Maternal and Child Health Journal

, Volume 16, Issue 4, pp 929–935 | Cite as

Depression and Pregnancy Stressors Affect the Association Between Abuse and Postpartum Depression

  • D. Yvette LaCoursiere
  • Kathryn P. Hirst
  • Elizabeth Barrett-Connor


To determine how psychosocial factors affect the association between a history of abuse and postpartum depression (PPD). Women at four urban hospitals in Utah were enrolled ≤48 h of delivering a live-born infant. At enrollment, pregravid history of physical or sexual abuse was obtained via self-report. Psychosocial covariates such as pregnancy stressors and depression were also collected. Pregnancy stressors were categorized using “stressor” questions from the Pregnancy Risk Assessment Monitoring System. The primary outcome measure, a pre-specified Edinburgh Postnatal Depression Scale score of ≥12 was obtained 6–8 weeks postpartum. Among the 1,038 women studied, psychosocial risk factors were common: abuse history 11.7%, pregnancy stressors–financial 49.1%, emotional 35.0%, partner-associated 19.8%, and traumatic 10.3% and depression history 16.7%. While abuse was associated with a +PPD screen in a preliminary model [aOR 2.05 (1.28, 3.26)], adding psychosocial covariates reduced the unadjusted association of abuse and PPD [aOR 1.12 (0.66, 1.91)]. After adjustment, PPD was associated with depression history [aOR 2.85 (1.90, 4.28)], prepregnancy BMI [aOR 1.04 (1.01, 1.07)] multiple stressors [3 categories aOR 4.35 (2.00, 9.46)]; 4 categories [aOR 6.36 (2.07, 19.49)] and sum of stressors * history of abuse [aOR 1.50 (0.92, 2.46)]. Interestingly only women with a moderate number of stressors were sensitive to an abuse history. Abuse and pregnancy stressors are common and interact to influence the likelihood of screening positive for PPD.


Abuse Pregnancy stressors Depression and postpartum depression 


  1. 1.
    Ross, L. E., & Dennis, C. L. (2009). The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: A systematic review. Journal of Womens Health (Larchmt), 18(4), 475–486.CrossRefGoogle Scholar
  2. 2.
    Lang, A. J., Rodgers, C. S., & Lebeck, M. M. (2006). Associations between maternal childhood maltreatment and psychopathology and aggression during pregnancy and postpartum. Child Abuse and Neglect, 30(1), 17–25.PubMedCrossRefGoogle Scholar
  3. 3.
    Nayak, M. B., & Al-Yattama, M. (1999). Assault victim history as a factor in depression during pregnancy. Obstetrics and Gynecology, 94(2), 204–208.PubMedCrossRefGoogle Scholar
  4. 4.
    O’Hara, M. W., & Swain, A. M. (1996). Rates and risk of postpartum depression–a meta-analysis. International Review of Psychiatry, 8, 37–54.CrossRefGoogle Scholar
  5. 5.
    Kendler, K. S., Bulik, C. M., Silberg, J., Hettema, J. M., Myers, J., & Prescott, C. A. (2000). Childhood sexual abuse and adult psychiatric and substance use disorders in women: An epidemiological and cotwin control analysis. Archives of General Psychiatry, 57(10), 953–959.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohen, M. M., Schei, B., Ansara, D., Gallop, R., Stuckless, N., & Stewart, D. E. (2002). A history of personal violence and postpartum depression: Is there a link? Archives of Women’s Mental Health, 4, 83–92.CrossRefGoogle Scholar
  7. 7.
    Records, K., & Rice, M. J. (2005). A comparative study of postpartum depression in abused and non-abused women. Archives of Psychiatric Nursing, 19(6), 281–290.PubMedCrossRefGoogle Scholar
  8. 8.
    O’Hara, M. W., Rehm, L. P., & Campbell, S. B. (1983). Postpartum depression. A role for social network and life stress variables. The Journal of Nervous and Mental Disease, 171(6), 336–341.PubMedCrossRefGoogle Scholar
  9. 9.
    Howell, E. A., Mora, P. A., DiBonaventura, M. D., & Leventhal, H. (2009). Modifiable factors associated with changes in postpartum depressive symptoms. Archives of Women’s Mental Health, 12(2), 113–120.PubMedCrossRefGoogle Scholar
  10. 10.
    Bunevicius, R., Kusminskas, L., Bunevicius, A., Nadisauskiene, R. J., Jureniene, K., & Pop, V. J. (2009). Psychosocial risk factors for depression during pregnancy. Acta Obstetricia et Gynecologica Scandinavica, 88(5), 599–605.PubMedCrossRefGoogle Scholar
  11. 11.
    Weiss, E. L., Longhurst, J. G., & Mazure, C. M. (1999). Childhood sexual abuse as a risk factor for depression in women: Psychosocial and neurobiological correlates. American Journal of Psychiatry, 156(6), 816–828.PubMedGoogle Scholar
  12. 12.
    McCutcheon, V. V., Heath, A. C., Nelson, E. C., Bucholz, K. K., Madden, P. A., & Martin, N. G. (2009). Accumulation of trauma over time and risk for depression in a twin sample. Psychological Medicine, 39(3), 431–441.PubMedCrossRefGoogle Scholar
  13. 13.
    Hammen, C., Kim, E. Y., Eberhart, N. K., & Brennan, P. A. (2009). Chronic and acute stress and the prediction of major depression in women. Depression and Anxiety, 26(8), 718–723.PubMedCrossRefGoogle Scholar
  14. 14.
    LaCoursiere, D. Y. (2010). The association between prepregnancy obesity and screening positive for postpartum depression. British Journal of Obstetrics and Gynaecology, 117, 1011–1018.PubMedCrossRefGoogle Scholar
  15. 15.
    Ahluwalia, I. B., Merritt, R., Beck, L. F., & Rogers, M. (2001). Multiple lifestyle and psychosocial risks and delivery of small for gestational age infants. Obstetrics and Gynaecology, 97(5 Pt 1), 649–656.Google Scholar
  16. 16.
    Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item edinburgh postnatal depression scale. The British Journal of Psychiatry, 150, 782–786.PubMedCrossRefGoogle Scholar
  17. 17.
    Cox, J. L., & Holden, J. M. (2003). Perinatal mental health: A guide to the Edinburgh postnatal depression scale. London: Gaskell, Royal College of Psychiatrists.Google Scholar
  18. 18.
    Schisterman, E. F., Cole, S. R., & Platt, R. W. (2009). Overadjustment bias and unnecessary adjustment in epidemiologic studies. Epidemiology, 20(4), 488–495.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • D. Yvette LaCoursiere
    • 1
  • Kathryn P. Hirst
    • 2
  • Elizabeth Barrett-Connor
    • 3
  1. 1.Division of General Obstetrics and Gynecology, Department of Reproductive MedicineUniversity of CaliforniaSan DiegoUSA
  2. 2.Department of Psychiatry and Department of Family and Preventive MedicineUniversity of CaliforniaSan DiegoUSA
  3. 3.Division of Epidemiology, Department of Family and Preventive MedicineUniversity of CaliforniaSan DiegoUSA

Personalised recommendations