Social dynamics of postpartum depression: a population-based screening in South-Eastern Hungary

  • Zoltan Kozinszky
  • Robert B. Dudas
  • Sarolta Csatordai
  • Iván Devosa
  • Éva Tóth
  • Dávid Szabó
  • János Sikovanyecz
  • János Zádori
  • Katalin Barabás
  • Attila Pál
Original Paper



To determine contributing psychosocial factors to postnatal depression (PND) in Hungary in 1996 and in 2006.


In 1996 and 2006, a total of 2,333 and 1,619 women, respectively, were screened for PND in South-Eastern Hungary, based on a Leverton questionnaire (LQ) score of ≥12 at 6–10 weeks after delivery.


The LQ scores indicated an increase in PND from 15.0% in 1996 to 17.4% in 2006. The best predictors for PND in a multiple regression analysis were living in an urban environment [adjusted odds ratio (AOR) = 11.26], unstable relationship (AOR = 3.1) and a perceived lack of social support from partner (AOR = 3.65) in 1996, and recent major life events (AOR = 3.38), unstable relationship (AOR = 3.84), self-reported low income (AOR = 1.82), and intention to return to work soon after delivery (AOR = 0.47) in 2006.


A self-defined low socioeconomic status and an intention to return to work have become significant factors in the development of PND. Besides the family factors recognized as salient variables in 1996, economic features came into prominence as newly identified main predictive factors for PND in 2006.


Leverton questionnaire Postpartum depression Multiple logistic regression Effects of social changes Hungary 


  1. 1.
    Affonso DD, De Anindya K, Horowitz JA, Mayberry LJ (2000) An international study exploring levels of postpartum depressive symptomatology. J Psychiatr Res 49:207–216Google Scholar
  2. 2.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, revised, 3rd edn. American Psychiatric Association, Washington, DCGoogle Scholar
  3. 3.
    Andersson L, Sundström-Poromaa I, Wulff M, Aström M, Bixo M (2006) Depression and anxiety during pregnancy and six months postpartum: a follow-up study. Acta Obstet Gynecol Scand 85:937–944PubMedCrossRefGoogle Scholar
  4. 4.
    Augusto A, Kumar R, Calheiros JM, Matos E, Figueiredo E (1996) Post-natal depression in an urban area of Portugal: comparison of childbearing women and matched controls. Psychol Med 26:135–141PubMedCrossRefGoogle Scholar
  5. 5.
    Austin MP (2003) Targeted group antenatal prevention of postpartum depression: a review. Acta Psychiatr Scand 107:244–250PubMedCrossRefGoogle Scholar
  6. 6.
    Boyce P, Hickey A (2005) Psychosocial risk factors to major depression after childbirth. Soc Psychiatry Psychiatr Epidemiol 40:605–612PubMedCrossRefGoogle Scholar
  7. 7.
    Becker AE (1998) Postpartum illness in Fiji: a sociosomatic perspective. Psychosom Med 60:431–438PubMedGoogle Scholar
  8. 8.
    Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50:275–285PubMedCrossRefGoogle Scholar
  9. 9.
    Burke KC, Burke JD, Regier DA, Rae DS (1990) Age at onset of selected mental disorders in five community populations. Arch Gen Psychiatry 47:511–518PubMedGoogle Scholar
  10. 10.
    Cox J, Holden J (2003) A guide to the Edinburgh Postpartum Depression Scale. Gaskell, LondonGoogle Scholar
  11. 11.
    Csatordai S, Kozinszky Z, Devosa I, Tóth E, Krajcsi A, Sefcsik T, Pál A (2007) Obstetric and sociodemographic risk of vulnerability to postpartum depression. Patient Educ Couns 67:84–92PubMedCrossRefGoogle Scholar
  12. 12.
    Csatordai S, Kozinszky Z, Devosa I, Dudas R, Tóth É, Sikovanyecz J, Szabó D, Zádori J, Barabás K, Pál A (2009) Validation of the Leverton questionnaire as a screening tool for postnatal depression in Hungary. Gen Hosp Psychiatry 31(1):56–66PubMedCrossRefGoogle Scholar
  13. 13.
    Dearing E, Taylor BA, McCartney K (2004) Implications of family income dynamics for women’s depressive symptoms during the first 3 years after childbirth. Am J Pub Health 94:1372–1377CrossRefGoogle Scholar
  14. 14.
    Dennis CL, Janssen PA, Singer J (2004) Identifying women at-risk for postpartum depression in the immediate postpartum period. Acta Psychiatr Scand 110:338–346PubMedCrossRefGoogle Scholar
  15. 15.
    Eberhard-Gran M, Eskild A, Tambs K, Opjordsmoen S, Samuelsen SO (2001) Review of validation studies of the Edinburgh Postpartum Depression Scale. Acta Psychiatr Scand 104:243–249PubMedCrossRefGoogle Scholar
  16. 16.
    Eberhard-Gran M, Eskild A, Tambs K, Samuelsen SO, Opjordsmoen S (2002) Depression in postpartum and non-postpartum women: prevalence and risk factors. Acta Psychiatr Scand 106:426–433PubMedCrossRefGoogle Scholar
  17. 17.
    Elliot SA (1984) Uses and misuses of the EPDS in primary care: a comparison of models developed in health visiting, Chap. 14. In: Cox J (ed) Perinatal psychiatry: uses and misuses of the EPDS. Gaskell, LondonGoogle Scholar
  18. 18.
    Elliott SA, Leverton TJ, Sanjack M, Turner H, Cowmeadow P, Hopkins J, Bushnell D (2000) Promoting mental health after childbirth: a controlled trial of primary prevention of postpartum depression. Br J Clin Psychol 39:223–241PubMedCrossRefGoogle Scholar
  19. 19.
    Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New YorkGoogle Scholar
  20. 20.
    Hungarian Statistical Office (2007) Social report 2007. Hungarian Statistical Office Budapest. Társadalmi Riport 2007 (in Hungarian)Google Scholar
  21. 21.
    Hungarian Statistical Office (2008) Dynamic indices of life circumstances and life style. Hungarian Statistical Office Budapest. Az életkörülmények és az életmód dinamikus jelzőszámai (in Hungarian)Google Scholar
  22. 22.
    Kopp MS, Skrabski A, Szedmák S (2000) Psychosocial risk factors, inequality and self-rated morbidity in a changing society. Soc Sci Med 51:1351–1361PubMedCrossRefGoogle Scholar
  23. 23.
    Kozinszky Z, Boda K, Gy Bártfai (2001) Determinants of abortion among women undergoing artificial termination of pregnancy. Eur J Contracept Reprod Health Care 6:145–152PubMedGoogle Scholar
  24. 24.
    Kozinszky Z, Orvos H, Katona M, Zoboki T, Pál A, Kovács L (2002) Perinatal outcome of induced and spontaneous pregnancies of primiparous women aged 35 or over. Int J Gyn Obstet 76:23–26CrossRefGoogle Scholar
  25. 25.
    Lee DT, Yip AS, Leung TY, Chung TK (2004) Ethnoepidemiology of postpartum depression. Prospective multivariate study of sociocultural risk factors in a Chinese population in Hong Kong. Br J Psychiatry 184:34–40PubMedCrossRefGoogle Scholar
  26. 26.
    Leverton TJ, Elliott SA (2000) Is the EPDS a magic wand? 1. A comparison of the Edinburgh Postpartum Depression Scale and health visitor report as predictors of diagnosis on the present state examination. J Reprod Inf Psychol 18:279–296CrossRefGoogle Scholar
  27. 27.
    Leverton TJ, Elliott SA (2000) Is the EPDS a magic wand? 2. ‘Myths’ and the evidence base. J Reprod Inf Psychol 18:297–307CrossRefGoogle Scholar
  28. 28.
    Lukasik A, Blaszczyk K, Wojcieszyn M, Belowska A (2003) Characteristic of affective disorders of the first week of puerperium. Ginekol Pol 74:1194–1199PubMedGoogle Scholar
  29. 29.
    McCulloch CE, Searle SR (2001) Generalized, linear, and mixed models. Wiley, New YorkGoogle Scholar
  30. 30.
    Nahas VL, Hillege S, Amasheh N (1999) Postpartum depression: the lived experiences of Middle Eastern migrant women in Australia. J Nurse Midwifery 44:65–74PubMedCrossRefGoogle Scholar
  31. 31.
    Newman SC, Bland RC (1994) Life events and the 1-year prevalence of major depressive episode, generalized anxiety disorder, and panic disorder in a community sample. Compr Psychiatry 35:76–82PubMedCrossRefGoogle Scholar
  32. 32.
    Pillsbury BL (1978) “Doing the month”: confinement and convalescence of Chinese women after childbirth. Soc Sci Med 12:11–22PubMedGoogle Scholar
  33. 33.
    Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26:289–295PubMedCrossRefGoogle Scholar
  34. 34.
    Ross LE, Sellers EM, Gilbert Evans SE, Romach MK (2004) Mood changes during pregnancy and the postpartum period: development of a biopsychosocial model. Acta Psychiatr Scand 109:457–466PubMedCrossRefGoogle Scholar
  35. 35.
    Segre LS, O’Hara MW, Arndt S, Stuart S (2007) The prevalence of postpartum depression: the relative significance of three social status indices. Soc Psychiatry Psychiatr Epidemiol 42:316–321PubMedCrossRefGoogle Scholar
  36. 36.
    Tammentie T, Tarkka MT, Astedt-Kurki P, Paavilainen E (2002) Sociodemographic factors of families related to postpartum depressive symptoms of mothers. Int J Nurs Pract 8:240–246PubMedCrossRefGoogle Scholar
  37. 37.
    Tammentie T, Tarkka MT, Astedt-Kurki P, Paavilainen E, Laippala P (2004) Family dynamics and postpartum depression. J Psychiatr Ment Health Nurs 11:141–149PubMedCrossRefGoogle Scholar
  38. 38.
    Teng HW, Hsu CS, Shih SM, Lu ML, Pan JJ, Shen WW (2005) Screening postpartum depression with the Taiwanese version of the Edinburgh Postpartum Depression scale. Compr Psychiatry 46:261–265PubMedCrossRefGoogle Scholar
  39. 39.
    Weich S, Lewis G (1998) Poverty, unemployment, and common mental disorders: population based cohort study. BMJ 317:115–119PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Zoltan Kozinszky
    • 1
  • Robert B. Dudas
    • 2
  • Sarolta Csatordai
    • 3
  • Iván Devosa
    • 4
  • Éva Tóth
    • 5
  • Dávid Szabó
    • 6
  • János Sikovanyecz
    • 6
  • János Zádori
    • 7
  • Katalin Barabás
    • 4
  • Attila Pál
    • 6
    • 7
  1. 1.Women and Children’s Division, Department of Obstetrics and GynaecologyOslo University Hospital, UllevaalOsloNorway
  2. 2.Department of PsychiatryUniversity of Cambridge, Box 189, Level 4, Addenbrooke’s HospitalCambridgeUK
  3. 3.Faculty of Health SciencesUniversity of SzegedSzegedHungary
  4. 4.Section of Behaviour ScienceUniversity of SzegedSzegedHungary
  5. 5.Faculty of Arts and Sciences, Institute of PsychologyUniversity of PécsPécsHungary
  6. 6.Department of Obstetrics and GynaecologyUniversity of SzegedSzegedHungary
  7. 7.Centre for Assisted Reproduction, Kaáli InstituteUniversity of SzegedSzegedHungary

Personalised recommendations