Year of Publication

2015

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Nursing

Department

Nursing

First Advisor

Dr. Kristin Ashford

Abstract

The prevalence of depression during pregnancy in the U. S. is approximately 13%. Poor quality of the intimate partner relationship is significantly correlated with depression during pregnancy. The adverse effects of antenatal depression have been widely documented. The relationship between the intimate partner relationship and depression during pregnancy has not been well delineated in the literature. Little data exist regarding the impact of prenatal immune status on risk for postpartum depression. Due to limited evidence, there is a critical need to examine the relationship among trimester specific cytokines, quality of the intimate partner relationship, and antenatal depressive symptoms on risk for postpartum depression. Examining this relationship is a crucial aspect in understanding the holistic aspects of depression during pregnancy.

The purpose of this dissertation was to examine the impact of the quality of the intimate partner relationship and immune status in early pregnancy on risk for postpartum depression. This was done in three ways: a critical review and analysis of the current state of measurement of antenatal depression via four instruments; a psychometric assessment of the Autonomy and Relatedness Inventory (ARI) during pregnancy; and an examination of the impact of trimester specific cytokines on depressive symptoms and the quality of the intimate partner relationship.

The critical review and analysis of the current state of measurement of four antenatal instruments measuring depression indicated similar results in detecting depression during pregnancy. The Postpartum Depression and Screening Scale (PDSS) performed more conclusively in detecting true cases of antenatal depression. In the next manuscript, psychometric assessment of the ARI revealed a 6 component model. Further, the ARI was significantly inversely correlated with depressive symptoms in the first trimester. For the final manuscript, first trimester serum MMP-8 levels were significant in predicting depression in the third trimester of pregnancy.

The findings of this dissertation study indicate that measuring and predicting pregnancy associated depression continues to be confounded by multitudinous factors. A comprehensive approach is warranted when screening for depression before, during, and after pregnancy. An emphasis on psychosocial, physical, immunological, and behavioral characteristics should be included when examining pregnancy associated depression in future research studies.

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