Sociodemographic and delivery risk factors for developing postpartum depression in a sample of 3233 mothers from the Czech ELSPAC study

Abstract

BackgroundIn the postpartum period, certain groups of women are at a higher risk for developing depressive episodes. Several studies have described risk factors for developing postpartum depression (PPD). However, these studies have used limited numbers of participants, and therefore the estimated prevalence of PPD varies greatly.MethodsThe objective of this study is to identify the main risk factors for developing PPD by using data collected via the Czech version of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC). This database provides a representative sample (n = 7589) observed prospectively and a large amount of data on depressive symptoms and on biological, socioeconomic, and environmental factors.The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for incidence of PPD. The affective pathology was examined at three time points: before delivery, 6 weeks after delivery, and 6 months after delivery.ResultsThe prevalence of depressive symptoms before delivery was 12.8%, 6 weeks after delivery 11.8%, and 6 months after delivery 10.1%. The prevalence rates are based on women who completed questionnaires at all three time-points (N = 3233).At all three time points, the main risk factors for developing PPD identified as significant by both univariate and multivariate analysis were personal history of depressive episodes and mothers experiencing psychosocial stressors. Other risk factors occurring in both types of analysis were: family history of depression from expectant mother’s paternal side (prenatal), mothers living without partners (6 weeks postpartum) and feelings of unhappiness about being pregnant (6 months postpartum). Several protective factors were also observed: male child gender (prenatal), primiparous mothers (6 months postpartum), and secondary education (prenatal, only by multivariate analysis).Significant risk factors found solely by univariate analysis were family history of depression in both parents of the expectant mother (prenatal and 6 weeks postpartum), family history of depression from subject’s maternal side (6 months postpartum), unintentional pregnancy (prenatal and 6 weeks postpartum), feelings of unhappiness about being pregnant (prenatal and 6 weeks postpartum), primary education (prenatal and 6 weeks postpartum), mothers who opted not to breastfeed (6 months postpartum) and mothers living without partners (prenatal and 6 months postpartum). Family savings were identified as protective factor (prenatal and 6 months postpartum).ConclusionsWe identified significant predictors of PPD. These predictors can be easily detected in clinical practice, and systematic screening can lead to identifying potentially at risk mothers. Since the risk is linked with experience of psychosocial stressors it seems that they might benefit from increased psychosocial support to prevent affective pathology.

Depressive symptoms during pregnancy and postpartum: a prospective cohort study

“…There are studies showing lower rate (1.4%) in South Korea, (5.4%) in the Netherlands and higher rate such as 12% in the Maldives, and 21.3% in Tabriz, Iran . Several protective factors from developing PPD described in the literature including social support from family members and friends . Generally, traditional support during postpartum period comes from other family members (grandparents, relatives) in Turkish family, and in this study, majority of women stated they had support during postpartum period from at least one of their relatives.…”

“…15 Several protective factors from developing PPD described in the literature including social support from family members and friends. 4,24 Generally, traditional support during postpartum period comes from other family members (grandparents, relatives) in Turkish family, 8 The rate of cesarean section in the sample was 37.2%, which is lower than the mean rate in Turkey overall. The Organization of Economic Co-operation and Development has reported that Turkey's rate of cesarean section (53.1%) is the highest worldwide, 26 which is significantly higher than the acceptable rate (15%) of the World Health Organization.…”

“…In the Diagnostic and Statistical Manual of Mental Disorders ( DSM‐V ), peripartum depression is described as any depressive disorder if onset occurred from the beginning of pregnancy or within 4 weeks postpartum . Although defined as the onset of a depressive episode within the first 4 weeks of the postpartum period, postpartum depression (PPD) is a severe, widespread mental disorder that can occur at any time during the 1st year after giving birth . The symptoms of PPD are similar to those of a major depressive episode, and PPD is characterized by such mood swings, disturbances of sleep, low energy, and anxiety, as well as irritability, pervasive depressed mood, and panic.…”

“…year after giving birth. [4][5][6] The symptoms of PPD are similar to those of a major depressive episode, and PPD is characterized by such mood swings, disturbances of sleep, low energy, and anxiety, as well as irritability, pervasive depressed mood, and panic. Worldwide, the estimated rate of PPD is 13% to 19% 2,5 and it is reported that 20% of new mothers experience major or minor depressive episodes within the first 3 months after delivery.…”

“…11 Previously identified risk factors of PPD include sociodemographic characteristics of women and their families (eg, primary education compared with secondary education, 4 advanced age, 15 large family structure, and low household income), health-related characteristics of women (eg, physical and mental health problems), and characteristics of healthcare and delivery services (eg, type of delivery and provision of antenatal care). 4,8,12,15,20 Along with those psychological and social risk factors, researchers have determined some biological risk factors of PPD that may contribute to its etiology. 7 Less known about risk factors for depression during pregnancy and postpartum and there is a need for cohort studies to expand our overall understanding of postpartum depression.…”