Trajectories of Maternal Postpartum Depressive Symptoms

Abstract

OBJECTIVES: To identify homogenous depressive symptom trajectories over the postpartum period and the demographic and perinatal factors linked to different trajectories. METHODS: Mothers (N = 4866) were recruited for Upstate KIDS, a population-based birth cohort study, and provided assessments of depressive symptoms at 4, 12, 24, and 36 months postpartum. Maternal demographic and perinatal conditions were obtained from vital records and/or maternal report. RESULTS: Four depression trajectories were identified: low-stable (74.7%), characterized by low symptoms at all waves; low-increasing (8.2%), characterized by initially low but increasing symptoms; medium-decreasing (12.6%), characterized by initially moderate but remitting symptoms; and high-persistent (4.5%), characterized by high symptoms at all waves. Compared with the high-persistent group, older mothers (maximum odds ratio [OR] of the 3 comparisons: 1.10; 95% confidence interval [CI]: 1.05 to 1.15) or those with college education (maximum OR: 2.52; 95% CI: 1.36 to 4.68) were more likely to be in all other symptom groups, and mothers who had a history of mood disorder (minimum OR: 0.07; 95% CI: 0.04 to 0.10) or gestational diabetes mellitus diagnosis (minimum OR: 0.23; 95% CI: 0.08 to 0.68) were less likely to be in other symptom groups. Infertility treatment, multiple births, prepregnancy BMI, gestational hypertension, and infant sex were not differentially associated with depressive symptom trajectories. CONCLUSIONS: One-quarter of mothers in a population-based birth cohort had elevated depressive symptoms in 3 years postpartum. Screening for maternal depression beyond the postpartum period may be warranted, particularly after mood and diabetic disorders.

Patterns of maternal depression, anxiety, and stress symptoms from pregnancy to 5 years postpartum in an Australian cohort experiencing adversity

“…This rate reaches double that of Australian population cohorts; the Longitudinal Study of Australian Children identified 10% of women as having high depression symptoms at 4 years (Giallo et al 2014), and the Maternal Health Study reported the highest rate of depression as 15% at 4 years postpartum (Woolhouse et al 2015). Moreover, our rates are up to four times greater than a US cohort which identified moderate depression symptoms in 7% of women at 3 years postpartum (Putnick et al 2020). Our study further extends on the existing literature by demonstrating similarly high rates of high anxiety and stress symptoms up to 5 years postpartum.…”

“…In a cohort of Australian first-time mothers, rates of depression were highest (15%) at 4 years compared to any time in the first 12 months postpartum (8–11%) (Woolhouse et al 2015 ). Similarly, in an Australian population-representative cohort, 16% of mothers experienced persistently high depression symptoms from birth to 7 years postpartum (Giallo et al 2014 ); and in a US cohort, 13% of women experienced increasing or persistently high depression symptoms up to 3 years postpartum (Putnick et al 2020 ). A Canadian cohort study further found that 8% of mothers reported persistently high anxiety symptoms and 13% persistently high stress symptoms from birth to 3 years postpartum (Mughal et al 2018 ).…”

“…Beyond the first 12 months postpartum, the prevalence of maternal mental health problems has been less well studied. However, the available studies suggest that maternal mental health problems persist (Putnick et al 2020 ), and that the prevalence may actually increase (Shorey et al 2018 ). In a cohort of Australian first-time mothers, rates of depression were highest (15%) at 4 years compared to any time in the first 12 months postpartum (8–11%) (Woolhouse et al 2015 ).…”

Giving birth under hospital visitor restrictions: Heightened acute stress in childbirth in COVID-19 positive women

“…While routine screening for traumatic childbirth does not exist in postpartum hospital units, our study suggests that assessment of acute stress responses in delivering mothers who are COVID-19 positive is warranted. Ongoing monitoring of mental health symptoms in this high risk group after hospital discharge is important as those with stable symptoms in accord with routine care are likely to be quickly discharged and face social isolation during the postpartum period, which is considered a time of heightened psychological vulnerability [27, 28].…”

A potential role for insulin treatment during pregnancy in reducing postpartum psychological distress in maternal obesity: An administrative population health study

“…It is also important to note that GDM itself is suggested to be a risk factor for peripartum depressive symptoms [24,[40][41][42]. One study effectuated in Brazil on a cohort of female participants who were pregnant and were diagnosed with GDM (N=820) aimed to assess the frequency and severity of depressive symptoms (according to the Edinburgh Postnatal Depression Scale) and their relationship to clinical and sociodemographic characteristics.…”