Regional Differences in Various Risk Factors for Postpartum Depression: Applying Mixed Models to the PRAMS Dataset

Abstract

Purpose: The purpose of this study was to assess the association between various risk factors with postpartum depression severity using a large dataset that included variables such as previous mental health status, social factors, societal factors, health care access, and other state-wide or region-specific variables.Methods: We obtained the most recently available (2016–2017) dataset from the Pregnancy Risk Assessment Monitoring System (PRAMS), which is a dataset compiled by the Centers for Disease Control (CDC) that collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy from over 73,000 women in 39 states. We utilized a hierarchical linear model to analyze the data across various levels, with a symptom severity scale (0–8) as the dependent variable.Results: Of the 21 variables included in the final model, nine variables were statistically significant predictors of symptom severity. Statistically significant predictors of increased postpartum depression symptom severity included previous depression diagnosis and depression symptoms during pregnancy, baby not residing with mother, unintentional pregnancy, women with less than a high school degree and more than a college degree, Women Infants Children (WIC) enrollment, and married women. In contrast to these other factors, attendance at a postpartum follow up appointment was associated with significantly increased symptom severity. Age revealed an inverted curve in predicting postpartum symptom severity.Conclusions: There was no significant difference in symptom severity scores across the 39 participating states. Most notably, postpartum depression symptom severity was associated with previous depression diagnosis and previous symptom severity, but our results also reveal novel social and education factors that contribute to the support and well-being of the mother and child.

Effects of limited bedding and nesting on postpartum mood state in rats

“…In humans, low socioeconomic status, lack of adequate resources and support can increase the risk of PPD up to 10 times greater than that of mothers of higher socioeconomic status mothers 9,35 . This study employed the LBN paradigm to model the low resource risk factor as a novel rodent model of PPD.…”

“…PPD affects more than just the mental health of the mother but can also alter her ability to care for her baby, resulting in long‐term consequences for her child 6–8 . Certain risk factors are known to leave mothers more vulnerable to PPD including maternal isolation, negative life events, low socioeconomic status, and age 9 . These risk factors suggest that when mothers do not have the necessary resources and support available to them, they are at increased risk of developing PPD 10 .…”

“…Stress activates the immune system, suppresses neural plasticity and has been implicated in mood disorders Bale 24 . Interestingly, the highest predictors of PPD are personal and socioenvironmental stressors 9 . Trauma, pregnancy complications, socioeconomic status, limited resources and unemployment are all associated with increased risk of PPD 10,25–27 .…”

“…24 Interestingly, the highest predictors of PPD are personal and socioenvironmental stressors. 9 Trauma, pregnancy complications, socioeconomic status, limited resources and unemployment are all associated with increased risk of PPD. 10,[25][26][27] The limited bedding and nesting (LBN) model has been adopted and well-validated with rodents as a naturalistic approach to model a low resource, stressful environment similar to that of lower socioeconomic status conditions in humans.…”

“…The present study sought to determine if there was a relationship between experiencing LBN stress and the expression of negative maternal behaviors, anhedonia, anxiety, altered neuroimmune and endocrine function in female Sprague-Dawley rats. Our prediction was that inadequate bedding and nesting material would mimic the stressors experienced by some new mothers, including the lack of social support and economic resources, 9 thus making it difficult to care for her new pups while simultaneously precipitating postpartum anhedonia and anxiety. For breeding, each female rat was placed with a single male rat for a maximum of 4 days and checked daily for the presence of a sperm plug, which determined the day of conception and was assigned as embryonic (E) day 1.…”