Preliminary communication
Effect of dysfunctional attitudes and postpartum state on vulnerability to depressed mood

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Abstract

Background

Postpartum depression (PPD) is the most common complication of childbearing with a 13% prevalence. Vulnerability to depressed mood has an important role in the onset of major depressive episodes (MDE), but has not been investigated in postpartum. The aim is to assess whether day-5 postpartum blues and severity of dysfunctional attitudes predicts vulnerability to depressed mood.

Methods

About 45 healthy women were recruited: group 1 (n=12) was day-5 postpartum during the typical peak of postpartum blues. Group 2 (n=11) was within 18 months postpartum and reported a vulnerability to cry (and had elevated dysfunctional attitudes but no MDE). Group 3 (n=11) was within 18 months postpartum and no vulnerability to cry. Group 4 (n=11) was not recently postpartum. Vulnerability to depressed mood was measured by the change in the visual analog scale from the sad mood induction procedure (MIP).

Results

Univariate analysis of covariance demonstrated that day-5 postpartum blues and level of dysfunctional attitudes were highly predictive of change in sad mood (postpartum blues: F(1,41)=12.9, p<0.005, dysfunctional attitudes scale score: F(1,41)=11.49, p<0.005).

Limitations

Although the effects were robust, sample sizes were 11–12 within each group.

Conclusion

Two factors (day-5 postpartum and severity of dysfunctional attitudes) predicted vulnerability to sad mood. Since the severity of postpartum blues predicts PPD, MIP on day-5 postpartum represents a quantitative measure that can be applied to screen novel, early interventions for preventing PPD. Interventions to prevent PPD through increasing resilience against mood induction should target postpartum women with greater severity of dysfunctional attitudes.

Introduction

Postpartum depression (PPD) is the most common complication of childbearing with a prevalence rate of approximately 13% (O’Hara and Swain, 1996) and an optimal approach for widespread prevention has not been established. It is generally accepted that vulnerability to sad mood is an important factor in the onset of major depressive episodes (MDE), but vulnerability to sad mood has not been explored in postpartum. In this study vulnerability to sad mood is examined in relation to several factors: dysfunctional attitudes, state of postpartum blues (day 5 postpartum) and general postpartum state (within 18 months postpartum).

The relationship of vulnerability to sad mood with dysfunctional attitudes was chosen because a cornerstone of the cognitive model of depression is that dysfunctional attitudes interact with negative life events to create depressed mood and more pessimistic dysfunctional attitudes are associated with greater risk for MDE(Alloy et al., 2006; Otto et al., 2007). While it might be assumed that greater severity of dysfunctional attitudes would be associated with greater vulnerability to depressed mood, this specific relationship has not been studied during the postpartum period. Investigations of mood induction in relation to dysfunctional attitudes have typically focused upon inducing sad mood in subjects such as in remitted and recovered depressed individuals and measuring changes in dysfunctional attitudes afterwards rather than vice versa (Jarrett et al., 2012, Miranda and Persons, 1988, Segal et al., 2006).

Vulnerability to sad mood is implicated in early postpartum specifically at day 5, but also thereafter. The rationale for day 5 is that it is the peak point of postpartum blues, a time of healthy range sadness reported in as many as 75% of women (O’Hara et al., 1991a, O’Hara et al., 1991b). A laboratory based method to assess the severity of postpartum blues has not been previously applied, instead, a common approach to measure postpartum blues is the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987), which is less precisely oriented towards the day of assessment, and is less state dependent, inquiring about recent insomnia, fatigue, poor appetite, crying, anxiety and emotional lability. In addition, as demonstrated by endorsement on the crying question of the EDPS, approximately 20% of women have crying spells in their first 18 months of postpartum without experiencing a full MDE (Evans et al., 2001).

The objective of this study was to determine whether higher dysfunctional attitude scale severity, the presence of day 5 postpartum blues, or being within 18 months postpartum will be associated with greater sadness after sad mood induction. Given the importance of dysfunctional attitudes in the cognitive theory of depression (Alloy et al., 2006, Otto et al., 2007), given that day 5 postpartum is associated with postpartum blues (O’Hara et al., 1991a), and that MDE occurs with a high prevalence in postpartum (O’Hara and Swain, 1996), it is hypothesized that these three factors will be associated with greater vulnerability to negative mood induction.

Section snippets

Participants and study design

This study was approved by the Research Ethics Board for Human Subjects at the Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada. Written informed consents were obtained from all subjects after a through explanation of the study details and each subject was free to withdraw anytime during the study. All experiments on human subjects were conducted in accordance with the Declaration of Helsinki (1997).

Women aged 18–45 were recruited through advertisement. They were

Results

Forty-five healthy women completed this study. Of these, 12 women were in group 1 (day-5 postpartum), 11 were in group 2 (within 18 months postpartum, report vulnerability towards crying but not experiencing a MDE), 11 were in group 3 (within 18 months postpartum with no vulnerability towards crying), and 11 were in group 4 (not recently postpartum). The mean age was similar across the four groups being, 32.75±3.39, 29.09±4.18, 31.18±4.17 and 31.09±6.74.

Repeated measures of ANOVA revealed a

Discussion and conclusion

This study has several novel findings: Greater dysfunctional attitude levels and being day 5 postpartum predicted vulnerability to depressed mood, and cognitive reactivity was present in this healthy sample. The predisposition to mood induction has implications for developing resilience against depressed mood in postpartum through psychological and biological means, an important issue, given that PPD is the most common adverse complication of childbearing and that, according to the world health

Role of funding source

This research received project support from the Canadian Institutes of Health Research, through Dr. Jeffrey Meyer’s Canada Research Chair, and Yekta Dowlati received salary support from the Ontario Mental Health Foundation (OMHF).

Conflict of interest

Yekta Dowlati is assessing the effect of dietary supplements upon mood in early postpartum.

Jeffrey H. Meyer has received operating grant funds for other studies from Eli-Lilly, GlaxoSmithKline, Bristol Myers Squibb, Lundbeck, and SK Life Sciences in the past 5 years. Dr. Meyer has consulted to several of these companies as well as Takeda, Sepracor, Trius, Mylan and Teva. None of these companies participated in the design or execution of this study or in writing the paper. Dr. Meyer is

Acknowledgments

Not applicable.

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