Posttraumatic growth in women after a childbirth experience: The influence of individual characteristics and intrusive and deliberate rumination.

OBJECTIVE: This study targets women who had a self-defined traumatic childbirth experience to (a) explore the differences between sociodemographic-, obstetric-, and trauma-related variables in relation to the rumination style; (b) determine differences between intrusive and deliberate rumination in relation to posttraumatic growth (PTG) dimensions, and (c) test whether intrusive rumination is associated with deliberate rumination, which in turn is associated with PTG dimensions. METHOD: A cross-sectional study design was employed using a web-based survey method for data collection. In total, 202 women who identified their childbirth experience as traumatic participated in this study. RESULTS: Intrusive rumination and deliberate rumination were positively associated with all dimensions of PTG in women following the traumatic childbirth event. Deliberate rumination fully explained the relationship between intrusive rumination and PTG aspects of relating to others, new opportunities, and personal strength, and partially explained the relationship between intrusive rumination and PTG aspects of spiritual changes and appreciation of life. CONCLUSIONS: The results suggest that deliberate rumination can contribute to explain the occurrence of PTG. These findings could help develop psychosocial interventions to maximize opportunities for deliberate rumination for women with traumatic childbirth experiences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Diagnosis of peripartum depression disorder: A state-of-the-art approach from the COST Action Riseup-PPD.

BACKGROUND: Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice. METHODS: To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis. RESULTS: When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications. CONCLUSION: There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either "pregnancy onset" or "postpartum onset". Diagnostic criteria for PPD are further discussed.

Paternal peripartum depression: emerging issues and questions on prevention, diagnosis and treatment. A consensus report from the cost action Riseup-PPD.

INTRODUCTION: Paternal peripartum depression (P-PPD) is a serious and understudied public health problem associated with impaired family functioning and child development. The lack of recognition of P-PPD may result in limited access to both information and professional help. OBJECTIVE: The aim of the study was to review studies on paternal peripartum depression and to identify issues and questions where future research and theory formation are needed. METHODS: A literature search for systematic reviews, meta-analyses and primary studies was conducted using PubMed, Web of Science, Embase, Scopus, Medline, PsychInfo and Informit databases. Key results within the retrieved articles were summarised and integrated to address the review objectives. RESULTS: Based on the literature, the knowledge related to prevalence, screening, risk factorsunique to fathers, management strategies and outcomes of P-PPD is lacking. Currently, there is no consensual understanding of the definition of P-PPD and recommendations for dealing with P-PPD. Limited data were available regarding the barriers preventing fathers from accessing support systems. CONCLUSION: Emerging issues that need to be addressed in future research include: P-PPD definition and pathogenetic pathways; prevention strategies and assessment tools; self-help seeking and engagement with interventions; the cost-effectiveness of P-PPD management; needs of health professionals; effect on child development, and public awareness. Future studies and clinical practice should account the complexities that may arise from the father's perceptions of health care services. Results from this review highlights the critical issues on how to plan, provide and resource health services, to meet the health needs of fathers.

Separation in Unity: Dialogical Transformation of Maternal Bond.

The objective of this paper is to explore mothers' psychological adaptation related to separation from their newborn children immediately after birth. Mother and child separation has traditionally received attention from the child's perspective, but given that the bond is dyadic, the mother's wellbeing should also be considered. This qualitative study is based on interview data with mothers of premature infants. From the analysis, three themes emerged: concerns during pregnancy about premature birth; emotional strain caused by separation; and the need to protect and to be close to the newborn. Drawing on the perspectives of dialogical self theory and semiotic regulation model, the paper will focus on intra-psychological dynamics and will analyze the adaptation process in terms of I-positions. Based on the analysis, the maternal bond represents the integration of the I-position I-as-mother and My child, which is integrated during the pregnancy into the core of the self. It can be assumed that rupture of the self-continuity is activated by the birth of the child, which is then compounded if the child leaves. The maternal superordinate viewpoint (meta-I-position) directs a woman's behavior and allows for a sense of coherence under dynamic organization related to the birth of the child. The potential for psychological adaptation is presented as an ability to establish self-continuity.

Clinical practice guidelines with recommendations for peripartum depression: A European systematic review.

OBJECTIVE: This study aims to systematically review all Clinical Practice Guidelines (CPGs) with recommendations for peripartum depression in European countries. METHODS: A systematic review according to the PRISMA statement was conducted. CPGs focussing on peripartum depression or with at least one specific recommendation for peripartum depression from European countries were selected. Searching was conducted in electronic databases (MEDLINE and PsycINFO), and by contacting professional societies and international experts until November 24th, 2021. Characteristics of the included CPGs and their recommendations were extracted. A methodological quality assessment was conducted using the AGREE-II tool. RESULTS: A total of 239 records were identified after duplicate removal. Of these, 54 were examined for full-text inspection. The final selection yielded 14 CPGs from 11 European countries in 10 languages. Of them, 11 provided recommendations on pharmacological treatments, 10 on psychological treatment (e.g., cognitive-behavioural therapy), 10 on screening, 8 on diagnosis, 6 on other treatments (e.g., physical exercise), 5 on prevention, and 5 other recommendations (e.g., provide information). Regarding the overall methodological quality, only five (35.7%) guidelines were rated as of adequate quality, reaching a score ≥ 70% in the overall assessment of the AGREE-II instrument. Of the six AGREE-II domains, applicability scored the lowest and clarity of presentation scored the highest. CONCLUSION: The absence of CPGs in most European countries, the discrepancy in recommendations and the low methodological quality of the guidelines may lead to disparities and inequalities in peripartum depression management in Europe. The COST Action Riseup-PPD highlights key considerations for future guideline developers.

Dialogues in Infertility: Exploring the Potential for Psychological Adaptation.

The objective of this paper is to detail the process of psychological adaptation for a woman navigating the world after a diagnosis of age-related infertility. Infertility is a medical condition, but it occurs within a social and cultural context, thereby creating social and psychological dimensions. Discrepancies between a woman's fertility ideals and her reality may be related to both personal preferences and contributing social factors. The discussion will be based on longitudinally collected interview data. Drawing on the Dialogical Self Theory, the paper will focus on intra-psychological dynamics (dialogues) and will analyze the adaptation process in terms of I-positions. Based on idiographic analyses the conclusion is that adaptation takes place by taking subjective personal control over the uncertainty of infertility. By integrating new I-position into intra-personal phenomena, the core "I" will be united with new qualities and is seen as an authentic elaboration resulting from the formation of personal, subjective meaning in a uniquely personal developmental trajectory.

Semiotic Regulation in the Construction of Maternal Bond: From Body Experience to the Semiotic Field.

The objective of this paper is to analyze how the maternal bond in first-time pregnant women emerges from bodily experiences in the pre-semiotic level and leads to the emergence of the semiotic field. The bond as a sign field is internally structured and enables the regulation of connections with other signs outside the field. As a result of the dialogue between biological and sociocultural imperatives, sociocultural meanings are turned into personal meanings and presented by women through behavior. This study is based on longitudinally-collected interview data consisting of six interviews with women from the time they were pregnant until their child turned one year old. During this period, three ruptures as turning points in the formation of the bond were identified. Based on idiographic analyses, it was concluded that body signals caused by the development of the fetus are coded by women into signs of various kinds, which define the status of mother and create the foundation for the mother-child relationship which continues throughout the lifespan.