Stress and Maternal Postpartum Depression: The Importance of Stress Type and Timing

Abstract

Interest in identifying social risk factors for maternal postpartum depression has increased, with a growing emphasis placed on stress exposure. Despite increased interest, questions about the importance of lifetime stress exposure relative to stress surrounding childbirth, along with the importance of different types of stressful events, remain unanswered. The stress process model has gained prominence as a guiding framework for examining stress type and timing in studies of major depression and poor pregnancy outcomes, suggesting that this framework has the potential to advance our understanding of the relationship between stress exposure and depressive symptoms in postpartum women. Using in-person interviews and medical record data from the Fragile Families and Child Well-being Study (N = 4362), we draw on a stress process framework to examine: (1) whether lifetime acute stress exposure prior to pregnancy and birth is a risk factor for postpartum depression net of more proximate acute stressors occurring after pregnancy and birth, and (2) which types of stress (acute, chronic) are most salient for this outcome. Our results show that both acute stressors and chronic strains are independently associated with postpartum depression and acute stressors occurring prior to pregnancy and birth have long-lasting effects on postpartum mental health even when more proximate acute stressors are considered. Our findings underscore the need to more fully capture stressors and strains occurring throughout a woman's life course with regard to postpartum depression, and suggest the importance of rooting postpartum research and screening in a stress process framework.

Do Successive Preterm Births Increase the Risk of Postpartum Depressive Symptoms?

“…These findings are consistent with those from previous studies that reported increased risk of postpartum depressive symptoms in women with preterm birth [ 5 , 7 – 9 ]. Although, no study has previously examined the effect of successive preterm birth on the risk of postpartum depressive symptoms, Bener reported that postpartum mothers of preterm infants with a history of preterm birth had higher prevalence of psychological distress [ 32 ], which may increase their risk of developing postpartum depressive symptoms [ 12 ]. The elevated risk of postpartum depressive symptoms observed in women with preterm birth in the current study may be due to an increase in maternal level of stress associated with infant illness and complications and concerns about the infant's outcome as explained by the preterm parental distress model [ 10 ].…”

“…This may suggest that even though preterm birth in the index delivery increases the risk of postpartum depressive symptoms, the risk may only be evident in women with very preterm birth. This may be due to greater level of stress in women with very preterm birth [ 33 ], as higher maternal stress levels have been associated with greater postpartum depressive symptoms [ 11 , 12 ].…”

“…The increased risk of postpartum depressive symptoms observed in women with preterm birth may be due to stress [ 10 – 12 ]. Mothers of infants with preterm birth may experience increased stress related to feelings of helplessness, exclusion, and alienation and lack of sufficient knowledge regarding parenting and interacting with their infants [ 13 ].…”

Psychosocial Determinants of Postpartum Depression and Maternal Well-Being among Postnatal Women

“…A longitudinal study involving developed and Sub-Saharan African countries revealed that the experiences of stressful life events during pregnancy and in the postpartum period were significant predictors of PPD especially among women with a history of mental health problems [29] [30] [31]. A study by [32] using in-person interviews of 4362 women and data from medical records showed that any experience of stress (acute and chronic) is significantly associated with PPD and that acute stressors occurring before pregnancy and during birth have long-lasting effects on maternal mental health.…”

Factor of Anxiety Level Primiparous Women

“…The majority of primiparous woman signs of anxiety are often overlooked due to a lack of awareness of the impact of later life on the child's mother, husband or other family relationships which will be a psychological burden for primiparaous. In addition, the ignorance and shame that is possessed to express the form of anxiety that is being experienced due to environmental stigma regarding psychological complaints becomes the cause of the post-partum process maladptation that cannot be overcome early on (Reid, 2015 ).…”