Abstract
Up to 50% of mothers report postpartum depressive symptoms yet providers do a poor job predicting and preventing their occurrence. Our goal was to identify modifiable factors (situational triggers and buffers) associated with postpartum depressive symptoms. Observational prospective cohort telephone study of 563 mothers interviewed at 2 weeks and 6 months postpartum. Mothers reported on demographic factors, physical and emotional symptoms, daily function, infant behaviors, social support, and skills in managing infant and household. Mothers were categorized into four groups based on the presence of depressive symptoms at 2 weeks and at 6 months postpartum: never, always, late onset, and remission groups. Fifty-two percent did not have depressive symptoms at 2 weeks or at 6 months (never group), 14% had symptoms at both time points (always group), 10% had late onset, and 24% had early onset of symptoms with remission. As compared with women in the never group, women in the always and late onset groups had high-risk characteristics (e.g., past history of depression), more situational triggers (e.g., physical symptoms), and less robust social and personal buffers (i.e., social support and self-efficacy). As compared with the never group, mothers in the remission group had more situational triggers and fewer buffers initially. Changes in situational triggers and buffers were different for the four groups and were correlated with group membership. Situational triggers such as physical symptoms and infant colic, and low levels of social support and self-efficacy in managing situational demands are associated with postpartum depressive symptoms. Further research is needed to investigate whether providing education about the physical consequences of childbirth, providing social support, and teaching skills to enhance self-efficacy will reduce the incidence of postpartum symptoms of depression.
Similar content being viewed by others
References
Beeghly M, Olson KL, Weinberg MK, Pierre SC, Downey N, Tronick EZ (2003) Prevalence, stability, and socio-demographic correlates of depressive symptoms in Black mothers during the first 18 months postpartum. Matern Child Health J 7(3):157–168
Bennett IM, Coco A, Coyne JC et al (2008) Efficiency of a two-item pre-screen to reduce the burden of depression screening in pregnancy and postpartum: an IMPLICIT network study. J Am Board Fam Med 21(4):317–325
Brown S, Lumley J (2000) Physical health problems after childbirth and maternal depression at six to seven months postpartum. BJOG 107:1194–1201
Cogill SR, Caplan HL, Alexandra H, Robson KM, Kumar R (1986) Impact of maternal postnatal depression on cognitive development of young children. Br Med J (Clin Res Ed) 292(6529):1165–1167
Cohen S, Wills TA (1985) Stress, social support, and the buffering hypothesis. Psychol Bull 98(2):310–357
Dennis CL (2004) Influence of depressive symptomatology on maternal health service utilization and general health. Arch Women Ment Health 7(3):183–191
Eberhard-Gran M, Eskild A, Tambs K, Samuelsen SO, Opjordsmoen S (2002) Depression in postpartum and non-postpartum women: prevalence and risk factors. Acta Psychiatr Scand 106(6):426–433
Fawcett J, Tulman L, Myers ST (1988) Development of the inventory of functional status after childbirth. J Nurse Midwifery 33(6):252–260
Field T (1998) Maternal depression effects on infants and early interventions. Prev Med 27(2):200–203
Field T, Healy B, Goldstein S et al (1988) Infants of depressed mothers show “depressed” behavior even with nondepressed adults. Child Dev 59(6):1569–1579
Fox J (1997) Applied regression analysis, linear models, and related methods. Sage, Thousand Oaks, CA
Gotlib IH, Whiffen VE, Wallace PM, Mount JH (1991) Prospective investigation of postpartum depression: factors involved in onset and recovery. J Abnorm Psychol 100(2):122–132
Holden JM, Sagovsky R, Cox JL (1989) Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression. BMJ 298(6668):223–226
Howell EA, Mora P, Leventhal H (2006) Correlates of early postpartum depressive symptoms. Matern Child Health J 10(2):149–157
Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613
Kroenke K, Spitzer RL, Williams JB (2003) The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 41(11):1284–1292
Leventhal EA, Leventhal H, Shacham S, Easterling DV (1989) Active co** reduces reports of pain from childbirth. J Consult Clin Psychol 57(3):365–371
Löwe B, Kroenke K, Gräfe K (2005) Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res 58(2):163–171
Lundy BL, Jones NA, Field T et al (1999) Prenatal depression effects on neonates. Infant Behav Dev 22(1):119–129
Mayberry LJ, Affonso DD (1993) Infant temperament and postpartum depression: a review. Health Care Women Int 14(2):201–211
McLearn KT, Minkovitz CS, Strobino DM, Marks E, Hou W (2006) Maternal depressive symptoms at 2 to 4 months post partum and early parenting practices. Arch Pediatr Adolesc Med 160(3):279–284
Murray L (1992) The impact of postnatal depression on infant development. J Child Psychol Psychiatry 33(3):543–561
Pfost KS, Stevens MJ, Lum CU (1990) The relationship of demographic variables, antepartum depression, and stress to postpartum depression. J Clin Psychol 46(5):588–592
Righetti-Veltema M, Conne-Perreard E, Bousquet A, Manzano J (1998) Risk factors and predictive signs of postpartum depression. J Affect Disord 49(3):167–180
Righetti-Veltema M, Bousquet A, Manzano J (2003) Impact of postpartum depressive symptoms on mother and her 18-month-old infant. Eur Child Adolesc Psychiatry 12(2):75–83
Ross LE, Gilbert Evans SE, Sellers EM, Romach MK (2003) Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Arch Womens Ment Health 6:51–57
Seguin L, Potvin L, St-Denis M, Loiselle J (1999) Depressive symptoms in the late postpartum among low socioeconomic status women. Birth 26(3):157–163
Vera M, Alegria M, Freeman D, Robles RR, Rios R, Rios CF (1991) Depressive symptoms among Puerto Ricans: Island poor compared with residents of the New York City area. Am J Epidemiol 134(5):502–510
Ware J Jr, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233
Webster J, Pritchard MA, Linnane JW, Roberts JA, Hinson JK, Starrenburg SE (2001) Postnatal depression: use of health services and satisfaction with health-care providers. J Qual Clin Pract 21(4):144–148
Whooley MA, Avins AL, Miranda J, Browner WS (1997) Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med 12(7):439–445
Zayas LH, Cunningham M, McKee MD, Jankowski KR (2002) Depression and negative life events among pregnant African-American and Hispanic Women. Women’s Health Issues 12(1):16–21
Acknowledgements
Supported by Agency for Healthcare Research and Quality and Robert Wood Johnson Foundation grants.
The opinions, view, and conclusions expressed in this article are those of the authors and not necessarily those of the Robert Wood Johnson Foundation or Agency for Healthcare Research and Quality.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Howell, E.A., Mora, P.A., DiBonaventura, M.D. et al. Modifiable factors associated with changes in postpartum depressive symptoms. Arch Womens Ment Health 12, 113–120 (2009). https://doi.org/10.1007/s00737-009-0056-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-009-0056-7