Rumination and postnatal depression: A systematic review and a cognitive model

Abstract

Postnatal depression (PND) confers risk for a range of negative child developmental outcomes, at least in part through its impact on parenting behaviour. Whilst the behavioural effects of depression on parenting are well established, the cognitive mechanisms that may mediate this effect are less well understood. The current paper proposes that rumination may be a key cognitive mechanism through which parenting is affected in PND, and provides a systematic review of the existing literature on rumination in the context of perinatal depression. The review identifies ten relevant papers. Eight are questionnaire-based studies examining the role of rumination in predicting future depression and/or mother-infant relationship outcomes, such as bonding. Two are experimental studies examining the effects of induced rumination on parenting behaviours. The results of the review are discussed, and remaining questions highlighted. We then present a new theoretical model, developed specifically for the perinatal context, and informed by existing models of rumination and worry. Our cognitive model emphasises the relationship between rumination, cognitive biases and cognitive control, and the impact of these variables on infant cue processing and subsequent parenting responses. The model provides a potential framework for future work in this area, and to guide the development of treatment interventions.

Does fathers’ and mothers’ rumination predict emotional symptoms in their children?

“…DeJong et al . () developed a testable theoretical model of the effects of rumination on maternal sensitivity during mother–infant interactions. Other environmental pathways by which parental rumination exerts its adverse effects on children's outcomes across different age groups would be a fruitful area of research.…”

Repetitive Negative Thinking and Its Role in Perinatal Mental Health

“…The hypothesis that the tendency to engage in RNT heightens the risk for, and contributes to the maintenance of, post-partum depression has been minimally tested, despite repeated calls for such work [21]. This is surprising given the hypothesised key role for RNT (in the form of rumination) in mediating the impact of maternal psychopathology on parenting [22].…”

“…Moreover, such studies have yielded conflicting findings: some have demonstrated that RNT is predictive, while others have reported no such relationship [21]. For example, Barnum et al [25] found that levels of rumination (brooding) predicted increases in depression symptoms from the third trimester to 8 weeks (but not 4 weeks) post-partum.…”

“…Stein et al [23, 24] proposed maternal “preoccupation” (including rumination, worry) as a key mechanism that may account for the transmission of psychopathology from a mother to her offspring – highlighting the potential significance of RNT in the postnatal context. There is clearly a need for more research to advance the understanding of how rumination contributes to poor maternal mental health, compromised parenting quality, and impoverished child outcomes [21]. In light of our case for adopting a transdiagnostic approach, we propose the value of expanding the focus of the existing literature in this area beyond rumination and depression, and examining the role of other forms of RNT (such as worry) in the prediction and maintenance of depression.…”

“…A minimal number of studies have tested the hypothesis that the tendency to engage in RNT (assessed during pregnancy) predicts postnatal depression symptoms [for a review, see 21]. Moreover, such studies have yielded conflicting findings: some have demonstrated that RNT is predictive, while others have reported no such relationship [21].…”