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.
Similar content being viewed by others
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.
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.
Barber, C. C. (2009). Perinatal mental health care in New Zealand: The promise of beginnings. New Zealand Journal of Psychology, 38, 32–38.
Beck, C. T. (2001). Predictors of postpartum depression. An update. Nursing Research, 50(5), 275–285.
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.
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.
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.
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.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health Social Behavior, 24, 385–396.
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.
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.
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.
Dennis, C. L., & Dowswell, T. (2013). Psychosocial and psychological interventions for preventing postpartum depression. Cochrane Database of Systematic Reviews (Online), 28(2), CD001134.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Ministry of Health. (2003). District Health Board toolkit: Physical Activity. Wellington: New Zealand Ministry of Health.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
Statistics New Zealand. (2004). Report of the review of the measurement of ethnicity. Wellington: Statistics New Zealand
Teychenne, M., & York, R. (2013). Physical activity, sedentary behavior, and postnatal depressive symptoms: A review. American Journal of Preventive Medicine, 45(2), 217–227.
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.
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.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-016-2191-x