Development of a regulatory risk-versus-resilience phenotype for maternal distress

ABSTRACTElisabeth R. Bernhardt: Development of a Regulatory Focus Risk-Versus-Resilience Phenotype for Maternal Distress (Under the direction of Dr. Jessica Williams)The postpartum period represents a uniquely sensitive time during which a mother must rapidly adapt to the demands of caregiving while simultaneously recovering from childbirth and navigating shifts in identity, making effective self-regulation essential for maternal and family well-being. Maladaptive self-regulation can increase vulnerability to symptoms of depression and anxiety (i.e., maternal distress) by constraining a mother’s ability to modulate her own emotional and behavioral responses to unexpected stressors inherent to the postpartum transition. Across the United States, the prevalence of postpartum depression has nearly doubled to 20% over the last decade. When early symptoms are missed or left untreated, maternal distress can worsen, leading to diminished functioning, compromised caregiving, and negative effects on infants’ emotional, cognitive, and behavioral development. The purpose of this study is to identify a risk-versus-resilience phenotype for maternal distress by applying a novel regulatory focus framework to integrate findings on neural activation during postpartum hormone changes, distress symptoms, caregiving behaviors and mothers’ lived experiences of goal pursuit and perceived functionality during the postpartum period. Specifically, this dissertation aims to: 1) examine the neural reward response to loss and behavioral effects of hormone withdrawal that occur after childbirth, 2) explore relationships among regulatory focus, symptoms of distress, and variations in caregiving behaviors, and 3) describe the experience of goal pursuit and perceived functionality during the postpartum period. The proposed risk-versus-resilience phenotype provides an important first step toward integrating regulatory focus theory into our understanding of maternal distress. This framework has the potential to advance nursing practice by improving the identification of mothers at risk and guiding the development of more individualized, targeted interventions.