Considering a Relational Model for Depression in Women with Postpartum Depression

Abstract

Purpose: To extend testing of a relational theory that a low sense of belonging, delayed or impaired bonding, and loneliness are salient risk factors for postpartum depression (PPD) in women.

Methods: Data for this theory-testing analysis came from a larger prospective longitudinal cohort study and included women who were retained to the end of the study at the 6 week postpartum interview (n=564). Structural equation modeling was used to test the "fit" of the model and determine significance of direct and indirect paths.

Results: The model explained 35% of the variance in postpartum depression with impaired bonding and loneliness as the strongest indicators. Lower sense of belonging, less perceived social support from a healthcare practitioner and a partner, and lower parenting sense of competence were additional predictors.

Conclusion: Study findings challenge current thinking about the relationship between impaired bonding and PPD as this study raises the possibility that impaired bonding is a risk for PPD as opposed to the reverse relationship. The study provided evidence of the importance of healthcare practitioners' alliance with patients. This paper contributes to advancing the science of women's mental health in relation to depression by considering additional predictors which might be amenable to intervention.

Keywords: bonding; conflict; loneliness; postpartum depression; sense of belonging; social support.

Figure 1

The theoretical model of postpartum depression

Figure 2

The theoretical model for postpartum depression tested by using SEM with standardized regression coefficients (above straight arrows) and R2 values (above endogenous variables, top right corner). Observed variables are represented by squares.