Neighborhood socioeconomic disadvantage and antenatal depressive symptoms

We evaluated whether neighborhood-level socioeconomic disadvantage was associated with mid-pregnancy antenatal depressive symptoms.

We conducted a secondary analysis of data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be, a prospective cohort of nulliparous pregnant individuals. The exposure was socioeconomic disadvantage by the Area Deprivation Index (ADI) categorized by tertile, with the least deprived tertile (T1) as the reference. The ADI was calculated per participant residential address in early pregnancy geocoded at the block group level. The outcome was depressive symptoms assessed between 22 and 29 weeks as a score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS), and secondarily as a score ≥ 13. Multivariable modified Poisson regression was used and adjusted for age, individual-level social determinants of health, and the EPDS score in early pregnancy.

Of 8678 nulliparous individuals, the median ADI score was 38.0 (interquartile range [IQR]: 18.0, 69.0). A total of 16.1 % of individuals had an EPDS score ≥ 10, and 6.5 % had an EPDS score ≥ 13 at a median gestational age of 26.9 weeks. Individuals who lived in a neighborhood with the highest tertile of ADI were more likely to have a score ≥ 10 compared with those in the lowest tertile (21.6 % vs. 11.7 %; adjusted risk ratio [aRR]: 1.29; 95 % CI: 1.12, 1.50). The association was similar at the higher EPDS screening threshold ≥13 (9.9 % vs. 3.8 %; aRR: 1.60; 95 % CI: 1.23, 2.09). These results held in sensitivity analyses, including without adjusting for the EPDS in early pregnancy, when adjusting for additional clinical characteristics, when analyzing the ADI in declines and as a continuous variable, and when analyzing the ADI per national tertile cutoffs.

Neighborhood-level socioeconomic disadvantage was associated with an increased risk of screening positive for elevated antenatal depressive symptoms in mid-pregnancy.