Prediction of depression in the postpartum period: a longitudinal follow-up study in high-risk and low-risk women

Abstract

Aim: The present study investigates both the antenatal prediction of the occurrence of depression during the first year postpartum and the course of depression in populations at different degrees of risk. Methods: In a population-based prospective study, 1618 women were screened during mid-pregnancy for risk factors with regard to depression. High-risk and low-risk women were identified, and depression (Research Diagnostic Criteria, RDC) was assessed at 32 weeks gestation and at 3, 6, and 12 months postpartum. Results: In the high-risk group (n=97), 25% of the women were depressed during the first year postpartum compared to 6% of the low-risk women (n=87). At 3 months postpartum, significantly more high-risk (17%) than low-risk women (1%) were depressed. While prevalence rates decreased after 3 months postpartum in the high-risk group, no significant fluctuations of prevalence rates were found in the low-risk group. Two risk factors were independently predictive of depression during the postpartum period: a personal history of depression, and high depressive symptomatology during mid-pregnancy. Conclusions: Women at high risk and low risk for depression during the early postpartum period can be detected during pregnancy. High-risk women were only at particular risk during the first 3 months postpartum.

Introduction

The prevalence rate of postpartum depression in Western countries is 10–15% (O’Hara and Swain, 1996, Beck and Gable, 2001). In non-Western countries prevalence rates range from 5 to 60% (Lee et al., 1998, Cooper et al., 1999, Affonso et al., 2000), indicating that populations differ considerably in terms of risk (Henshaw, 2000). As maternal depressive symptoms may have an impact on both infant and family, continued exploration of the prevalence and degree of postpartum depressive symptomatology is important (Affonso et al., 2000). In particular, for accurate prevention, diagnosis, and treatment, more information is needed about the differences between populations with various degrees of risk in the prevalence and course of postpartum depression.

Psychosocial risk factors for postpartum depression have been identified: past history of psychopathology, psychological disturbance during pregnancy, poor relationship between the parents during childhood, poor marital relationship, low self-esteem, low socioeconomic status, low social support, stressful life events, and unwanted pregnancy (Kumar and Robson, 1984, O’Hara and Swain, 1996, Bernazzani et al., 1997, Rigetti-Veltema et al., 1998, Da Costa et al., 2000, Beck, 2001, Logsdon and Usui, 2001). Furthermore, studies have indicated that a family history of depression is a risk factor for postpartum depression (O’Hara et al., 1984, Watson et al., 1984, Campbell et al., 1992).

Although Appleby et al. (1994) were not successful in antenatal differentiation between women at different degrees of risk for postpartum depression, others were. Cooper et al. (1996) developed a predictive index of risk factors for postpartum depression at 6–10 weeks postpartum. Nielsen Forman et al. (2000) produced a similar index for depressive symptomatology at 4 months postpartum. However, for populations at different degrees of risk, the course of depression during the first year postpartum is not known, predominantly due to the fact that earlier research has only assessed depression on one single occasion, and only took into account a follow-up period covering the first months postpartum.

The present study investigates whether the occurrence of depression during the first year postpartum can be predicted during mid-pregnancy, and examines the course of depression in populations at different degrees of risk. This paper describes a longitudinal follow-up study in a large community sample of pregnant women in the Netherlands. Risk factors were assessed during mid-gestation. Subsequently, women with high-risk and low-risk profiles were defined and followed up during the first year postpartum involving assessment of depression at three different measurement points.