ABSTRACT
Methodological challenges encountered in evaluating the relationships between life stress, mental illness and pregnancy outcome are identified and several studies on the relationships between pregnancy and childbirth and psychosocial factors, including life stresses, major psychiatric disorders, and puerperal depression, are reviewed. Certain methodological pitfalls are illustrated by showing how relationships between psychiatric diagnosis, severity of psychiatric symptomatology, life stresses, strains specific to the pregnancy, amount of intervention received and outcome of keeping or losing the infant have been explored. Five stages of research are identified and particular difficulties encountered at each stage are described with application to the authors' longitudinal study.
Subject(s)
Mental Disorders , Pregnancy Complications , Puerperal Disorders , Research Design , Stress, Psychological , Female , Humans , Life Change Events , Mental Disorders/epidemiology , Mental Disorders/prevention & control , Planning Techniques , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Pregnancy Outcome , Puerperal Disorders/epidemiology , Puerperal Disorders/prevention & control , Stress, Psychological/epidemiology , Stress, Psychological/prevention & controlABSTRACT
As part of an ongoing prospective study to correlate mother and infant outcome with social isolation during pregnancy, the Schedule for Affective Disorders, SADS-C, was administered to twenty-seven psychotic patients late in pregnancy. Extensive standardized evaluation of life stresses and social supports included a Prenatal Interview with sixty items relating to demographics, drug use, health and obstetrical history, family involvement and development expectations of the infant, and a thirty-item Difficult Life Circumstances questionnaire. In this sample the patients' previous life adjustments were stabilized by their pregnancy unless the pregnancy itself created personal stress for the patient. Higher scores on Difficult Life Circumstances were found to be associated with more psychiatric symptomatology. Symptoms of pregnancy confounded SADS-C items measuring vegetative signs of depression. One group of items on the SADS-C appeared to selectively identify a subset of women whose underlying affective symptomatology was potentiated by pregnancy. A second group of items identified women whose symptoms appeared to be reactive to current situational strains.
