A Life Course Perspective on Depressive Symptoms in Mid-Pregnancy
- 467 Downloads
Objective: To examine the prevalence of depressive symptoms in mid-pregnancy and their relation to life circumstances across the life course in a community-based sample. Methods: The Pregnancy Outcomes and Community Health (POUCH) Study enrolled women at 16–26 weeks' gestation from 52 clinics in five Michigan communities. At enrollment women completed a screening instrument for depressive symptoms (CES-D) and questions about life circumstances covering three “periods,” i.e. previous 6 months, adulthood, and childhood. Questions were grouped into sub-constructs (e.g., abuse, economic, substance use, loss, and legal) for each “period” and evaluated in relation to CES-D scores. Analyses included 1321 POUCH participants divided into three subgroups: teens; women ≥20 years insured by Medicaid (disadvantaged); and women ≥20 years not insured by Medicaid (advantaged). Results: A positive CES-D screen (≥16) was more common in teens (46%) and disadvantaged women (47%) than in advantaged women (23%). Recent problems (previous 6 months) with abuse, economics, and substance use in someone close were each associated with higher adjusted mean CES-D scores (2.3–7.5 increase) in the three subgroups of women. In life course analyses, abuse and substance use in teens, and abuse and economic problems in disadvantaged and advantaged women were strongly linked to higher adjusted mean CES-D scores when these problems occurred both in childhood and adulthood (range 2.2–7.1 increase), whereas the associations were more modest when problems were confined to childhood. Conclusions: Strategies for addressing the public health problem of depressive symptoms in mid-pregnancy will benefit from a life course perspective.
KEY WORDS:depression pregnancy life course life events.
This study was supported by the National Institute of Child Health and Human Development grant numbers R01 HD34543-01 and R01 HD034543-07 and National Institute of Nursing Research and the March of Dimes Perinatal Epidemiological Research Initiative Program grants 20-FY98-0697 through 20-FY04-37. The contributions of the other members of the Prematurity Study Group, Nigel Paneth, Rachel Fisher, Lynn Reuss, Bertha Bullen, David Kallen, Eric Devos, Joseph Marshall, Karen Friderici, Renee Canady, and Pat Senagore, are greatly acknowledged. The authors thank POUCH study participants, the participating clinics for their assistance and cooperation, and Sean Zhou for data management.
- 21.Suri R, Altshuler L, Hendrick V, Rasgon N, Lee E, Mintz J. The impact of depression and fluoxetine treatment on obstetrical outcome. Arch Women Ment Health 2004;7(3):193–200.Google Scholar
- 27.Ainsworth M, Blehar MC, Waters E, Wall S. Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Lawrence Earlbaum, 1978.Google Scholar
- 34.Elder GH, Jr, George LK, Shanahan MJ. Psychosocial stress over the life course. In: Kaplan HB, editor. Psychosocial stress: Perspectives on structure, theory, life-course, and methods. New York: Academic Press; 1996:247–92.Google Scholar
- 38.Hatcher L. A step-by step approach to using the SAS system for factor analysis and structural equation modeling. SAS Institute Inc., 1994.Google Scholar
- 39.IVEware: Imputation and Variance Estimation Software. In: Raghunathan TE, Solenberger PW, Van Hoewyk J, Lepkowski JM, editors. A multivariate technique for multiply imputing missing values using a sequence of regression models. Ann Arbor: Survey Methodology Program, Survey Research Center, Institute for Social Research, University of Michigan, 1998.Google Scholar
- 41.Mazure CM, Keita GP, Glehar MC. Summit on women and depression: Proceedings and recommendations. Washington, DC: American Psychological Association, 2002.Google Scholar