Considering a Relational Model for Depression in Women.

Abstract

Purposes of these secondary analyses studies were to extend testing of a relational theory of depression and show that low sense of belonging, poor social support, and loneliness were salient risk factors in women. The models took additional known predictors into account including adult attachment, mother-infant bonding, and conflict. Data came from: (1) a cross-sectional cohort study of female Navy recruits (n=114), and (2) a prospective longitudinal cohort study of diverse women enrolled in prenatal care (n=564). Participants in both studies were administered a battery of instruments that included the aforementioned model variables. Structural equation modeling was used to test the “fit” of the theoretical models and determine significance of direct and indirect paths. The proposed model for female Navy recruits explained 53% of the variance in depressive symptoms with loneliness and sense of belonging as the strongest indicators of depression. Perceived social support indirectly impacted depression as well. The Navy should consider interventions that increase perceived social support and sense of belonging in high risk for depression recruits to decrease loneliness and depression and circumvent recruits not completing basic training. The assumption that recruits are in close quarters and contact with other people and therefore are not lonely and receive adequate social support is not supported. In the second study, the model for postpartum depression (PPD) explained 35% of the variance in depressive symptoms with impaired bonding and loneliness as the strongest indicators. Sense of belonging, perceived social support from a healthcare practitioner and a partner, and parenting sense of competence were additional indicators. Findings from this study challenge current thinking about the relationship between impaired bonding and PPD as this study raises the possibility that impaired bonding is a risk for PPD as opposed to the reverse relationship. Additionally, the study provided evidence of the importance of healthcare practitioners’ alliance with patients especially for women who were sociodemographically disadvantaged as the healthcare relationship influenced PPD more than family or a partner. Sense of belonging, social support, and loneliness were strong predictors of depression in women, which highlights that there is a relational component to depression.