OJD  Vol.10 No.2 , May 2021
Postpartum Depression: Far Reaching Impact and the Role of Empowerment
Abstract: Postpartum depression (PPD) is a significant public and mental health issue, with long-lasting effects on mothers and children. It is expected to be the second largest problem among all general health issues by the year 2030 and 10% - 20% of new mothers experience PPD globally. Early intervention has shown to be effective yet the consensus on best practice is not clear. This systematic review aimed to synthesize prior research to provide practical recommendations for the best practices for both intervention and prevention of PPD. The following databases were scanned: PsychiatryOnline, PsycArticles, PsycBooks, Psychology and Behavioral Sciences Collection, ERIC, and EBSCO. The search included the following keywords: postpartum depression, postpartum mental health, risk factors, intervention, prevention, efficacy, group therapy and empowerment, and perinatal and postnatal. The PRISMA checklist was used to screen studies for inclusion. Using the described search strategy, 45 articles were identified for synthesis. The following themes emerged in the literature: a variety of approaches focus on empowerment, and perceived competency. These themes appeared across various at-risk groups and in different cultural and socioeconomic groups. Recommendations for further investigation include the development of targeted treatment approaches, defining and objectifying maternal empowerment and self-efficacy, and the development of standardized training to improve provider competency so as to benefit mothers, children, communities, and the psychological community at large.
Cite this paper: King, C. , Morgan, S. , Firebaugh, C. , Beeson, T. , Legg, T. and Wardlow, R. (2021) Postpartum Depression: Far Reaching Impact and the Role of Empowerment. Open Journal of Depression, 10, 29-42. doi: 10.4236/ojd.2021.102003.

[1]   Abrams, L., & Curran, L. (2007). Not Just a Middle Class Affliction: Crafting a Social Work Research Agenda on Postpartum Depression. Health & Social Work, 32, 289-296.

[2]   Anokye, R., Acheampong, E., Budu-Ainooson, A., Obeng, E. I., & Akwasi, A. G. (2018). Prevalence of Postpartum Depression and Interventions Utilized for Its Management. Annals of General Psychiatry, 17, 1-8.

[3]   APA, American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: APA.

[4]   Austin, M.-P. (2004). Antenatal Screening and Early Intervention for “Perinatal” Distress, Depression and Anxiety: Where to from Here? Archives of Women’s Mental Health, 7, 1-6.

[5]   Barlow, J., McMillan, A. S., Kirkpatrick, S., Ghate, D., Barnes, J., & Smith, M. (2010). Health-Led Interventions in the Early Years to Enhance Infant and Maternal Mental Health: A Review of Reviews Jane Barlow et al. Health-Led Interventions in the Early Years. Child & Adolescent Mental Health, 15, 178-185.

[6]   Beck, C. T. (2002). Theoretical Perspectives of Postpartum Depression and Their Treatment Implications. The American Journal of Maternal/Child Nursing, 27, 282-287.

[7]   Bowlby, J. (1958). The Nature of the Child’s tie to His Mother. International Journal of Psychoanalysis, 39, 350-371.

[8]   Brazeau, N., George, C., Reisz, S., & Jacobvitz, D. (2018). Understanding the Connection between Attachment Trauma and Maternal Self-Efficacy in Depressed Mothers. Infant Mental Health Journal, 39, 30-43.

[9]   Brealey, S., Hewitt, C., Green, J., Morrell, J., & Gilbody, S. (2010). Screening for Postnatal Depression—Is It Acceptable to Women and Healthcare Professionals? A Systematic Review and Meta-Synthesis. Journal of Reproductive & Infant Psychology, 28, 328-344.

[10]   Brock, R. L., O’Hara, M. W., & Segre, L. S. (2017). Depression Treatment by Non-Mental-Health Providers: Incremental Evidence for the Effectiveness of Listening Visits. American Journal of Community Psychology, 59, 172-183.

[11]   Brüggmann, D., Wagner, C., Klingelhöfer, D., Schoffel, L., Bendels, M., Louwen, F., Jaque, J., & Groneberg, D. A. (2017). Maternal Depression Research: Socioeconomic Analysis and Density-Equalizing Mapping of the Global Research Architecture. Archives of Women’s Mental Health, 20, 25-37.

[12]   Carter, W., Grigoriadis, S., Ravitz, P., & Ross, L. E. (2010). Conjoint IPT for Postpartum Depression: Literature Review and Overview of a Treatment Manual. American Journal of Psychotherapy, 64, 373-392.

[13]   Cattaneo, L., & Chapman, A. (2010). The Process of Empowerment a Model for Use in Research and Practice. The American Psychologist, 65, 646-659.

[14]   Claridge, A. M. (2014). Efficacy of Systemically Oriented Psychotherapies in the Treatment of Perinatal Depression: A Meta-Analysis. Archives of Women’s Mental Health, 17, 3-15.

[15]   Closa-Monasterolo, R., Gispert-Llaurado, M., Canals, J., Luque, V., Zaragoza-Jordana, M., Koletzko, B. et al. (2017). The Effect of Postpartum Depression and Current Mental Health Problems of the Mother on Child Behaviour at Eight Years. Maternal & Child Health Journal, 21, 1563-1572.

[16]   Corrigan, C. P., Kwasky, A. N., & Groh, C. J. (2015). Social Support, Postpartum Depression, and Professional Assistance: A Survey of Mothers in the Midwestern United States. The Journal of Perinatal Education, 24, 48-60.

[17]   Dennis, C.-L., Merry, L., Gagnon, A., & Gagnon, A. J. (2017). Postpartum Depression Risk Factors among Recent Refugee, Asylum-Seeking, Non-Refugee Immigrant, and Canadian-Born Women: Results from a Prospective Cohort Study. Social Psychiatry & Psychiatric Epidemiology, 52, 411-422.

[18]   Dixon, S., & Dantas, J. A. R. (2017). Best Practice for Community-Based Management of Postnatal Depression in Developing Countries: A Systematic Review. Health Care for Women International, 38, 118-143.

[19]   Field, T. (2017). Postpartum Depression Effects, Risk Factors and Interventions: A Review. Clinical Depression, 3, Article ID: 1000122.

[20]   Fiorelli, M., Aceti, F., Marini, I., Giacchetti, N., Macci, E., Tinelli, E. et al. (2015) Magnetic Resonance Imaging Studies of Postpartum Depression: An Overview. Behavioural Neurology, 2015, Article ID: 913843.

[21]   Fitelson, E., Kim, S., Baker, A. S., & Leight, K. (2010). Treatment of Postpartum Depression: Clinical, Psychological and Pharmacological Options. International Journal of Women’s Health, 3, 1-14.

[22]   Fonseca, A., Monteiro, F., Alves, S., Gorayeb, R., & Canavarro, M. C. (2019). Be a Mom, a Web-Based Intervention to Prevent Postpartum Depression: The Enhancement of Self-Regulatory Skills and Its Association with Postpartum Depressive Symptoms. Frontiers in Psychology, 10, 265.

[23]   Frieder, A., Fersh, M., Hainline, R., & Deligiannidis, K. M. (2019). Pharmacotherapy and Postpartum Depression: Current Approaches and Novel Drug Treatment. CNS Drugs, 33, 265-282.

[24]   Glasser, S., Levinson, D., Bina, R., Munitz, H., Horev, Z., & Kaplan, G. (2016). Primary Care Physicians’ Attitudes toward Postpartum Depression: Is It Part of Their Job? Journal of Primary Care & Community Health, 7, 24-29.

[25]   Goodman, J. H. (2009). Women’s Attitudes, Preferences, and Perceived Barriers to Treatment for Perinatal Depression. Birth, 36, 60-69.

[26]   Goodman, J. H., & Tyler-Viola, L. (2010). Detection, Treatment, and Referral of Perinatal Depression and Anxiety by Obstetrical Providers. Journal of Women’s Health, 19, 477-490.

[27]   Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal Depression and Child Psychopathology: A Meta-Analytic Review. Clinical Child & Family Psychology Review, 14, 1-27.

[28]   Hairston, S., Handelzalts, I. E., Assis, J., & Kovo, M. (2018). Postpartum Bonding Difficulties and Adult Attachment Styles: The Mediating Role of Postpartum Depression and Childbirth-Related PTSD. Infant Mental Health Journal, 39, 198-208.

[29]   Hansotte, E., Payne, S. I., & Babich, S. M. (2017). Positive Postpartum Depression Screening Practices and Subsequent Mental Health Treatment for Low-Income Women in Western Countries: A Systematic Literature Review. Public Health Reviews, 38, Article No. 3.

[30]   Hassert, S., & Kurpius, S. E. R. (2011). Latinas and Postpartum Depression: Role of Partner Relationship, Additional Children, and Breastfeeding. Journal of Multicultural Counseling and Development, 39, 90-100.

[31]   Heck, J. L. (2018). Screening for Postpartum Depression in American Indian/Alaska Native Women: A Comparison of Two Instruments. American Indian & Alaska Native Mental Health Research: The Journal of the National Center, 25, 74-102.

[32]   Heneghan, A. M., Morton, S., & DeLeone, N. L. (2007). Paediatricians’ Attitudes about Discussing Maternal Depression during a Paediatric Primary Care Visit. Child Care Health Development, 33, 333-339.

[33]   Hong, Y. R., & Park, J. S. (2012). Impact of Attachment, Temperament and Parenting on Human Development. Korean Journal of Pediatrics, 55, 449-454.

[34]   Jewell, S. L., Luecken, L. J., Gress-Smith, J., Crnic, K. A., & Gonzales, N. A. (2015). Economic Stress and Cortisol among Postpartum Low-Income Mexican American Women: Buffering Influence of Family Support. Behavioral Medicine, 41, 138-144.

[35]   Kingston, D., McDonald, S., Austin, M.-P., & Tough, S. (2015). Association between Prenatal and Postnatal Psychological Distress and Toddler Cognitive Development: A Systematic Review. PLoS ONE, 10, e0126929.

[36]   Kingston, D., Tough, S., & Whitfield, H. (2012). Prenatal and Postpartum Maternal Psychological Distress and Infant Development: A Systematic Review. Child Psychiatry & Human Development, 43, 683-714.

[37]   Kleinman, C., & Reizer, A. (2018). Negative Caregiving Representations and Postpartum Depression: The Mediating Roles of Parenting Efficacy and Relationship Satisfaction. Health Care for Women International, 39, 79-94.

[38]   Kozhimannil, K. B., Adams, A. S., Soumerai, S. B., Busch, A. B., & Huskamp, H. A. (2011). New Jersey’s Efforts to Improve Postpartum Depression Care Did Not Change Treatment Patterns for Women on Medicaid. Health Affairs, 30, 293-301.

[39]   Leis, J. A., Mendelson, T., Tandon, D., & Perry, D. F. (2009). A Systematic Review of Home-Based Interventions to Prevent and Treat Postpartum Depression. Archives of Women’s Mental Health, 12, 3-13.

[40]   Letourneau, N. L., Dennis, C., Cosic, N., & Linder, J. (2017). The Effect of Perinatal Depression Treatment for Mothers on Parenting and Child Development: A Systematic Review. Depression & Anxiety, 34, 928-966.

[41]   Limandri, B. J. (2019). Postpartum Depression: When the Stakes Are the Highest. Journal of Psychosocial and Mental Health Services, 57, 9-14.

[42]   Liu, C., & Tronick, E. (2013). Rates and Predictors of Postpartum Depression by Race and Ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System). Maternal & Child Health Journal, 17, 1599-1610.

[43]   Malis, F. R., Meyer, T., & Gross, M. M. (2017). Effects of an Antenatal Mindfulness-Based Childbirth and Postpartum Programme on the Postpartum Experience of Mothers: A Qualitative Interview Study. BMC Pregnancy & Childbirth, 17, Article No. 57.

[44]   Mao, H.-J., Li, H.-J., Chiu, H., Chan, W.-C., & Chen, S.-L. (2012). Effectiveness of Antenatal Emotional Self-Management Training Program in Prevention of Postnatal Depression in Chinese Women. Perspectives in Psychiatric Care, 48, 218-224.

[45]   Maxwell, D., Robinson, S. R., & Rogers, K. (2019). “I Keep It to Myself”: A Qualitative Meta-Interpretive Synthesis of Experiences of Postpartum Depression among Marginalised Women. Health & Social Care in the Community, 27, e23-e36.

[46]   McFarlane, E., Burrell, L., Duggan, A., & Tandon, D. (2016). Outcomes of a Randomized Trial of a Cognitive Behavioral Enhancement to Address Maternal Distress in Home Visited Mothers. Maternal and Child Health Journal, 21, 475-484.

[47]   Meltzer-Brody, S., & Stuebe, A. (2014). The Long-Term Psychiatric and Medical Prognosis of Perinatal Mental Illness. Best Practice & Research. Clinical Obstetrics & Gynaecology, 28, 49-60.

[48]   Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G., The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Annals of Internal Medicine, 151, 264-269.

[49]   Mundorf, C., Shankar, A., Moran, T., Heller, S., Hassan, A., Harville, E., & Lichtveld, M. (2018). Reducing the Risk of Postpartum Depression in a Low-Income Community through a Community Health Worker Intervention. Maternal and Child Health Journal, 22, 520-528.

[50]   Nonnenmacher, N., Noe, D., Ehrenthal, J., & Reck, C. (2016). Postpartum Bonding: The Impact of Maternal Depression and Adult Attachment Style. Archives of Women’s Mental Health, 19, 927-935.

[51]   O’Hara, M. W. (2009). Postpartum Depression: What We Know. Journal of Clinical Psychology, 65, 1258-1269.

[52]   O’Hara, M. W. (2014). Psychosocial and Psychological Interventions Reduce the Risk of Postnatal Depression Compared with Standard Care. Evidence Based Nursing, 17, 38-39.

[53]   O’Mahen, H. A., & Flynn, H. A. (2018). Preferences and Perceived Barriers to Treatment for Depression during the Perinatal Period. Journal of Women’s Health, 17, 1301-1309.

[54]   Pearlstein, T., Howard, M., Salisbury, A., & Zlotnick, C. (2009). Postpartum Depression. American Journal of Obstetrics and Gynecology, 200, 357-364.

[55]   Pessagno, R. A., & Hunker, D. (2013). Using Short-Term Group Psychotherapy as an Evidence-Based Intervention for First-Time Mothers at Risk for Postpartum Depression. Perspectives in Psychiatric Care, 49, 202-209.

[56]   Scott, D. A. (2014). Attachment Ratings in Couples as Predictors of Depressive Symptomatology Postpartum. Journal of Reproductive & Infant Psychology, 32, 377-387.

[57]   Segre, L. S., Brock, R. L., & O’Hara, M. W. (2015). Depression Treatment for Impoverished Mothers by Point-of-Care Providers: A Randomized Controlled Trial. Journal of Consulting and Clinical Psychology, 83, 314-324.

[58]   Sheydaei, H., Ghasemzadeh, A., Lashkari, A., & Kajani, P. G. (2017). The Effectiveness of Mindfulness Training on Reducing the Symptoms of Postpartum Depression. Electronic Physician, 9, 4753-4758.

[59]   Srivastava, A. S., Mara, B., Pandey, S., Tripathi, M. N., Pandit, B., & Yadav, J. S. (2015). Psychiatric Morbidities in Postpartum Females: A Prospective Follow-Up during Puerperium. Open Journal of Psychiatry & Allied Sciences, 6, 101-105.

[60]   Sterling, B., Fowles, E., Kim, S., Latimer, L., & Walker, L. O. (2011). Ethnic-Specific Perceptions of Altered Control among American Women Implications for Health Programs after Pregnancy. Health Care for Women International, 32, 39-56.

[61]   Swanson, R. A., & Chermack, T. J. (2013). Theory Building in Applied Disciplines. San Francisco, CA: Berrett-Koehler Publications Inc.

[62]   Tandon, S. D., Leis, J. A., Mendelson, T., Perry, D. F., & Kemp, K. (2014). Six-Month Outcomes from a Randomized Controlled Trial to Prevent Perinatal Depression in Low-Income Home Visiting Clients. Maternal and Child Health Journal, 18, 873-881.

[63]   Tandon, S. D., Ward, E. A., Hamil, J. L., Jimenez, C., & Carter, M. (2018). Perinatal Depression Prevention through Home Visitation: A Cluster Randomized Trial of Mothers and Babies 1-on-1. Journal of Behavioral Medicine, 41, 641-652.

[64]   Thitipitchayanant, K., Somrongthong, R., Kanchanakharn, N., & Kumar, R. (2018). Effectiveness of Self-Empowerment-Affirmation-Relaxation (Self-EAR) Program for Postpartum Blues Mothers: A Randomize Controlled Trial. Pakistan Journal of Medical Sciences, 34, 1488-1493.

[65]   Thorsteinsson, E. B., Loi, N. M., & Farr, K. (2018). Changes in Stigma and Help-Seeking in Relation to Postpartum Depression: Non-Clinical Parenting Intervention Sample. PeerJ, 6, e5893.

[66]   Turan, J. M., Darbes, L. A., Musoke, P. L., Kwena, Z., Rogers, A. J., Hatcher, A. M. et al. (2018). Development and Piloting of a Home-Based Couples Intervention during Pregnancy and Postpartum in Southwestern Kenya. AIDS Patient Care & STDs, 32, 92-103.

[67]   Wilkinson, R. B., & Mulcahy, R. (2010). Attachment and Interpersonal Relationships in Postnatal Depression. Journal of Reproductive & Infant Psychology, 28, 252-265.

[68]   Wissow, L. S., Brown, J. D., & Krupnick, J. (2010). Therapeutic Alliance in Pediatric Primary Care: Preliminary Evidence for a Relationship with Physician Communication Style and Mothers’ Satisfaction. Journal of Developmental & Behavioral Pediatrics, 31, 83-91.

[69]   Yator, O., Mathai, M., Vander Stoep, A., Rao, D., & Kumar, M. (2016). Risk Factors for Postpartum Depression in Women Living with HIV Attending Prevention of Mother-to-Child Transmission Clinic at Kenyatta National Hospital, Nairobi. AIDS Care, 28, 884-889.

[70]   Zee-van den Berg, A., Boere-Boonekamp, M., IJzerman, M., Haasnoot-Smallegange, R., & Reijneveld, S. (2017). Screening for Postpartum Depression in Well-Baby Care Settings: A Systematic Review. Maternal & Child Health Journal, 21, 9-20.