Sara Casalin

The course of postpartum depression: a review of longitudinal studies.

Learning Objectives: After participating in this educational activity, the physician should be better able to1. Identify the risk factors associated with persistence of postpartum depression.2. Evaluate the limitations of the literature.3. Determine the implications of the findings on women with postpartum depression and their children.This article aims to critically review studies published between 1985 and 2012 concerning the course of postpartum depression (PPD), as well as factors implicated in PPD with a chronic course. We provide a systematic, qualitative review of studies on the course of PPD, following PRISMA guidelines. The results show that although the majority of women recover from PPD, it becomes chronic in a relatively large subgroup of women. Several studies have identified risk factors predicting a chronic course of PPD. This review also emphasizes and discusses important conceptual and methodological limitations in existing research, which preclude drawing strong conclusions. Finally, the implications of these findings and suggestions for future research and clinical intervention are outlined.

The structure and stability of temperament from infancy to toddlerhood: A one-year prospective study

This study investigated the factor structure and longitudinal stability of temperament in a multi-informant (i.e., as reported by mothers and fathers), one-year prospective study from infancy (8-13 months) to toddlerhood (20-25 months). Confirmatory factor analyses (CFAs) replicate and extend earlier studies; in that evidence was found for a three-factor structure for both infant and toddler temperament, consisting of Surgency/Extraversion, Negative Affectivity and Effortful Control. There were, especially in toddlerhood, few differences between mother and father reports in average scores on the three temperament factors, which were in part related to differences in parental involvement between mothers and fathers. In addition, there were few differences between average scores for boys and girls on these temperament factors, with the exception that both mothers and fathers rated girls higher on Effortful Control, and fathers rated boys higher on Extraversion/Surgency, especially in toddlerhood. Finally, results showed that the three factors showed high relative, absolute, and structural stability over a one-year period. The implications of these findings for contemporary temperament research are discussed.

Stability and Change in Levels of Depression and Personality: A Follow-up Study of Postpartum Depressed Mothers That Were Hospitalized in a Mother-Infant Unit

This prospective longitudinal study investigated the role of the personality dimensions of dependency and self-criticism in the course of depressive symptoms in a sample of inpatient severely postpartum depressed mothers (n = 55). Depressive symptoms and personality were measured during hospitalization and on average 3 1/2 years later. In line with previous research, a considerable subgroup of mothers (39%) reported moderate to severe symptoms of depression at time 2. In addition, although these mothers did not exhibit more depressive episodes during follow-up period compared with mothers with a less chronic course of depression, their depressive episodes were considerably longer, and they had higher levels of severity of depression as well as of dependency and self-criticism at Time 1. Finally, self-criticism, but not dependency, assessed at Time 1, predicted both depression diagnosis and levels of depression at follow-up, supporting a vulnerability model positing that self-criticism confers vulnerability for depression over time.

Hospitalization-based treatment for postpartum depressed mothers and their babies: rationale, principles, and preliminary follow-up data.

This paper describes the rationale and treatment principles of a mother-infant unit for severely depressed mothers and their infants in Flanders (Belgium). The unit integrates systemic, psychodynamic, and cognitive behavioral treatment approaches, and aims at improvements on three levels: (1) improving mood and interpersonal relationships in depressed mothers, (2) fostering a positive motherinfant relationship, and (3) establishing a supportive environment outside the treatment setting for both mother and infant. In addition, we present preliminary data of a 3.5–year naturalistic follow-up study of postpartum depressed mothers (n = 41) admitted at this mother-infant unit between April 2003 and April 2005. Results showed that at 3.5–year follow-up a considerable subgroup of mothers (61%) were functioning relatively well, as indicated by low levels of depressive symptoms, anxiety and anger, negative affect, and relatively high levels of positive affect. Yet, in line with other studies, a relatively large subgroup of mothers (39%) continued to suffer from (severe) depression during follow-up. Using a Life History Calendar method, it was found that, compared to currently nondepressed mothers, mothers who were depressed at follow-up did not have more depressive episodes but had longer depressive episodes, received more psychotherapy after hospitalization, and experienced more negative life events during the 3.5–year follow-up period. Implications of these findings for future research and intervention strategies in postpartum depression are discussed.

Kinderen van depressieve moeders

SamenvattingGoodman en Gotlib (1999) ontwierpen een integratief model waarin ze de mechanismen beschrijven die de overdracht van depressie van moeders op hun kinderen verklaren. Ook worden modererende variabelen beschreven in de relatie tussen de depressie van de moeder en het functioneren van haar kind. Het model tracht veronderstellingen en empirische onderzoeken bij elkaar te brengen. In het artikel bespreken we dit model kritisch en schenken daarbij vooral aandacht aan wat klinisch relevant is.