Longitudinal study of depression and health status in pregnant women: incidence, course and predictive factors

  • Vicenta Escribà-Agüir
  • Manuela Royo-Marqués
  • Lucía Artazcoz
  • Patrizia Romito
  • Isabel Ruiz-Pérez
Original Paper

Abstract

The aim of this study was to determine the effect of isolated psychological intimate partner violence and psychosocial factors (social support and alcohol or drug use by a partner/family member) on psychological well-being (depression or poor self-perceived health status) at 5 and 12 months post-partum. A longitudinal cohort study was carried out with a consecutive sample of 1,400 women in their first trimester of pregnancy, who attended the prenatal programme in the Valencia Region (Spain) in 2008 and were followed up at 5 months and 12 months post-partum. A logistic regression model was fitted using generalized estimating equations, to assess the effect of isolated psychological intimate partner violence, social support, alcohol consumption and illicit drug use problems by a partner or family member on subsequent psychological well-being at follow-up. We observed a decrease in the incidence of poorer psychological well-being (post-partum depression and poor self-perceived health status) at 12 months post-partum. The strongest predictor of poor psychological well-being was depression (AOR = 6.83, 95 % CI: 3.44–13.58) or poor self-perceived health status (AOR = 5.34, 95 % CI: 2.37–12.02) during pregnancy. Isolated psychological IPV increased the risk of a deterioration in psychological well-being. Having a tangible social network was also a predictor of both post-partum depression and poor self-perceived health status. The effect of functional social support varied according to the type of psychological well-being indicator being used. Problems of alcohol consumption or illicit drug use by a partner or family member were a predictor of post-partum depression only. Psychological well-being during the first year after birth is highly affected by isolated psychological IPV and psychosocial factors.

Keywords

Post-partum depression Health status Partner abuse Longitudinal study Pregnancy 

Abbreviations

AOR

Adjusted odds ratio

CI

Confidence interval

IPV

Intimate partner violence

PPD

Post-partum depression

SPHS

Self-perceived health status

AAS

Abuse assessment screen

MOS-SS

Medical outcome study-social support survey

GEE

Generalized estimating equations

IQR

Inter-quartile range

References

  1. 1.
    Ammerman RT, Putnam FW, Altaye M, Chen L, Holleb LJ, Stevens J, Short JA, Van Ginkel JB (2009) Changes in depressive symptoms in first time mothers in home visitation. Child Abuse Negl 33:127–138PubMedCrossRefGoogle Scholar
  2. 2.
    Angst J, Gamma A, Rossler W, Ajdacic V, Klein DN (2011) Childhood adversity and chronicity of mood disorders. Eur Arch Psychiatry Clin Neurosci 261:21–27PubMedCrossRefGoogle Scholar
  3. 3.
    Beydoun HA, Al-Sahab B, Beydoun MA, Tamim H (2010) Intimate partner violence as a risk factor for postpartum depression among Canadian women in the maternity experience survey. Ann Epidemiol 20:575–583PubMedCrossRefGoogle Scholar
  4. 4.
    Blasco-Ros C, Sanchez-Lorente S, Martinez M (2010) Recovery from depressive symptoms, state anxiety and post-traumatic stress disorder in women exposed to physical and psychological, but not to psychological intimate partner violence alone: a longitudinal study. BMC Psychiatry 10:98PubMedCrossRefGoogle Scholar
  5. 5.
    Bogat GA, Levendosky AA, DeJonghe E, Davidson WS II (2004) Pathways of suffering: the temporal effects of domestic violence on women’s mental health. Maltrattamento e Abuso all’infanzia 6:97–112Google Scholar
  6. 6.
    Bowen E, Heron J, Waylen A, Wolke D, ALSPAC Study Team (2005) Domestic violence risk during and after pregnancy: findings from a British longitudinal study. BJOG 112:1083–1089Google Scholar
  7. 7.
    Boyce PM (2003) Risk factors for postnatal depression: a review and risk factors in Australian populations. Arch Womens Ment Health 6(Suppl 2):S43–S50PubMedCrossRefGoogle Scholar
  8. 8.
    Boyce PM, Hickey AR (2005) Psychosocial risk factors to major depression after childbirth. Soc Psychiatry Psychiatry Epidemiol 40:605–612CrossRefGoogle Scholar
  9. 9.
    Brugha T, Sharp H, Cooper PJ, Weisender C, Britto D, Shinkwin R, Sherrif T, Kirwan P (1998) The Leicester 500 Proyect. Social support and the development of postnatal depressive symptoms, a prospective cohort survey. Psychol Med 28:63–79PubMedCrossRefGoogle Scholar
  10. 10.
    Cokkinides VE, Coker AL (1998) Experiencing physical violence during pregnancy: prevalence and correlates. Fam Community Health 20:19–37CrossRefGoogle Scholar
  11. 11.
    Costa Requena G, Salamero M, Gil F (2007) Validación del cuestionario MOS-SSS de apoyo social en pacientes con cáncer. (Validity of the questionnaire MOS-SSS of social support in neoplastic patients). Med Clin (Barc) 128:687–691CrossRefGoogle Scholar
  12. 12.
    Da Costa D, Larouche J, Due P, Brender W (2000) Psychosocial correlates of prepartum and postpartum depressed mood. J Affect Disord 59:31–40PubMedCrossRefGoogle Scholar
  13. 13.
    Eberhard-Grand M, Tambs K, Opjordsmoen S, Skrondal A, Eskild A (2004) Depression during pregnancy and after delivery: a repeated measurement study. J Psychosom Obstet Gynaecol 25:15–21CrossRefGoogle Scholar
  14. 14.
    Ellsberg M, Heise LL (2002) Bearing witness: ethics in domestic violence research. Lancet 359:1599–1604PubMedCrossRefGoogle Scholar
  15. 15.
    Escribà-Agüir V, Artazcoz L (2011) Gender differences in postpartum depression: a longitudinal cohort study. J Epidemiol Community Health 65:320–326PubMedCrossRefGoogle Scholar
  16. 16.
    Escribà-Agüir V, Royo-Marqués M, Ruiz-Perez I, Plazaola-Castaño J, Artazcoz L (2009) Validación del instrumento “Abuse Assessment Screen” de detección precoz de violencia contra las mujeres. Gac Sanit 23:13–203CrossRefGoogle Scholar
  17. 17.
    Escribà-Agüir V, Ruiz-Perez I, Montero-Pinar MI, Vives-Cases C, Plazaola-Castano J, Martin-Baena D (2010) Partner violence and psychological well-being: buffer or indirect effect of social support. Psychosom Med 72:383–389PubMedCrossRefGoogle Scholar
  18. 18.
    Evans J, Heron J, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323:257–260PubMedCrossRefGoogle Scholar
  19. 19.
    Gao W, Paterson J, Abbott M, Carter S, Iusitini L, Donald-Sundborn G (2010) Impact of current and past intimate partner violence on maternal mental health and behaviour at 2 years after childbirth: evidence from the Pacific Islands Families Study. Aust N Z J Psychiatry 44:174–182PubMedCrossRefGoogle Scholar
  20. 20.
    Garcia-Esteve L, Ascaso Terrén C, Ojuel J, Navarro P (2003) Validation of the edinburgh postnatal depression scale (EPDS) in Spanish mothers. J Affect Disord 75:71–76PubMedCrossRefGoogle Scholar
  21. 21.
    Gielsen AC, O’Campo PJ, Faden RR, Kass N, Xue X (1994) Interpersonal conflict and physical violence during the childbearing year. Soc Sci Med 39:781–787CrossRefGoogle Scholar
  22. 22.
    Gjerdingen D, Froberg D, Fontaine P (1991) The effects of social support on women′s health during pregnancy, labor and delivery and the postpartum period. Fam Med 23:370–375PubMedGoogle Scholar
  23. 23.
    Gotlib IH, Whiffen VE, Wallace PM, Mount JH (1991) Prospective investigation of postpartum depression: factors involved in onset and recovery. J Abnorm Psychol 100:122–132PubMedCrossRefGoogle Scholar
  24. 24.
    Haas JS, Jackson RA, Fuentes-Afflick E, Stewart AL, Dean ML, Brawarsky P, Escobar GJ (2004) Changes in the health status of women during and after pregnancy. J Gen Intern Med 20:45–51CrossRefGoogle Scholar
  25. 25.
    Idler E, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37PubMedCrossRefGoogle Scholar
  26. 26.
    Irion O, Boulvain M, Straccia AT, Bonnet J (2000) Emotional, physical and sexual violence against women before or during pregnancy. BJOG 107:1306–1308PubMedCrossRefGoogle Scholar
  27. 27.
    Lau Y, Wong DFK, Sin Chan K, Phil M (2008) The impact and cumulative effects of intimate partner abuse during pregnancy on healh-related quality of life among Hong Kong chinese women. Midwifery 24:22–37PubMedCrossRefGoogle Scholar
  28. 28.
    Leigh B, Milgrom J (2008) Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 8:24PubMedCrossRefGoogle Scholar
  29. 29.
    Lindhorst T, Oxford M (2008) The long-term effects of intimate partner violence on adolescent mothers’ depressive symptoms. Soc Sci Med 66:1322–1333PubMedCrossRefGoogle Scholar
  30. 30.
    Lobato G, Moraes CL, Dias AS, Reichenheim ME (2011) Alcohol misuse among partners: a potential effect modifier in the relationship between physical intimate partner violence and postpartum depression. Soc Psychiat Epidemiol 47:427–438CrossRefGoogle Scholar
  31. 31.
    Ludermir AB, Lewis G, Valongueiro SA, de Araujo TV, Araya R (2010) Violence against women by their intimate partner during pregnancy and postnatal depression: a prospective cohort study. Lancet 376:903–910PubMedCrossRefGoogle Scholar
  32. 32.
    Macy RJ, Martin SL, Kupper LL, Casanueva C, Guo S (2007) Partner violence among women before, during, and after pregnancy: multiple opportunities for intervention. Womens Health Issues 17:290–299PubMedCrossRefGoogle Scholar
  33. 33.
    Martin SL, Mackie L, Kupper LL, Buescher PA, Moracco KE (2001) Physical abuse of women before, during, and after pregnancy. JAMA 285:1581–1584PubMedCrossRefGoogle Scholar
  34. 34.
    McFarlane J, Parker B, Soeken KL, Bullock L (1992) Assessing for abuse during pregnancy. severity and frequency of injures and associeted entry into prenatal Care. JAMA 267:3176–3178PubMedCrossRefGoogle Scholar
  35. 35.
    Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, Ericksen J, Ellwood D, Buist A (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108:147–157PubMedCrossRefGoogle Scholar
  36. 36.
    Miller LJ (2002) Postpartum depression. JAMA 287:762–765PubMedCrossRefGoogle Scholar
  37. 37.
    Muhajarine N, D’Arcy C (1999) Psysical abuse during pregnanacy: prevalence and risk factors. CMAJ 160:1007–1011PubMedGoogle Scholar
  38. 38.
    Nagy E, Molnar P, Pal A, Orvos H (2011) Prevalence rates and socioeconomic characteristics of post-partum depression in Hungary. Psychiatry Res 185:113–120PubMedCrossRefGoogle Scholar
  39. 39.
    Nielsen FD, Videbech P, Hedegaard M, Dalby SJ, Secher N (2000) Postpartum depression: identification of women at risk. Br J Obstet Gynaecol 107:1210–1217CrossRefGoogle Scholar
  40. 40.
    O’Hara MW, Neunaber DJ, Zekoski EM (1984) Prospective study of postpartum depression: prevalence, course, and predictive factors. J Abnorm Psychol 93:158–171PubMedCrossRefGoogle Scholar
  41. 41.
    O’Hara MW (1986) Social support, life events, and depression during pregnancy and the puerperium. Arch Gen Psychiatry 43:569–573PubMedCrossRefGoogle Scholar
  42. 42.
    Pajarita C, Perreira KM (2007) Intimate Partner Violence during pregnancy and 1-year post partum. J Fam Violence 22:609–619CrossRefGoogle Scholar
  43. 43.
    Pompili M, Serafini G, Innamorati M, Biondi M, Siracusano A, Di Giannantonio M, Giupponi G, Amore M, Lester D, Girardi P, Möller-Leimkühler A (2012) Substance abuse and suicide risk among adolescents. Eur Arch Psychiatry Clin Neurosci. doi:10.1007/s00406-012-0292-0
  44. 44.
    Radestad I, Rubertsson C, Ebeling M, Hildingsson I (2004) What factors in early pregnancy indicate that the mother will be hit by her partner during the year after childbirth? A nationwide swedish survey. Birth 31:84–92PubMedCrossRefGoogle Scholar
  45. 45.
    Rich-Edwards JW, James-Todd T, Mohllajee A, Kleinman K, Burke A, Gillman MW, Wright RJ (2011) Lifetime maternal experiences of abuse and risk of pre-natal depression in two demographically distinct populations in Boston. Int J Epidemiol 40:375–384PubMedCrossRefGoogle Scholar
  46. 46.
    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
  47. 47.
    Rodriguez MA, Valentine J, Ahmed SR, Eisenman DP, Sumner LA, Heilemann MV, Liu H (2010) Intimate partner violence and maternal depression during the perinatal period: a longitudinal investigation of Latinas. Violence Against Women 16:543–559PubMedCrossRefGoogle Scholar
  48. 48.
    Romito P, Molzan Turan J, Neilands T, Lucchetta C, Pomicino L, Crimin F (2009) Violence and women’s psychological distress after birth: an exploratory study in Italy. Health Care Women Int 30:160–180PubMedCrossRefGoogle Scholar
  49. 49.
    Schytt E, Lindmark G, Waldenstrom U (2005) Physical symptoms after childbirth: prevalence and associations with self-rated health. BJOG 112:210–217PubMedCrossRefGoogle Scholar
  50. 50.
    Schytt E, Waldenstrom U (2007) Risk factors for poor self-rated health in women at 2 months and 1 year after childbirth. J Womens Health (Larchmt) 16:390–405CrossRefGoogle Scholar
  51. 51.
    Segovia J, Bartlett R, Edwards A (1989) An empirical analysis of the dimensions of health status measures. Soc Sci Med 29:761–768PubMedCrossRefGoogle Scholar
  52. 52.
    Seguin L, Potvin L, St-Denis M, Loiselle J (1995) Chronic stressors, social support, and depression during pregnancy. Obstet Gynecol 85:583–589PubMedCrossRefGoogle Scholar
  53. 53.
    Setse R, Grogan R, Pham L, Cooper LA, Strobino D, Powe NR, Nicholson W (2009) Longitudinal study of depressive symptoms and health-related quality of life during pregnancy and after delivery: the health status in pregnancy (HIP) study. Matern Child Health J 13:577–587PubMedCrossRefGoogle Scholar
  54. 54.
    Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32:705–714PubMedCrossRefGoogle Scholar
  55. 55.
    Silverman ME, Loudon H (2010) Antenatal reports of pre-pregnancy abuse is associated with symptoms of depression in the postpartum period. Arch Womens Ment Health 13:411–415PubMedCrossRefGoogle Scholar
  56. 56.
    Stampfel CC, Chapman DA, Alvarez AE (2010) Intimate partner violence and posttraumatic stress disorder among high-risk women: does pregnancy matter? Violence Against Women 16:426–443PubMedCrossRefGoogle Scholar
  57. 57.
    Stewart DE, Cecutti A (1993) Physical abuse in pregnancy. CMAJ 149:1257–1263PubMedGoogle Scholar
  58. 58.
    Sumner LA, Valentine J, Eisenman D, Ahmed S, Myers H, Wyatt G, Liu H, Zhang M, Rodriguez MA (2010) The Influence of Prenatal Trauma, Stress, Social Support, and Years of Residency in the US on Postpartum Maternal Health Status Among Low-Income Latinas. Matern Child Health J 15:1046–1054CrossRefGoogle Scholar
  59. 59.
    Surkan PJ, Peterson KE, Hughes MD, Gottlieb BR (2006) The role of social networks and support in postpartum women’s depression: a multiethnic urban sample. Matern Child Health J 10:375–383PubMedCrossRefGoogle Scholar
  60. 60.
    Tiwari A, Chan K, Fong D, Leung W, Brownridge D, Lam H, Wong B, Lam C, Chau F, Chan A, Cheung K, Ho P (2008) The impact of psychological abuse by an intimate partner on the mental health of pregnant women. BJOG 115:377–384PubMedCrossRefGoogle Scholar
  61. 61.
    Valentine JM, Rodriguez MA, Lapeyrouse LM, Zhang M (2010) Recent intimate partner violence as a prenatal predictor of maternal depression in the first year postpartum among Latinas. Arch Womens Ment Health 14:135–143PubMedCrossRefGoogle Scholar
  62. 62.
    Verker GJ, Pop VJ, Van Son MJ, Van Heck GL (2003) Prediction of depression in the postpartum period: a longitudinal follow-up study in high-risk and low-risk women. J Affect Disord 77:159–166CrossRefGoogle Scholar
  63. 63.
    Watt S, Sword W, Krueger P, Sheehan D (2002) A cross-sectional study of early identification of postpartum depression: Implications for primary care providers from the Ontario Mother & Infant survey. BMC Fam Pract 11:3–5Google Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Vicenta Escribà-Agüir
    • 1
    • 2
    • 3
  • Manuela Royo-Marqués
    • 1
  • Lucía Artazcoz
    • 2
    • 4
  • Patrizia Romito
    • 5
  • Isabel Ruiz-Pérez
    • 2
    • 6
  1. 1.Centre for Public Health ResearchValenciaSpain
  2. 2.CIBER Epidemiología y Salud Pública (CIBERESP)MadridSpain
  3. 3.Department of NursingUniversity of ValenciaValenciaSpain
  4. 4.Barcelona Public Health AgencyBarcelonaSpain
  5. 5.Department of PsychologyUniversity of TriesteTriesteItaly
  6. 6.Andalusia School of Public HealthGranadaSpain

Personalised recommendations