Maternal and Child Health Journal

, Volume 13, Issue 5, pp 577–587 | Cite as

Longitudinal Study of Depressive Symptoms and Health-Related Quality of Life During Pregnancy and After Delivery: The Health Status in Pregnancy (HIP) Study

  • Rosanna Setse
  • Ruby Grogan
  • Luu Pham
  • Lisa A. Cooper
  • Donna Strobino
  • Neil R. Powe
  • Wanda NicholsonEmail author


Objective Depressive symptoms are known to affect functioning in early pregnancy. We estimated the effect of a change in depressive symptoms status on health-related quality of life (HRQoL) throughout pregnancy and after delivery. Methods Longitudinal study of 200 women. The independent variable was depressive symptoms, defined as a Center for Epidemiologic Studies Depression (CES-D) score of ≥16. The dependent variable was HRQoL from 8 domains of the Medical Outcomes Study (SF-36) Short Form. Women were categorized based on the change in CES-D score: (1) never depressed, (2) became well, (3) became depressed and (4) always depressed. A random effects model was used to (1) estimate the effect of a change in depressive symptomatology from the first to the second trimester on HRQOL in the second trimester and (2) estimate the change in depressive symptomatology from the second to the third trimester on HRQoL in the third trimester and after delivery, adjusting for covariates. Intra-individual correlations were accounted for using generalized estimating equations (GEE). Results The proportion of women with depressive symptoms was 15%, 14%, and 30% in the first, second and third trimesters, respectively, and 9% after delivery. Women who became depressed had scores in the social domains that were 10–23 points and 19–31 points lower in the second and third trimesters, respectively, compared to women with no depressive symptoms. Women who became well had scores that were 3–31 points lower, compared to women with no depressive symptoms. Conclusions Alterations in depressive symptomatology have a substantial effect on functioning during pregnancy and after delivery.


Pregnancy Depressive symptoms Health-related quality of life Longitudinal analysis 



Dr. Nicholson was funded, in part, by the American Gynecological and Obstetrical Society. Drs. Nicholson and Powe are supported, in part, by the National Institute for Diabetes and Digestive and Kidney Diseases (Grant numbers: 1K23 DK-067944-01 to Dr. Nicholson; 2K24 DKO2643-06A1 to Dr. Powe).


  1. 1.
    Haas, J. S., Jackson, R. A., Fuentes-Afflick, E., Stewart, A. L., Dean, M. L., Brawarsky, P., et al. (2005). Changes in the health status of women during and after pregnancy. Journal of General Internal Medicine, 20(1), 45–51. doi: 10.1111/j.1525-1497.2004.40097.x.PubMedCrossRefGoogle Scholar
  2. 2.
    Hueston, W. J., & Kasik-Miller, S. (1998). Changes in functional health status during normal pregnancy. The Journal of Family Practice, 47(3), 209–212.PubMedGoogle Scholar
  3. 3.
    Nicholson, W. K., Setse, R., Hill-Briggs, F., Cooper, L. A., Strobino, D., & Powe, N. R. (2006). Depressive symptoms and health-related quality of life in early pregnancy. Obstetrics and Gynecology, 107(4), 798–806.PubMedGoogle Scholar
  4. 4.
    Howell, E. A., Mora, P., & Leventhal, H. (2006). Correlates of early postpartum depressive symptoms. Maternal and Child Health Journal, 10(2), 149–157. doi: 10.1007/s10995-005-0048-9.PubMedCrossRefGoogle Scholar
  5. 5.
    Howell, E. A., Mora, P. A., Horowitz, C. R., & Leventhal, H. (2005). Racial and ethnic differences in factors associated with early postpartum depressive symptoms. Obstetrics and Gynecology, 105(6), 1442–1450.PubMedGoogle Scholar
  6. 6.
    Steer, R. A., Scholl, T. O., Hediger, M. L., & Fischer, R. L. (1992). Self-reported depression and negative pregnancy outcomes. Journal of Clinical Epidemiology, 45(10), 1093–1099. doi: 10.1016/0895-4356(92)90149-H.Google Scholar
  7. 7.
    Paarlberg, K. M., Vingerhoets, A. J., Passchier, J., Dekker, G. A., Heinen, A. G., & van Geijn, H. P. (1999). Psychosocial predictors of low birthweight: A prospective study. British Journal of Obstetrics and Gynaecology, 106(8), 834–841.PubMedGoogle Scholar
  8. 8.
    Neggers, Y., Goldenberg, R., Cliver, S., & Hauth, J. (2006). The relationship between psychosocial profile, health practices, and pregnancy outcomes. Acta Obstetricia et Gynecologica Scandinavica, 85(3), 277–285.PubMedCrossRefGoogle Scholar
  9. 9.
    Beeghly, M., Olson, K. L., Weinberg, M. K., Pierre, S. C., Downey, N., & Tronick, E. Z. (2003). Prevalence, stability, and socio-demographic correlates of depressive symptoms in Black mothers during the first 18 months postpartum. Maternal and Child Health Journal, 7(3), 157–168. doi: 10.1023/A:1025132320321.PubMedCrossRefGoogle Scholar
  10. 10.
    Vera, M., Alegria, M., Freeman, D., Robles, R. R., Rios, R., & Rios, C. F. (1991). Depressive symptoms among Puerto Ricans: Island poor compared with residents of the New York City area. American Journal of Epidemiology, 134(5), 502–510.PubMedGoogle Scholar
  11. 11.
    Zayas, L. H., Cunningham, M., McKee, M. D., & Jankowski, K. R. (2002). Depression and negative life events among pregnant African-American and Hispanic women. Women’s Health Issues, 12(1), 16–22. doi: 10.1016/S1049-3867(01)00138-4.PubMedCrossRefGoogle Scholar
  12. 12.
    Cogill, S. R., Caplan, H. L., Alexandra, H., Robson, K. M., & Kumar, R. (1986). Impact of maternal postnatal depression on cognitive development of young children. British Medical Journal (Clinical Research Edition), 292(6529), 1165–1167.Google Scholar
  13. 13.
    Field, T., Healy, B., Goldstein, S., Perry, S., Bendell, D., Schanberg, S., et al. (1988). Infants of depressed mothers show “depressed” behavior even with nondepressed adults. Child Development, 59(6), 1569–1579. doi: 10.2307/1130671.PubMedCrossRefGoogle Scholar
  14. 14.
    Wells, K. B., Stewart, A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., et al. (1989). The functioning and well-being of depressed patients. Results from the medical outcomes study. Journal of the American Medical Association, 262(7), 914–919. doi: 10.1001/jama.262.7.914.Google Scholar
  15. 15.
    Stewart, A. L., Greenfield, S., Hays, R. D., Wells, K., Rogers, W. H., Berry, S. D., et al. (1989). Functional status and well-being of patients with chronic conditions. Results from the medical outcomes study. Journal of the American Medical Association, 262(7), 907–913. doi: 10.1001/jama.262.7.907.Google Scholar
  16. 16.
    Chen, H., Chan, Y. H. 3rd, Tan, K. H., & Lee, T. (2004). Depressive symptomatology in pregnancy––a Singaporean perspective. Social Psychiatry and Psychiatric Epidemiology, 39(12), 975–979. doi: 10.1007/s00127-004-0823-8.
  17. 17.
    Radloff, L. (1977). A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. doi: 10.1177/014662167700100306.CrossRefGoogle Scholar
  18. 18.
    Roberts, R. E. (1980). Reliability of the CES-D scale in different ethnic contexts. Psychiatry Research, 2(2), 125–134. doi: 10.1016/0165-1781(80)90069-4.PubMedCrossRefGoogle Scholar
  19. 19.
    Gaynes, B. N., Gavin, N., Meltzer-Brody, S., Lohr, K. N., Swinson, T., Gartlehner, G., et al. (2005). Perinatal depression: Prevalence, screening accuracy, and screening outcomes. Evidence report/technology assessment, Summ, Feb(119), 1–8.Google Scholar
  20. 20.
    Marcus, S. M., Flynn, H. A., Blow, F. C., & Barry, K. L. (2003). Depressive symptoms among pregnant women screened in obstetrics settings. Journal of Women’s Health, 12(4), 373–380. Larchmt. doi: 10.1089/154099903765448880.Google Scholar
  21. 21.
    Weissman, M. M., Sholomskas, D., Pottenger, M., Prusoff, B. A., & Locke, B. Z. (1977). Assessing depressive symptoms in five psychiatric populations: A validation study. American Journal of Epidemiology, 106(3), 203–214.PubMedGoogle Scholar
  22. 22.
    Ware, J. (1993). SF-36 health survey. Manual and interpretation guide.Google Scholar
  23. 23.
    Elsenbruch, S., Benson, S., Rucke, M., Rose, M., Dudenhausen, J., Pincus-Knackstedt, M. K., et al. (2007). Social support during pregnancy: Effects on maternal depressive symptoms, smoking and pregnancy outcome. Human Reproduction (Oxford, England), 22(3), 869–877. doi: 10.1093/humrep/del432.Google Scholar
  24. 24.
    Norbeck, J. S., Lindsey, A. M., & Carrieri, V. L. (1983). Further development of the Norbeck social support questionnaire: Normative data and validity testing. Nursing Research, 32(1), 4–9. doi: 10.1097/00006199-198301000-00002.PubMedCrossRefGoogle Scholar
  25. 25.
    Diggle, P. J. (1988). An approach to the analysis of repeated measurements. Biometrics, 44(4), 959–971. doi: 10.2307/2531727.PubMedCrossRefGoogle Scholar
  26. 26.
    Zeger, S. L., & Diggle, P. J. (1994). Semiparametric models for longitudinal data with application to CD4 cell numbers in HIV seroconverters. Biometrics, 50(3), 689–699. doi: 10.2307/2532783.PubMedCrossRefGoogle Scholar
  27. 27.
    Lipsitz, S. R., & Fitzmaurice, G. M. (1996). Estimating equations for measures of association between repeated binary responses. Biometrics, 52(3), 903–912. doi: 10.2307/2533051.PubMedCrossRefGoogle Scholar
  28. 28.
    Gavin, N. I. , Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and gynecology, 106(5 Pt 1), 1071–1083.Google Scholar
  29. 29.
    Burt, V. K., & Stein, K. (2002). Epidemiology of depression throughout the female life cycle. The Journal of Clinical Psychiatry, 63(Suppl 7), 9–15.PubMedGoogle Scholar
  30. 30.
    O’Connor, T. G., Heron, J., Golding, J., Beveridge, M., & Glover, V. (2002). Maternal antenatal anxiety and children’s behavioural/emotional problems at 4 years. Report from the avon longitudinal study of parents and children. The British Journal of Psychiatry, 180(3), 502–508. doi: 10.1192/bjp.180.6.502.Google Scholar
  31. 31.
    Locke, R., Baumgart, S., Locke, K., Goodstein, M., Thies, C., & Greenspan, J. (1997). Effect of maternal depression on premature infant health during initial hospitalization. The Journal of the American Osteopathic Association, 97(3), 145–149.PubMedGoogle Scholar
  32. 32.
    Miller, A. H. (1998). Neuroendocrine and immune system interactions in stress and depression. The Psychiatric Clinics of North America, 21(2), 443–463. doi: 10.1016/S0193-953X(05)70015-0.PubMedCrossRefGoogle Scholar
  33. 33.
    Miller, G. E., Cohen, S., & Herbert, T. B. (1999). Pathways linking major depression and immunity in ambulatory female patients. Psychosomatic Medicine, 61(6), 850–860.PubMedGoogle Scholar
  34. 34.
    Haas, J. S., Meneses, V., & McCormick, M. C. (1999). Outcomes and health status of socially disadvantaged women during pregnancy. Journal of Women’s Health & Gender-Based Medicine, 8(4), 547–553.Google Scholar
  35. 35.
    Otchet, F., Carey, M. S., & Adam, L. (1999). General health and psychological symptom status in pregnancy and the puerperium: What is normal? Obstetrics and Gynecology, 94(6), 935–941. doi: 10.1016/S0029-7844(99)00439-1.PubMedCrossRefGoogle Scholar
  36. 36.
    Chittleborough, C. R., Baldock, K. L., Taylor, A. W., & Phillips, P. J. (2006). Health status assessed by the SF-36 along the diabetes continuum in an Australian population. Quality of Life Research, 15(4), 687–694. doi: 10.1007/s11136-005-3570-8.PubMedCrossRefGoogle Scholar
  37. 37.
    Bromberger, J. T., Harlow, S., Avis, N., Kravitz, H. M., & Cordal, A. (2004). Racial/ethnic differences in the prevalence of depressive symptoms among middle-aged women: The study of women’s health across the nation (SWAN). American Journal of Public Health, 94(8), 1378–1385.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Rosanna Setse
    • 1
  • Ruby Grogan
    • 2
  • Luu Pham
    • 3
  • Lisa A. Cooper
    • 1
    • 4
    • 5
    • 6
  • Donna Strobino
    • 7
  • Neil R. Powe
    • 1
    • 4
    • 5
    • 6
  • Wanda Nicholson
    • 2
    • 7
    Email author
  1. 1.Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of Gynecology and ObstetricsJohns Hopkins School of MedicineBaltimoreUSA
  3. 3.Department of BiostatisticsThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Department of Health Policy and ManagementThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  5. 5.Department of MedicineJohns Hopkins School of MedicineBaltimoreUSA
  6. 6.Welch Center for Prevention, Epidemiology, and Clinical ResearchBaltimoreUSA
  7. 7.Department of Population and Family Health SciencesThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations