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A Population Based Survey of Infant Inconsolability and Postpartum Depression

A Population Based Survey of Infant Inconsolability and Postpartum Depression. Pamela C. High*, Rachel Cain**, Hanna Kim** and Samara Viner-Brown** Hasbro Children’s Hospital/ Brown Medical School* Division of Family Health RI Department of Health** Providence, RI

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A Population Based Survey of Infant Inconsolability and Postpartum Depression

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  1. A Population Based Survey of Infant Inconsolability and Postpartum Depression Pamela C. High*, Rachel Cain**, Hanna Kim** and Samara Viner-Brown** Hasbro Children’s Hospital/ Brown Medical School* Division of Family Health RI Department of Health** Providence, RI Presentation for Society of Developmental-Behavioral Pediatrics, Sept. 26, 2005, San Diego, CA

  2. Background • Excessive and inconsolable crying in the first few months of life has been reported in 2% to 40% of otherwise healthy infants • Postpartum depression is reported in 15-20% of new mothers • Link between early postpartum depressive symptoms and infant crying has been described

  3. Objectives • To assess the prevalence of infantile inconsolability and maternal postpartum depressive symptoms in a population based sample • To identify demographic and modifiable behavioral risk factors associated with these conditions • To determine the co-occurrence and possible relationship between infant inconsolability and maternal depressive symptoms

  4. Methods • Data was obtained from RI’s Pregnancy Risk Assessment Monitoring System (PRAMS), sponsored by the National Centers for Disease Control and Prevention (CDC) • Data was weighted to demographically represent all births in RI in 2002 and 2003 • 4,214 mothers were sampled • 2,947 responded (72% weighted response rate)

  5. Data Analysis • Chi-squared tests for bivariate analysis • Multivariate logistic regression models were used controlling for demographic variability to predict post partum depression • SUDANN software was used for this analysis

  6. Infant Demographics • 62-252 days old (mean 111 days) • 90% <152 days (<5 months) • 49 % male infants • 8.4% <37 weeks gestation • 7.2 % <2,500 grams • 37 % Breast fed (current); 70% (ever)

  7. Maternal Demographics • Age: 9.8 % <20yo 46.5 % 20-29yo 27.3 % 30-34yo 16.5 % > 35 • Race: 87.3% White, 8.2% Black, 3.2% Asian 1.1% Amer Indian 0.2% Other non-white • Hispanic Ethnicity: 22.1% • Income: 27% <$16 K, 10.1% $16-25K 14.2% $25-40 K 48.7 % > $40K • Education: 15.2% <12, 30.1% 12, 54.7% >12

  8. Maternal Demographics • Married: 64 % • Insurance: 38 % Public 61 % Private • Parity: 42% 1st Birth 58% 2nd or later • Smoking: (Current) 16% (last 3 mo) 12% • Unintended pregnancy: 36%

  9. Variable: Fussy Baby • In general, how easy is it to calm your baby when he or she is crying or fussing? Very easy 50.7% Somewhat easy 41.0% Somewhat difficult 7.2% Very difficult 1.1%

  10. Fussy Babies and Age 9.6 % 8.0 %6.8% 8.9% p= NS 2 mo. 3 mo. 4 mo. > 5 mo.

  11. Fussy Babies and Low Birth Weight 11.2 % 8.1 % p<0.001 <2,500 gm >2,500 gm No difference for VLBW <1,500 gm. (8.8% vs. 8.3%)

  12. Fussy Babies and Maternal Race 17.1 % p<0.05 7.7 % 9.4 % White Black Other (n=149)

  13. Fussy Babies • Hispanic ethnicity, maternal age, education, marital status, household income, insurance, parity, smoking and breast feeding did not predict inconsolability in these babies

  14. Variable: Post Partum Depression • In the months after your delivery, would you say that you were……. Not at all depressed 43.0% A little depressed 37.8% Moderately depressed 12.2% Very depressed 3.4% Very depressed and had to get help 3.5%

  15. Postpartum Depression and Maternal Education 21.9% 22% 16.4% p<0.01 <12 12 >12

  16. Postpartum Depression and Marital Status 23.9% 16.6% p<0.001 Unmarried Married

  17. Postpartum Depression and Household Income >$40,000 24 % p<0.0001 14.4 % <$40,000 >$40,000

  18. Postpartum Depression and Health Insurance 23.1 % 16.3 % p<0.001 Public Private

  19. Postpartum Depression and Low Birth Weight 29.2 % p<0.0001 18.4 % < 2,500 gm > 2,500 gm

  20. Postpartum Depression and Very Low Birth Weight 48.8 % p<0.0001 18.6 % < 1,500 gm > 1,500 gm

  21. Postpartum Depression and Unintended Pregnancy 22.8 % 16.8 % p<0.01 Unintended Intended

  22. Postpartum Depression and Smoking 28.9 % 27.5% 27.4% p<0.01 16.3 % 17.7% 17.4% smoke no smoke smoke no smoke smoke no smoke 3 months before last 3 months current pregnancy pregnancy

  23. Postpartum Depression and Breast Feeding 23 % 22.5% 17.4 % 12.6% p<0.01 p<0.0001 Ever BF Never BF Current BF Not BF now

  24. Postpartum Depression • Maternal age, race, Hispanic ethnicity and parity as well as infant age and sex did not predict report of depressive symptoms in these new mothers

  25. Postpartum Depression and Fussy Babies 34.7 % p<0.0001 17.4 % Fussy Consolable

  26. Fussy Babies and Postpartum Depression 15.3 % p<0.0001 6.7 % PP Depression No depression

  27. Logistic Regression:Fussy Baby AOR (95% CI) Fussy Baby • Post Partum Depression 2.58 (1.74-3.82) *** • Other Race 2.79 (1.48-5.24) ** • Infant < 2,500 grams 1.26 (1.05-1.51) * *p<0.05 **p<0.01 ***p<0.0001 Maternal age, ethnicity, marital status and education, family income, unintended pregnancy, current smoking or breast feeding and infant age did not predict postpartum depressive symptoms in this model

  28. Logistic Regression:Postpartum Depression AOR (95% CI) Postpartum Depression • Fussy Baby 2.57 (1.71-3.85)*** • Not currently breast fed 2.28 (1.64-3.16)*** • Family Income < $40,000 1.75 (1.19-2.59)** • Unintended Pregnancy1.44 (1.06-1.94) * • Infant < 2,500 grams 1.26 (1.05-1.51)* *p<0.05 **p<0.01 ***p<0.0001 Maternal age, ethnicity, race, education, marital status and current smoking as well as infant age did not predict postpartum depressive symptoms in this model

  29. Conclusions • In this population based survey, 1 in 12 babies were reported to be difficult to console by their mothers and almost 1 in 5 new mothers acknowledged postpartum depressive symptoms • Postpartum depressive symptoms were more prevalent in disadvantaged mothers

  30. Conclusions • Inconsolability was more prevalent in low birth weight infants and also in those few babies in our small but diverse “other” race category

  31. There are definitelimitations to this study • Infant inconsolability was measured by a single question posed to new mothers. No information on the amount of crying was obtained • Maternal depressive symptoms were also measured using a single question • The population sampled is that in RI and may not reflect families in other parts of the US

  32. Implications • Pediatric primary care providers are in a unique position to identify mothers who are experiencing depressive symptoms and may be effective in supporting them, counseling them and referring them for treatment

  33. Logistic Regression:Postpartum Depression (w/o child age) AOR (95% CI) Postpartum Depression • Fussy Baby 2.57 (1.72-3.85) *** • Not currently breast fed 2.22 (1.6-3.07) *** • Family Income < $40,000 1.73 (1.17-2.55) ** • Unintended Pregnancy1.43 (1.06-1.92) * • Infant < 2,500 grams 1.26 (1.05-1.51) * *p<0.05 **p<0.01 ***p<0.0001 Maternal age, ethnicity, race, marital status, current smoking and education did not predict postpartum depressive symptoms

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