title: Considering a Relational Model for Depression in Women with Postpartum Depression.
abstract: OBJECTIVE
  To extend testing of a relational theory that a low sense of belonging, delayed or impaired bonding, and loneliness are salient risk factors for postpartum depression (PPD) in women.
  
  
  METHODS
  Data for this theory-testing analysis came from a larger prospective longitudinal cohort study and included women who were retained to the end of the study at the 6 week postpartum interview (n=564). Structural equation modeling was used to test the "fit" of the model and determine significance of direct and indirect paths.
  
  
  RESULTS
  The model explained 35% of the variance in postpartum depression with impaired bonding and loneliness as the strongest indicators. Lower sense of belonging, less perceived social support from a healthcare practitioner and a partner, and lower parenting sense of competence were additional predictors.
  
  
  CONCLUSIONS
  Study findings 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. The study provided evidence of the importance of healthcare practitioners' alliance with patients. This paper contributes to advancing the science of women's mental health in relation to depression by considering additional predictors which might be amenable to intervention.
authors.affiliation: Lourdes University College of Nursing, 6832 Convent Blvd., Sylvania, OH 43560, , , jkruse@umich.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Kruse
authors.affiliation: University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, rawill@umich.edu.
authors.forename: Reg A
authors.initials: RA
authors.lastname: Williams
authors.affiliation: Institute for Research on Women and Gender, University of Michigan, 204 S. State Street, Ann Arbor, Michigan, 48109-1290, jseng@umich.edu.
authors.forename: Julia S
authors.initials: JS
authors.lastname: Seng
keywords: bonding; conflict; loneliness; postpartum depression; sense of belonging; social support