Postpartum Depression Linked to Stressors During Pregnancy.
Pregnant women who argued with their partners, had financial problems, or reported other kinds of stress were more likely to experience postpartum depression, according to a new study led by School of Public Health researchers.
The study, published online in the Journal of Women’s Health, recommends that women be routinely screened during pregnancy for a range of stressors and encouraged to seek help for postpartum depressive symptoms (PDS).
Researchers analyzed responses from more than 5,000 mothers who participated in the Massachusetts Pregnancy Risk Assessment Monitoring System between 2007 and 2010. They evaluated associations between a dozen perinatal stressors, categorized into four groups—partner, traumatic, financial, and emotional—and postpartum depression and subsequent help-seeking behaviors. They found a “strong dose-response relationship” between the number of stressors reported by the mothers and PDS prevalence.
Almost half of the mothers reported between one and three stressors (47.7 percent), while 9.3 percent had four to six stressors, and 1.3 percent had seven or more stressors. The prevalence of PDS climbed as the number of stressors increased.
The strongest association was observed for partner-related problems, which contributed to a nearly two-fold increase in PDS prevalence, compared with no stressors. But mothers with partner-related stress also were less likely to seek help, compared with mothers with other kinds of stressors. Overall, 38 percent of mothers with PDS sought help.
“These data suggest that women should be routinely screened during pregnancy for a range of stressors and encouraged to seek help for PDS,” the authors said.
Among the stresses that women were asked about having experienced during the 12 months before giving birth were: arguing with a partner more than usual, or getting separated or divorced; facing bills they could not pay, or losing jobs; or losing a close friend or relative.
Overall, mothers who reported any stressor were more likely to be younger, unmarried, overweight or obese, smokers, and have lower education and family income than mothers who reported no stressors. They also were more likely to report that they did not want to become pregnant, compared with mothers who reported no stressors.
Postpartum depressive symptoms include feelings of sadness and hopelessness during the year after giving birth. The prevalence of PDS in the US ranges from 80 percent for mothers with transient “baby-blues” to 10 percent to 15 percent for mothers meeting criteria for major postpartum depression.
Although there are effective treatments for PDS, including cognitive behavioral therapies and pharmacological interventions, seeking help for PDS is still underutilized, the authors said.
Nearly half of the mothers with PDS reported a partner-related (49.6 percent) or financial-related (48.6 percent) stressor. While 94.2 percent of mothers reported having a postpartum checkup, less than half of all mothers with PDS who experienced any of the categories of stressors discussed their depressive symptoms at the postpartum visit or sought help for their PDS, the study found.
The prevalence of financial-related stressors, particularly “partner lost job,” and the association between mothers with financial-related stressors and seeking help for PDS both increased in 2009–2010, compared with 2007–2008 reports. These increases coincide with both the national economic downturn and with an increase in awareness of depression, the authors said.
The researchers said their findings were important because new mothers “are still in frequent contact with health care professionals during pregnancy and early postpartum, providing opportunities for monitoring mood and early intervention for mothers experiencing partner-related stressors. Such mothers may need additional encouragement and support to seek help.”
Authors on the study from SPH include: Sarah Lederberg Stone, a former doctoral student in epidemiology who is now a fellow in maternal and child health at the Massachusetts Department of Public Health; Lauren Wise, associate professor of epidemiology; Eugene Declercq, professor of community health sciences; Howard Cabral, professor of biostatistics; and Matthew Fox, associate professor of epidemiology and global health and development.
The study was supported by the Boston University Reproductive, Perinatal, and Pediatric Epidemiology Training Grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development, and by Stone’s appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention.
Submitted by: Lisa Chedekel