Social exclusion, infant behavior, social isolation, and maternal expectations independently predict maternal depressive symptoms

The objective of the study was to identify latent variables that can be used to inform theoretical models of perinatal influences on postnatal depressed mood and maternal–infant attachment. A routine survey of mothers with newborn infants was commenced in South Western Sydney in 2000. The survey included the Edinburgh Postnatal Depression Scale (EPDS) and 46 psychosocial and health‐related variables. Mothers (n = 15,389) delivering in 2002 and 2003 were surveyed at 2–3 weeks for depressive symptoms. Nonlinear principal components analysis was undertaken to identify dimensions that might represent latent variables. Correlations between latent variables and EPDS >12 were assessed by logistic regression. A five‐dimension solution was identified, which accounted for 51% of the variance among the items studied. The five dimensions identified were maternal responsiveness, social exclusion, infant behavior, migrant social isolation, and family size. In addition, the variable maternal expectation contributed significantly to total variance and was included in the regression analysis. Regression on EPDS >12 was predictive for all variables except for maternal responsiveness, which was considered an outcome variable. The findings are consistent with the proposition that social exclusion, infant behavior, social isolation among migrant mothers, and maternal expectations are determinants of maternal mood.

[1]  K. Hillman,et al.  A framework for monitoring maternal and infant health status. , 2001, Australian health review : a publication of the Australian Hospital Association.

[2]  H. Phung,et al.  Postnatal Depression and Socio-Demographic Risk: Factors Associated with Edinburgh Depression Scale Scores in a Metropolitan Area of New South Wales, Australia , 2011, The Australian and New Zealand journal of psychiatry.

[3]  S. Brown,et al.  Physical health problems after childbirth and maternal depression at six to seven months postpartum , 2000, BJOG : an international journal of obstetrics and gynaecology.

[4]  P. Saunders.  Can Social Exclusion Provide a New Framework for Measuring Poverty , 2003 .

[5]  D. Stewart,et al.  Postpartum Depression Symptoms in Newcomers , 2008, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[6]  Jane Millar.  Social Exclusion and Social Policy Research: Defining Exclusion , 2008 .

[7]  E. Gaffan,et al.  Effects of early maternal depression on patterns of infant-mother attachment: a meta-analytic investigation. , 2000, Journal of child psychology and psychiatry, and allied disciplines.

[8]  M. Austin.  Targeted group antenatal prevention of postnatal depression: a review , 2003, Acta psychiatrica Scandinavica.

[9]  K. Durkin,et al.  First-time mothers' expectations of parenthood: What happens when optimistic expectations are not matched by later experiences? , 2007, Developmental psychology.

[10]  Diana Adams,et al.  High EPDS scores in women from ethnic minorities living in London , 2003, Archives of Women’s Mental Health.

[11]  Willem J. Heiser,et al.  Principal Components Analysis With Nonlinear Optimal Scaling Transformations for Ordinal and Nominal Data , 2005 .

[12]  R. Darlington,et al.  Factor Analysis , 2008 .

[13]  R. Kumar,et al.  Impact of maternal postnatal depression on cognitive development of young children. , 1986, British medical journal.

[14]  J. Cox,et al.  Detection of Postnatal Depression , 1987, British Journal of Psychiatry.

[15]  E. Leerkes,et al.  Infant social and emotional development in family context. , 2000 .

[16]  B. Vaughn,et al.  Attachment and temperament: Redundant, independent, or interacting influences on interpersonal adaptation and personality development? , 1999 .

[17]  U. Halbreich,et al.  Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. , 2006, Journal of affective disorders.

[18]  M. O’Hara,et al.  Rates and risk of postpartum depression—a meta-analysis , 1996 .

[19]  T. Brugha,et al.  Psychological interventions for postnatal depression: cluster randomised trial and economic evaluation. The PoNDER trial. , 2009, Health technology assessment.

[20]  P. Tsakloglou,et al.  Aggregate level and determining factors of social exclusion in twelve European countries , 2002 .

[21]  M. Hill,et al.  Nonlinear Multivariate Analysis. , 1990 .

[22]  S. Mangelsdorf,et al.  Temperament and attachment: one construct or two? , 1999, Advances in child development and behavior.

[23]  Cheryl Tatano Beck.  Postpartum Depression: A Metasynthesis , 2002, Qualitative health research.

[24]  M. Abbott,et al.  Postnatal depressive symptoms among Pacific mothers in Auckland: prevalence and risk factors. , 2006, Australian and New Zealand journal of psychiatry (Print).

[25]  Pranee Liamputtong,et al.  Detection of Postnatal Depression , 2011 .

[26]  J. Gervai.  Environmental and genetic influences on early attachment , 2009, Child and adolescent psychiatry and mental health.

[27]  C. Dennis.  Psychosocial and psychological interventions for prevention of postnatal depression: systematic review , 2005, BMJ : British Medical Journal.

[28]  P Fonagy,et al.  Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. , 1991, Child development.

[29]  Jacqueline J Meulman,et al.  Nonlinear principal components analysis: introduction and application. , 2007, Psychological methods.

[30]  Cheryl Tatano Beck,et al.  Acculturation Level and Postpartum Depression in Hispanic Mothers , 2005, MCN. The American journal of maternal child nursing.

[31]  C. Tennant,et al.  Maternal attachment state of mind moderates the impact of postnatal depression on infant attachment. , 2006, Journal of child psychology and psychiatry, and allied disciplines.

[32]  M. Austin,et al.  Clinical issues in perinatal mental health: new developments in the detection and treatment of perinatal mood and anxiety disorders , 2005, Acta psychiatrica Scandinavica.

[33]  John T. Behrens,et al.  Principles and procedures of exploratory data analysis. , 1997 .

[34]  M. F. van der Wal,et al.  Infant crying and abuse , 2004, The Lancet.

[35]  M. Lovejoy,et al.  Maternal depression and parenting behavior: a meta-analytic review. , 2000, Clinical psychology review.

[36]  D. Ellwood,et al.  Postnatal Mental Health of Women Giving Birth in Australia 2002–2004: Findings from the Beyondblue National Postnatal Depression Program , 2008, The Australian and New Zealand journal of psychiatry.

[37]  A. Paglia,et al.  Attachment security: a meta-analysis of maternal mental health correlates. , 2000, Clinical psychology review.

[38]  H. Williams,et al.  Depression in mothers in a multi-ethnic urban industrial municipality in Melbourne. Aetiological factors and effects on infants and preschool children. , 1985, Journal of child psychology and psychiatry, and allied disciplines.

[39]  Gerald Gartlehner,et al.  Perinatal Depression: A Systematic Review of Prevalence and Incidence , 2005, Obstetrics and gynecology.

[40]  R. Muñoz,et al.  Interpersonal factors and perinatal depressive symptomatology in a low-income Latina sample. , 2007, Cultural diversity & ethnic minority psychology.

[41]  I. Jolliffe,et al.  Nonlinear Multivariate Analysis , 1992 .

[42]  C. Dennis,et al.  Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial , 2009, BMJ : British Medical Journal.

[43]  P. Cooper,et al.  The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcome. , 1996, Child development.

[44]  C T Beck,et al.  Predictors of Postpartum Depression: An Update , 2001, Nursing research.

[45]  John W. Tukey,et al.  We Need Both Exploratory and Confirmatory , 1980 .