Mental vulnerability before and depressive symptoms during pregnancy and postpartum: a prospective population-based cohort study from general practice

Abstract

Purpose

The aim was to investigate and compare the prevalence of symptoms of depression throughout pregnancy and postpartum among women who at the first pregnancy consultation had (1) record of mental disease, (2) self-reported psychological difficulties but no record of mental disease, or (3) no mental vulnerability.

Materials and methods

Prospective cohort study. An electronic questionnaire containing the Major Depression Inventory (MDI) was e-mailed to 1494 pregnant women after the first, second and third prenatal care consultation and eight weeks postpartum. High depression score was considered present with MDI scores of 21 or more. Information on sociodemographic, somatic comorbidities and previous psychiatric disorders was collected. We used logistic regression to estimate odds ratios with 95% confidence intervals.

Results

The overall prevalence of symptoms of depression (MDI ≥ 21) dropped throughout pregnancy. At the first prenatal care consultation the prevalence was 15.3%, 10.7% in the second trimester, 9.3% in the third trimester and 5.6% postpartum. Logistic regression showed increased risk of symptoms of depression throughout pregnancy and postpartum for both women with mental disease and psychological difficulties. For each outcome, the increase in odds for the psychological difficulties group was about one third of the increase in odds for the mental illness group.

Conclusions

Self-reported psychological difficulties may indicate higher odds of depressive symptoms. The healthcare staff meeting the pregnant women in early pregnancy have a good opportunity to identify this subgroup of vulnerable women by means of the Pregnancy Health Records and additional questions exploring women’s experiences with previous psychological difficulties.

Keywords:

• Pregnancy
• psychological difficulties
• mental vulnerability
• depression
• general practitioner

Acknowledgments

Per Bech passed away during the writing of this paper. He has contributed with an inspiring discussion based on his great knowledge of clinical psychiatry and psychometry. He was inspiring, visionary, energetic and helpful. He was highly respected, and we have lost a fantastic colleague.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Novo Nordic Foundation under [Grant: NNF130C0002689], Region Zealand under [Grant: 15-000342], the Danish General Practice Foundation under [Grant: EMN-2017-00265], A.P. Møller Foundation under [Grant: 14516093], Lilly and Herbert Hansen Foundation under [Grant: 082], Jacob and Orla Madsen Foundation under [Grant: 11.maj.2015].

Notes on contributors

Ruth K. Ertmann

Ruth Kirk Ertmann, MD, Associated professor; Research Unit for General Practice, and Section of General Medical Practice; University of Copenhagen, Copenhagen, Denmark.

Bente K. Lyngsøe

Bente Kjær Lyngsøe, MD, PhD; Research Unit for General. Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus, Denmark.

Dagny R. Nicolaisdottir

Dagny R Niclaisdottie, Data manager; Research Unit for General Practice, and Section of General Medical Practice; University of Copenhagen, Copenhagen, Denmark.

Jakob Kragstrup

Jakob Kragstrup, MD, professor Research Unit for General Practice, and Section of General Medical Practice; University of Copenhagen, Copenhagen, Denmark.

Volkert Siersma

Volkert Siersma, Staticien PhD, Statistics; Research Unit for General Practice, and Section or General Medical Practice; University of Copenhagen, Copenhagen, Denmark.