Abstract
Objectives
The social position of different minority groups in contemporary societies suggests different risk factors for postpartum depression (PPD). In this study, we used two cut-offs of the Edinburgh Postpartum Depression Scale (EPDS) to examine prevalence and risk factors for PPD among mothers participating in the Canadian Maternity Experiences Survey (MES), and to compare Indigenous, Canadian-born non-Indigenous and immigrant mothers.
Methods
We used cross-sectional nationwide data from the 2006 MES (unweighted N = 6237, weighted N = 74,231) and conducted multivariate logistic regression models for EPDS ≥ 10 and EPDS ≥ 13 to explore risk factors for the total sample of mothers and in each study group.
Results
Prevalence (%, 95 % CI) of EPDS ≥ 10 and EPDS ≥ 13 was significantly higher among immigrant (12.2 %, 10.2–14.2 and 24.1 %, 21.5–26.7) and Indigenous (11.1 %, 7.5–14.7 and 21.2 %, 16.5–25.9) compared to Canadian-born non-Indigenous mothers (5.6 %, 4.9–6.3 and 12.9 %, 11.9–13.9). Multivariate analysis of the total sample showed similar risk factors for EPDS ≥ 10 and EPDS ≥ 13 (ethnicity, low education, ≥ low income cut-off, taking antidepressants, experiencing abuse, low social support). Stratification by study group revealed differing risk factors in each group for EPDS ≥ 10 and EPDS ≥ 13. Indigenous mothers had the most distinct risk factors, followed by immigrant mothers. Non-indigenous Canadian-born mothers had risk factors most similar to the total sample.
Conclusion
Differing prevalence and risk factors for PPD within and across study groups suggest that instead of a universal approach, tailored programs and services to prevent PPD in Indigenous, immigrant and non-Indigenous Canadian-born groups could better protect the mental health of Canadian mothers.
Résumé
Objectifs
La position sociale de divers groupes minoritaires dans les sociétés contemporaines suggère des facteurs de risque différents pour la dépression postpartum. Notre étude emploie deux seuils de coupure dérivés de l’Échelle de dépression postnatale d’Edimbourg (EPDS) pour explorer la prévalence de la dépression postpartum et identifier facteurs de risque chez des mères participants à l’Enquête canadienne sur l’expérience de la maternité, et pour effectuer une comparaison entre trois groupes de mères : autochtones, non autochtones nées au Canada, et immigrantes.
Méthodes
Analyse de données de l’Enquête canadienne sur l’expérience de la maternité 2006 (N = 6237 non pondérées, N = 74,231 pondérées) et utilisation de modèles de régression logistique multivariés pour deux seuils de coupure (EPDS ≥ 10 et EPDS ≥ 13) pour explorer les facteurs de risque pour l’échantillon globale de mères, et pour chaqun des trois groupes.
Résultats
La prévalence (95 % IC) d’EPDS ≥ 10 et d’EPDS ≥ 13 était sensiblement plus haute chez les mères immigrantes (12,2 %, 10,2–14,2 et 24,1 %, 21,5–26,7) et autochtones (11,1 %, 7,5–14,7 et 21,2 %, 16,5–25,9) comparativement aux mères non autochtones nées au Canada (5,6 %, 4,9–6,3 et 12,9 %, 11,9–13,9). L’analyse multivariée de l’échantillon globale a démontré des facteurs de risque semblables pour EPDS ≥ 10 et EPDS ≥ 13 (ethnicité, faible niveau d’éducation, ≥ SFR, utilisation d’antidépresseurs, maltraitance, faible soutien). La stratification par groupe a révélé des facteurs de risques différents pour chaque groupe pour EPDS ≥ 10 et EPDS ≥ 13. Les mères autochtones avaient les facteurs de risque les plus distinctifs, suivi par les mères immigrantes. Les mères non autochtones nées au Canada avaient les facteurs de risque les plus semblables à ceux de l’échantillon globale.
Conclusion
Le taux de prévalence et les facteurs de risques variables entre les groupes sous étude indiquent qu’au lieu d’une politique universelle pour prévenir la dépression postpartum chez les mères autochtones, immigrantes, et non autochtones nées au Canada, des programmes et services sur mesure pourraient mieux protéger la santé mentale des mères canadiennes.
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We thank the Research Data Centre (RDC) team of the University of Toronto (UoT).
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Appendix 1- Summary of multivariate associations of risk factors for EPDS≥13 and EPDS≥10
Appendix 1- Summary of multivariate associations of risk factors for EPDS≥13 and EPDS≥10
EPDS≥13 | EPDS≥10 | |||||||
|---|---|---|---|---|---|---|---|---|
Indigenous | Non-Indigenous Canadian-born | Immigrant | Total | Indigenous | Non-Indigenous Canadian-born | Immigrant | Total | |
Ethnicity and immigrant status | + | + | ||||||
Age | - | - | - | - | - | - | - | - |
Education | - | + | - | + | + | + | - | + |
≤LICO | - | - | + | + | - | + | + | + |
Marital status | - | - | - | - | - | - | - | |
Parity | - | - | - | NR | - | - | - | NR |
Anti-depressants | + | + | - | + | + | + | - | + |
Experiencing any abuse | + | + | - | + | - | + | + | + |
Stressful life events | - | + | + | NR | + | + | + | NR |
Social support | - | + | + | + | - | + | + | + |
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Daoud, N., O’Brien, K., O’Campo, P. et al. Postpartum depression prevalence and risk factors among Indigenous, non-Indigenous and immigrant women in Canada. Can J Public Health 110, 440–452 (2019). https://doi.org/10.17269/s41997-019-00182-8
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DOI: https://doi.org/10.17269/s41997-019-00182-8
Keywords
- Postpartum depression
- Edinburgh Postnatal Depression Scale (EPDS)
- Risk factors
- Canada
- Indigenous, immigrant, and non-Indigenous Canadian-born mothers