Subtypes of postnatal depression? A comparison of women with recurrent and de novo postnatal depression

Abstract

Background It has been suggested that there may be two groups of women with postnatal depression (PND) — one who have a history of depression and whose depression is etiologically similar to depression experienced at other times of life, and another who develop depression de novo in the postnatal period and whose depression is uniquely ‘postnatal’. The primary aim of this study was to clarify the role of negative attitudes (general and maternal-specific) for these proposed subtypes, whilst also considering the role of a range of other potentially relevant etiological factors. Methods 157 postnatal women were classified into four groups: (i) ‘recurrent depression’, (ii) ‘de novo PND’, (iii) ‘prior (but not current) depression’, (iv) ‘healthy control’. Groups were compared on known vulnerability and situational risk factors for depression including negative attitudes (general and maternal-specific), personality style vulnerability, relationship insecurity, low social support, stressful life events and difficult infant behaviour. Hierarchical regressions were conducted to examine the role of general and maternal-specific negative attitudes in mediating the relationship between previous depression and PND. Results Women with recurrent depression had more personality vulnerability and maternal-specific negative attitudes than women with de novo PND, but there were no differences in general negative attitudes or relationship insecurity. Non-depressed women with a history of prior depression were characterized by elevated general depression vulnerability but lower maternal-specific negative attitudes. General negative attitudes mediated the relationship between previous depression and PND. Limitations All participants had unsettled infants and the generalizability of results to general postpartum samples is not known. Conclusions Although these results do not provide support for the proposed subtypes of PND, they highlight encouraging new avenues for cognitively based preventative interventions.