Archives of Women's Mental Health

, Volume 16, Issue 6, pp 489–498 | Cite as

Influence of health information levels on postpartum depression

  • Sabrina Youash
  • Karen Campbell
  • William Avison
  • Debbie Peneva
  • Verinder Sharma
  • Bin Xie
Original Article


While extensive research has been conducted on postpartum depression (PPD), the majority has been focused on psychological risk factors and treatments. There is limited research on the explicit relationship between the degree to which individuals are informed about relevant prenatal and postnatal health topics and whether this level of knowledge influences psychological outcome. This study assesses health information levels of new mothers and their influence on PPD as measured by Edinburgh Postnatal Depression Scale (EPDS) scores. Data from the 2006 Maternity Experiences Survey developed by the Canadian Perinatal Surveillance System (N = 6,421) were used. The study population included mothers ≥15 years of age at the time of the birth, who had a singleton live birth in Canada during a 3-month period preceding the 2006 Census and who lived with their infants at the time of the survey. Pre- and postnatal health information components were measured using latent variables constructed by structural equation modeling. EPDS score was added to the model, adjusting for known covariates to assess the effects of information levels on EPDS score. Pre- and postnatal health information levels are associated with decreased EPDS scores. More specifically, information on topics such as postnatal concerns and negative feelings was associated with the largest decrease in score for primiparous and multiparous women, respectively (p < 0.0001 for both). The pre-established predictors of PPD were confirmed for both samples, with life stress associated with the largest change in EPDS score for both samples (p < 0.0001 for both). This study demonstrates a distinct role for pre- and postnatal health information in influencing EPDS scores, supplementing previous literature. Primiparous and multiparous women benefited from different information content, with information on postnatal concerns had the largest effect on the primiparous group while information on negative feelings had the largest effect on the multiparous group. Therefore, information provision should be tailored to these two groups.


Postpartum depression (PPD) Consumer health information Prenatal care Postnatal care 


  1. Alder NE, Newman K (2002) Socioeconomic disparities in health: pathways and policies. Health Aff (Project Hope) 21(2):60CrossRefGoogle Scholar
  2. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, D.CGoogle Scholar
  3. Beck CT (1998) The effects of postpartum depression on child-development: a meta-analysis. Arch Psychiatr Nurs 12(1):12–20PubMedCrossRefGoogle Scholar
  4. Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50(5):275–285PubMedCrossRefGoogle Scholar
  5. Benzeval M, Judge K (2001) Income and health: the time dimension. Soc Sci Med 52(9):1371–1390PubMedCrossRefGoogle Scholar
  6. Bollen KA, Paxton P (1998) Interactions of latent variables in structural equation models. Struct Equ Model 5(3):267–293CrossRefGoogle Scholar
  7. Braveman P, Marchi K, Egerter S, Kim S, Metzier M, Stancil T et al (2010) Poverty, near-poverty, and hardship around the time of pregnancy. Matern Child Health J 14(1):20–35PubMedCrossRefGoogle Scholar
  8. Brugha T, Sharp H, Cooper S, Weisender C, Britto D, Shinkwin R et al (1998) The Leicester 500 project: social support and the development of postnatal depressive symptoms, a prospective cohort survey. Psychol Med 28(1):63–79PubMedCrossRefGoogle Scholar
  9. Chalmers B, Dzakpasu S, Heaman M, Kaczorowski J, Maternity Experiences Study Group of the Canadian Perinatal Surveillance System (2008) The Canadian Maternity Experiences Survey: an overview of findings. J Obstet Gynaecol Canada 30(3):217–228Google Scholar
  10. Clark LA, Watson D (1991) Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol 100(3):316–336PubMedCrossRefGoogle Scholar
  11. Collins JW, Wall SN, David RJ (1997) Adequacy of prenatal care utilization, maternal ethnicity, and infant birthweight in Chicago. J National Med Assoc 89(3):198–203Google Scholar
  12. Collins NL, Dunkel-Schetter C, Lobel M, Scrimshaw SCM (1993) Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression. J Personal Soc Psychol 65(6):1243–1258CrossRefGoogle Scholar
  13. Costello AB, Osborne JW (2005) Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Pract Assess Res Eval 10(7):1Google Scholar
  14. Cox JL, Murray D, Chapman G (1993) A controlled study of the onset, duration and prevalence of postnatal depression. Br J Psychiatry 163:27–31PubMedCrossRefGoogle Scholar
  15. Cox JL, Chapman G, Murray D, Jones P (1996) Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. J Affect Disord 39(3):185PubMedCrossRefGoogle Scholar
  16. Deaton A (2002) Policy implications of the gradient of health and wealth. Health Aff (Project Hope) 21(2):13CrossRefGoogle Scholar
  17. Dennis CL, Janssen PA, Singer J (2004) Identifying women at-risk for postpartum depression in the immediate postpartum period. Acta Psychiatr Scand 110(5):338–346PubMedCrossRefGoogle Scholar
  18. DiPietro JA, Costigan KA, Sipsma HL (2008) Continuity in self-report measures of maternal anxiety, stress, and depressive symptoms from pregnancy through two years postpartum. J Psychosom Obstet Gynecol 29(2):115–124CrossRefGoogle Scholar
  19. Dzakpasu S, Kaczorowski J, Chalmers B, Heaman M, Duggan J, Neusy E (2008) The Canadian maternity experiences survey: design and methods. J Obstet Gynaecol Canada 30(3):207Google Scholar
  20. Eiser C, Eiser JR (1985) Health education needs of primigravidae. Child Care Health Dev 11(2):53–60PubMedCrossRefGoogle Scholar
  21. Essex HN, Pickett E (2008) Mothers without companionship during childbirth: an analysis within the millennium cohort study. Birth 35(4):266–276PubMedCrossRefGoogle Scholar
  22. Forman DN, Videbech P, Hedegaard M, Salvig JD, Secher NJ (2000) Postpartum depression: identification of women at risk. British J Obstet Gynecol 107(10):1210–1217CrossRefGoogle Scholar
  23. Heh SS, Fu YY (2003) Effectiveness of informational support in reducing the severity of postnatal depression in Taiwan. J Adv Nurs 42(1):30–36PubMedCrossRefGoogle Scholar
  24. Heron J, O’Conner TG, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80(1):65–73PubMedCrossRefGoogle Scholar
  25. Himmelhoch J, Levine J, Gershon S (2001) Historical overview of the relationship between anxiety disorders and affective disorders. Depression and Anxiety 14(2):53–66PubMedCrossRefGoogle Scholar
  26. Johnstone S, Boyce P, Hickey A, Morris-Yates A, Harris M (2001) Obstetric risk factors for postnatal depression in community samples. Australian and New Zealand J Psychiatry 35(1):69–74CrossRefGoogle Scholar
  27. Josefsson A, Angelsioo L, Berg G, Ekstrom CM, Gunnervik C, Nordin C, Sydsjo G (2002) Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms. Obstet Gynecol 99(2):223–228PubMedCrossRefGoogle Scholar
  28. Kaplan D (1994) Estimator conditioning diagnostics for covariance structure models. Sociol Methods Res 23(2):200–229CrossRefGoogle Scholar
  29. Lundrigan DE (1991) Information seeking of pregnant women: a grounded theory approach. Unpublished master of nursing school of nursing. Memorial University of Newfoundland, NewfoundlandGoogle Scholar
  30. Marnot M (2002) The influence of income on health: views from an epidemiologist. Health Aff (Project Hope) 21(2):31–46CrossRefGoogle Scholar
  31. National Institute of Health (2005) Theory at a glance: A guide for health promotion practice. Retrieved May 15, 2013 from
  32. Newton RW, Hunt LP (1984) Psychosocial stress in pregnancy and its relation to low birthweight. British Med J 288:1191CrossRefGoogle Scholar
  33. Niven CA, Murphey-Black T (2000) Memory for labor pain: a review of the literature. Birth 27(4):244–253PubMedCrossRefGoogle Scholar
  34. O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression—a meta-analysis. Int Rev Psychiatry 8(1):37–54CrossRefGoogle Scholar
  35. Pop VJ, Essed GG, de Geus CA, van Som MM, Kromproe IH (1993) Prevalence of PPD or is it postpartum depression? Acta Obstet Gynecol Scand 72(5):354–358PubMedCrossRefGoogle Scholar
  36. R Development Core Team (2011). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, URL
  37. Robertson E, Grace S, Wallington T, Stewart D (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry 26(4):289–295PubMedCrossRefGoogle Scholar
  38. Rosenfield AI (2007) Barriers to postpartum depression screening, diagnosis and treatment. In: Rosenfield AI (ed) New research on postpartum depression. Nova Science Publishers, Inc., New York, p 59Google Scholar
  39. Ross LE, Sellers EM, Evans SEG, Romach MK (2004) Mood changes during pregnancy and the postpartum period: development of a biopsychosocial model. Acta Psychiatr Scand 109(6):457–466PubMedCrossRefGoogle Scholar
  40. Schumacker RE, Lomax RG (2010) A beginner’s guide to structural equation modeling, 3rd edn. Routledge, New YorkGoogle Scholar
  41. Seguin L, Therrien R, Champagne F, Larouche D (1999) The components of women’s satisfaction with maternity care. Birth 16(3):109–113CrossRefGoogle Scholar
  42. Shieh C, McDaniel A, Ke I (2009) Information-seeking and its predictor in low-income pregnant women. J Midwifery Women’s Health 54(5):364–372CrossRefGoogle Scholar
  43. Somers-Smith MJ (1999) A place for the partner? Expectations and experiences of support during childbirth. Midwifery 15(2):101–108PubMedCrossRefGoogle Scholar
  44. Statistics Canada. (2009a). Data quality, concepts and methodology: Definitions. Retrieved March 10, 2011, from
  45. Statistics Canada. (2009b). Low income cut-offs for 2008 and low income measures for 2007 Retrieved March 15, 2011, from
  46. Swendsen J, Mazure CM (2000) Life stress as a risk factor for postpartum depression: current research and methodological issues. Am Psychol Assoc 7(1):17–31Google Scholar
  47. Tomeo CA, Rich-Edwards JW, Michels KB, Berkey CS, Hunter DJ, Frazier AL (1999) Reproducibility and validity of maternal recall of pregnancy-related events. Epidemiology 10(6):774–777PubMedCrossRefGoogle Scholar
  48. Waldenstrom U (2003) Women’s memory of childbirth at two months and one year after the birth. Birth 30(4):248–254PubMedCrossRefGoogle Scholar
  49. Watson JP, Elliott SA, Rugg AJ, Brough DI (1984) Psychiatric disorder in pregnancy and the first postnatal year. Br J Psychiatry 144:453–462PubMedCrossRefGoogle Scholar
  50. Webster J, Linnane JWJ, Dibley LM, Hinson JK, Starrenburg SE, Roberts JA (2000) Measuring social support during pregnancy: can it be simple and meaningful? Birth 27(2):97–101PubMedCrossRefGoogle Scholar
  51. Xie RH, Guoping H, Koszycki D, Walker M, Wen SW (2009) Prenatal social support, postnatal social support and postpartum depression. Ann Epidemiol 19(9):637–643PubMedCrossRefGoogle Scholar
  52. Youash S, Campbell MK, Avison W, Penava D, Xie B (2012) Examining the pathways of pre- and postnatal health information. Canadian J Public Health 103(4):314–319Google Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Sabrina Youash
    • 1
  • Karen Campbell
    • 1
  • William Avison
    • 1
    • 2
  • Debbie Peneva
    • 3
  • Verinder Sharma
    • 4
  • Bin Xie
    • 1
    • 4
  1. 1.Department of Epidemiology and BiostatisticsUniversity of Western OntarioLondonCanada
  2. 2.Department of SociologyUniversity of Western OntarioLondonCanada
  3. 3.Department of Obstetrics and GynecologyUniversity of Western OntarioLondonCanada
  4. 4.Department of PsychiatryUniversity of Western OntarioLondonCanada

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