Maternal and Child Health Journal

, Volume 21, Issue 4, pp 915–931 | Cite as

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

  • Lisa Underwood
  • Karen E. Waldie
  • Stephanie D’Souza
  • Elizabeth R. Peterson
  • Susan M. B. Morton
Article

Abstract

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.

Keywords

Antenatal depression Postnatal depression Perceived stress Longitudinal research Cohort study Growing Up in New Zealand 

Abbreviations

ADS

Antenatal depression symptoms

CI

Confidence interval

EDS

Edinburgh Depression Scale

EPDS

Edinburgh Postnatal Depression Scale

PDS

Postnatal depression symptoms

M

Mean

ND

No data

PSS

Perceived Stress Scale

REF

Reference

SD

Standard deviation

Notes

Acknowledgements

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.

Funding

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.

References

  1. Austin, M. -P, Priest, S. R., Sullivan, E. A., & Cochrane Collaboration (2008). Antenatal psychosocial assessment for reducing perinatal mental health morbidity. New York: Wiley.CrossRefGoogle Scholar
  2. 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
  3. 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
  4. Beck, C. T. (2001). Predictors of postpartum depression. An update. Nursing Research, 50(5), 275–285.CrossRefPubMedGoogle Scholar
  5. Bennett, H. A., Einarson, A., Taddio, A., Koren, G., & Einarson, T. R. (2004). Prevalence of depression during pregnancy: Systematic review. Obstetrics and Gynecology, 103(4), 698–709.CrossRefPubMedGoogle Scholar
  6. Bowen, A., Bowen, R., Butt, P., Rahman, K., & Muhajarine, N. (2012). Patterns of depression and treatment in pregnant and postpartum women. Canadian Journal of Psychiatry, 57(3), 161–167.CrossRefPubMedGoogle Scholar
  7. Cankorur, V. S., Abas, M., Berksun, O., & Stewart, R. (2015). Social support and the incidence and persistence of depression between antenatal and postnatal examinations in Turkey: A cohort study. BMJ Open, 5, e006456.CrossRefPubMedPubMedCentralGoogle Scholar
  8. Chung, T. K. H., Lau, T. K., Yip, A. S. K., Chiu, H. F. K., & Lee, D. T. S. (2001). Antenatal depressive symtpomatology is associated with adverse obstetric and neonatal outcomes. Psychosomatic Medicine, 63, 830–834.CrossRefPubMedGoogle Scholar
  9. Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health Social Behavior, 24, 385–396.CrossRefPubMedGoogle Scholar
  10. Cox, J. L., Chapman, G., Murray, D., & Jones, P. (1996). Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. Journal of Affective Disorders, 39, 185–189.CrossRefPubMedGoogle Scholar
  11. 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(6), 782–786.CrossRefPubMedGoogle Scholar
  12. 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
  13. 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
  14. 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
  15. Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of depressed mood during pregnancy and after childbirth. British Medical Journal, 323(7307), 257–260.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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
  17. Gavin, N. I., Gaynes, B. N., Lohr, K. N., Meltzer-Brody, S., Gartlehner, G., & Swinson, T. (2005). Perinatal depression: A systematic review of prevalence and incidence. Obstetrics and Gynecology 106(5, Part 1), 1071.CrossRefPubMedGoogle Scholar
  18. 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
  19. Halbreich, U., & Karkun, S. (2006). Cross-cultural and social diversity of prevalence of postpartum depression and depressive symptoms. Journal of Affective Disorders, 91(2–3), 97–111.CrossRefPubMedGoogle Scholar
  20. 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
  21. Howard, L. M., Molyneaux, E., Dennis, C. L., Rochat, T., Stein, A., & Milgram, J. (2014). Perinatal mental health 1: Non-psychotic mental disorders in the perinatal period. Lancet, 384, 1775–1788.CrossRefPubMedGoogle Scholar
  22. Imran, N., & Haider, I. I. (2010). Screening of antenatal depression in Pakistan: Risk factors and effects on obstetric and neonatal outcomes. Asia-Pacific Psychiatry, 2(1), 26–32.CrossRefGoogle Scholar
  23. Kessler, R. C., Zhao, S., Blazer, D. G., Swartz, M. (1997). Prevalence, correlates, and course of minor depression and major depression in the national comorbidity survey. Journal of Affective Disorders, 45, 19–30.CrossRefPubMedGoogle Scholar
  24. Kim, Y. -K., Hur, J. -W., Kim, K. -H., Oh, K. -S., & Shin, Y. -C. (2008). Prediction of postpartum depression by sociodemographic, obstetric and psychological factors: A prospective study. Psychiatry and Clinical Neurosciences, 62(3):331–340.CrossRefPubMedGoogle Scholar
  25. 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
  26. Lancaster, C. A., Gold, K. J., Flynn, H. A., Yoo, H., Marcus, S. M., & Davis, M. M. (2010). Risk factors for depressive symptoms during pregnancy: A systematic review. American Journal of Obstetrics and Gynecology, 202(1), 5–14.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 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
  28. Milgrom, J. & Gemmill, A. W. (2014). Screening for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology, 28, 13–23.CrossRefGoogle Scholar
  29. Ministry of Health. (2003). District Health Board toolkit: Physical Activity. Wellington: New Zealand Ministry of Health.Google Scholar
  30. 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
  31. Morton, S. M. B., Ramke, J., Kinloch, J., Grant, C. C., Atatoa Carr, P., Leeson, H., Lee, A. C., & Robinson, E. (2015). Growing Up in New Zealand cohort alignment with all New Zealand births. Australian and New Zealand Journal of Public Health, 39(1), 82–87.CrossRefPubMedGoogle Scholar
  32. 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
  33. 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
  34. Onoye, J. M., Goebert, D., Morland, L., Matsu, C., & Wright, T. (2009). PTSD and postpartum mental health in a sample of Caucasian, Asian, and Pacific Islander women. Archives of Women’s Mental Health, 12(6), 393–400.CrossRefPubMedGoogle Scholar
  35. 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
  36. 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
  37. Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26(4), 289–295.CrossRefPubMedGoogle Scholar
  38. Schmied, V., Johnson, M., Naidoo, N., Austin, M. P., Matthey, S., Kemp, L., et al. (2013). Maternal mental health in Australia and New Zealand: A review of longitudinal studies. Women and Birth: Journal of the Australian College of Midwives, 26(3), 167–178.CrossRefGoogle Scholar
  39. Sidebottom, A. C., Hellerstedt, W. L., Harrison, P. A., & Hennrikus, D. (2014). An examination of prenatal and postpartum depressive symptoms among women served by urban community health centers. Archives of Womens Mental Health, 17, 27–40.CrossRefGoogle Scholar
  40. Slykerman, R. F., Thompson, J., Waldie, K., Murphy, R., & Mitchell, E. A. (2014). Maternal stress during pregnancy is associated with moderate to severe depression in 11-year-old children. Acta Paediatrica. doi: 10.1111/apa.12787.PubMedGoogle Scholar
  41. Statistics New Zealand. (2004). Report of the review of the measurement of ethnicity. Wellington: Statistics New ZealandGoogle Scholar
  42. Teychenne, M., & York, R. (2013). Physical activity, sedentary behavior, and postnatal depressive symptoms: A review. American Journal of Preventive Medicine, 45(2), 217–227.CrossRefPubMedGoogle Scholar
  43. 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
  44. Turrell, G., Kavanagh, A., & Subramanian, S. V. (2006). Area variation in mortality in Tasmania (Australia): The contributions of socioeconomic disadvantage, social capital and geographic remoteness. Health & place, 12(3), 291–305.CrossRefGoogle Scholar
  45. Underwood, L., Waldie, K. E., Peterson, E. R., D’Souza, S., & Morton, S. M. B. (2016). A review of longitudinal studies on antenatal and postnatal depression. Archives of Women’s Mental Health, 19(5), 711–720.CrossRefPubMedGoogle Scholar
  46. Waldie, K. E., Peterson, E. R., D’Souza, S., Underwood, L., Pryor, J. E., Carr, P. A., Grant, C., & Morton, S. M. B. (2015). Depression symptoms during pregnancy: Evidence from Growing Up in New Zealand. Journal of Affective Disorders, 186, 66–73.CrossRefPubMedGoogle Scholar
  47. 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

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Centre for Longitudinal Research, He Ara ki MuaUniversity of AucklandAucklandNew Zealand
  2. 2.School of PsychologyUniversity of AucklandAucklandNew Zealand
  3. 3.School of Population HealthUniversity of AucklandAucklandNew Zealand

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