Obstetric Risk Factors for Postnatal Depression in Urban and Rural Community Samples

Objective: The objective of this study was to examine obstetric risk factors for postnatal depression in an urban and rural community sample, with concurrent consideration of personality, psychiatric history and recent life events. Methods: This was a prospective study with women planning to give birth in one of the four participating hospitals recruited antenatally. Obstetric information was obtained from the New South Wales Midwives Data Collection, completed shortly after delivery. Personality, psychiatric history and life-events information were obtained from a questionnaire, administered within 1 week postpartum. Depression status was assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale. Results: Complete data were obtained from 490 women. Several non-obstetric risk factors for the development of postnatal depression at 8 weeks postpartum were reported including: sociodemographic (up to technical college level education, rented housing, receiving a pension/benefit), personality (those who described themselves as either nervy, shy/selfconscious, obsessional, angry or a worrier), psychiatric history (familial history of mental illness, personal history of depression or anxiety or a history of depression in the participant's mother) and recent life-events (major health problem, arguments with partner and friends/relatives). None of the obstetric variables were significantly associated with increased risk for postnatal depression, but several showed marginally significant increases (multiparous women, antepartum haemorrhage, forceps and caesarean section deliveries). Conclusions: The results emphasize the importance of psychosocial risk factors for postnatal depression and suggest that most obstetric factors during pregnancy and birth do not significantly increase risk for this depression. Early identification of potential risk for postnatal depression should include assessment of sociodemography, personality, psychiatric history and recent life events, as well as past and present obstetric factors.

[1]  M. O’Hara,et al.  Predicting depressive symptomatology: cognitive-behavioral models and postpartum depression. , 1982, Journal of abnormal psychology.

[2]  P. Boyce,et al.  The Edinburgh Postnatal Depression Scale: Validation for an Australian Sample , 1993, The Australian and New Zealand journal of psychiatry.

[3]  I. Brockington,et al.  Motherhood and Mental Illness 2: Causes and Consequences , 1988 .

[4]  R E Kendell,et al.  Prospective Study of the Psychiatric Disorders of Childbirth , 1982, British Journal of Psychiatry.

[5]  C. Homer,et al.  Early discharge and risk for postnatal depression , 1998, The Medical journal of Australia.

[6]  J. Astbury,et al.  Birth events, birth experiences and social differences in postnatal depression. , 2010, Australian journal of public health.

[7]  K. Dalton.  Prospective Study into Puerperal Depression , 1971, British Journal of Psychiatry.

[8]  E. Paykel,et al.  Life Events and Social Support in Puerperal Depression , 1980, British Journal of Psychiatry.

[9]  F. Cherry,et al.  The incidence of postnatal depression in a rural area and the needs of affected women. , 1994, The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation.

[10]  M. First,et al.  User's guide for the structured clinical interview for DSM-IV axis I disorders : SCID-I : clinical version , 1997 .

[11]  M. E. Martin.  A maternity hospital study of psychiatric illness associated with childbirth , 1977, Irish journal of medical science.

[12]  M. Righetti-Veltema,et al.  Risk factors and predictive signs of postpartum depression. , 1998, Journal of affective disorders.

[13]  P. Leaf,et al.  Psychological sequelae of medical complications during pregnancy. , 1993, Pediatrics.

[14]  B. Pitt.  “Atypical” Depression Following Childbirth , 1968, British Journal of Psychiatry.

[15]  L. Murray,et al.  The role of obstetric factors in postpartum depression , 1993 .

[16]  M. O’Hara,et al.  Rates and risk of postpartum depression—a meta-analysis , 1996 .

[17]  P. Huckle,et al.  The use of Rating Scales to Identify Post-natal Depression , 1989, British Journal of Psychiatry.

[18]  S. Porter,et al.  A pilot study of postnatal depression following caesarean section using two retrospective self-rating instruments. , 1994, Journal of psychosomatic research.

[19]  A. Carothers,et al.  The Validation of the Edinburgh Post-natal Depression Scale on a Community Sample , 1990, British Journal of Psychiatry.

[20]  J. Cox,et al.  Detection of Postnatal Depression , 1987, British Journal of Psychiatry.

[21]  J. Cox,et al.  Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women. , 1996, Journal of affective disorders.

[22]  M. O’Hara,et al.  Prospective study of postpartum depression: prevalence, course, and predictive factors. , 1985, Journal of abnormal psychology.

[23]  R. Kumar,et al.  A Prospective Study of Emotional Disorders in Childbearing Women , 1984, British Journal of Psychiatry.

[24]  C T Beck,et al.  A meta-analysis of predictors of postpartum depression. , 1996, Nursing research.

[25]  G. Andrews,et al.  A Scale to Measure the Stress of Life Events* , 1976, The Australian and New Zealand journal of psychiatry.

[26]  I. Brockington,et al.  Motherhood and Mental Illness , 1982 .

[27]  J. Watson,et al.  Psychiatric Disorder in Pregnancy and the First Postnatal Year , 1984, British Journal of Psychiatry.

[28]  D. Stewart,et al.  Antenatal psychosocial risk factors associated with adverse postpartum family outcomes. , 1996, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[29]  L. Appleby,et al.  Demographic and Obstetric Risk Factors for Postnatal Psychiatric Morbidity , 1996, British Journal of Psychiatry.

[30]  C. Ballinger.  Emotional disturbance during pregnancy and following delivery. , 1982, Journal of psychosomatic research.