Theory, therapy, fashion and a swansong: PND, PTSD, or just postnatal distress?

It’s amazing how quickly the last five years has flown by and it’s hard to believe my tenure as editor of JRIP has now come to an end. It’s been an exciting five years and the Journal of Reproductive and Infant Psychology has gone from strength to strength in terms of quality and breadth of submissions, as evidenced by the recent substantial increase in the impact factor. Thus, the journal is in good health and continues to represent both the aims of the society for reproductive and infant psychology (SRIP) and the interests of those working within the whole spectrum of areas defined by the broad brush stroke terms of ‘reproductive’ and ‘infant’ psychology.

The nice thing about writing a final editorial is that it provides an opportunity for reflection over the key debates and issues highlighted over the past five years in this exciting area. It also provides the rare opportunity to offer an evidence- or at least experience-informed opinion! Consequently, I shall offer one, based not only on papers coming into the journal including the special edition planned for 2015, edited by Professor Susan Ayers, but also wider engagement within the clinical and research community working in our area. One observation concerns the changing focus of attention, and the shift to specific areas of interest which seem to have become a ‘staple diet’ of reproductive research fayre. These include the perennial favourite, postnatal depression (PND), and more recently, postpartum post-traumatic stress disorder (PTSD). Critically important as these areas are, the question is raised: do these areas represent significant areas of concern and key research questions or just the particular research interests of the society members and researchers working in the field of perinatal and maternity care? I would argue the former and in fact see these areas as ‘safe ground’ for the reproductive psychology researcher, incrementally building on developing theory and an established evidence base and, more critically, in the case of both depression and PTSD, ‘borrowing’ significantly from mainstream applied psychology practice. I would go further in arguing that there is a good case, based on the evidence, to query the quintessential ‘uniqueness’ of postnatal depression as distinct from depression per se, given that antenatal depression rates are very similar (Jomeen & Martin, 2008). Similarly, the recent focus and interest of postpartum PTSD, which espouses this as a unique area, seems also to miss one awkward and singularly important point that postpartum rates (Polachek, Harari, Baum, & Strous, 2012) appear to be very similar to general population rates (National Institute of Health, 2014). This serves to remind us to consider not only the issues of broadly based phenomena occurring in many different contexts, but also what is unique to reproductive and infant psychology. Of course, there are several areas which are unique to our area, many within the sphere of fertility, a subject which is sometimes underrepresented in manuscript submissions to the journal. There are others areas, though, where there is a dearth of research and where there is consequently the opportunity to make a distinct contribution to knowledge that may offer both theoretical insight and clinical application. One of these areas is puerperal psychosis. Puerperal psychosis is surprisingly underresearched within the broad umbrella of reproductive psychology, and yet represents an area where women who experience it incur perhaps the most distressing form of mental health phenomena imaginable, the current range of interventions is limited and the potential to gain valuable psychological insight into this distressing condition is great. Importantly, illumination of areas such as puerperal psychosis through systematic psychological research enquiry also offer the opportunity for theory development in relation to perinatal mental health and indeed mental health more broadly, ranging from intense short-term perinatal distress (PD) to more long-lasting and disabling conditions. Thus, we have within reproductive psychology the potential to modify the most often ‘one-way’ traffic of theory osmosis from general theory to reproductive psychology and to engage in a more reciprocal exchange of ideas and research methodologies. We might also wish to reflect on the notion that if these ideas present themselves as innovative and influential within the reproductive psychology field, why is it we seem not to take them on and develop them with greater enthusiasm? I suspect part of the reason may be conservatism within our field, or else simply the silos within which many of us operate. I had the pleasure recently to attend a workshop looking at establishing priority areas for reproductive psychology in terms of research enquiry and funding. The meeting was attended by a number of the ‘great and the good’. What was quite striking was the ease with which agreement was found on priorities such as postnatal depression, postpartum PTSD and the transition to parenthood, but some considerable resistance to areas such as puerperal psychosis, among others. It was interesting to ponder on the rationale for this, and I can only guess at whether the relatively small but significant numbers of women and families affected by this condition is influencing research in this area, or the very real difficulties associated with researching in this area. Whatever is the case, the issue is worthy of discussion and reflection in terms of the perceptions that seemed to arise. I wonder whether sometimes there is an issue of fear, both in terms of broaching a relatively unexplored area of research and also fear in terms of an area which, in the case of puerperal psychosis, may engender discomfort among decision-makers? Either way, it does raise the spectre of the whole structure of influence on the research process and how this may permeate to what ultimately informs both the evidence base and contemporary clinical practice. Given that we are increasingly becoming aware of important and controversial areas of concern which need to be addressed within the realm of reproductive psychology, such as infanticide, Couvade syndrome, female genital mutilation and, indeed, non-medically justified male circumcision, perhaps the time has come for us to be a little less conservative and recognise that, in terms of reproductive psychological science, our role is to ask and address all the important research questions within our field.

In leaving, I welcome the new co-editor Professor Fiona Alderdice, based in Queens University Belfast, and junior editor Dr James Newman, based at the University of Newcastle, to the journal editorial team and really look forward to seeing how the journal both changes and progresses. I have no doubt that it will, supported by the Society for Reproductive and Infant Psychology, continue, in turn, to support, encourage and publish researchers from many different disciplines working in this exciting and dynamic area.

Colin R. Martin