رابطه مکانیسم‌های دفاعی رشد نایافته و افسردگی پس از زایمان با نقش میانجی تنهایی اجتماعی

Postpartum depression, one of the most common postpartum disorders, disrupts the mother's adjustment to the newborn and raising the child in a healthy relationship with the mother by causing harmful and destructive changes in the mother's mood and family environment. Therefore, the present study aimed to investigate the mediating role of social loneliness on the relationship between immature defence mechanisms and postpartum depression. In a correlational study, we selected 227 women visiting Tehran health centres by convenience sampling among all postpartum women in Tehran. They were asked to answer the Edinburgh Postpartum Depression Scale, Andrews and colleagues' Defense Styles questionnaire, and the Social Loneliness Scale. Data were analyzed using the Pearson correlation test and structural equation modelling by AMOS software and SPSS. The results showed that at the 95% confidence level of the structural model of the research, it has a good fit; Thus, immature defence mechanisms have a positive indirect effect due to social loneliness on postpartum depression, and they can increase the risk of the disorder.
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Postpartum Depression, Immature Defense Mechanism, Social Loneliness, Women in Postpartum Period.
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‌Introduction
Entering the stage of motherhood leads to significant changes in the individual and social identity of the mother and other family members. Also, it increases the risk of postpartum depression due to substantial changes in physiological and psychological dimensions ( Dennis & Vigod, 2020), which begins with symptoms of depressed mood, excessive anxiety, insomnia, and weight change within four weeks after childbirth. Such a situation can negatively affect the degree of attachment between mother and baby and other family relationships and pose a threat to the safety and health of the baby and other children (Norouzi & Mohammadi, 2015). Among the psychological factors that can affect postpartum depression are defence mechanisms, which are subconscious psychological processes that protect “the ego” from anxiety, painful thoughts, and feelings away from the realm of consciousness (Freud, 1923).  Moreover, it can be said that neurosis is due to the continuous use of immature defences. Given this relationship, it is crucial to identify the mediating structures between them, one of which is social loneliness. If newly delivered women do not receive the social support they need or do not consider existing sources of support as social support, they will feel lonely, predicting postpartum depression (Pourkhaleghi, Askarizadeh, & Fazilat-Pour, 2017). Considering the effect of immature defence mechanisms and social loneliness on postpartum depression, it is vital to discover the mechanism of these relationships. Therefore, this study investigates the relationship between immature defence mechanisms and postpartum depression concerning the mediating role of social loneliness.
 
Methodology
The research method of the present study is descriptive, and the statistical population consists of all newly delivered women in Tehran in 1400. To determine the sample size in multivariate regression studies, between 5 and 15 observations per measured (observed) variable are considered (Hooman, 2005). Considering that the number of variables measured in the present study is equal to 12 subscales, the minimum sample size was estimated to be 60, and the ideal volume was estimated to be 180. According to the probability of falling subjects, 230 people were considered. Participants were selected based on inclusion and exclusion criteria through the available sampling method. After deleting the distorted data, the information of 227 participants was statistically analyzed using SPSS and AMOS software. The instruments used in this study included the Edinburgh Postpartum Depression Scale, the Defense Styles Questionnaire, and the Social Loneliness Scale, which was completed by newly delivered women referring to health centres after obtaining informed consent. Firstly, the correlations between the variables were calculated using the Pearson correlation coefficient. Then, path analysis was used to investigate the mediating role of social loneliness in the relationship between immature defence mechanisms and postpartum depression.
 
Findings
The mean age of newly delivered women was 28.44, and its standard deviation was 4.55 (age range: 20-45). The highest frequency in terms of age group is related to the class of 20 to 29 years. Also, 127 of them (55.9%) had a cesarean delivery, and 100 (44.1%) had a normal delivery. In addition, in terms of educational level, the highest frequency is related to undergraduate education, and in terms of employment status, the highest frequency is allocated to the housewife class. Social loneliness showed a significant positive correlation with immature defence mechanisms (r = 0.37, p <0.01) and postpartum depression (r = 0.46, p <0.01). The path analysis method was used to test the mediation pattern of social loneliness with immature defence mechanisms and postpartum depression. In this model, the direct pathway from immature defence mechanisms to postpartum depression was statistically significant (p = 0.040). The values of good fit indices obtained for the final model showed that the assumed model perfectly fits the data. The bootstrap procedure's indirect effect study results that immature defence mechanisms could significantly predict postpartum depression through social mediation alone. The indirect effect of immature defence mechanisms on postpartum depression was 0.15 and statistically significant (p <0.001). In the final model, 0.14% of the variance of social loneliness was explained by immature defence mechanisms, and 0.23% of the variance of postpartum depression was explained by defence mechanisms mediated by social loneliness.
 
Result
The results showed that immature defence mechanisms and postpartum depression were significantly correlated. Due to the use of immature defence mechanisms, they feel more social loneliness, which in turn causes depressive symptoms. It can be said that with the birth of a child, the mother becomes a new and unique psychological organization that is closely related to representations, unconscious processes, feelings, and experiences that are often overlooked in other moments of life (Stern, 1995). Thus, childbirth and the need to reorganize the conscious and subconscious aspects of representing oneself and others may reactivate unprocessed experiences, such as loss and grief. Also, based on the interaction hypothesis, it can be said that the emotion of depression activates the compensatory mechanism, and the compensatory mechanism, in turn, intensifies the feeling of depression. If "the ego" can not find another way out in the face of these emotions and fails to regulate and manage emotions, a mood disorder such as depression will form or persist. As a result, finding immature defence mechanisms in newborn women therapists and informing mothers about the function of these mechanisms in different life situations can change their perception of social loneliness. In this case, by reducing the feeling of social loneliness, the occurrence and persistence of postpartum depression can be prevented.