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Optimistic outlook regarding maternity protects against depressive symptoms postpartum

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Abstract

The transition to motherhood is a time of elevated risk for clinical depression. Dispositional optimism may be protective against depressive symptoms; however, the arrival of a newborn presents numerous challenges that may be at odds with initially positive expectations, and which may contribute to depressed mood. We have explored the relative contributions of antenatal and postnatal optimism regarding maternity to depressive symptoms in the postnatal period. Ninety-eight pregnant women underwent clinician interview in the third trimester to record psychiatric history, antenatal depressive symptoms, and administer a novel measure of optimism towards maternity. Measures of depressive symptoms, attitudes to maternity, and mother-to-infant bonding were obtained from 97 study completers at monthly intervals through 3 months postpartum. We found a positive effect of antenatal optimism, and a negative effect of postnatal disconfirmation of expectations, on depressive mood postnatally. Postnatal disconfirmation, but not antenatal optimism, was associated with more negative attitudes toward maternity postnatally. Antenatal optimism, but not postnatal disconfirmation, was associated with reduced scores on a mother-to-infant bonding measure. The relationships between antenatal optimism, postnatal disconfirmation of expectations, and postnatal depression held true among primigravidas and multigravidas, as well as among women with prior histories of mood disorders, although antenatal optimism tended to be lower among women with mental health histories. We conclude that cautious antenatal optimism, rather than immoderate optimism or frank pessimism, is the approach that is most protective against postnatal depressive symptoms, and that this is true irrespective of either mood disorder history or parity. Factors predisposing to negative cognitive assessments and impaired mother-to-infant bonding may be substantially different than those associated with depressive symptoms, a finding that merits further study.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, 401 Quarry Road, MC 5723, Stanford, CA, 94305, USA

    Thalia K. Robakis, Katherine E. Williams, Heather Kenna & Natalie L. Rasgon

  2. Department of Obstetrics and Gynecology, Stanford University School of Medicine, 770 Welch Road, Suite 201, Stanford, CA, 94304, USA

    Susan Crowe

  3. Palo Alto University, 1791 Arrastradero Road, Palo Alto, CA, 94304, USA

    Heather Kenna & Jamie Gannon

Authors
  1. Thalia K. Robakis
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  2. Katherine E. Williams
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  3. Susan Crowe
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  4. Heather Kenna
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  5. Jamie Gannon
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  6. Natalie L. Rasgon
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Correspondence to Thalia K. Robakis.

Appendix. Novel ten-item Measure of Maternal Optimism (MMO)

Appendix. Novel ten-item Measure of Maternal Optimism (MMO)

For the following ten questions, please choose the answer that most closely describes how you feel.

(Scoring: Answers marked ‘O’ are scored +1; answers marked ‘F’ are scored 0; answers marked ‘P’ are scored −1.)

  1. 1.

    Birth plans

    • O. If one prepares adequately, birth will most likely go as planned.

    • F. It is important to prepare, but birth is inherently unpredictable.

    • P. Birth is frightening and dangerous.

  2. 2.

    Baby needs

    • O. It is a pleasure to care for a baby.

    • F. Babies have many tiresome needs but also offer much joy.

    • P. Young babies are a severe drain on the mother’s resources.

  3. 3.

    Daily routine

    • O. The daily tasks of baby care are manageable and mostly pleasant.

    • F. Baby care can be frustrating but also rewarding.

    • P. Baby care makes daily life more difficult and unpleasant.

  4. 4.

    Lifestyle

    • O. The changes a baby brings to the mother’s lifestyle are welcome and easy to handle.

    • F. A baby brings both welcome and unwelcome changes to the mother’s lifestyle.

    • P. A baby puts many unpleasant restrictions on the mother’s lifestyle.

  5. 5.

    Parental emotional relationship

    • O. Having a baby brings the parents closer to each other.

    • F. Babies have both positive and negative effects on their parents’ relationship.

    • P. A new baby is a severe test of the parents’ bond with each other.

  6. 6.

    Parental sexual relationship

    • O. The parents’ sexual relationship is typically not much affected by the arrival of a baby.

    • F. It is difficult to predict what effect the baby may have on the parents’ sexual life, but a strong relationship will survive any changes.

    • P. A new baby generally has a bad effect on the parents’ sexual relationship.

  7. 7.

    Expectations of own needs

    • O. Mothers want to be with their babies all the time.

    • F. Mothers enjoy caring for their babies but are relieved to have breaks as well.

    • P. Mothers need frequent breaks in order to cope with the demands of an infant.

  8. 8.

    Expectations of own mood

    • O. Most mothers experience their babies’ first months as a joyful and rewarding time.

    • F. It is normal for a mother to have some emotional ups and downs during her baby’s first months.

    • P. Most mothers find their babies’ first months are a stressful and difficult time.

  9. 9.

    Bodily changes after pregnancy and delivery

    • O. The changes to the mother’s body are healthy and constructive.

    • F. The changes to the mother’s body are unfortunate but not overly bothersome.

    • P. Having a baby is destructive to the mother’s body.

  10. 10.

    Being a good parent

    • O. I am confident in my ability to raise a happy and healthy child.

    • F. I am somewhat concerned about my ability to raise a happy and healthy child.

    • P. It is very easy for a mother to make mistakes that will have lifelong negative consequences for the baby.

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Robakis, T.K., Williams, K.E., Crowe, S. et al. Optimistic outlook regarding maternity protects against depressive symptoms postpartum. Arch Womens Ment Health 18, 197–208 (2015). https://doi.org/10.1007/s00737-014-0446-3

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  • DOI: https://doi.org/10.1007/s00737-014-0446-3

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