The role of assertiveness and cognitive flexibility in the development of postpartum depressive symptoms

Objective: To examine whether lower levels of assertiveness and cognitive flexibility as well as the interaction of these variables would predict postpartum depressive symptoms. Background: Prevalence rates estimate that 13% of women experience postpartum depression. Studies of depression in the general population suggest that lower levels of assertiveness and cognitive flexibility are associated with depression. Research is needed to identify whether these variables influence the development of postpartum depression. Methods: A prospective cohort design with 45 women who were 18 years of age or older and in their third trimester of pregnancy (28 weeks or beyond) from urban and suburban hospital-based obstetrician/midwifery offices. Women's levels of assertiveness and cognitive flexibility were assessed in the offices of healthcare providers during the third trimester of pregnancy. Postpartum depressive symptoms were assessed two months postpartum or beyond via postal mail or online. Results: The hypotheses that lower levels of assertiveness and cognitive flexibility would predict subclinical symptoms of postpartum depression were not supported. Cognitive flexibility was found to moderate the relationship between assertiveness and subclinical postpartum depressive symptoms. For women with higher cognitive flexibility, being more assertive was associated with fewer postpartum depressive symptoms. Conversely, for women with lower cognitive flexibility, being more assertive was associated with more postpartum depressive symptoms. Conclusion: The findings of this study highlight the importance of identifying interpersonal predictors of postpartum depressive symptoms in order to inform treatment and prevention efforts, which could potentially increase long-term benefits for the mother, infant, and family system.