Psychosocial risk factors and treatment of new onset and recurrent depression during the post-partum period

Abstract

Background: When developing maternity care services, it is important to know how psychosocial factors affect the course of post-partum depression (PPD), and how depressed mothers are treated. Aims: The aim of this study is to assess how adverse childhood experiences, poor present support and violence, and low socioeconomic status (SES) associate with PPD, specifically in new onset and recurrent post-partum depression. The second aim is to assess the treatment received for PPD.

Methods: This is a cross-sectional study. The study group comprises 104 mothers with a current episode of PPD, and a control group of 104 mothers without an episode. The Structured Clinical Interview for DSM-IV Axis I Disorders was used for data collection. Psychosocial risk factors, treatment issues, and the course of depression were assessed with a structured self-report questionnaire.

Results: In age-adjusted multivariate analyses, adverse childhood experiences, a low level of present support in close relationships, and a poor SES were associated significantly with PPD. Childhood adversity was associated with both new onset and recurrent depression. Nevertheless, a low level of support and a poor SES were also associated with recurrent depression. A quarter of mothers with a major depressive episode in the post-partum period attended psychiatric services. In mothers with new onset depression, the proportion was only 5%.

Conclusions: There is an urgent need to develop the diagnostics of depression in maternity care services. An awareness of psychosocial risk factors might help in this. More depressed mothers should be referred to psychiatric services.

Keywords:

• Postpartum depression
• violence
• risk factor
• maternity care

Acknowledgements

This study was supported with an EVO (special state funding) grant from North Karelia Central Hospital and Päijät-Häme Central Hospital. We wish to thank Eeva Koistinen, MD, PhD, Department of Obstetrics and Gynaecology at North Karelia Central Hospital, for participating in the conception of the study and the primary healthcare nurses at the antenatal clinics in Joensuu for recruiting the participants for the psychiatric assessments.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This study was supported with an Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland) by North Karelia Central Hospital and Päijät-Häme Central Hospital.