Risk Factors of Postpartum Depression

Abstract

Postpartum depression (PPD) is a widespread mental health problem and one of the prime causes of maternal suffering and ill health. On a global level, the prevalence of the disorder is about 10 to 15%. Symptoms generally appear within the first four to six weeks, which is the high-risk period. However, it may develop up to one year post-delivery. PPD presents with symptoms of classical depression, including mood fluctuations, bouts of crying, lack of interest in the child, and even thoughts of suicide. PPD not only has adverse effects on the mother's health but also hampers the growth and development of the child. It hampers the formation of a healthy mother-child bond, which in turn may impact feeding practices. The social environment of the infant during the first few months is primarily provided by the mother, and PPD may thus impact the child's development. It also increases the child's susceptibility to malnutrition.Research on postpartum depression has garnered momentum within the last few years. However, the masses are still largely unaware of the disorder and its implications. There is also an inadequacy of awareness of the risk factors of PPD. The cross-cultural differences in manifestations and appropriate preventive measures have not been extensively studied. Some risk factors for PPD are similar to those for classic depression; however, obstetrical and pediatric factors are also involved. This literature review aims to assess the currently known risk factors for PPD, their strength of association, and probable mechanisms to help identify the high-risk group and enable the implementation of preventive measures or facilitate early diagnosis. The factors identified spanned sociodemographic, biological, psychological, and obstetric domains. These included socioeconomic standing, marital relationship, history of psychiatric illness, social support, gestational diabetes, vitamin D deficiency, immigration status, delivery method, violence and abuse, birth experience, and biological and epigenetic markers. The risk factors for postpartum depression are numerous and may have strong to weak associations with the development of PPD. A previous history of depression or psychiatric illness, depressive symptoms during pregnancy, gestational diabetes, and a lack of spousal and social support were the most powerful risk factors. Other significant factors include complications during pregnancy, low socioeconomic status, and stressful life events. Studies on maternal age and chronic illness as risk factors were inconclusive. The roles of genetic and epigenetic markers, cultural factors, and vitamin D insufficiency require further investigation.

Social support as a coping resource for psychosocial conditions in postpartum period: a systematic review and logic framework

“…Furthermore, our findings demonstrated that social support and postpartum quality of life were mutually dependent. These results are consistent with previous studies, including review or meta-analysis studies with random- effects model, which have identified a lack of social support as a major risk factor for PPD [ 49 – 51 , 54 , 55 ]. Riem et al’s review study also supports our results, as it found that low social support is associated with self- reported mental disorders symptoms, such as stress and anxiety, during postpartum [ 7 ].…”

Effect of online health training/counseling and progressive muscle relaxation exercise on postpartum depression and maternal attachment: A randomized controlled trial

“…It has been reported that there is an increase in maternal attachment due to the decrease in depression during pregnancy and the postpartum period 29,30 . It has been observed that a proportion of women with postpartum depression also have depression during pregnancy and that this effect is maintained in the postpartum period 31,32 . In this context, assessing mothers for postpartum depression risk during pregnancy and taking appropriate precautions for at‐risk groups will have positive outcomes for both postpartum depression and maternal attachment.…”

Mendelian randomization analyses for the causal relationship between early age at first sexual intercourse, early age at first live birth, and postpartum depression in pregnant women

“…In addition to having adverse effects on mothers’ health for several months or even one year, PPD may also have serious consequences for children and families ( 3 , 4 ). PPD is not conducive to forming a healthy mother−child relationship which is important for child development and may affect maternal attachment, sensitivity and parenting style, making children more prone to malnutrition and delaying development ( 5 , 6 ). PPD patients are at increased risk of developing depressive episodes in the future and are more likely to be diagnosed with bipolar disorder ( 7 , 8 ).…”

“…To date, various environmental or genetic risk factors that may lead to PPD have been comprehensively studied, but the etiology and pathophysiology of PPD are not fully understood ( 9 ). The powerful risk factors for PPD include a history of psychiatric illness, such as depression; gestational diabetes; risky pregnancy; domestic violence; and lack of social support ( 5 , 10 , 11 ).These risk factors for PPD reduce individuals’ ability to cope with crisis conditions and increase susceptibility to stress. Stress and previous adverse life events, which are associated with neuroendocrine changes, are important risk factors for PPD ( 12 ).…”