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Postpartum Depression: Diagnosis and Treatment
Postpartum Depression: Diagnosis and Treatment

Section 5
Mother's Risk for Depression

CEU Question 5 | CEU Test | Table of Contents | Depression
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

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In the last section, we discussed marital disharmony, violence and depression.  This included increased irritability, physical abuse and a lessened sense of self.

Do you have a pregnant client whose mother has recently passed away? 

In this section,
we will discuss loss and depression.  This will include mothers who lose mothers and the confluence of causes regarding depression.  As you read, think of your client.  What symptoms of depression does she show, and how do you respond?  Would playing this section be beneficial as an educational tool during your next session with a client you are currently treating?

Marital disharmony and abuse increases the risk for depression in part because most women in these situations are unwilling or unable to share their pain or have no one to whom they can turn for support.  Many women turn to their own mothers for advice and comfort during pregnancy.

♦ Mothers Who Lose Mothers
First, let’s discuss mothers who lose their mothers.  Pregnancy is a time when women are likely to think about the way they themselves were mothered and to consider, if they haven’t already done so, which of their mother’s habits or ways of parenting they wanted to emulate and which they hope to avoid.  If their relationship with their mother was difficult, this may be a time when they want to heal it.  If the relationship was good, warm, and close, this may be a time when it almost always becomes closer. 

In fact, women who have a particularly good relationship with their mothers will generally feel particularly good about their own pregnancies.  When a woman loses her mother either during or just prior to pregnancy, that loss can be a trigger for postnatal depression.  If their relationship was less than ideal, death robs the mother of the opportunity to reconcile or repair it; If it was especially close, death denies her a key source of support, as it did my client Tiffany, age 25.

Tiffany had always been extremely close to her mother, perhaps because her parents were divorced when she was very young.  Even after Tiffany was married, she and her mother lived in the same city, and when she became pregnant, she shared all her plans as well as every little physical change she was experiencing with her mother. Then, early one morning Tiffany was awakened out of a deep sleep by a phone call informing her that her mother, who was only sixty-two years old and in seemingly good health, had died suddenly of a massive heart attack.

Tiffany was devastated.  It was almost impossible for her to take in the fact that her mother, which whom she’d had a long phone conversation just hours before, planning the colors for the nursery, was now gone.  Rushing to her mother’s apartment, Tiffany stared in disbelief at her mother’s lifeless body.  Instead of making plans for the nursery, Tiffany would now be planning a funeral.

Tiffany’s depression came on suddenly.  Instead of thinking about her own impending motherhood, she found herself ruminating incessantly upon her loss and unable to get the picture of her mother’s dead body out of her mind.  All the joy she’d been feeling was gone.  Now there was only sorrow and increasingly uncontrolled anxiety.  Loss, however, is not the only cause of postpartum depression.  There are often a host of other factors involved.

♦ The Confluence of Causes Regarding Depression
Second, let’s discuss the confluence of causes regarding depression.  It seems clear that more than coincidence is involved when women experience depressive mood disorders at critical times of change in their reproductive biology.  These normal biological changes, including puberty during teen years and menopause in their fifties, put women at risk for recurrent depression through most of their adult lives. 

What is more, the biological changes associated with depression in women are also associated with times of particular stress in their lives.  I have found these factors to indicate that treating women requires me to be sensitive to both the physical and emotional changes they are experiencing.  I have also found that pregnancy, which, as you know can be a time of mental and emotional stress as well as major biological change, is a turning point when a woman will be particularly vulnerable to depression.

Do you have a Tiffany who might benefit from hearing this section in your next session? 

In this section, we have discussed loss and depression.  This has included mothers who lose mothers and the confluence of causes regarding depression.  Would playing this section be beneficial during your next session with a client you are currently treating to validate the normalcy of what she is experiencing?

In the next section, we will discuss unplanned pregnancy.  This will include when partners disagree, the acceptance technique and termination.

Peer-Reviewed Journal Article References:
Kita, S., Hayashi, M., Umeshita, K., Tobe, H., Uehara, N., Matsunaga, M., & Kamibeppu, K. (2020). Intimate partner violence and maternal child abuse: The mediating effects of mothers’ postnatal depression, mother-to-infant bonding failure, and hostile attributions to children’s behaviors. Psychology of Violence, 10(3), 279–289. 

Kudinova, A. Y., Woody, M. L., James, K. M., Burkhouse, K. L., Feurer, C., Foster, C. E., & Gibb, B. E. (2019). Maternal major depression and synchrony of facial affect during mother-child interactions. Journal of Abnormal Psychology, 128(4), 284–294. 

Markin, R. D. (2018). “Ghosts” in the womb: A mentalizing approach to understanding and treating prenatal attachment disturbances during pregnancies after loss. Psychotherapy, 55(3), 275–288. 

Markin, R. D., & McCarthy, K. S. (2020). The process and outcome of psychodynamic psychotherapy for pregnancy after loss: A case study analysis. Psychotherapy, 57(2), 273–288.

Ruybal, A. L., & Siegel, J. T. (2017). Increasing social support for women with postpartum depression: An application of attribution theory. Stigma and Health, 2(2), 137–156. 

Woody, M. L., McGeary, J. E., & Gibb, B. E. (2014). Brooding rumination and heart rate variability in women at high and low risk for depression: Group differences and moderation by COMT genotype. Journal of Abnormal Psychology, 123(1), 61–67.

Online Continuing Education QUESTION 5
Why are women at risk for depression during most of their adult lives? To select and enter your answer go to CEU Test.

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Postpartum Depression: Diagnosis and Treatment

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