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Published on: June 13, 2021
Antenatal risk factors for postnatal depression: a large prospective study
Jeannette Milgrom1, Alan W Gemmill, Justin L Bilszta
1Department of Psychology, School of Behavioural Science, University of Melbourne, Victoria, Australia. jeannette.milgrom@austin.org.au
Insights
Antenatal depression, previous depression, and low partner support are key predictors of postnatal depression. Early intervention targeting these factors can improve maternal mental health.
Area of Science:
- Perinatal mental health research
- Psychiatry
- Public health
Background:
- Investigated antenatal risk factors for postnatal depression in Australia.
- Utilized data from the beyondblue National Postnatal Depression Program (2002-2005).
Purpose of the Study:
- To identify and analyze antenatal risk factors for postnatal depression.
- To understand the combined and individual effects of these risk factors.
Main Methods:
- Screened pregnant women using the Edinburgh Postnatal Depression Scale (EPDS) and a psychosocial risk factor questionnaire.
- Collected antenatal data from over 35,000 women and postnatal data from over 12,000 women.
Main Results:
- 8.9% of women screened positive for antenatal depression (EPDS >12).
- 7.5% of women screened positive for postnatal depression (EPDS >12).
- Antenatal depression, prior depression history, and low partner support were significant predictors of postnatal depression.
Conclusions:
- Antenatal depressive symptoms are as prevalent as postnatal symptoms.
- Key modifiable risk factors include current depression/anxiety and social support.
- Targeting these factors offers potential for intervention to prevent postnatal depression.
Background:
This study measured antenatal risk factors for postnatal depression in the Australian population, both singly and in combination. Risk factor data were gathered antenatally and depressive symptoms measured via the beyondblue National Postnatal Depression Program, a large prospective cohort study into perinatal mental health, conducted in all six states of Australia, and in the Australian Capital Territory, between 2002 and 2005.
Methods:
Pregnant women were screened for symptoms of postnatal depression at antenatal clinics in maternity services around Australia using the Edinburgh Postnatal Depression Scale (EPDS) and a psychosocial risk factor questionnaire that covered key demographic and psychosocial information.
Results:
From a total of 40,333 participants, we collected antenatal EPDS data from 35,374 women and 3144 of these had a score >12 (8.9%). Subsequently, efforts were made to follow-up 22,968 women with a postnatal EPDS. Of 12,361 women who completed postnatal EPDS forms, 925 (7.5%) had an EPDS score >12. Antenatal depression together with a prior history of depression and a low level of partner support were the strongest independent antenatal predictors of a postnatal EPDS score >12.
Limitations:
The two main limitations of the study were the use of the EPDS (a self-report screening tool) as the measure of depressive symptoms rather than a clinical diagnosis, and the rate of attrition between antenatal screening and the collection of postnatal follow-up data.
Conclusions:
Antenatal depressive symptoms appear to be as common as postnatal depressive symptoms. Previous depression, current depression/anxiety, and low partner support are found to be key antenatal risk factors for postnatal depression in this large prospective cohort, consistent with existing meta-analytic surveys. Current depression/anxiety (and to some extent social support) may be amenable to change and can therefore be targeted for intervention.
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