribute to post-partum depression and describes how previewing may help to resolve this depression.
Ainsworth, M. D. S., Bell, S. M., Blehar, M. C. & Main, M. (1971). Physical contact: A study of infant responsiveness and its relation to maternal handling. Paper presented at the biennial meeting of the Society for Research in Child Development, Minneapolis, Minnesota.
Ammaniti, M. (1989, September). Symposium on maternal representations. Paper presented at the rVth World Congress of Infant Psychiatry and Allied Disciplines, Lugano, Switzerland.
Ammaniti, M., Baumgartner, E., Candelori, C., Perucchini, P., PoIa, M., Tambelli, R., & Zampino, F. (1992). Representations and narratives during pregnancy. Infant Mental Health Journal, 13(2), 167-182.
Atkinson, A. K., and Rickel, A. U. (1984). Postpartum depression in primiparous parents. Journal of Abnormal Psychology, 93(1), 115-119.
Bibring, G. L., & Valenstein, A. F. (1976). Psychological aspects of pregnancy. Clinical Obstetrics and Gynecology, 19, 357-371.
Bittman, S. & Zalk, S. (1978). Ejectant Fathers. New York: Hawthorn Books.
Bleuler, M. (1954). Endokrinilogishe Psychiatre. Thieme; Stuttgart, F.R.G.
Blumberg, N. L. (1980). Effects of neonatal risk, maternal attitude, and cognitive style on early postpartum adjustment. Journal of Abnormal Psychology, 89, 139-150.
Bowlby, J. (1969). Attachment and Loss: Vol 1, Attachment. New York: Basic Books. (2nd rev. ed., 1982).
Bowlby, J. (1973). Attachment and Loss: Vol 2, Separation. New York: Basic Books.
Bowlby, J. (1980). Attachment and Loss: Vol 3, Loss, sadness and depression. New York: Basic Books.
Brandon, S. (1980). Depression after childbirth. British Medical Journal, 284, 613-614.
Bretherton, I. (1987). New perspectives on attachment relations: security, communications and internal working models. In J. Osofsky (Ed.), Handbook of Infant Development (2nd ed., pp. 1061-1100). New York: Wiley.
Bretherton, I. (1990). Communication patterns, internal working models, and the intergenerational transmission of attachment relationships. Infant Mental Health Journal, 11(3), 237-252.
Brown, G. W., Ni Bhrolchain, M., & Harris, T. (1975). Social class and psychiatric disturbance among women in an urban population. Sociology, 9, 225-254.
Buesching, D. P., Glasser, M. L., & Frate, D. A. (1986). Progression of depression in the prenatal and postpartum periods. Women and Health, 11(2), 61-78.
Byng-Hall, J., & Stevenson-Hinde, J. (1991). Attachment relationships within a family system. Infant Mental Health Journal, 12(3), 187-200.
Caplan, G. (1959). Concepts of mental health and consultation; their application in public health social work. Washington D.C.: U.S. Children's Bureau.
Cassidy, J. (1988). The self as related to child-mother attachment at six. Child Development, 59, 121-134.
Coleman, T. R. (1974). Abnormal psychology. New York: MSS Information Corp.
Condon, J. T. & Drum, D. J. (1988). Nature and determinants of parent-to-infant attachment in the early postnatal period. Journal of the American Academy of Child and Adolescent Psychiatry, 27(3), 293-299.
Crittenden, P. M. (1990). Internal representational models of attachment relationships. Infant Mental Health Journal, 11(3), 259-277.
Cutrona, C. E. (1982). Nonpsychotic postpartum depression: A review of the recent research. Clinical Psychology Review, 2, 487-503.
Cutrona, C. E. (1983). Casual attributions and perinatal depression. Journal of Abnormal Psychology, 92, 161-172.
Cutrona, C. E., & Troutman, B. R. (1986). Social support, infant temperament, and parenting self-efficacy: A mediational model of postpartum depression. Child Development, 57, 1507-1518.
Cutrona, C. E., & Troutman, B. R. (1990). Nonpsychotic postpartum depression among adolescent mothers. Journal of Abnormal Psychology, 99(1), 69-78.
Dalton, K. (1971). Prospective study into puerperal depression. British Journal of Psychiatry, 118, 689-692.
Escher-Graub, D. and Grossmann, K. E. (1983). Bindungssicherheit im zweiten Lebensjar-die Regensburger Querschnittuntersuchung (Attachment security in the second year of life: The Regensburg cross-sectional study). Research Report, University of Regensburg.
Fava-Vizziello, G. (1989, September). Symposium on maternal representations. Paper presented at the IVth World Congress of Infant Psychiatry and Allied Disciplines, Lugano, Switzerland.
Field, T. M. (1982). Affective displays of high-risk infants during early interaction. In T. Field & A. Fogel (Eds.), Emotion and early interactions. Hillsdale, NJ: Erlbaum.
Field, T. M. (1990). Behavior states and rhythms of depressed mother-infant dyads. In C. Rovee-Collier (Ed.), Abstracts of papers presented at the Seventh International Conference on Infant Studies (p. 58), Montreal. Norwood, NJ: Ablex.
Fonagy, P., Steele, H., & Steele, M. (1991). Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Development, 62, 891-905.
Handley, S. L., Dunn, T. L., Waldron, G., & Baker, J. M. (1980). Tryptophan cortisol and puerperal mood. British Journal of Psychiatry, 136, 498-508.
Harris, B. (1980). Prospective trial of L-tryptophan in maternity blues. British Journal of Psychiatry, 137, 233-235.
Hayworth, J., Little, B. C., Bonham Carter, S., Raptopoulos, P., Priest, R. G., & Sandier, M. (1980). A predictive study of postpartum depression: Some predisposing characteristics. British Journal of Medical Psychology, 53, 161-167.
Kendell, R. E., Chalmers, J. C., & Platz, C. (1987). Epidemiology of puerperal psychoses. British Journal of Psychiatry, 150, 662-673.
Kennerley, H., & Gath, D. (1989). Associations with obstetric, psychological, and psychiatric factors. British Journal of Psychiatry, 155, 367-373.
Kestenberg, J. S. (1976). Regression and reintegration in pregnancy. Journal of the American Psychoanalytic Association, 24, 213-250.
Kumar, R., Robson, K. M. (1984). A prospective study of emotional disorders in childbearing women. British Journal of Psychiatry, 115, 797-805.
Laughlin, C. D. Jr., McManus, J., & d'Aquili, E. G. (1993). Brain, Symbol and Experience. New York: Columbia University Press.
Main, M., Kaplan, K., & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. In I. Bretherton & E. Waters (Eds.), Growing points of attachment theory and research. Monographs of the Society for Research in Child Development, 50(1-2, Serial No. 209), 66-104.
McNeil, T. F. (1986). A prospective study of post-partum psychoses in a high risk group. 1. Clinical characteristics of the current post-partum episode. ACTA Psychiatrica Scandinavica, 74, 205-216.
Melges, F. T. (1968). Postpartum psychiatric syndromes. Psychosomatic Medicine, 30, 95-108.
Nelson, K., and Gruendel, J. (1981). Generalized event representations: Basic building blocks of cognitive development. In A. Brown and M. Lamb (Eds.). Advances in Developmental Psychology (Vol. 1, pp. 131-159). Hillsdale, NJ: Erlbaum.
O'Hara, M. W. (1986). Social support, life events, and depression during pregnancy and the puerperium. Archives of General Psychiatry, 43(6), 569-573.
O'Hara, M. W, Zekoski, E. M., Philipps, L. H., & Wright, E. J. (1990). Controlled prospective study of postpartum mood disorders: Comparison of childbearing and nonchildbearing women. Journal of Abnormal Psychology, 99(1), 3-15.
Paffenbarger, R. S. Jr. (1982). Epidemiological aspects of mental illness associated with childbirth. In: I. Brockington and R. Kumar (Eds.), Motherhood and mental illness, Vol. 1. London: Academic Press.
Papousek, H., & Papousek, M. (1987). Intuitive parenting: A dialectic counterpart to the infant's integrative competence. In J. D. Osofsky (Ed.), Handbook of infant development (2nd ed.). New York: Wiley.
Paykel, E. S., Emms, E. M., Fletcher, J., & Rassaby, E. S. (1980). Life events and social support in puerperal depression. British Journal of Psychology, 136, 339-346.
Pines, D. (1972a). Pregnancy and motherhood: Interaction between fantasy and reality. British Journal of Medical Psychology, 45(4), 333-343.
Pines, N. (1972b). Hilda Abraham: 1906-1971. International Journal of Psycho-Analysis, 53(3), 331.
Platz, C., & Kendell, R. E. (1988). A matched control follow-up and family study of 'puerperal psychoses'. British Journal of Psychiatry, 153, 90-94.
Raphael-Leff, J. (1980). Psychotherapy with pregnant women. In B. Blum (Ed.), Psychological Aspects of Pregnancy, Birthing and Bonding, pp. 174-205. New York: Human Sciences Press.
Raphael-Leff, J. (1986). Facilitators and regulators: Conscious and unconscious processes in pregnancy and early motherhood. British Journal of Medical Psychology, 59, 43-55.
Saks, B. R., Frank, J. B., Lowe, T. L., Berman, W., Naftolin, F., & Cohen, D. J. (1985). Depressed mood during pregnancy and the puerperium: Clinical recognition and implications for clinical practice. American Journal of Psychiatry, 142(6), 728-731.
Sandler, J., & Sandier, A. (1978). On the development of object relationships and affects. 30th International Psycho-Analytical Congress: Dialogue on "The development of object relationships and affects" (1977, Jerusalem, Israel). International Journal of Psycho-Analysis, 59(2-3), 285-296.
Shareshefsky, P. M., & Yarrow, L. J. (1973). Psychological aspects of a first pregnancy and postnatal adaption. New York: Raven Press.
Slough, N., & Greenberg, M. (1993). 5-year-olds' representations of separation from parents: Responses for self and a hypothetical child. In I. Bretherton & M. Watson (Eds.), Children's perspectives on the family (New Directions for Child Development, W. Damon, Series Editor). San Francisco: Jossey-Bass.
Spitz, R. A., & Wolf, K. M. (1946). Anaclitic depression. Psychoanalytical Study of the Child, 314, 85-119.
Paul V. Trad, M.D.
Paul V. Trad, M.D., is the Director of the Child and Outpatient Department at New York Hospital, Westchester Division, and is an Assistant Professor of Psychiatry on the faculty of Cornell University Medical College.