The Functions of Postpartum Depression



Study


Correlate of PPD

Prenatal and delivery problems:

Campbell and Cohen 1991

Campbell et al. 1992

*Pregnancy and delivery complications, p<.01

*Minor pregnancy and delivery complications (e.g., elevated blood
pressure, gestational diabetes, prolonged labor) p<.001

O’Hara 1984

Obstetric risk factors (abnormal weight gain during pregnancy, abnormal
uterine size, preeclampsia, significant bleeding, abnormal presentation,
fever in labor, and the presence of meconium-stained amniotic fluid)
accounted for 19% of the variance in depressive symptomology.

Paykel et al 1980

Subjective stress of pregnancy p<.05; Objective rating of labor
complications p<.01

Postnatal problems:

Atkinson and Rickel 1984

Hopkins et al 1987

PPD in men predicted by perception that infant was below average p<.05
*Infant complications accounted for 12% of variability in depression
scores

Kumar and Robson 1984

Whiffen and Gotlib 1989

*Premature baby p<.05

*Mental development at 2 months p<.05; infants more tense, less happy
and have lower endurance at 2 months p<.05

Unexpected correlations:

O’Hara et al 1982

Paykel et al 1980

No correlation:

PPD associated with less complicated deliveries
PPD associated with less complicated deliveries

Warner et al 1996

PPD not associated with complicated pregnancy (sampling of women was
not random with respect to pregnancy problems, which may have affected
the results).

Table 2: Studies that found a correlation between infant quality variables and PPD (*PPD assessed by clinical
diagnosis).

The third hypothesis applies to major rather than minor PPD. A minor form of PPD
involving fewer and less severe symptoms is sometimes distinguished from PPD involving a
major depressive episode.2 Minor PPD is consistent with the psychological pain hypothesis and
the two proposed functions described earlier. Symptoms of major PPD not well accounted for
by the psychological pain hypothesis—e.g., marked loss of interest in virtually all activities,
psychomotor retardation, significant weight loss, diminished ability to think or concentrate, and
recurrent thoughts of death—may enable the mother to negotiate greater levels of social support,
the third functional hypothesis. In the same way that a valuable employee may attempt to
negotiate a larger salary by threatening to quit, mothers receiving insufficient social support may
attempt to negotiate larger levels of support by threatening to defect from (i.e., quit) the
childrearing endeavor. This hypothesis cannot be adequately tested with the data that are
currently available and it is justified on purely theoretical grounds; as such, it is quite
speculative.

2Virtually all studies of PPD rely on either a clinical diagnosis according to the criteria in the Diagnostic and
Statistical Manual (DSM), International Classification of Diseases (ICD), or on depression instrument scores (e.g.,
Edinburgh Postnatal Depression Scale, Cox et al. 1987) representing a continuum of severity. Minor PPD is
usually not diagnosed separately, but is defined by establishing a lower cutoff for a self-report score, or for
number of symptoms reported.



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