Perinatal and postpartum depression: From attachment to personality. A pilot study

Objectives: The perinatal period is associated with an increased risk for affective disorders, with consequences on mother's interaction with the newborn baby and on child development. The prevalence of postpartum depression (PPD) ranges between 10 and 20% in the general population. This study investigates the prevalence of perinatal depression and the role of sociodemographic variables, personality structure and maternal attachment style in PPD in order to identify potential primary and secondary prevention strategies. Methods: Data were collected in two phases. During the third trimester, a sample of 253 women completed a Socio-demographic Data Sheet and the Edinburgh Post-natal Depression Scale (EPDS). Among patients scoring 12 or more at EPDS, 22 entered the second phase of the study and were compared with healthy controls. Diagnosis of PPD was confirmed by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and both groups completed the Experience in Close Relationship (ECR) and Minnesota Multiphasic Personality Inventory 2 (MMPI-2) questionnaires. Results: The overall prevalence of depressive symptoms based on the EPDS score (cut-off ≥ 12) was 19.3% in perinatal period, according to literature data. The presence of depressive symptoms was significantly associated with previous psychiatric disorders (χ2 = 12.8, p < 0.01), family history of psychiatric disorders (χ2 = 4.5, p < 0.05), family conflict (χ2 = 5.9, p < 0.05), dissatisfaction with partner (χ2 = 11.5, p < 0.01), economic difficulties of partner (χ2 = 5.9, p < 0.05), inadequate family support (χ2 = 4.1, p < 0.05) and inadequate partner support (χ2 = 6.7, p = 0.01). Postpartum depressive symptoms were associated with an insecure attachment style (ECR anxious and avoidant attachment scores: χ2 = 4.7, p < 0.05 and χ2 = 5.9, p < 0.05) compared to healthy controls. In 60% of depressed mothers, the MMPI-2 revealed specific patterns such as a "4-6 configuration", known as "Passive-Aggressive Valley": it reveals individuals demanding and over-identified with the traditional feminine role, with high levels of dependence, unexpressed hostility and poor coping strategies. Conclusions: An approach to post-natal affective disorders that includes psychological factors such as personality structure and attachment style could improve prevention and therapeutic strategies, and provide depressed mothers with specific interventions.