Research reportPrediction of depression in the postpartum period: a longitudinal follow-up study in high-risk and low-risk women
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.
Section snippets
High risk and low risk for depression
A risk profile of depression was a priori defined as follows: (i) poor relationship between the parents during the participant’s childhood, (ii) family history (first degree) of depression, (iii) personal history of depression, or (iv) high depressive symptomatology during mid-pregnancy (>11 on the Edinburgh Postnatal Depression Scale; EPDS). Women who reported positive on one of these four risk factors were assigned to the high-risk group. Those reporting none of the first three risk factors
Sample characteristics
From Table 1, it can be seen that there were no significant differences between the high-risk and low-risk group with regard to demographic characteristics.
In the high-risk group, the most commonly reported risk factor (63%) was a personal history of depression (Table 1). Moreover, in the high-risk group, 47% of the participants reported only one risk factor, 35% a combination of two factors, and 18% a combination of three or more factors. A total of 75% of the women in the high-risk group
Discussion
Prediction during mid-pregnancy of the occurrence of postpartum depression depends on the time of assessment of depression postnatally.
Our results confirm and extend those obtained by Cooper et al. (1996) and Nielsen Forman et al. (2000): we found that differentiation between women at high and low risk of postpartum depression proves to be possible. In addition, the present study shows that differentiation is limited to depression in the early 3-month postpartum period, excluding the later 6-
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