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Postpartum depressive symptoms : the influence of women’s inner-self, spiritual, and social resources Bachmann, Linda Ellen

Abstract

Limited progress has been made toward the development of holistic and theoretically informed models of postpartum depression (PPD). Researchers have ignored the spiritual dimension and paid little attention to interrelationships among qualities of women's specific interpersonal relationships, personality processes, and PPD. The primary purpose of the study was to test a theoretical model of postpartum depressive symptoms. Women (N = 203) in the Fraser Valley Health Region of British Columbia who gave birth to a live child were sequentially recruited by public health nurses and completed two mailout questionnaires at 1 - and 8-weeks postpartum. Causal modelling was used to test a theoretically-based model of PPD. Women's spiritual and social resources and depressive : symptoms at 1-week postpartum were hypothesized to have direct and indirect effects on depressive symptoms at 8-weeks postpartum (DS8). The first of the major study findings revealed that depressive symptoms at 1-week postpartum and self-esteem were the strongest predictors of DS8. Depressive symptoms at 1- week postpartum negatively influenced the quality of women's relationship with their spouses and female friends and were associated with a diminished sense of social support and selfesteem. Conflict with spouses/partners and female friends had similar and negative effects on DS8, marked negative effects on the perceived supportiveness of these relationships, and a negative influence on DS8 through diminished global perceived social support and self-esteem. Spousal conflict was also directly related to lower self-esteem. Lack of confidence in God's forgiveness had a direct negative effect, of the same magnitude as did conflict with spouses and female friends, on DS8. Aspects of spirituality were significant in the lives of a majority of the women; 72% experienced some sense of closeness to God and 59% expected God's wisdom and guidance with parenting. Results indicate a need to identify women who feel very depressed in the first week after delivery. Early interventions may be more effective if they aim to protect and bolster women's self-esteem and encourage them to obtain appropriate counselling for relational conflict. Practitioners should explore possible spiritual concerns and assist women in finding spiritual support as needed. The role of female friends in women's lives merits further study. Properties of interpersonal relationships, such as trust, commitment, and intimacy may be more potent predictors of PPD than social support, and should be examined in theoretical models that include personality and spiritual factors.

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