Cheryl Tatano Beck

Predictors of postpartum depression: an update.

BackgroundApproximately 13% of women experience postpartum depression. Early recognition is one of the most difficult challenges with this mood disorder because of how covertly it is suffered. ObjectivesThe purpose of this meta-analysis was to update the findings of an earlier meta-analysis of postpartum depression predictors that had synthesized the results of studies conducted mostly in the 1980s. MethodA meta-analysis of 84 studies published in the decade of the 1990s was conducted to determine the magnitude of the relationships between postpartum depression and various risk factors. Using the software system Advanced Basic Meta-Analysis, effect sizes were calculated three ways: unweighted, weighted by sample size, and weighted by quality index score. ResultsThirteen significant predictors of postpartum depression were revealed. Ten of the 13 risk factors had moderate effect sizes while three predictors had small effect sizes. The mean effect size indicator ranges for each risk factor were as follows: prenatal depression (.44 to .46), self esteem (.45 to. 47), childcare stress (.45 to .46), prenatal anxiety (.41 to .45), life stress (.38 to .40), social support (.36 to .41), marital relationship (.38 to .39), history of previous depression (.38 to .39), infant temperament (.33 to .34), maternity blues (.25 to .31), marital status (.21 to .35), socioeconomic status (.19 to .22), and unplanned/unwanted pregnancy (.14 to .17). ConclusionsResults confirmed findings of an earlier meta-analysis and in addition revealed four new predictors of postpartum depression: self-esteem, marital status, socioeconomic status, and unplanned/unwanted pregnancy.

The Effects of Postpartum Depression on Maternal-infant Interaction: A Meta-analysis

A meta-analysis of 19 studies was conducted to determine the magnitude of the effect of postpartum depression on maternal-infant interaction during the first year after delivery. Maternal-infant interaction was divided into three subcategories: maternal interactive behavior, infant interactive behavior, and dyadic interactive behavior. Substantive, methodological, and miscellaneous variables were extracted and coded by both the researcher and two research assistants. Combinations were calculated as unweighted, weighted by sample size, and weighted by the quality index score. Effects for maternal interactive behavior ranged from .32 to .36 for the r index, .68 to .78 for the d index, and .33 to .38 for the Fischers Z. For infant interactive behavior, effects ranged from .35 to .38, .75 to .83, and .37 to .41 for the r, d, and Fishers Z indexes, respectively. Effects for dyadic interactive behavior ranged from .47 to .50 for the r index, 1.07 to 1.15 for the d index, and .51 to .55 for Fishers Z. Results of the meta-analysis indicate that postpartum depression has a moderate to large effect on maternal-infant interaction. Nursing interventions for depressed mother-infant dyads during the first year after delivery are addressed.

The effects of postpartum depression on child development: A meta-analysis

The adverse, short-term effects of postpartum depression on maternal-infant interaction have been repeatedly documented. Are there long-term sequelae for children whose mothers had experienced postpartum depression? The purpose of this meta-analysis was to determine the magnitude of the effect of postpartum depression on the cognitive and emotional development of children older than the age of 1 year. Nine studies which met the sample criteria were included in this meta-analysis. Results indicated that postpartum depression had a small but significant effect on childrens cognitive and emotional development. The r indicator for effect size ranged from .18 to .22 whereas the d indicator ranged from .36 to .45. Implications for future research are addressed.

A meta-analysis of predictors of postpartum depression.

A meta-analysis of 44 studies was conducted to determine the magnitude of the relationship between postpartum depression and each of the following predictor variables: prenatal depression, history of previous depression, social support, life stress, child care stress, maternity blues, marital satisfaction, and prenatal anxiety. Effect sizes were calculated three ways: unweighted, weighted by sample size, and weighted by quality index score. Moderate to large significant effect sizes were revealed between these eight predictor variables and postpartum depression. The mean r effect size indicator range for each predictor variable was as follows: prenatal depression (.49 to .51), child care stress (.48 to .49), life stress (.36 to .40), social support (.37 to .39), prenatal anxiety (.30 to .36), maternity blues (.35 to .37), marital satisfaction (.29 to .37), and history of previous depression (.27 to .29).

Generalization in quantitative and qualitative research: myths and strategies.

Generalization, which is an act of reasoning that involves drawing broad inferences from particular observations, is widely-acknowledged as a quality standard in quantitative research, but is more controversial in qualitative research. The goal of most qualitative studies is not to generalize but rather to provide a rich, contextualized understanding of some aspect of human experience through the intensive study of particular cases. Yet, in an environment where evidence for improving practice is held in high esteem, generalization in relation to knowledge claims merits careful attention by both qualitative and quantitative researchers. Issues relating to generalization are, however, often ignored or misrepresented by both groups of researchers. Three models of generalization, as proposed in a seminal article by Firestone, are discussed in this paper: classic sample-to-population (statistical) generalization, analytic generalization, and case-to-case transfer (transferability). Suggestions for enhancing the capacity for generalization in terms of all three models are offered. The suggestions cover such issues as planned replication, sampling strategies, systematic reviews, reflexivity and higher-order conceptualization, thick description, mixed methods research, and the RE-AIM framework within pragmatic trials.

Postpartum Depression: A Metasynthesis

Postpartum depression has been described as a dangerous thief that robs mothers of the love and happiness they expected to feel toward their newborn babies. Even though the number of qualitative studies on postpartum depression is increasing, knowledge development will be impeded unless the rich understandings gleaned from these studies are synthesized. Using Noblit and Hare’s 1988 approach, the author conducted a metasynthesis of 18 qualitative studies on postpartum depression. Four overarching themes emerged that reflected four perspectives involved in postpartum depression: (a) incongruity between expectations and the reality of motherhood, (b) spiraling downward, (c) pervasive loss, and (d) making gains. Implications for clinical practice and theory development are addressed.

Qualitative Research: The Evaluation of Its Credibility, Fittingness, and Auditability:

The three criteria of credibility, fittingness, and auditability have been focused on in the hope of facilitating the critique of qualitative research. Once criteria that are appropriate to qualitative methodologies are developed, the scientific merit of these research studies can truly be appreciated. If traditional scientific criteria relevant to quantitative studies are used to critique qualitative methods, the development and acceptance of this paradigm-transcending research will be hindered.

Postpartum Depression Screening Scale: Development and Psychometric Testing

BACKGROUND Approximately 400,000 mothers in the United States experience postpartum depression each year. However, only a small proportion of these women are identified as depressed by health care professionals. OBJECTIVES To improve detection of this postpartum mood disorder, the purpose of this study was to assess the psychometric properties of a newly devised instrument, the Postpartum Depression Screening Scale (PDSS), a 35-item Likert-type self-report instrument. METHODS Content validity was supported through the literature and the judgments rendered by a panel of five content experts and a focus group. The PDSS was administered to 525 new mothers. RESULTS Confirmatory factor analysis provided empirical support for the existence of the hypothesized seven dimensions. A Tucker-Lewis goodness-of-fit index of 0.87 and a root mean square residual of 0.05 were judged supportive of model fit. Item response theory techniques provided further construct validity support for finer interpretations of the respective seven dimensions. Analysis of the Likert 5-point response categories further supported meaningful score interpretations. Alpha internal consistency reliabilities ranged from 0.83 (sleeping/eating disturbances) to 0.94 (loss of self). CONCLUSIONS Empirically, all of the reliability and validity analyses supported the score interpretations posited for the PDSS. Currently, the sensitivity, specificity, and positive predictive value of the PDSS are being determined.

The lived experience of postpartum depression: a phenomenological study

The purpose of this phenomenological study was to describe the essential structure of the lived experience of postpartum depression. Seven mothers who had suffered from postpartum depression were interviewed regarding their subjective experiences. Data were analyzed using Colaizzis (1978) method of phenomenology. Forty-five significant statements were extracted and clustered into 11 themes. These results were integrated into the essential structure of postpartum depression. Postpartum depression was a living nightmare filled with uncontrollable anxiety attacks, consuming guilt, and obsessive thinking. Mothers contemplated not only harming themselves but also their infants. The mothers were enveloped in loneliness and the quality of their lives was further compromised by a lack of emotions and all previous interests. Fear that their lives would never return to normal was all-encompassing.

Birth trauma: in the eye of the beholder.

BackgroundThe reported prevalence of posttraumatic stress disorder after childbirth ranges from 1.5% to 6%. ObjectiveTo describe the meaning of women’s birth trauma experiences. MethodsDescriptive phenomenology was the qualitative research design used to investigate mothers’ experiences of traumatic births. Women were recruited through the Internet, primarily through Trauma and Birth Stress (TABS), a charitable trust located in New Zealand. The purposive sample consisted of 40 mothers: 23 in New Zealand, 8 in the United States, 6 in Australia, and 3 in the United Kingdom. Each woman was asked to describe the experience of her traumatic birth and to send it over the Internet to the researcher. Colaizzi’s method was used to analyze the 40 mothers’ stories. ResultsFour themes emerged that described the essence of women’s experiences of birth trauma: To care for me: Was that too much too ask? To communicate with me: Why was this neglected? To provide safe care: You betrayed my trust and I felt powerless, and The end justifies the means: At whose expense? At what price? ConclusionsBirth trauma lies in the eye of the beholder. Mothers perceived that their traumatic births often were viewed as routine by clinicians.