Maternal and paternal postpartum early mood and bonding.

BACKGROUND: Whereas the maternal 'blues' has been widely researched, comparatively less is known about the "highs" following childbirth, and the relation between mothers and fathers' mood in this early period. We aimed to investigate the association between maternal 'blues' and 'highs' with paternal postpartum mood (here described as 'lows' and 'highs') in the early postpartum and their associations with the quality of child bonding. METHODS: Women and their cohabitating male partners, fathers of the index child (N = 98 couples), attending an obstetric hospital unit completed questionnaires on mood, bonding and socio-demographics between the 3rd and the 5th postpartum day. We used generalised estimating equations to analyse the data. RESULTS: The 'blues' scores were higher in mothers, whereas 'highs' and bonding were higher in fathers. Maternal 'blues' were significantly correlated with paternal 'lows' (rs = .23, p < .05) and maternal 'highs' were also associated with paternal 'highs' (rs = .22, p < .05). Parental 'highs' were significantly associated with better baby bonding (B = .13, p = .02). CONCLUSIONS: Our study demonstrates moderate associations between both 'blues/lows' and 'highs' in mothers and fathers shortly after the birth of the child. Associations between mood, particularly 'highs', and bonding were similar for mothers and fathers. Greater consideration of 'blues/lows' and 'highs' in both parents is needed to promote adjustment in the postpartum period.

Associated symptoms of depression: patterns of change during pregnancy.

Little is known about the natural course of depressive symptoms and associated features throughout pregnancy. We examined the course of some psychological and somatic symptoms in each month of pregnancy in a normative sample. A consecutive, unselected sample of women (N = 374) were interviewed retrospectively at 6 weeks postpartum with the Structured Clinical Interview (DSM-IV). Women were asked whether they had experienced each symptom at any time during pregnancy and the occurrence of the symptom for each month of pregnancy. Associated symptoms of depression showed complex changes across pregnancy. Depressed mood (F(df) = 5.15(1); p = 0.02) showed a quadratic pattern with elevations at the beginning and end of pregnancy. Both linear increases (a) and quadratic (b) changes over time were observed for sensitivity to criticism (F a(df) = 20.9(1), p a = 0.00; F b(df) = 7.02(1), p b = 0.00), lack of concentration (F a(df) = 37.0(1), p a = 0.00; F b(df) = 10.3(1); p b = 0.00), decreased energy (F a(df) = 13.4(1); p a = 0.00; F b(df) = 62.6(1); p b = 0.00) and feelings of heavy limbs (F a (df) = 92.9(1); p a = 0.00; F b(df) = 67.7(1); p b = 0.00). Only guilt (F(df) = 0.00(1); p = 0.93) showed no significant change over pregnancy. Psychological symptoms changed throughout pregnancy as much as somatic symptoms. A linear increase was found for most symptoms, but significant non-linear changes were also found. The discrepancy between the patterns of depressed mood and most somatic and psychological symptoms suggest complex interactions and potentially important implications for assessment and monitoring treatment.

The DSM IV diagnoses of melancholic and atypical depression in pregnancy.

Atypical and melancholic subtypes of depression based on the Diagnostic and Statistical Manual (DSM) IV are important concepts, especially for biological psychiatry. The aim of this study was to determine whether the symptoms used for the diagnoses of atypical and melancholic depression can distinguish these subtypes during pregnancy. A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all DSM IV symptoms of melancholic and atypical depression with depressed and non-depressed women in pregnancy. A Swiss cohort of 449 women was interviewed. Four diagnostic groups were compared: women with melancholic, atypical or non specified depression, and those without depression. Seventeen per cent of the cohort met SCID criteria for a depressive episode of depression at least once in pregnancy, with melancholic depression 2.4%, atypical depression 4.4% and non specified depression 10.2%. Many of the symptoms used to distinguish atypical and melancholic depression did not discriminate between these groups during pregnancy. However some, such as mood reactivity, distinct quality of mood and sleep pattern, did discriminate. Differential diagnosis between melancholic and atypical depression in pregnancy needs to be based on pregnancy specific definitions. The possible therapeutic consequences and the neurobiological basis for these findings warrant further research.