A Longitudinal Study of Pre-pregnancy and Pregnancy Risk Factors Associated with Antenatal and Postnatal Symptoms of Depression: Evidence from Growing Up in New Zealand
- 1.3k Downloads
Objectives Antenatal and postnatal depression can lead to poor outcomes for women and their children. The aim of this study was to explore whether risk factors differ for depression symptoms that are present during pregnancy and/or after childbirth. Methods An ethnically and socioeconomically diverse sample of 5301 women completed interviews during the third trimester of pregnancy and 9 months after childbirth. Depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Depression symptoms (defined as EPDS >12) among participants and associations with pre-pregnancy and pregnancy maternal characteristics were explored using logistic regression. Results The rate of antenatal depression symptoms (ADS) only was 8.5, 5% of women had depression symptoms at 9 months postpartum (PDS) only and 3% experienced depression symptoms at both time points. Perceived stress and Pacific or Asian ethnicity were risk factors for ADS and PDS. Anxiety during and before pregnancy was a risk factor for ADS only while having a pre-pregnancy diagnosis of depression was a risk factor for PDS only. Having ADS increased the odds ratio of PDS by 1.5 (95% CI 1.01–2.30). Conclusions The results supported evidence from previous longitudinal studies that depression symptoms appear to be higher during pregnancy than in the first year following childbirth. The study found that PDS may often be a continuation or recurrence of ADS.
KeywordsAntenatal depression Postnatal depression Perceived stress Longitudinal research Cohort study Growing Up in New Zealand
Antenatal depression symptoms
Edinburgh Depression Scale
Edinburgh Postnatal Depression Scale
Postnatal depression symptoms
Perceived Stress Scale
The Growing Up in New Zealand study has been funded by the New Zealand Ministries of Social Development, Health, Education, Justice and Pacific Island Affairs; the former Ministry of Science Innovation and the former Department of Labour (now both part of the Ministry of Business, Innovation and Employment); the former Ministry of Women’s Affairs (now the Ministry for Women); the Department of Corrections; the Families Commission (now known as the Social Policy Evaluation and Research Unit); Te Puni Kokiri; New Zealand Police; Sport New Zealand; the Housing New Zealand Corporation; and the former Mental Health Commission, The University of Auckland and Auckland UniServices Limited. Other support for the study has been provided by the New Zealand Health Research Council, Statistics New Zealand, the Office of the Children’s Commissioner and the Office of Ethnic Affairs.
The study has been designed and conducted by the Growing Up in New Zealand study team, led by the University of Auckland. The authors acknowledge the contributions of the original study investigators: Susan M.B. Morton, Polly E. Atatoa Carr, Cameron C. Grant, Arier C. Lee, Dinusha K. Bandara, Jatender Mohal, Jennifer M. Kinloch, Johanna M. Schmidt, Mary R. Hedges, Vivienne C. Ivory, Te Kani R. Kingi, Renee Liang, Lana M. Perese, Elizabeth Peterson, Jan E. Pryor, Elaine Reese, Elizabeth M. Robinson, Karen E. Waldie and Clare R. Wall. The views reported in this paper are those of the authors and do not necessarily represent the views of the Growing Up in New Zealand study investigators.
- Banti, S., Mauri, M., Oppo, A., Borri, C., Rambelli, C., Ramacciotti, D., & Cassano, G. B. (2011). From the third month of pregnancy to 1 year postpartum. Prevalence, incidence, recurrence, and new onset of depression. Results from the Perinatal Depression-Research and Screening Unit study. Comprehensive Psychiatry, 52(4), 343–351.CrossRefPubMedGoogle Scholar
- Barber, C. C. (2009). Perinatal mental health care in New Zealand: The promise of beginnings. New Zealand Journal of Psychology, 38, 32–38.Google Scholar
- Daley, A. J., Foster, L., Long, G., Palmer, C., Robinson, O., Walmsley, H., & Ward, R. (2015). The effectiveness of exercise for the prevention and treatment of antenatal depression: Systematic review with meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 122(1), 57–62.CrossRefGoogle Scholar
- Dennis, C. L., & Dowswell, T. (2013). Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews (Online), 28(2), CD001134.Google Scholar
- Dunst, C. J., Jenkins, V., & Trivette, C. M. (1984). Family support scale: Reliability and validity. Journal of Individual, Family and Community Wellness, 1, 45–52.Google Scholar
- Gao, W., Paterson, J., Abbott, M., Carter, S., Iusitini, L., & McDonald-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. Australian and New Zealand Journal of Psychiatry, 44(2), 174–182.CrossRefPubMedGoogle Scholar
- Haas, J. S., Jackson, R. A., Fuentes-Afflick, E., Stewart, A. L., Dean, M. L., Brawarsky, P., & Escobar, G. J. (2005). Changes in the health status of women during and after pregnancy. Journal of General Internal Medicine: Official Journal of the Society for Research and Education in Primary Care Internal Medicine, 20(1), 45–51.CrossRefGoogle Scholar
- Hein, A., Rauh, C., Engel, A., Haberle, L., Dammer, U., Voigt, F., Fasching, P. A., Faschingbauer, F., Burger, P., Beckmann, M. W., Kornhuber, J., & Goecke, T. W. (2014). Socioeconomic status and depression during and after pregnancy in the Franconian Maternal Health Evaluation Studies (FRAMES). Archives of Gynecology and Obstetrics, 289(4), 755–763.CrossRefPubMedGoogle Scholar
- Lamb, Y. N., Thompson, J. M., Murphy, R., Wall, C., Kirk, I. J., Morgan, A. R., et al. (2014). Perceived stress during pregnancy and the catechol-O-methyltransferase (COMT) rs165599 polymorphism impacts on childhood IQ. Cognition, 132(3), 461–470. doi: 10.1016/j.cognition.2014.05.009.CrossRefPubMedGoogle Scholar
- Melby, J. N., Conger, R. D., Book, R., Rueter, M., Lucy, L., Repinski, D., et al. (1993). The Iowa family interaction rating scales (4th ed.). Coding manual. Ames, Iowa State University, Institute for Social and Behavioral Research.Google Scholar
- Ministry of Health. (2003). District Health Board toolkit: Physical Activity. Wellington: New Zealand Ministry of Health.Google Scholar
- Morton, S. M. B., Atatoa Carr, P. E., Grant, C. C., Lee, A. C., Bandara, D. K., Mohal, J., Kinloch, J., Schmidt, J. M., Hedges, M. R., Ivory, V. C., Kingi, T. K., Liang, R., Perese, L. M., Peterson, E. R., Pryor, J. E., Reese, E., Robinson, E. M., Waldie, K. E. & Wall, C. (2012). Growing Up in New Zealand: A longitudinal study of New Zealand Children and their families. Report 2: Now we are born. Auckland: Growing Up in New ZealandGoogle Scholar
- National Institute for Health and Clinical Excellence. (2014). Antenatal and postnatal mental health. Clinical management and service guidance. London: National Insitute of Health and Clinical Excellence.Google Scholar
- New Zealand Gazette. (2007). http://www.health.govt.nz/system/files/documents/publications/s88-primary-maternity-services-notice-gazetted-2007.pdf.
- Pryor, J. E. (2004). Stepfamilies and resilience. Final report. Prepared for Centre for Social Research and Evaluation/Te Pokapū Rangahau Arotaki Hapori. Roy McKenzie Centre for the Study of Families, Wellington, Victoria University.Google Scholar
- Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H., & Gillman, M. W. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60(3), 221–227.CrossRefPubMedPubMedCentralGoogle Scholar
- Statistics New Zealand. (2004). Report of the review of the measurement of ethnicity. Wellington: Statistics New ZealandGoogle Scholar
- Thompson J. M. D, Sonuga-Barke, E. J., Morgan, A. R., Cornforth, C., Ferguson, L. R., Mitchell, E. A., & Waldie, K. E. (2012). The catechol-O-methyltransferase (COMT) Val158Met polymorphism moderates the effect of antenatal stress on behavioural problems. Developmental Medicine and Child Neurology, 54(2), 148–154.CrossRefPubMedGoogle Scholar
- Ware, J. E., Kosinski, M., & Keller, S. K. (1994). SF-36 physical and mental health summary scales: A user’s manual. Boston, MA: The Health Institute.Google Scholar