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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

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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.

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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

References

  • Austin, M. -P, Priest, S. R., Sullivan, E. A., & Cochrane Collaboration (2008). Antenatal psychosocial assessment for reducing perinatal mental health morbidity. New York: Wiley.

    Book  Google Scholar 

  • 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.

    Article  PubMed  Google 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 

  • Beck, C. T. (2001). Predictors of postpartum depression. An update. Nursing Research, 50(5), 275–285.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health Social Behavior, 24, 385–396.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  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.

    Article  CAS  Google 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 

  • 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.

    Article  CAS  PubMed  PubMed Central  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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google 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.

  • Milgrom, J. & Gemmill, A. W. (2014). Screening for perinatal depression. Best Practice & Research Clinical Obstetrics & Gynaecology, 28, 13–23.

    Article  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 Zealand

    Google Scholar 

  • 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.

    Article  PubMed  Google 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.

  • O’Hara, M. W., Swain, A. M. (1996). Rates and risk of postpartum depression-a meta-analysis. International Review of Psychiatry, 8, 37–54.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • Statistics New Zealand. (2004). Report of the review of the measurement of ethnicity. Wellington: Statistics New Zealand

    Google Scholar 

  • Teychenne, M., & York, R. (2013). Physical activity, sedentary behavior, and postnatal depressive symptoms: A review. American Journal of Preventive Medicine, 45(2), 217–227.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google 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 

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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.

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Authors and Affiliations

  1. Centre for Longitudinal Research, He Ara ki Mua, University of Auckland, PO Box 18288, Auckland, 1743, New Zealand

    Lisa Underwood, Stephanie D’Souza & Susan M. B. Morton

  2. School of Psychology, University of Auckland, Auckland, New Zealand

    Karen E. Waldie, Stephanie D’Souza & Elizabeth R. Peterson

  3. School of Population Health, University of Auckland, Auckland, New Zealand

    Susan M. B. Morton

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  1. Lisa Underwood
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  2. Karen E. Waldie
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  3. Stephanie D’Souza
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  5. Susan M. B. Morton
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Correspondence to Lisa Underwood.

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Underwood, L., Waldie, K.E., D’Souza, S. et al. 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. Matern Child Health J 21, 915–931 (2017). https://doi.org/10.1007/s10995-016-2191-x

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