Problem-Solving Appraisal and the Prediction of Depression During Pregnancy and in the Postpartum Period

Problem-Solving Appraisal and Human Adjustment

This article reviews and synthesizes more than 120 studies from 20 years (1982-2002) of research that has examined problem-solving appraisal as measured by the Problem Solving Inventory (PSI). The goals of the article are fourfold: (a) introduce the construct of problem-solving appraisal and the PSI within the applied problem-solving literature, (b) summarize and integrate existing findings using the PSI within and across four major content areas (psychological adjustment, physical health, coping, and educational and vocational issues), (c) identify promising research directions that might stimulate future research and promote theory development, and (d) identify implications for practitioners in the helping professions. We conclude that problem-solving appraisal as measured by the PSI is a useful psychological construct with implications for theory and many applications to build on peoples' strengths to enhance their life satisfaction and well-being.

Towards an idiothetic understanding of the role of social problem solving in daily event, mood and health experiences: A prospective daily diary approach

OBJECTIVES

Utilising D'Zurilla's (1986, 1990) transactional social problem solving model as the theoretical framework, the present study sought to examine the dynamics of the social problem solving process in relation to intraindividual experiences of events, mood, and physical health in daily life.

DESIGN

The study incorporated both idiographic and nomothetic strategies, combining a daily diary approach within a prospective design. As such, each individual's experience of events, mood, and health were assessed on a daily basis, and the prospective relations between social problem solving and these day-to-day experiences examined.

METHODS

Participants' (university students) completed a measure of social problem solving at baseline followed, approximately 5 weeks later, by daily self-reports of mood (positive & negative), events (hassles & uplifts), and physical health (health status & URI symptoms) for a period of 14 days. The data were analysed using multilevel hierarchical modelling.

RESULTS

Days on which individuals had greater than their average hassles were associated with higher negative and lower positive mood (i.e. domain specific & cross-over effects), whilst greater uplifts were linked to positive mood only. With regard to health, individuals reported worse status and more URI symptoms on days with greater than their average negative (hassles, negative mood) but not positive influences (uplifts, positive mood). Both social problem solving orientations and skills dimensions were associated prospectively with daily health outcomes, and these relationships were not moderated by day-to-day experiences of mood or events.

CONCLUSIONS

The data clarify the importance of social problem solving to within-person daily event, mood, and health experiences. The implications of these findings for contemporary transactional social problem solving models are discussed.

A Social Problem-Solving Model of Adherence to HIV Medications

HIV medication adherence remains a challenge and limits the degree to which treatment benefit can be maximized. This study tested an explanatory model of HIV medication adherence using a social problem-solving (SPS) framework. Associations of SPS with adherence are hypothesized to be direct and/or indirect via psychological health. HIV+ adults were interviewed using validated measures of SPS, psychological health, and antiretroviral therapy (ART) medication adherence. Structural equation modeling (SEM) techniques were used to test hypothesized relationships and to evaluate overall fit of the model to the data. SEM supported an indirect association (but not direct) of SPS on adherence via psychological health among the 545 HIV+ adults included in the analyses. Overall, the findings resulted in a model of adherence that offered very good fit to the data and correctly classified 97% of the cases as adherent versus nonadherent. Results support the use of SPS as a conceptual framework for understanding adherence to ART. Findings offer rationale and direction for SPS interventions to enhance adherence by improving psychological health. Such approaches, if effective, have the potential to positively impact psychological well being and adherence, thereby maximizing clinical benefit from treatment, which is linked to lower mortality from AIDS.

Predictors of postpartum depression: an update

BACKGROUND

Approximately 13% of women experience postpartum depression. Early recognition is one of the most difficult challenges with this mood disorder because of how covertly it is suffered.

OBJECTIVES

The purpose of this meta-analysis was to update the findings of an earlier meta-analysis of postpartum depression predictors that had synthesized the results of studies conducted mostly in the 1980s.

METHOD

A meta-analysis of 84 studies published in the decade of the 1990s was conducted to determine the magnitude of the relationships between postpartum depression and various risk factors. Using the software system Advanced Basic Meta-Analysis, effect sizes were calculated three ways: unweighted, weighted by sample size, and weighted by quality index score.

RESULTS

Thirteen significant predictors of postpartum depression were revealed. Ten of the 13 risk factors had moderate effect sizes while three predictors had small effect sizes. The mean effect size indicator ranges for each risk factor were as follows: prenatal depression (.44 to .46), self esteem (.45 to. 47), childcare stress (.45 to .46), prenatal anxiety (.41 to .45), life stress (.38 to .40), social support (.36 to .41), marital relationship (.38 to .39), history of previous depression (.38 to .39), infant temperament (.33 to .34), maternity blues (.25 to .31), marital status (.21 to .35), socioeconomic status (.19 to .22), and unplanned/unwanted pregnancy (.14 to .17).

CONCLUSIONS

Results confirmed findings of an earlier meta-analysis and in addition revealed four new predictors of postpartum depression: self-esteem, marital status, socioeconomic status, and unplanned/unwanted pregnancy.

Self-appraised social problem solving abilities, emotional reactions and actual problem solving performance

Self-report measures of social problem solving abilities have yet to be associated with objective problem solving performance in any consistent manner. In the present study, we investigated the relation of social problem solving abilities--as measured by the Social Problem Solving Skills Inventory--Revised (SPSI-R [Maydeu-Olivares, A. & D'Zurilla, T. J. (1996). A factor analytic study of the Social Problem Solving Inventory: an integration of theory and data. Cognitive Therapy and Research, 20, 115-133])--to performance on a structured problem solving task. Unlike previous studies, we examined the relation of problem solving skills to performance curves observed in repeated trials, while controlling for affective reactions to each trial. Using hierarchical modeling techniques, a negative problem orientation was significantly predictive of performance and this effect was not mediated by negative affectivity. Results are discussed as they pertain to contemporary models of social problem solving.