Different patterns of attentional bias in antenatal and postpartum depression

Abstract

Background: Biased information processing in attention, memory, and interpretation is proposed to be central cognitive alterations in patients with major depressive disorder, but studies in women with peripartum depression are scarce. Because of the many similarities with depression in nonperipartum states as regards symptom profile and risk factors, we hypothesized that women with antenatal and postpartum depression would display attentional bias to negatively and positively valenced words.

Methods: One hundred and seventy-seven pregnant and 157 postpartum women were included. Among these, 40 suffered from antenatal depressive disorder and 33 from postpartum depressive disorder. An emotional Stroop task with neutral, positive, negative, and negatively valenced obstetric words was used.

Results: No significant difference in emotional interference scores was noted between women with antenatal depression and nondepressed pregnant women. In contrast, women with postpartum depression displayed shorter reaction times to both positive (p = .028) and negative (p = .022) stimuli, compared with neutral words. Pregnant women on antidepressant treatment displayed longer reaction times to negatively valenced obstetric words in comparison with untreated depressed women (p = .012), and a trend toward greater interference in comparison with controls (p = .061).

Conclusions: In contrast with the hypothesis, we found no evidence of attentional bias to emotionally valenced stimuli in women with untreated peripartum depression. However, the shorter reaction times to emotional stimuli in women with postpartum depression may indicate emotional numbing, which in turn, is a functional impairment that may have repercussions for child development and well-being. Our findings emphasize the need to identify and treat women with postpartum depression at the earliest possible time point to ensure swift recovery and support for the family.

Keywords: antenatal depression; attentional bias; emotional Stroop; postpartum depression; pregnancy; women.

Figure 1

Emotional interference scores (mean ± SD) in (a) nondepressed pregnant women (n = 149) and women with antenatal depression (n = 28), and (b) nondepressed postpartum women (n = 131) and women with postpartum depression (n = 26). In this contrast, euthymic women on antidepressant treatment are regarded as nondepressed. No differences in emotional interference scores were noted between women with antenatal depression and nondepressed pregnant women. Women with postpartum depression displayed less emotional interference to positive and negative words, compared with nondepressed postpartum women (*p < .05, independent t‐test)

Figure 2

Emotional interference scores (mean ± SD) in pregnant women with antidepressant treatment (n = 15), nontreated depressed women (n = 25), and healthy controls (n = 137). Women on antidepressant treatment displayed greater emotional interference by negatively valenced obstetric stimuli than nontreated depressed women (*p = .012, independent t‐test), and a tendency to greater emotional interference by negatively valenced obstetric stimuli than healthy controls (^# p = .061, independent t‐test)