Investigating Risk Factors for Postpartum Depression

Postpartum depression is not a uniform phenomenon. It can begin at different times and can follow several distinct trajectories, according to a study published in the Journal of Women’s Health.

A team of researchers headed by Jennifer McCall-Hosenfeld, MD, MSc, Assistant Professor of Medicine, Pennsylvania State University College of Medicine, identified and characterized six different depression paths based on their analysis of participants in The First Baby Study, a cohort of women pregnant with their first baby. Women (n=2 802) completed telephone surveys measuring depression during the mother’s third trimester, and then at 1, 6, and 12 months postpartum.

The researchers estimated “distinct, group-based developmental trajectories of depression”, and determined the impact of maternal characteristics on trajectory group membership.

Women with a history of anxiety or depression, single marital status, and inadequate social support had the highest likelihood of belonging to the trajectories representing the most depressed groups. Most depression trajectories remained stable or were slightly decreased over time. However, 1.7% of women were not depressed at baseline, but developed depression or became increasingly depressed during the postpartum period.

Mothers with no risk factors (ie, no history of anxiety or depression, strong social support, and being married) had a probability of 30% of belonging to trajectory group 1 (those with the lowest depression trajectory), and a low probability (0.04%) of belonging to trajectory group 6 (those with the highest depression trajectory). In contrast, mothers with all three risk factors (ie, history of anxiety or depression, inadequate social support, and unattached marital status) had a low probability (1%) of belonging to trajectory group 1, compared with a relatively higher probability (11%) of belonging to trajectory group 6.

“A mother with these three risk factors had substantially higher probability of belonging to the trajectory group that was always depressed, relative to a mother with no risk factors,” the researchers observed.

They acknowledged that additional risk factors, such as peripartum or delivery complications, significant stressful life events occurring in the postpartum period, and variation in the hormonal milieu, were not measured in their study. Moreover, participants in their cohort tended to be more educated and of higher socioeconomic study than other women in the state of Pennsylvania. The study also did not adequately account for racial and ethnic categories. These concerns limit the generalizability of the findings, they stated.

However, investigators regarded their findings as clinically important, highlighting “a need for further awareness of risk factors that may predispose women to become depressed during the postpartum period, and the implementation of early intervention strategies.” They encouraged the use of “promising models,” such as “home visits and further education for mothers with inadequate social support and who are not married.”

Reference

McCall-Hosenfeld JS, Phiri K, Schaefer E, et al. Trajectories of depressive symptoms throughout the peri- and postpartum period: results from the first baby study. J Womens Health (Larchmt). 2016. PMID: 27310295