Thinking Through the Fog: How Postpartum Depression Disrupts Mental Clarity

academicmemories
Aug 11
5 min read

Written by: Hannah Ramirez

Postpartum depression is a mood disorder that impacts pregnant or postpartum women and affects 10-20% of mothers (Mavrogiorgou et al., 2012), leading to symptoms of anxiety and depression. Every mother is susceptible to distress giving birth, yet research often underrepresents the complexity of maternal changes when an infant is born. Maternal research has limited accessibility in culturally responsive interventions for postpartum depression (PD) and overall lack of knowledge as to how PD may influence caregiving as mothers are struggling with their mental clarity. By sharing the challenges mothers experience through not only quantitative but also qualitative methods, it may push for more accessible culturally competent interventions in mental health settings.

Physiological Factors in Postpartum Depression

Studies have explored how PD influences maternal cognitive functions by analyzing real-time, computer-based, assessments of mother-infant interactions. They are able to observe real-time caregiving behaviors, alongside looking at biological factors such as measuring cortisol levels, which increase when the body is responding to stress. A study by Beebe et al. (2012a) in particular has depicted 10-13% of mothers with PD observed their own interactions with their infants had been disturbed as a result of the depression. Examples of maternal disturbance included reduced eye contact or decrease in affectionate vocalization (tone of voice) when mothers interact with their infant, measuring cortisol levels to represent maternal disturbance (Mavrogiorgou et al., 2012).

When looking deeper into how emotional distress and cognitive disruptions affect infant bonding, Mavrogiorgou et al. (2012) study observed hormonal levels and other biological measures using a computer-based interactions analysis This analysis with biological measures such as observing cortisol levels allows researchers to look at a variety of components when analyzing the participants. Nine out twenty-five of the participants were experiencing behaviors, personality, or anxiety disorders making comorbidity (medical diagnosis that occurs at the same time as another) a factor to consider as symptoms of depression may be expressed differently. Acknowledging comorbidity in the study is an important factor to consider when looking to translate these findings into interventions, in comparison to other studies using participants who are overly filtered for research settings purposes.

Henry and Sherwin (2012) conducted a longitudinal study that examined the same individuals across a span of time, strengthening the interpretations of results, while additionally having a control group to compare results to. Focused on looking into the cognitive functions during late pregnancy and postpartum, they explored associations with hormonal levels like estrogen, progesterone, testosterone, cortisol, and prolactin and made observations on the influence of hormones on performance. Prolactin is known for the role it plays in stimulating milk production and has been linked to bonding and nurturing instincts in those who breastfeed (Henry & Sherwin, 2012). Prolactin (PRL) is a hormone associated with bonding and nurturing infants, with increased levels showing negative associations with paragraph recall and executive function during pregnancy (Henry & Sherwin, 2012). Meaning when one variable goes up the other goes down, an inverse relationship.

Biological and psychological factors play a complex role during pregnancy and the postpartum period impacting maternal functioning, as depicted across studies exploring hormonal disruption and PD. Henry and Sherwin (2012) studies the role of prolactin and cortisol in cognitive performance during late pregnancy up until early postpartum period. Findings discovered elevated prolactin correlated with reduced executive cognitive function (Henry & Sherwin, 2012). This finding implies dysregulation of bonding hormones may lead to impaired skills for responsive caregiving.

Cultural & Economic Accessibility to Clinical Interventions

Traditional clinical interventions often fail to reach low-income mothers due to systemic barriers. In-home cognitive behavioral therapy (IH-CBT) was designed for low-income mothers and accounted for cultural considerations in community-based care. Cognitive behavioral therapy (CBT) is a psychological treatment meant to change how the patient thinks to reduce stressors. Maternal mental health directly impacts caregiving, responsiveness, and engagement towards their infants during the postpartum period. Ammerman et al. (2013) focuses on examining how in-home cognitive behavioral therapy (IH-CBT) affects social functions and psychological distress. IH-CBT showed significant results in reducing psychological distress . Improving perceived support was an important finding as well because social isolation is a strong predictor of PD .

Key Findings in Studies

As noted before, mothers with depression-diagnosis showed key signs of impaired bonding like reduced eye contact and affect on vocal tone. Ammerman et al. (2013) offered an intervention of IH-CBT, decreasing psychological distress and increasing perceived social support among depressed mothers. While this study did not explore cognitive functions, it suggests improvements in social engagement supporting the mother’s emotional availability.

What Future Research Should Look for

These studies revealed shared vulnerabilities among mothers particularly those experiencing overlapping systemic stressors. Hormonal instability and psychological distress compromise the health and well-being of mothers while having to learn how to bond and nurture their infant. Future studies are needed to investigate the timeframe of the onset and the duration of changes in cognitive function during pregnancy and the postpartum period that we observed. By expanding the timeframe in longitudinal design to 12 months post-treatment to assess relapse risk and review how participants retained positive progress.

Finally, studies should further examine how IH-CBT outcomes vary across race, immigrant status, single parenting, and historical trauma contexts. Overall recruiting participants from minority backgrounds to better understand the impact of systemic stress components and have that representation in research conducted. These populations are historically overlooked adding to the limited generalizability in current research studies, these findings may inspire change in public policy reducing systemic stressors that influence maternal health outcomes through accessible interventions.

Cited Resources

Ammerman, R. T., Putnam, F. W., Altaye, M., Teeters, A. R., Stevens, J., & Van Ginkel, J. B. (2013). Treatment of depressed mothers in home visiting: Impact on psychological distress and social functioning. Child Abuse & Neglect, 37(8), 544–554. https://doi.org/10.1016/j.chiabu.2013.03.003

Beebe, B., Lachmann, F., Jaffe, J., Markese, S., Buck, K.A., Chen, H., et al., 2012b. Maternal postpartum depressive symptoms and 4-month mother–infant interaction. Psychoanal. Psychol. 29, 383–407. https://doi.org/10.1037/a0029387.

Henry, J. F., & Sherwin, B. B. (2012). Hormones and Cognitive Functioning During Late Pregnancy and Postpartum: A Longitudinal Study. Behavioral Neuroscience, 126(1), 73–85. https://doi.org/10.1037/a0025540

Mavrogiorgou, P., Diop, S., Turmes, L., Specht, C., Vanscheidt, S., Seehagen, S., & Juckel, G. (2022). Computer-based mother–infant interaction analysis and mental functioning in postpartum depression. Psychiatry Research, 311, 114506. https://doi.org/10.1016/j.psychres.2022.114506

Thinking Through the Fog: How Postpartum Depression Disrupts Mental Clarity

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