Postpartum Depression: A multivariate analysis of prenatal and perinatal risk factors

1. Postpartum Depression:A multivariate analysis of prenatal and perinatal risk factors Heather Davey, MSc MCH EPI Conference, Atlanta Georgia • Acknowledgements: • Suzanne Tough, PhD • Carol Adair, PhD • Sue Ross, PhD

2. Background • Postpartum depression prevalence 10-15% • Depression within first postpartum year • Symptoms: feelings of inadequacy and inability to cope with infant, feelings of being a “bad” or unloving mother, tearfulness, feelings of guilt, appetite and sleep disturbances. • Impacts maternal well-being, marital relationships, child cognitive and behavioral development

3. Major vs. Minor Postpartum Depression • Major – presence of at least 5 symptoms of depression for at least 2 weeks • Minor - presence of at least 2 symptoms of depression for at least 2 weeks • Both are associated with compromised psychosocial functioning • Understanding women at risk of both disorders is vital to preventing the negative health outcomes for the mother, family and child.

4. Risk Factors • Depression during pregnancy • Anxiety during pregnancy • Stressful life events • Insufficient social support • History of depression

5. Limitations of the Current Research • Focus on risk factors in isolation • Retrospective designs • Small sample sizes

6. Research Questions • What combination of prenatal and early perinatal risk factors are most predictive of minor postpartum depression? • What combination of prenatal and early perinatal risk factors are most predictive of major postpartum depression?

7. Study Design • Analysis of data from a community based randomized control trial Calgary, Alberta Canada

8. Intervention • ~2000 pregnant women seeking low risk maternity services • Randomly Allocated to: • Standard of care • Standard of care + Nurse support • Standard of care + Nurse + Home Visitor support

9. Data Collection • April 2001 – July 2004 • Telephone questionnaires administered at 3 points in time: 1 2 3 First trimester 32-34 weeks gestation 3 months postpartum • 1403 women (70% completion rate) completed the postpartum depression screen during the third questionnaire

10. Postpartum Depression • Edinburgh Postnatal Depression Scale • Continuous scale from 1 to 30

11. Potential Risk Factors • Demographics • Obstetric History • Behavioral Risk • Mental Health • Psychosocial

12. Statistical Analysis • Participant Characteristics - Frequency and percentages or mean and standard deviations • Risk Factors and PPD - Chi-square test for linear trend • Multiple Risk Factors and PPD - Multivariate logistic regression modeling

13. Results • 6.5% Minor PPD • 4.5% Major PPD • The interventions in the study (additional prenatal support provided by a nurse or nurse and home visitor) had no effect on postpartum depression status.

14. Multivariate Prediction of Minor Postpartum Depression

15. Multivariate Prediction ofMajor Postpartum Depression

16. Conclusions Minor PPD • History of Depression • Mother born outside Canada • Anxiety during pregnancy • Abuse during pregnancy • Low parenting self-efficacy • Major PPD • History of Depression • Non-Caucasian mother • Social isolation during pregnancy • Abuse postpartum • Not breastfeeding at 3 months • Women at risk of both sub-clinical and major postpartum depression can be identified by similar risk factors • Women at risk of most severe depression were differentiated by postpartum abuse and not breastfeeding at 3 months.

17. Acknowledgements Support for this project was provided by: • The Canadian Institute of Health Research Training Program in Genetics, Child Development and Health • The University of Calgary Child Health Research Group • The Alberta Heritage Foundation for Medical Research • The Calgary Children’s Initiative • The Physicians Partnership Steering Committee • The Calgary Health Region