Introduction and objective: Postnatal mental health problems are a global problem that affects the well-being and functioning in over 10% of women, as well as the child’s development, costing society billions. Therefore, it is crucial to identify risk factors to prevent the onset of mental illness and/or symptoms the first year after birth. One such factor may be the consistently more prevalent need to set unrealistically high expecta-tions and standards for oneself, and consequently critically evaluate one’s own behav-ior. The objective of this master thesis is therefore to investigate to what degree perfec-tionism may increase the risk of developing different mental illnesses and/or symptoms among mothers in the postpartum period.
Method: A systematic review, based on the PRISMA guidelines, retrieved cohort studies and case-control-studies from database search in Embase, PsycInfo and Pub-Med, March 29. 2021, to investigate the forementioned research question. Eligibility criteria included peer-reviewed, research articles using quantitative and validated measures for assessing the relationship between perfectionism and mental health prob-lems among mothers the first year after birth. The participants were over 18 years of age and without the need for special assistance.
Results: The seven studies identified used five different self-report measures of perfec-tionism, where depression was assessed using DSM-IV and ICD-10 criteria by two studies and six administered self-reported measures to evaluate symptoms of depres-sion, anxiety and/or post-traumatic stress disorder. Five studies found a weak to mod-erate association between perfectionism and depressive symptoms. Two studies inves-tigating depressive disorder showed inconsistent results. A moderate relationship was identified by one study between perfectionistic concerns and anxiety symptoms, and another study reported a weak relation between perfectionism and PTSS. Still, two of the studies identified postnatal symptoms of depression and anxiety as moderating the effect of perfectionism on postnatal symptoms. As well as one study did not identify a relationship between perfectionism and depressive symptoms when controlling for other established risk factors and body dissatisfaction. Furthermore, the analysis of risk of bias indicated that all studies had reduced internal validity.
Conclusion: A weak to moderate relationship was identified, but few studies were retrieved, there are several methodological issues in the included studies as well as lack of grounds to infer causality, and there is the possibility that other factors are more evident and/or mediate the relationship between perfectionism and postnatal mental health problems. Thus, the results indicated that perfectionism may, to some degree, make new mothers more vulnerable to depression or symptoms of depression, anxiety, or PTSD, but the systematic review cannot conclude that it is an especially prominent risk factor for postnatal mental health problems. Moreover, the evidence does not sup-port the need for a systematic evaluation of perfectionism in the perinatal period but advocates for enhanced awareness of possible negative effects of perfectionism and identification of especially vulnerable women with perfectionistic tendencies. More longitudinal studies with multiple measure points and assessment of moderating factors between perfectionism and postnatal mental health problems are required, as well as experimental designs with randomization allowing to assess causality to a stronger degree. Furthermore, it would be advantageous to administer performance-based or observer-rated measures for perfectionism, as well as utilizing more diagnostic criteria and interview to assess postnatal mental health disorders.
Additional perspectivation: The results of the systematic review, as well as additional theory and research, were used to discuss the possibility of treating different postnatal mental health problems trough reducing perfectionistic concerns, as well as focusing on disruptive perfectionistic tendencies in therapy to enhance the therapeutic alliance.
Limitations: Significant limitations of the systematic review are that data extraction and critical appraisal was conducted by a single individual which may have caused bias, not all relevant studies were identified, and there is the possibility of publication bias.