https://orcid.org/0000-0003-2918-0546
Abstract
Purpose
This study aimed to examine the association between social support, postpartum depression (PPD), anxiety and perceived stress among women within 12 months of childbirth in South Korea.
Methods
A cross-sectional, web-based survey was conducted from 21 to 30 September 2022 and included women within 12 months of childbirth in Chungnam Province, South Korea. A total of 1486 participants were included. Multiple linear regression models were used to evaluate the association between social support and mental health.
Results
In total, 40.0% of the participants had mild to moderate PPD; 12.0%, anxiety symptoms; and 8.2%, perceived severe stress. Social support (from family and significant others) is significantly associated with PPD, anxiety and perceived severe stress. Current maternal health problems, unplanned pregnancy and low household income were risk factors for PPD, anxiety and perceived stress. The increase in the time elapsed after childbirth showed a positive association with PPD and perceived severe stress.
Conclusions
Our findings provide insights to identify at-risk mothers and emphasize the importance of social support in families, early screening and continuous monitoring for postpartum women to prevent PPD, anxiety and stress.
Introduction
Poor maternal mental health during the postpartum period can have significant effects on the health of mothers, infants and families. Anxiety, depressive disorders and perceived stress are the most common mental health issues in females during their reproductive age [Citation1]. Approximately, 10–15% of women experience postpartum depressive symptoms, including feelings of hopelessness, lack of interest or dysphoria, with onset during the first year after delivery [Citation2]. The prevalence of postpartum depression (PPD) is 13–32% worldwide [Citation3,Citation4]. In South Korea, it is between 22.4% and 32.8%, reflected in a prospective cohort study [Citation5].
Postpartum anxiety symptoms, including increased autonomic arousal (racing heart, dry mouth or perspiration) and subjective experiences of anxious feelings, also often occur among new mothers, with an estimated 18% of women experiencing anxiety symptoms during the first three months postpartum [Citation2]. For any type of anxiety disorder, estimates of overall period prevalence in developed countries are from 8.6% to 9.9% [Citation6,Citation7]. Exposure to stressors and stress often increase during the postpartum period due to infant care demands and changing social role expectations [Citation2]. The physiological mechanisms associated with pregnancy and birth can exacerbate the maternal stress response and increase psychological problems during the perinatal period [Citation8].
PPD predictors have been investigated extensively and some reported quite consistently (e.g. marital difficulties, unplanned pregnancy, lower household income level, high maternal age, parity, being unmarried, mental disorders or trauma experience prior to pregnancy, and low social support) [Citation9]. However, there are less studies on correlates and risk factors for anxiety after delivery [Citation1]. Several studies have assessed depressive symptoms in women after the early postpartum period [Citation10,Citation11]. Maternal mental health issues or PPD symptoms decrease as the period after childbirth elapses [Citation12]. However, for some women, the onset of depressive symptoms occurs later during the first postpartum year [Citation13]. Therefore, we investigated the mental health and risk factors among women up to 12 months of childbirth.
Social support is defined as the emotional, psychological and physical support provided by another person [Citation10]. It is operationalized within different domains depending on the assessment measure and a study’s research question [Citation1]. Despite variations in the definitions of social support, existing research supports a consistent and strong relationship between social support, irrespective of the domain, and maternal mental health during the postpartum period [Citation14–16].
This study aimed to: (1) describe the sociodemographic and maternal health-related factors, social support and mental health of women within 12 months of childbirth and (2) identify the risk factors of maternal mental health problems and association between social support, PPD, anxiety and perceived stress.
Methods
Data and study population
Women in South Korea register for the Maternal and Child Health Service from 40 days before the scheduled childbirth date to 30 days after childbirth to obtain access to reproductive health, delivery and parenting services. Our study population included 5234 mothers registered for the Maternal and Child Health Service in Chungnam Province in 2022. Of these, 1490 mothers agreed to participate in the web-based survey and completed the questionnaire (response rate: 28.5%). All eligible participants provided informed consent. After excluding respondents with missing data, 1481 women were included in the analysis. We conducted a web-based, cross-sectional survey between 21 September 2022 and 30 September 2022.
Measures
Dependent variables
Postpartum depression
The Korean version of the Edinburgh Postnatal Depression Scale (K-EPDS) was used to assess whether participants had PPD. The K-EPDS is a reliable and valid assessment tool widely used to measure PPD in the Korean population [Citation17]. It consists of 10 items rated on a four-point scale. The total score ranges from 0 to 30, with higher scores indicating a higher level of PPD symptoms [Citation18]. Following previous studies, a cutoff value of 10 or higher was used to distinguish clinical PPD [Citation19]. The Cronbach α coefficient of the K-EPDS was .842.
Anxiety
The Generalized Anxiety Disorder 7-item scale (GAD-7) was used to evaluate anxiety symptoms. The GAD-7 consists of seven items rated on a four-point scale [Citation20]. The Korean version of the GAD-7 is a valid and reliable measurement [Citation21]. The total score ranges from 0 to 21, with higher scores indicating a higher level of anxiety symptoms. The score cutoff points were categorized as none/normal (0–4), mild anxiety (5–9), moderate anxiety (10–14) and severe anxiety (15–21) [Citation22]. The Cronbach α coefficient of the GAD-7 was .874.
Perceived stress
The Perceived Stress Scale (PSS) was used to assess perceived stress levels. The PSS is used for psychological assessments to measure perceived stress [Citation23]. The Korean version of the PSS is a reliable and valid instrument widely used to measure perceived stress in the Korean population [Citation24]. It consists of 10 items rated on a five-point scale. The total score ranges from 0 to 40, with higher scores indicating a higher level of perceived stress [Citation23]. Following previous studies, a cutoff value of 27 or higher was used to distinguish perceived severe stress [Citation25,Citation26]. The Cronbach α coefficient of the PSS was .861.
Independent variable
Social support
We used the Multidimensional Scale of Perceived Social Support (MSPSS) to assess the social support level [Citation27,Citation28]. We used the MSPSS (Korean version), which has good reliability, concurrent and construct validity in the Korean population [Citation29]. It measures perceived social support from three sub-factors (family, friends and significant other) [Citation30]. The inclusion of significant others is unique to the MSPSS. The significant others subscale is a strong supplement to the family and friend subscales because it evaluates a different support source [Citation28]. It consists of 12 items rated on a five-point scale. The total score ranges from 12 to 60, with higher scores indicating a higher level of perceived social support [Citation31]. Cronbach’s α coefficient of the MSPSS was .951.
Sociodemographic and maternal health-related variables
The sociodemographic factors included age, educational level, employment status and household income level. We categorized age as 20–29, 30–39 and 40–49 years, and education level as high school graduation and college or higher. Employment status was classified into three groups: employed (full- or part-time), employed/maternity leave and unemployed.
Household income was assessed by requesting participants to select the category that best described their annual household income from the following list: <1,000,000 won; ≥1,000,000 to <2,000,000 won; ≥2,000,000 to <3,000,000 won; ≥3,000,000 to <5,000,000 won; ≥5,000,000 won. The first two categories were combined in the analysis due to small sample size. Monthly household income level was categorized as <2,000,000 won, ≥2,000,000 to <3,000,000 won, ≥3,000,000 to <5,000,000 won and ≥5,000,000 won.
Maternal health-related factors included parity, method of conception, mode of delivery, time elapsed after childbirth, current maternal health problems, unplanned pregnancy and miscarriage experience. Method of conception was categorized into natural pregnancy and artificial insemination or test-tube. Modes of delivery were categorized into vaginal delivery and cesarean section. Time elapsed after childbirth was categorized into <1 month; ≥1 to <2 months; ≥2 to <3 months; ≥3 to <6 months; ≥6 to <12 months [Citation32,Citation33]. Current maternal health problems, unplanned pregnancy and miscarriage experiences were classified as yes or no.
Statistical analysis
The participants’ general characteristics were assessed using descriptive statistics. Means and standard deviations (SDs) were indicated for continuous variables and frequencies/percentages for categorical variables. The Chi-squared test and t-test were used for comparisons. Differences in variables were tested using the Chi-squared test, analysis of variance (ANOVA) or Fisher’s exact test. Fisher’s exact test was used when the expected values in any of the cells of a contingency table were <5.
Multiple linear regression analysis was applied to examine the associations between social support, PPD, anxiety and perceived severe stress levels. Estimates were analyzed for sociodemographic characteristics and maternal health-related factors: age, education level, employment status, household income level, parity, method of conception, mode of delivery, time elapsed after childbirth, unplanned pregnancy, current maternal health problems and miscarriage experience. We used SPSS software, version 25 to conduct statistical analyses (IBM, New York, NY). Statistical significance was set at p < .05.
Ethical considerations
The Institutional Review Board (IRB) approved this study (approval number: MC22ZISI0095).
Results
shows the sociodemographic characteristics and maternal health-related factors of 1486 participants. The mean age was 32.9 years (SD = 4.04; range = 20–46). Of the total, 50.2% reported that the last childbirth was their first, 91.8% had conceived spontaneously and 62.9% had a cesarean section. Of the participants, 29.3% complained of current maternal health problems, 20.2% had miscarriage experiences, 33.0% reported that their last pregnancy was unplanned and 34.4% were on temporary maternity leave. The mean MSPSS score was 48.07 (SD = 9.57). Among the sub-factors, family support scored 16.47 (3.37); friend support, 15.16 (3.99); and significant other’s support, 16.44 (3.35).
Table 1. Demographic characteristics of study participants (N = 1486).
Among the respondents, 40.0% had a mild to moderate PPD level, 12.0% anxiety symptoms and 8.2% perceived severe stress (). PPD and PSS were higher in women with lower educational levels than those with higher educational levels. Women with unplanned pregnancies had higher levels of PPD, anxiety and PSS. Among the MSPSS score, the mean (SD) of the family support, friend support and significant other’s support, was lower in women with PPD, anxiety and perceived severe stress than those without these conditions.
Table 2. Mental health of study populations (N = 1486).
The mean (SD) of K-EPDS score was 8.64 (5.93), GAD-7 score 4.43 (4.12) and PSS score 18.34 (5.92) (Supplemental Table 1).
shows the associations between sociodemographic and maternal health-related factors, social support and postpartum mental health. After adjusting for sociodemographic and maternal health-related factors, family support and significant other’s support remained significantly associated with PPD, anxiety and perceived stress. Women with a cesarean section were likely to have 0.2 points higher K-EPDS score than those with vaginal delivery. The time elapsed after childbirth showed a consistently higher PPD prevalence and perceived severe stress. Current maternal health problems and household income levels significantly associated with PPD, anxiety and perceived stress. Women who reported unplanned pregnancy were likely to have 0.8, 0.5- and 1.1-points higher K-EPDS, GAD-7 and PSS scores, respectively, than those who had planned pregnancies.
Table 3. Association between individual factors, social support, postpartum depression, anxiety and perceived stress.
Discussion
This study found that 40.0% of the participants had mild-to-moderate PPD. The PPD prevalence was significantly higher than other studies. A cohort study in South Korea showed PPD prevalence ranged from 22.4 to 32.8% [Citation5], and Japan 10–15% [Citation34]. The PPD prevalence was estimated at 13–19% worldwide [Citation35,Citation36]. However, recent studies suggested that it is approximately 50% [Citation37,Citation38].
We found that 12.0% of the participants had anxiety symptoms, and 8.2% perceived severe stress. Generalized anxiety disorder has a prevalence rate of approximately 7% at six months postpartum; it is frequently comorbid with depression and leads to significant social impairment [Citation39]. Anxiety in the postpartum period is less studied than depression. One in three primiparous women experiences either depression, anxiety or stress symptoms. However, in only a third of them, these symptoms will be identified when screening is conducted only for depression [Citation40]. Therefore, it is necessary to shift the focus from PPD only to other signs of distress and anxiety in postpartum women [Citation41].
This broad variation in the prevalence of maternal mental health may be related to diverse reporting practices, cultural variations or difference in public health services [Citation42]. Additionally, the variation in prevalence could be due to the use of diverse assessment tools to measure mental health status and having study participants at different periods after childbirth.
Our study showed time elapsed after childbirth significantly associated with PPD, anxiety and perceived stress. Specifically, the level of PPD, anxiety and perceived stress was statistically significantly higher in mothers >3 months after childbirth than those <1 month. These findings contrast with those of other studies reporting that maternal mental health issues or PPD symptoms decrease as the period after childbirth elapses [Citation39,Citation43]. As the mother’s external activities gradually increase after six months, stress may also increase, partly due to multiple, conflicting roles and responsibilities [Citation32]. Depressive symptoms after childbirth are more likely to occur from 3 to 6 months postpartum than in the first four weeks [Citation44,Citation45]. Mothers’ mental health symptoms fluctuate between various issues as they experience transitions from prenatal–postnatal to parenthood periods [Citation5]. Additionally, PPD could last for several years. Many questions regarding the course of persistent PPD, and associated factors with persistence or remission, remain unclear. Thus, monitoring and screening of maternal mental health should be ensured from pregnancy to the postpartum period.
This study also showed that a lower level of household income among mothers was associated with PPD, anxiety and perceived stress. Recent systematic reviews have found that the prevalence of mental health symptoms differs significantly according to household income level [Citation46,Citation47]. Accordingly, information on screening for mental health assessments and related support services should be preemptively provided to mothers before childbirth, considering their household income level.
We found that miscarriage and unplanned pregnancy significantly related to PPD, anxiety and perceived stress. This concurred with a study that found most mothers with mental health issues experienced stressful events, such as unplanned pregnancies [Citation38,Citation48,Citation49]. Miscarriage experiences and unplanned pregnancies can be identified prior to childbirth. Therefore, obstetricians need to identify pregnant women with risk factors and implement psychoeducation to understand and manage their mental health states during prenatal care.
We found that social support is a significant protective factor against PPD, anxiety and perceived stress [Citation7,Citation11,Citation50,Citation51]. Social support (from family, friends and significant other) can increase the mother’s ability to adjust and manage stressors after childbirth and strengthen mother–child bonding [Citation52]. Social support could be a protective factor that might reduce the effects of life stressors and increase positive mental health status under adverse circumstances [Citation8]. Family support is a key element in alleviating maternal mental health symptoms [Citation53]. When adjusting to parenthood after childbirth, the spouse’s physical and psychological support is needed by mothers for their physical and emotional recovery [Citation54].
In summary, it is necessary to provide protective social support to mothers who have given birth, provide opportunities to reduce their mental health risks, and improve their ability to manage stress. Additionally, psychosocial support services should be provided to their family and children, and individual support for the mother during the prenatal and postpartum periods. It is necessary to provide opportunities to mothers and their family members to participate in programs such as parental education during visits for regular infant checkups, and online education or counseling. Our results suggest the need for preventive screening and interventions, such as mental health management, for mothers and their families during the prenatal and postpartum periods.
This study had several limitations. First, it was a community-based study in Korea; therefore, its generalizability is limited. Second, this was a cross-sectional study, and reverse causality could not be ruled out. Third, the data were self-reported measures of maternal mental health status and other variables. Nevertheless, this study measured mental health status using scales with confirmed reliability and validity. Fourth, it was conducted during the coronavirus disease (COVID-19) pandemic. Overall, PPD, anxiety and stress levels could have been elevated during the pandemic.
Conclusions
Mental health after childbirth is often overlooked during postnatal visits, missing the critical window for early intervention. Low mood in the postpartum period is largely deemed “normal.” Our study indicated a high prevalence of and risk factors for PPD, anxiety and perceived stress among women within 12 months of childbirth in Chungnam, South Korea. This provides important insights to identify at-risk mothers and emphasizes the need for early screening and continuous monitoring. This study’s findings reinforce the importance of social support in families for postpartum women and suggest that interpersonal relationships with family members play an important role in preventing PPD through social support. Therefore, family support needs to be enhanced to reduce PPD and improve mental health.
Ethical approval
All eligible participants were surveyed using a web-based questionnaire after obtaining their informed consent. The study was approved by the Institutional Review Board (IRB) of the College of Medicine, Catholic University of Korea (approval number: MC22ZISI0095).
Author contributions
Mi-Sun Lee: conceptualization, methodology, software, validation, visualization, formal analysis, data curation, writing – original draft, writing – review and editing. Jung Jae Lee: conceptualization, data acquisition and investigation. Soyeon Park: conceptualization, methodology and data curation. Seongju Kim: methodology, software and data curation. Hooyeon Lee: conceptualization, methodology, validation, investigation, supervision, project administration, funding acquisition, writing, review and editing.
Supplemental Material
Download MS Word (12.9 KB)Acknowledgements
This study was supported by the National R&D Program for Cancer Control through the National Cancer Center (NCC) funded by the Ministry of Health & Welfare, Republic of Korea (Grant number: HA21C0225).
Disclosure statement
The authors declare no conflict of interest.
Data availability statement
The data from this study cannot be made publicly available to protect participants’ information. Inquiries about the data can be referred to the corresponding author (HY, LEE, [email protected]).
Correction Statement
This article has been corrected with minor changes. These changes do not impact the academic content of the article.
Additional information
Funding
References
- Martini J, Petzoldt J, Einsle F, et al. Risk factors and course patterns of anxiety and depressive disorders during pregnancy and after delivery: a prospective-longitudinal study. J Affect Disord. 2015;175:385–395. doi:10.1016/j.jad.2015.01.012
- Schwab-Reese LM, Schafer EJ, Ashida S. Associations of social support and stress with postpartum maternal mental health symptoms: main effects, moderation, and mediation. Women Health. 2017;57(6):723–740. doi:10.1080/03630242.2016.1181140
- Kroska EB, Stowe ZN. Postpartum depression: identification and treatment in the clinic setting. Obstet Gynecol Clin North Am. 2020;47(3):409–419. doi:10.1016/j.ogc.2020.05.001
- Stewart DE, Vigod SN. Postpartum depression: pathophysiology, treatment, and emerging therapeutics. Annu Rev Med. 2019;70:183–196. doi:10.1146/annurev-med-041217-011106
- Yoo H, Ahn S, Park S, et al. Factors influencing prenatal and postpartum depression in Korea: a prospective cohort study. Korean J Women Health Nurs. 2021;27(4):326–336. doi:10.4069/kjwhn.2021.11.17
- Nakano M, Sourander A, Luntamo T, et al. Early risk factors for postpartum depression: a longitudinal Japanese population-based study. J Affect Disord. 2020;269:148–153. doi:10.1016/j.jad.2020.03.026
- Zhang Y, Jin S. The impact of social support on postpartum depression: the mediator role of self-efficacy. J Health Psychol. 2016;21(5):720–726. doi:10.1177/1359105314536454
- Mollard E, Kupzyk K, Moore T. Postpartum stress and protective factors in women who gave birth in the United States during the COVID-19 pandemic. Womens Health. 2021;17:17455065211042190. doi:10.1177/17455065211042190
- Howard LM, Molyneaux E, Dennis C-L, et al. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384(9956):1775–1788. doi:10.1016/S0140-6736(14)61276-9
- Eslahi Z, Bahrami N, Allen K-A, et al. Spouse’s social support in the postpartum period, predictors and its relationship with postpartum depression in a sample of Iranian primiparous women. Int J Gynaecol Obstet. 2021;154(1):24–30. doi:10.1002/ijgo.13488
- Mercan Y, Tari Selcuk K. Association between postpartum depression level, social support level and breastfeeding attitude and breastfeeding self-efficacy in early postpartum women. PLOS One. 2021;16(4):e0249538. doi:10.1371/journal.pone.0249538
- Falah-Hassani K, Shiri R, Vigod S, et al. Prevalence of postpartum depression among immigrant women: a systematic review and meta-analysis. J Psychiatr Res. 2015;70:67–82. doi:10.1016/j.jpsychires.2015.08.010
- Goodman JH. Postpartum depression beyond the early postpartum period. J Obstet Gynecol Neonatal Nurs. 2004;33(4):410–420. doi:10.1177/0884217504266915
- Feinberg E, Declercq E, Lee A, et al. The relationship between social support and postnatal anxiety and depression: results from the listening to mothers in California survey. Womens Health Issues. 2022;32(3):251–260. doi:10.1016/j.whi.2022.01.005
- Tani F, Castagna V. Maternal social support, quality of birth experience, and post-partum depression in primiparous women. J Matern Fetal Neonatal Med. 2017;30(6):689–692. doi:10.1080/14767058.2016.1182980
- Leung BMY, Letourneau NL, Giesbrecht GF, et al. Predictors of postpartum depression in partnered mothers and fathers from a longitudinal cohort. Community Ment Health J. 2017;53(4):420–431. doi:10.1007/s10597-016-0060-0
- Kim YK, Hur JW, Kim KH, et al. Clinical application of Korean version of Edinburgh Postnatal Depression Scale. J Korean Neuropsychiatr Assoc. 2008;47:36–44.
- Cox JL, Holden JM, Henshaw C. Perinatal mental health: the Edinburg Postnatal Depression Scale (EPDS) manual. London (UK): RCPsych; 2014.
- Benvenuti P, Ferrara M, Niccolai C, et al. The Edinburgh Postnatal Depression Scale: validation for an Italian sample. J Affect Disord. 1999;53(2):137–141. doi:10.1016/s0165-0327(98)00102-5
- Huang X-J, Ma H-Y, Wang X-M, et al. Equating the PHQ-9 and GAD-7 to the HADS Depression and Anxiety Subscales in patients with major depressive disorder. J Affect Disord. 2022;311:327–335. doi:10.1016/j.jad.2022.05.079
- Seo JG, Park SP. Validation of the generalized anxiety disorder-7 (GAD-7) and GAD-2 in patients with migraine. J Headache Pain. 2015;16:97. doi:10.1186/s10194-015-0583-8
- Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. doi:10.1001/archinte.166.10.1092
- Katus L, Foley S, Murray AL, et al. Perceived stress during the prenatal period: assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity. Arch Womens Ment Health. 2022;25(3):633–640. doi:10.1007/s00737-022-01229-5
- Lee J, Shin C, Ko YH, et al. The reliability and validity studies of the Korean version of the Perceived Stress Scale. Korean J Psychosom Med. 2012;20(2):127–134.
- Lee E-H, Chung BY, Suh C-H, et al. Korean versions of the Perceived Stress Scale (PSS-14, 10 and 4): psychometric evaluation in patients with chronic disease. Scand J Caring Sci. 2015;29(1):183–192. doi:10.1111/scs.12131
- Lee H, Choi D, Lee JJ. Depression, anxiety, and stress in Korean general population during the COVID-19 pandemic. Epidemiol Health. 2022;44:e2022018. doi:10.4178/epih.e2022018
- Santiago PHR, Quintero A, Haag D, et al. Drop-the-p: Bayesian CFA of the Multidimensional Scale of Perceived Social Support in Australia. Front Psychol. 2021;12:542257. doi:10.3389/fpsyg.2021.542257
- Cartwright AV, Pione RD, Stoner CR, et al. Validation of the Multidimensional Scale of Perceived Social Support (MSPSS) for family caregivers of people with dementia. Aging Ment Health. 2022;26(2):286–293. doi:10.1080/13607863.2020.1857699
- Park H, Nguyen T, Park H. Validation of Multidimensional Scale of Perceived Social Support in middle-aged Korean women with diabetes. Asia Pac J Soc Work. 2012;22(3):202–213. doi:10.1080/02185385.2012.691719
- Cho H, Lee K, Choi E, et al. Association between social support and postpartum depression (vol 12, 3128, 2022). Sci Rep. 2022;12(1):3128. doi:10.1038/s41598-022-07248-7
- Shin JS, Lee YB. The effects of social supports on psychosocial well-being of the unemployed. Korean J Soc Welfare. 1999;37:241–269.
- Bahadoran P, Tirkesh F, Oreizi HR. Association between physical activity 3–12 months after delivery and postpartum well-being. Iran J Nurs Midwifery Res. 2014;19(1):82–87.
- Jin Y, Coad J, Pond R, et al. Selenium intake and status of postpartum women and postnatal depression during the first year after childbirth in New Zealand – Mother and Infant Nutrition Investigation (MINI) study. J Trace Elem Med Biol. 2020;61:126503. doi:10.1016/j.jtemb.2020.126503
- Ando H, Shen J, Morishige K-I, et al. Association between postpartum depression and social support satisfaction levels at four months after childbirth. Arch Psychiatr Nurs. 2021;35(4):341–346. doi:10.1016/j.apnu.2021.03.010
- O'Hara MW, McCabe JE. Postpartum depression: current status and future directions. Annu Rev Clin Psychol. 2013;9:379–407. doi:10.1146/annurev-clinpsy-050212-185612
- Ukatu N, Clare CA, Brulja M. Postpartum depression screening tools: a review. Psychosomatics. 2018;59(3):211–219. doi:10.1016/j.psym.2017.11.005
- Shorey S, Chee CYI, Ng ED, et al. Prevalence and incidence of postpartum depression among healthy mothers: a systematic review and meta-analysis. J Psychiatr Res. 2018;104:235–248. doi:10.1016/j.jpsychires.2018.08.001
- Norhayati MN, Hazlina NHN, Asrenee AR, et al. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord. 2015;175:34–52. doi:10.1016/j.jad.2014.12.041
- Brief scales to detect postpartum depression and anxiety symptoms. J Women’s Health. 2012;21(12):1237–1243.
- Miller RL, Pallant JF, Negri LM. Stress in the postpartum: is there more to postnatal distress than depression. BMC Psychiatry. 2006;6:12. doi:10.1186/1471-244X-6-12
- Nakić Radoš S, Brekalo M, Matijaš M. Measuring stress after childbirth: development and validation of the Maternal Postpartum Stress Scale. J Reprod Infant Psychol. 2023;41(1):65–77. doi:10.1080/02646838.2021.1940897
- Wang Z, Liu J, Shuai H, et al. Mapping global prevalence of depression among postpartum women (vol 11, 543, 2021). Transl Psychiatry. 2021;11(1):543. doi:10.1038/s41398-021-01663-6
- Mori T, Tsuchiya KJ, Matsumoto K, et al. Psychosocial risk factors for postpartum depression and their relation to timing of onset: the Hamamatsu Birth Cohort (HBC) study. J Affect Disord. 2011;135(1–3):341–346. doi:10.1016/j.jad.2011.07.012
- Hoffman C, Dunn DM, Njoroge WFM. Impact of postpartum mental illness upon infant development. Curr Psychiatry Rep. 2017;19(12):100. doi:10.1007/s11920-017-0857-8
- Aoyagi SS, Tsuchiya KJ. Does maternal postpartum depression affect children’s developmental outcomes? J Obstet Gynaecol Res. 2019;45(9):1809–1820. doi:10.1111/jog.14064
- Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and health predictors of national postpartum depression prevalence: a systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front Psychiatry. 2017;8:248. doi:10.3389/fpsyt.2017.00248
- Upadhyay RP, Chowdhury R, Sarkar K, et al. Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ. 2017;95(10):706–717C. doi:10.2471/BLT.17.192237
- Bener A, Gerber LM, Sheikh J. Prevalence of psychiatric disorders and associated risk factors in women during their postpartum period: a major public health problem and global comparison. Int J Womens Health. 2012;4:191–200. doi:10.2147/IJWH.S29380
- Youn JH, Jeong IS. Predictors of postpartum depression: prospective cohort study. J Korean Acad Nurs. 2013;43(2):225–235. doi:10.4040/jkan.2013.43.2.225
- Negron R, Martin A, Almog M, et al. Social support during the postpartum period: mothers’ views on needs, expectations, and mobilization of support. Matern Child Health J. 2013;17(4):616–623. doi:10.1007/s10995-012-1037-4
- Csatordai S, Kozinszky Z, Devosa I, et al. Obstetric and sociodemographic risk of vulnerability to postnatal depression. Patient Educ Couns. 2007;67(1–2):84–92. doi:10.1016/j.pec.2007.02.004
- Mann JR, Mannan J, Quiñones LA, et al. Religion, spirituality, social support, and perceived stress in pregnant and postpartum Hispanic women. J Obstet Gynecol Neonatal Nurs. 2010;39(6):645–657. doi:10.1111/j.1552-6909.2010.01188.x
- Kizilirmak A, Calpbinici P, Tabakan G, et al. Correlation between postpartum depression and spousal support and factors affecting postpartum depression. Health Care Women Int. 2021;42(12):1325–1339.
- Bell AF, Andersson E. The birth experience and women’s postnatal depression: a systematic review. Midwifery. 2016;39:112–123. doi:10.1016/j.midw.2016.04.014