Maternal anger in the perinatal period
Restricted (Penn State Only)
- Author:
- Level, Rachel
- Graduate Program:
- Psychology
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 23, 2023
- Committee Members:
- Jenae Neiderhiser, Major Field Member
Rina Eiden, Co-Chair & Dissertation Advisor
Martha Wadsworth, Major Field Member
Danielle Downs, Outside Unit & Field Member
Ginger Moore, Co-Chair of Committee
Kristin Buss, Program Head/Chair - Keywords:
- Pregnancy
Anger
Perinatal
Women's Health
Smoking - Abstract:
- Maternal anger is often overlooked in studies of maternal mood during pregnancy and the postpartum period. One reason for this oversight are the inherent challenges to studying anger, including a broad range of empirical conceptualizations, missing explicit definitions of anger, and lack of differentiation between related constructs like hostility, irritability, and aggression (Eckhardt et al., 2004). Also contributing to this oversight is the significant lack of empirical studies examining the expression of anger in women (Crowley, 2001; Eatough et al., 2008; Fischer et al., 2004; Sharkin et al., 1993). Despite increasing evidence that women are more likely to express anger than men (Fischer & Evers, 2011), societal perceptions continue to maintain the stereotype that women experience less anger compared to men (Crowley, 2001; Thomas, 2005). Some researchers have postulated that misconceptions can arise because women tend to express anger differently than men, for example through crying which is not often captured in instruments measuring anger (Simon & Lively, 2010). Women may also feel forced to modulate outward displays of anger because expressing anger is often characterized as “unfeminine” and “nonmaternal” with more social sanctions applied to women’s anger expression compared to men (Fischer & Evers, 2011). Indeed, this may be especially true for women of color who face significant, negative stereotypes of being seen as overly aggressive when expressing normative emotions (Thomas & González-Prendes, 2009; Walley-Jean, 2014). Qualitative data has consistently documented anger as a common, salient emotion occurring across pregnancy and the postnatal period, and support the notion that societal sanctions of women’s anger can lead new mothers to feel guilt, shame, and disappointment when angry which may prevent them from seeking much-needed support (Grant et al., 2020; Ou & Hall, 2017). Without support or intervention, extreme or atypical anger expression increase the risk of Postpartum Depression (PPD), harsh or hostile parenting, and even child abuse potential (Hien et al., 2010; Shay & Knutson, 2008). Given maternal anger’s potential as a contributor of risk, this dissertation sought to address the important gap in the empirical literature on women’s anger with the long-term goal of legitimizing and destigmatizing perinatal anger to improve prevention and intervention efforts for women and families. First, I investigated the course of anger across pregnancy and postpartum as well as the factors associated with between-individual differences. Although there are few quantitative studies examining risk and protective factors associated with elevated anger (see Ou & Hall, 2017 for an in-depth review), qualitative studies have revealed several common themes. Notably, feeling powerless seems to contribute most strongly to maternal anger. Specifically, factors associated with low social or economic mobility such as economic hardship, relationship conflict, and younger age appear to undermine women’s sense of power and autonomy and contribute to their anger (Thomas & González-Prendes, 2009; Ou & Hall, 2017). General strain theory (GST) emphasizes the impact of personal and economic strain on anger and risky/impulsive behavior (Agnew, 1985; Agnew, 1992). GST contends that strain or chronic environmental stressors increase the likelihood of negative emotions such as anger and frustration which, in turn, create pressure for individuals to correct or relieve these negative emotions. Originally developed to explain the development of criminal behavior, classic strain theories have largely focused on male populations and assumed that because women commit fewer crimes compared to men, they also experience less strain and anger (Merton, 1938; Cohen, 1965). More recent tests of GST, however, have demonstrated that women experience both higher levels of objective and subjective strain due to greater demands associated with family life and experience of gender-based discrimination (Broidy & Agnew, 1997; Sharp et al., 2012). Given the significant stressors associated with the transition to parenthood for women (Deave et al., 2008), GST offers a useful framework to examine the course of maternal anger across the perinatal period. I used latent growth curve modeling to examine levels and patterns of changes in maternal anger across pregnancy and postpartum. Additionally, I investigated risk and protective factors associated with maternal anger because of their implication for prevention and intervention. A second question addressed in this dissertation is the longitudinal association between anger and smoking. Tobacco is one of the most commonly used substances during pregnancy (NIDA, 2022) and has profound effects on maternal health and child development (Cnattingus et al., 2004; Shea & Steiner, 2008). Converging evidence indicates that there are significant sociodemographic disparities associated with smoking. Most notably, women who are younger, unmarried, lower-income, and who have a high school or less than high school education, have more difficulty quitting/reducing smoking during pregnancy than other mothers (Cnattigus et al., 2004; Cornelius & Day, 2000; Schneider et al., 2010). Previous literature has examined depression and stress as key mediators of lower cessation rates among low-income pregnant smokers (Ludman et al., 2000; Businelle et al., 2010). In fact, new treatment development studies targeted depression-focused treatment for pregnant smokers with some success, particularly for women with higher depressive symptoms (Cinciripini et al., 2010). However, treatment effects have not lasted beyond 6 months. One explanation for the lack of long-lasting effects of depression-focused treatments may be that they have not incorporated other aspects of negative affect that may be particularly salient among low-income, pregnant smokers. GST speculates that individuals may try to manage negative emotions produced by strain by engaging in self-destructive behavior—including substance use (Broidy & Agnew, 1997). Indeed, anger and hostility are positively associated with cigarette smoking in the general population (Lipkus et al., 1994; Siegler et al., 1992; Whiteman et al., 1997), as well as persistent smoking during pregnancy, even above depression and stress (Eiden et al., 2011). Therefore, I hypothesized that anger may be a key predictor of changes in smoking behavior in low-income mothers who are more likely to experience strain. I tested this hypothesis by examining bidirectional associations between maternal anger and smoking across a time period particularly vulnerable to negative consequences associated with cigarette exposure, pregnancy to early toddlerhood. Together, these papers offer complimentary perspectives on the course and development of maternal anger across the perinatal period by studying various predictors and outcomes of maternal anger in a diverse and high-risk sample. Findings may provide critical insight into the prevention and intervention efforts for women and families most vulnerable to maternal anger.