Social Support and Social Conflict as Predictors of Prenatal Depression

Abstract

OBJECTIVE-To estimate how social support and social conflict relate to prenatal depressive symptoms and to generate a brief clinical tool to identify women at increased psychosocial risk.METHODS-This is a prospective study following 1,047 pregnant women receiving care at two university-affiliated clinics from early pregnancy through 1 year postpartum. Structured interviews were conducted in the second trimester of pregnancy. Hierarchical and logistic regressions were used to examine potential direct and interactive effects of social support and conflict on prenatal depressive symptoms measured by the Center for Epidemiologic Studies-Depression Scale.RESULTS-Thirty-three percent of the sample reported elevated levels of depressive symptoms predicted from sociodemographic factors, social support, and social conflict. Social support and conflict had independent effects on depressive symptoms although social conflict was a stronger predictor. There was a "dose-response," with each increase in interpersonal risk factor resulting in consequent risk for probable depression based on symptom reports (Center for Epidemiologic Studies-Scale greater than or equal to 16). A composite of one social support and three conflict items were identified to be used by clinicians to identify interpersonal risk factors for depression in pregnancy. Seventy-six percent of women with a composite score of three or more high-risk responses reported depressive symptoms.CONCLUSION-Increased assessment of social support and social conflict by clinicians during pregnancy can identify women who could benefit from group or individual interventions to enhance supportive and reduce negative social interactions.Pregnancy is a time of profound physical and emotional change that inherently affects interpersonal relationships. Social interactions and conflict and the individual's response to them can be crucial triggers for depression. 1,2 Social conflict can be defined as behaviors or interactions perceived as harmful, critical, and hostile and contribute to poor psychological outcome. 3-5 Interpersonal risk factors such as insufficient social support and aggravated social conflict may have profound effects on women's mental and physical health during pregnancy, 6-10 influencing pregnancy outcomes either directly or indirectly through unhealthy life style factors such as smoking or alcohol. 11-14 Among women who gave birth to low birth weight infants, women who experienced any interpersonal conflict gave birth to infants with a mean weight of 261 g lower than women without conflict. 15 There are also societal costs, including increased use of healthcare resources and lost productivity. 16 MATERIALS AND METHODSData for this study are from a larger study of young pregnant women (ages 14−25) enrolled in a randomized controlled trial aimed at promoting improved outcomes through group prenatal care. 26,27 This was a prospective study following participants from early pregnancy through 1 year postpartum. Participants were recruited from large unive...

Antenatal Depression in a Multi-Ethnic, Community Sample of Canadian Immigrants: Psychosocial Correlates and Hypothalamic-Pituitary-Adrenal Axis Function

“…Miszkurka et al 1 noted large differences in prenatal depression by region of origin with women from the Caribbean, Maghreb, Sub-Saharan Africa, and South In our study, we found that high levels of depressive symptoms were associated with greater perceived stress and lower levels of social support, consistent with literature on nonimmigrant pregnant women. 4,5,[43][44][45] We confirmed previous findings that immigrant women in Canada suffering from prenatal depression report more somatic symptoms, 40 and report a novel finding that immigrant women who were not working or going to school during pregnancy were more likely to have a high level of depressive symptoms. Studies in nonimmigrant populations have also found associations between prenatal depression and increased somatic symptoms 46 and (or) unemployment.…”

Emotional and Psychological Effects on Women after Induced Abortion

“…Other factors such as harassment, a history of miscarriage and the unplanned vs. planned nature of the pregnancy were also significantly associated with antenatal anxiety and depression, and have been identified repeatedly in earlier studies [16,17].…”

The factors affecting depression, anxiety and perceived social support level of pregnant women who have the diagnosis of preterm labor

“…Yapılan araştırmalarda sosyal destek sistemlerinde yetersizlik olan gebelerin depresyon ve kaygı düzeylerinde artış olduğu ortaya konulmuştur (19)(20)(21)(22)(23)(24). Gebelikte sosyal destek sistemlerinin yeterli olması; gebe kadınları duygusal ve bilişsel olarak rahatlatmakta, anksiyete ve depresyon ile daha kolay baş etmelerine yardımcı olmakta ve annelik rolüne geçişlerini kolaylaştırmaktadır (23).…”