Social Psychiatry and Psychiatric Epidemiology

, Volume 40, Issue 8, pp 605–612

Psychosocial risk factors to major depression after childbirth

Original Paper



Risk factors to postnatal depression (PND) have generally been identified in well-defined homogenous samples of primiparous women. There is a need for studies to assess risk factors in a heterogeneous sample of women.


This study is aimed to identify psychosocial risk factors to postnatal depression.


Subjects underwent a baseline assessment within 2 days of childbirth and completed postal questionnaires at 6, 12, 18 and 24 weeks postpartum. Postnatal depression was defined as scoring above 12 on the Edinburgh Postnatal Depression Scale on two occasions and meeting criteria for major depression using the Structured Clinical Interview for DSM-III-R.


Four hundred and twenty-five women with a mean age of 26.9 years participated in the study. Forty-two women were considered to be cases of postnatal depression. A significantly increased risk for postnatal depression was associated with (a) being 16 years old or younger, (b) a past history of psychiatric illness, (c) experiencing one or more life events, (d) marital dissatisfaction, (e) experiencing unsatisfactory social support, (f) a vulnerable personality and (g) having a baby of the nondesired sex.


This study confirmed that psychosocial risk factors, predominantly in the areas of social support and personality style, are closely associated with postnatal depression.


postnatal depression psychosocial risk personality support marital relationship 


  1. 1.
    Barnett B, Lockhart K, Bernard D et al (1993) Mood disorders among mothers of infants admitted to a mothercraft hospital. J Paediatr Child Health 29:270–275PubMedGoogle Scholar
  2. 2.
    Bloch M, Schmidt PJ, Danaceau M et al (2000) Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatr 157:924–930CrossRefPubMedGoogle Scholar
  3. 3.
    Boyce PM (1994) Personality dysfunction, marital problems and postnatal depression. In: Cox J, Holden J (eds) Perinatal psychiatry. Use and misuse of the Edinburgh postnatal depression scale. Gaskell, London, pp 82–102Google Scholar
  4. 4.
    Boyce P (2003) Risk factors for postnatal depression: a review and risk factors in Australian populations. Arch Women Ment Health 6:s43–s50CrossRefPubMedGoogle Scholar
  5. 5.
    Boyce P, Stubbs J, Todd A (1993) The Edinburgh postnatal depression scale: validation for an Australian sample. Aust N Z J Psychiatry 27:472–476PubMedGoogle Scholar
  6. 6.
    Boyce P, Hickey A, Gilchrist J et al (2001) The development of a brief personality scale to measure a vulnerability to postnatal depression. Arch Women Ment Health 3:147–153CrossRefGoogle Scholar
  7. 7.
    Brown GW, Harris T (1978) Social origins of depression: a study of psychiatric disorders in women. Tavistock, LondonGoogle Scholar
  8. 8.
    Brown GW, Harris T (1986) Stressor, vulnerability and depression: a question of replication. Psychol Med 16:739–744PubMedGoogle Scholar
  9. 9.
    Burnell I, McCarthy M, Chamberlain GVP et al (1982) Patient preference and postnatal hospital stay. J Obstet Gynaecol 3:43–47Google Scholar
  10. 10.
    Carty EM, Bradley CF (1990) A randomized, controlled evaluation of early postpartum hospital discharge. Birth 17:199–204PubMedGoogle Scholar
  11. 11.
    Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression: development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786PubMedGoogle Scholar
  12. 12.
    Evans J, Heron J, Francomb H et al (2001) Cohort study of depressed mood during pregnancy and after childbirth. Br Med J 323:257–260Google Scholar
  13. 13.
    Hickey A, Boyce P, Ellwood D et al (1997) Early discharge and risk for postnatal depression. Med J Aust 167:244–247PubMedGoogle Scholar
  14. 14.
    James ML, Hudson CN, Gebski VJ et al (1987) An evaluation of planned early postnatal transfer home with nursing support. Med J Aust 147:434–438PubMedGoogle Scholar
  15. 15.
    Murray L (1992) The impact of postnatal depression on infant development. J Child Psychol Psychiatry 33:543–561PubMedGoogle Scholar
  16. 16.
    Murray L, Carothers AD (1990) The validation of the Edinburgh post-natal depression scale on a community sample. Br J Psychiatry 157:288–290PubMedGoogle Scholar
  17. 17.
    Murray L, Cartwright W (1993) The role of obstetric factors in postpartum depression. J Reprod Infant Psychol 11:215–219Google Scholar
  18. 18.
    Murray L, Cooper PJ, Stein A (1991) Postnatal depression and infant development. Br Med J 302:978–979Google Scholar
  19. 19.
    O’Hara MW (1986) Social support, life events, and depression during pregnancy and the puerperium. AMA Arch Gen Psychiatry 43:569–573Google Scholar
  20. 20.
    O’Hara MW, Swain AM, (1996) Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry 8:37–54Google Scholar
  21. 21.
    O’Hara MW, Rehm LP, Campbell SB (1983) Postpartum depression: a role for social network and life stress variables. J Nerv Ment Dis 171:336–341PubMedGoogle Scholar
  22. 22.
    O’Hara MW, Neunaber J, Zekoski EM (1984) Prospective study of postpartum depression: prevalence, course and predictive factors. J Abnorm Psychology 93:158–171CrossRefGoogle Scholar
  23. 23.
    O’Hara MW, Zekoski EM, Philipps LH et al (1990) Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. J Abnorm Psychology 99:3–15CrossRefGoogle Scholar
  24. 24.
    Paykel ES, Emms EM, Fletcher J et al (1980) Life events and social support in puerperal depression. Br J Psychiatry 136:339–346PubMedGoogle Scholar
  25. 25.
    Pitt B (1968) ‘Atypical’ depression following childbirth. Br J Psychiatry 114:1325–1335PubMedGoogle Scholar
  26. 26.
    Pope S, Watts J, Evans S et al (2000) An information paper. Postnatal depression. A systematic review of published scientific literature to 1999. National Health and Medical Research Council, Canberra, AustraliaGoogle Scholar
  27. 27.
    Small R, Lumley J, Brown S (1992) To stay or not to stay: are fears about shorter postnatal hospital stays justified? Midwifery 8:170–177CrossRefPubMedGoogle Scholar
  28. 28.
    Spitzer RL, Williams JBW, Gibbon M et al (1990) Structured Clinical Interview for DSM-III-R: SCID user’s guide for the structured clinical interview for DSM-III-R. American Psychiatric Press Inc, WashingtonGoogle Scholar
  29. 29.
    Tennant C, Andrews G (1976) A scale to measure the stress of life events. Aust N Z J Psychiatry 10:27–32PubMedGoogle Scholar
  30. 30.
    Uddenberg N (1974) Reproductive adaptation in mother and daughter. Acta Psychiatr Scand Suppl 254:1–115PubMedGoogle Scholar
  31. 31.
    Veiel HOF (1990) The Mannheim interview on social support: reliability and validity data from three samples. Soc Psychiatry Psychiatr Epidemiol 25:250–259CrossRefPubMedGoogle Scholar
  32. 32.
    Waldenstrom U (1988) Early and late discharge after hospital birth: fatigue and emotional reactions in the postpartum period. J Psychosom Obstet Gynaecol 8:127–135Google Scholar
  33. 33.
    Watson JP, Elliott SA, Rugg AJ et al (1984) Psychiatric disorder in pregnancy and the first postnatal year. Br J Psychiatry 144:453–462PubMedGoogle Scholar
  34. 34.
    Webster ML, Thompson JMD, Mitchell EA et al (1994) Postnatal depression in a community cohort. Aust N Z J Psychiatry 28:42–49PubMedGoogle Scholar
  35. 35.
    Wrate RM, Rooney AC, Thomas PF et al (1985) Postnatal depression and child development: a three-year follow-up study. Br J Psychiatry 146:622–627PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of PsychiatryWestmead HospitalWentworthvilleAustralia
  2. 2.Associated Psychology PracticePenrithAustralia

Personalised recommendations