Postpartum depression theory
M. Katherine Maeve
“The birth of a baby is an occasion for joy—or so the saying goes …. But for some women, joy is not an option”
(Beck, 2006d, p. 40).
Cheryl Tatano Beck
Credentials and background of the theorist
Cheryl Tatano Beck graduated from the Western Connecticut State University with a baccalaureate in nursing in 1970. She recognized during her first clinical rotation that obstetrical nursing was to be her lifelong specialty. After graduation, Beck worked as a registered nurse at the Yale New Haven Hospital on the postpartum and normal newborn nursery unit. By 1972, Beck had graduated from Yale University with a master’s degree in maternal-newborn nursing and a certificate in nurse midwifery. In 1982, she received a doctorate in nursing science from Boston University.
The author wishes to thank Dr. Cheryl Tatano Beck for her generosity of spirit in allowing me liberties with the interpretation of her life’s work. Dr. Beck’s work represents an enormous contribution to nursing, made even more remarkable because it did not depend on boatloads of NIH funding. That alone is an inspiration. Thanks are also extended to Dr. Peggy L. Chinn, who happily has not retired as a mentor or friend.
Beginning at the rank of instructor in 1973, Beck has held academic appointments with increasing rank at several major universities, including the University of Maryland, the University of Michigan, Florida Atlantic University, the University of Rhode Island, and Yale University, and as professor at the University of Connecticut, where she holds a joint appointment in the School of Nursing and School of Medicine. Beck has served as consultant on numerous research projects for universities and state agencies in the northeastern United States. During her career, Beck has received more than 30 awards, including Distinguished Researcher of the Year from the Eastern Nursing Research Society in 1999. She was inducted as a fellow in the American Academy of Nursing in 1993.
This body of work has resulted in a substantive theory of postpartum depression (Beck, 1993) and the development of the Postpartum Depression Screening Scale (PDSS) (Beck, 2002c; Beck & Gable, 2000) and the Postpartum Depression Predictors Inventory (PDPI) (Beck, 1998, 2001, 2002b). A timeline of Beck’s research that demonstrates the logical progression of her work is outlined in Table 34–1.
TABLE 34-1
Timeline of Beck’s Perinatal Research
| Year | Focus of Research |
| 1972 | Women’s cognitive and emotional responses to fetal monitoring (master’s thesis) |
| 1977 | Replication of master’s thesis |
| 1982 | Parturients’ temporal experiences during labor (doctoral dissertation) |
| 1985 | Mothers’ temporal experiences in postpartum period after vaginal and cesarean deliveries |
| 1988 | Postpartum temporal experiences of primiparas |
| 1989 | Incidence of maternity blues in primiparas and length of hospital stay |
| 1990 | Teetering on the edge: A grounded theory study of PPD |
| 1992 | The lived experience of PPD |
| 1994 | Nurses’ caring with postpartum depressed mothers |
| 1995 | Screening methods for PPD |
| 1995 | PPD and maternal-infant interaction |
| 1995 | Mothers’ with PPD perceptions of nurses’ caring |
| 1996 | Relationship between PPD and infant temperament |
| 1996 | Predictors of PPD metaanalysis |
| 1996 | Mothers with PPD and their experiences interacting with children |
| 1996 | Concept analysis of panic |
| 1997 | Developing research programs using qualitative and quantitative approaches |
| 1998 | Effects of PPD on child development |
| 1998 | Checklist to identify women at risk for PPD |
| 1999 | Maternal depression and child behavioral problems |
| 2000 | PDSS: Development and psychometric testing |
| 2001 | Comparative analysis between PDSS and two other depression instruments |
| 2001 | Item response theory in affective instrument development |
| 2001 | Ensuring content validity |
| 2002 | PPD—metasynthesis |
| 2002 | Revision of PDPI |
| 2002 | Mothering multiples |
| 2003 | PPD in mothers of babies in the NICU |
| 2003 | PDSS—Spanish version |
| 2004 | Birth trauma |
| 2004 | Posttraumatic stress disorder after childbirth |
| 2004 | Benefits of internet interviews |
| 2005 | DHA in pregnancy |
| 2005 | Birth trauma and breastfeeding |
| 2005 | Mapping birth trauma narratives |
| 2007 | PDSS—Internet |
| 2009 | Mothers caring for a child with a brachial plexus injury |
| 2012 | Subsequent childbirth after previous birth trauma |
A prolific author and disseminator of her research, Beck has authored more than 100 research-based articles and given scores of research presentations locally, nationally, and internationally. She has served on the editorial boards of many nursing journals, including Advances in Nursing Science, Nursing Research, and the Journal of Nursing Education. Beck served on the executive board for the Marce Society, an international society for the understanding, prevention, and treatment of mental illness associated with childbirth, and on the advisory committee of the Donaghue Medical Research Foundation in Connecticut. Over her career, Beck has been given numerous local, national, and international awards for her work. Most recently, in 2011, Beck was given the Best Publication by Sigma Theta Tau International Honor Society award for Best of Journal of Nursing Scholarship-Profession, World Health, and Health Systems.
Many in nursing recognize the classic Polit and Hungler research text, a fixture in countless graduate nursing programs. Beck became coauthor of Polit’s seventh edition (Polit & Beck, 2003), reflecting Beck’s research expertise. In 2011, this text received the American Journal of Nursing Book of the Year Award for the 9th edition. Beck has also written articles regarding statistical analysis strategies and approaches for qualitative research.
Although Beck conducted seven major studies regarding educational and caring issues with undergraduate nursing students, for over 3 decades she contributed to knowledge development in obstetrical nursing. Her research career began by studying women in labor, with interest in fetal monitoring. Beck’s research focus eventually became the postpartum period and specific studies of postpartum mood disorders.
Theoretical and philosophical sources
Although Beck does not address caring as a theoretical or philosophical construct specific to her research, she has conducted studies that evidence her belief about the importance of caring in nursing . Beck’s use of the ideas of Jean Watson with regard to caring theory endorses caring as central to nursing, while acknowledging Watson’s concern that quantitative methodologies may not adequately reflect the ideal of transpersonal caring. It is obvious throughout Beck’s writings, including research reports using both quantitative and qualitative methods, that advancing nursing as a caring profession is desirable and achievable in practice, research, and education.
Because many of the studies used to develop Beck’s Postpartum Depression Theory were qualitative in nature, Beck has cited various theoretical sources reflecting the philosophical and theoretical roots of methodologies important for the kind of knowledge developed in each study. Phenomenology was used in the first major study of how women experienced postpartum depression, with Colaizzi’s (1978) approach. In her next study, Beck used grounded theory as influenced by the theoretical and philosophical ideas of Glaser (1978), Glaser and Strauss (1967), and Hutchinson (1986), all seminal contributors to the evolution of grounded theory in nursing. Throughout all of Beck’s work and consistent with feminist theory, there is explicit valuing of the importance of understanding pregnancy, birth, and motherhood through “the eyes of women” (Beck, 2002a). Furthermore, Beck acknowledges that childbirth occurs in many simultaneous contexts (medical, social, economic) and that mothers’ reactions to childbirth and motherhood are shaped by their contextual responses.
An unusual theoretical source came from the work of Sichel and Driscoll (1999), who developed an earthquake model to conceptualize how interactions between biology and life result in what they term biochemical loading. Over time, with constant chemical challenges related to stressors, women’s brains may develop a kind of “fault line” that is less likely to remain intact during critical moments in women’s lives, such as the challenges women face around childbirth, resulting in a kind of “earthquake.” Beck understood Sichel and Driscoll’s model to “suggest that a woman’s genetic makeup, hormonal and reproductive history, and life experiences all combine to predict her risk of ‘an earthquake’ which occurs when her brain cannot stabilize and mood problems erupt” (Beck, 2001, p. 276). Although it is easy to understand the physiological and hormonal challenges of pregnancies for women, Sichel and Driscoll’s earthquake model was important in helping Beck to holistically conceptualize the phenomena that might affect the development of postpartum depression for women. Although Beck states that she never experienced postpartum depression after the birth of her own children, those who have may relate to the earthquake metaphor complete with tremors culminating in postpartum depression or, worse, postpartum psychosis.
Beck has identified Robert Gable as a particularly important source in her work. As Professor Emeritus at the University of Connecticut, Neag School of Education, Gable had coauthored an important text called Instrument Development in the Affective Domain (Gable & Wolf, 1993). After developing a wealth of knowledge about postpartum depression, the next logical steps for Beck became developing instruments that could predict and screen for postpartum depression. Gable assisted Beck with theoretical operationalization of her theory for practical use. Gable has remained directly involved through the step-by-step development of the PDSS, including the Spanish version (Beck & Gable, 2003).
