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SYNOPSISObjective. This study investigates observed and self-reported emotional availability in clinically depressed and nondepressed mother-infant pairs. Design. Observations of mother-infant interaction were made during 30-min free-play interaction during the first year of life in clinically postpartum depressed (n = 49) and nondepressed mothers (n = 35) in Flanders (Belgium). Results. Postpartum depressed mothers had significantly lower scores on most emotional availability dimensions, both as observed by clinicians and on the self-report measure of emotional availability, except for observed hostility and self-reported intrusiveness and hostility, and appeared to have difficulty in being engaged in play interaction with their infants. Both dyadic dimensions of the self-report questionnaire, mutual attunement and affect quality, are related to all six observed dimensions; children seen by their mothers as able to involve them in play are scored as responsive and involving by external observers; mothers of involving infants were observed as more sensitive; self-reported hostility is associated with observed nonhostility and nonintrusiveness; and, as expected, self-reported maternal intrusiveness is not related to observed nonintrusiveness or with other aspects of observed emotional availability. Conclusion. The current study underlines the differences in most aspects of observed and self-reported emotional availability between postpartum depressed and nondepressed mothers, as well the potential divergences between observed and self-perceived aspects of this construct.

After participating in this educational activity, the physician should be better able to 1. Identify the risk factors associated with persistence of postpartum depression. 2. Evaluate the limitations of the literature. 3. Determine the implications of the findings on women with postpartum depression and their children.This article aims to critically review studies published between 1985 and 2012 concerning the course of postpartum depression (PPD), as well as factors implicated in PPD with a chronic course. We provide a systematic, qualitative review of studies on the course of PPD, following PRISMA guidelines. The results show that although the majority of women recover from PPD, it becomes chronic in a relatively large subgroup of women. Several studies have identified risk factors predicting a chronic course of PPD. This review also emphasizes and discusses important conceptual and methodological limitations in existing research, which preclude drawing strong conclusions. Finally, the implications of these findings and suggestions for future research and clinical intervention are outlined.

This paper describes the rationale and treatment principles of a mother-infant unit for severely depressed mothers and their infants in Flanders (Belgium). The unit integrates systemic, psychodynamic, and cognitive behavioral treatment approaches, and aims at improvements on three levels: (1) improving mood and interpersonal relationships in depressed mothers, (2) fostering a positive mother infant relationship, and (3) establishing a supportive environment outside the treatment setting for both mother and infant. In addition, we present preliminary data of a 3.5-year naturalistic follow-up study of postpartum depressed mothers (n = 41) admitted at this mother-infant unit between April 2003 and April 2005. Results showed that at 3.5-year follow-up a considerable subgroup of mothers (61%) were functioning relatively well, as indicated by low levels of depressive symptoms, anxiety and anger, negative affect, and relatively high levels of positive affect. Yet, in line with other studies, a relatively large subgroup of mothers (39%) continued to suffer from (severe) depression during follow-up. Using a Life History Calendar method, it was found that, compared to currently nondepressed mothers, mothers who were depressed at follow-up did not have more depressive episodes but had longer depressive episodes, received more psychotherapy after hospitalization, and experienced more negative life events during the 3.5-year follow-up period. Implications of these findings for future research and intervention strategies in postpartum depression are discussed.

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Research suggests that parental reflective functioning-the parent's capacity to envision the mind of his/her child-may play an important role in the intergenerational transmission of attachment and reflective functioning. Studies also suggest the importance of this capacity for the transition to parenthood, and particularly parents' capacity to deal with parenting stress. This study focused on the potential mediating role of PRF dimensions in the relationship between parental attachment dimensions (attachment anxiety and avoidance) and parenting stress, using data from a 1-year longitudinal study in biological first-time parents (N=106). Structural Equation Modeling showed that parents' use of prementalizing modes of reflecting upon their child (PM) fully mediated the relationship between attachment anxiety and three parenting stress dimensions (marital relationship, role restriction, and social isolation) across a 1-year interval, while attachment avoidance was indirectly related to these parenting stress dimensions through PM. Further, PM partially mediated the relationship between parental attachment anxiety and avoidance and a fourth dimension of parenting stress, lack of trust in parental competence. In addition, multi-group analyses revealed some interesting gender differences. Implications of these findings for the conceptualization of the relationship between parental attachment, PRF, and parenting stress are discussed.

Parental attachment and parental reflective functioning (PRF) have been shown to be related to attachment, mentalizing capacities, and psychopathology in children. Studies also suggest that parental insecure attachment is related to lower levels of PRF. However, no study has directly investigated whether PRF dimensions mediate the relationship between parental attachment dimensions and features of social-emotional development other than attachment, mentalizing, and psychopathology. We prospectively investigated whether PRF mediates the relationship between parental attachment dimensions (i.e., levels of attachment avoidance and anxiety) and socialemotional competences and problems, using data from a 1-year longitudinal study of first-time parents and their biological children (N = 106). We found that low PRF as assessed with the Parental Reflective Functioning Questionnaire at one-year follow-up, was an intervening variable in the relationship between parental attachment dimensions at time 1 and child social-emotional development at time 2. In particular, maternal attachment avoidance and paternal attachment anxiety were indirectly related to child competences and problems through high levels of prementalizing modes (i.e., attributing malevolent mental states to the child and an inability to enter the child's internal world). Additionally, in mothers only, there was a partial mediation effect of PM in the relation between attachment anxiety and child competences.

In a recent paper, Lawrence Blum (2007) identified emotional conflicts in three areas typical in postpartum depression: (1) dependency, (2) aggression, and (3) motherhood. In this commentary, the authors consider agreements and disagreements with Blum's views on the psychodynamics of postpartum depression. In contrast to Blum's assertion, a theoretically derived extensive empirical psychoanalytic database exists which confirms and extends Blum's analysis of the core dynamics involved in this disorder. This recent research derives primarily from the comprehensive theoretical framework proposed by Blatt (1974Blatt ( , 2004Blatt ( , 2006Blatt ( , 2008 on the psychodynamics of depression that are part of a broad theory of normal and pathological personality development which Blum (2007), in his otherwise thorough search of the literature, seems to have overlooked. The authors close with reflections on how psychoanalysis and psychodynamically inspired research might increasingly influence mainstream clinical practice and research.