Risk Factors for Sub-Clinical and Major Postpartum Depression Among a Community Cohort of Canadian Women

Decision Support Research Team, Calgary Health Region, Child Development Centre, c/o 2888 Shaganappi Trail NW, Calgary, AB, Canada, T3B 6A8.
Maternal and Child Health Journal (Impact Factor: 2.24). 03/2008; 15(7):866-75. DOI: 10.1007/s10995-008-0314-8
Source: PubMed


To identify prenatal and perinatal factors that predict women at risk of sub-clinical and major postpartum depression among a cohort of low medical risk pregnant women in Canada.
Data from 1,403 women who completed a randomized controlled trial of supplementary support during pregnancy was analyzed to identify risk factors for sub-clinical and major postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS), completed at eight weeks postpartum, was used to classify each woman's depression symptom severity. Demographic, obstetric, behavioral risk, mental health and psychosocial factors were considered. Multiple logistic regression analyses were used to identify risk factors most predictive of sub-clinical and major postpartum depression.
After adjustment for other covariates, variables that increased the risk of sub-clinical postpartum depression included a history of depression (OR = 2.27, CI = 1.42-3.63), anxiety symptoms during pregnancy (OR = 2.12, CI = 1.09-4.11), being born outside Canada (OR = 1.87, CI = 1.17-3.00), and low parenting self-efficacy (OR = 1.65, CI = 1.06-2.55). Variables that increased the risk of major postpartum depression included a history of depression (OR = 2.78, CI = 1.56-4.97), being born outside Canada (OR = 2.97, CI = 1.70-5.17), depressive symptoms during pregnancy (OR = 2.83, CI = 1.29-6.19) and not breastfeeding at eight weeks postpartum (OR = 2.12, CI = 1.21-3.70).
A history of depression and being born outside Canada predicted women who were at an increased risk of sub-clinical and major postpartum depression. The remaining risk factors specific to sub-clinical and major postpartum depression suggest some differences between women vulnerable to sub-clinical compared to major depressive symptoms in the postpartum period, which may have implications for targeted screening and intervention strategies.

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    • "Two analyses of data from the Canadian Maternity Experiences Survey, conducted during the 2006 Canadian census, concluded that postpartum depression (PPD) symptomatology has a prevalence ratio of 2.42 (confidence interval (CI) 1.89 to 3.06) for recent immigrants as compared to Canadian-born women of European descent [7] and that interventions for PPD symptomatology should target immigrant and adolescent mothers due to these groups’ higher risk [8]. Moreover, the aforementioned level of increased risk may be conservative since other studies have found relative risks for depressive symptomatology of four-to-five times for refugee and immigrant women, respectively [9] and an odds ratio of 2.97 (CI 1.70 to 5.17) for major PPD [10]. These statistics urge more attention to the timely identification and appropriate treatment of PPD among immigrant women. "
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    ABSTRACT: Literature documents that immigrant women in Canada have a higher prevalence of postpartum depression symptomatology than Canadian-born women. There exists a need to synthesize information on the contextual factors and social determinants of health that influence immigrant women's reception of and behavior in accessing existing mental health services. Our research question is: what are the ethnoculturally defined patterns of help-seeking behaviors and decision-making and other predictive factors for therapeutic mental health care access and outcomes with respect to postpartum depression for immigrant women in Canada?Methods/design: Our synthesis incorporates a systematic review using narrative synthesis of reports (peer- and non-peer reviewed) of empirical research and aims to provide stakeholders with perspectives on postpartum mental health care services as experienced by immigrant women. To reach this goal we are using integrated knowledge translation, thus partnering with key stakeholders throughout the planning, implementation and dissemination stages to ensure topic relevancy and impact on future practice and policy. The search and selection strategies draw upon established systematic review methodologies as outlined by the Centre for Reviews and Dissemination and also incorporate guidelines for selection and appraisal of gray literature. Two search phases (a database and a gray literature phase) will identify literature for screening and final selection based on an inclusion/exclusion checklist. Quality appraisal will be performed using the tools produced by the Centre for Evidence Based Management. The narrative synthesis will be informed by Popay et al.'s (2006) framework using identified tools for each of its four elements. The integrated knowledge translation plan will ensure key messages are delivered in an audience-specific manner to optimize their impact on policy and practice change throughout health service, public health, immigration and community sectors. The narrative synthesis methodology will facilitate understandings and acknowledgement of the broader influences of theoretical and contextual variables, such as race, gender, socio-economic status, pre-migration history and geographical location. Our review aims to have a substantive and sustainable impact on health outcomes, practice, programs and/or policy in the context of postpartum mental health of immigrant women. PROSPERO registration number CRD42012003020.
    Full-text · Article · Aug 2013 · Systematic Reviews
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    • "Gagnon et al. (2007) demonstrated that having additional support in health and social supports was higher for immigrant women living in Toronto or Montreal, than for those living in Vancouver, suggesting some geographical variation. Being born outside Canada predicted women who were at an increased risk of sub-clinical and major post partum depression in one study (Davey et al., 2011). Additionally , lack of informal supports (family/friends), barriers to formal supports (community groups) and limited financial resources are factors that may contribute to post partum depression in immigrants (Zelkowitz et al., 2004; O'Mahony and Donnelly, 2010). "
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    ABSTRACT: to synthesise data on immigrant women's experiences of maternity services in Canada. a qualitative systematic literature review using a meta-ethnographic approach METHODS: a comprehensive search strategy of multiple databases was employed in consultation with an information librarian, to identify qualitative research studies published in English or French between 1990 and December 2011 on maternity care experiences of immigrant women in Canada. A modified version of Noblit and Hare's meta-ethnographic theoretical approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. The seven-phase process involved comparative textual analysis of published qualitative studies, including the translation of key concepts and meanings from one study to another to derive second and third-order concepts encompassing more than that offered by any individual study. ATLAS.ti qualitative data analysis software was used to store and manage the studies and synthesise their findings. the literature search identified 393 papers, of which 22 met the inclusion criteria and were synthesised. The literature contained seven key concepts related to maternity service experiences including social (professional and informal) support, communication, socio-economic barriers, organisational environment, knowledge about maternity services and health care, cultural beliefs and practices, and different expectations between health care staff and immigrant women. Three second-order interpretations served as the foundation for two third-order interpretations. Societal positioning of immigrant women resulted in difficulties receiving high quality maternity health care. Maternity services were an experience in which cultural knowledge and beliefs, and religious and traditional preferences were highly relevant as well but often overlooked in Canadian maternity settings. in order to implement woman-centered care, to enhance access to maternity services, and to promote immigrant women's health, it is important to consider these women's social position, cultural knowledge and beliefs, and traditional customs in the health care.
    Full-text · Article · Aug 2013 · Midwifery
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    • "y yn nn ni ik ki i r ry yz zy yk ka a Istotnymi demograficznymi i psychospołecznymi czynnikami ryzyka wystąpienia PPD są: młody wiek, niski status socjoekonomiczny, niedostateczne wsparcie ze strony partnera lub samotne macierzyństwo (Le Strat i wsp. 2011; O'Hara 2009; Silva i wsp. 2012) oraz poczucie nieradzenia sobie z opieką nad dzieckiem (Davey i wsp. 2011). Autorzy badania Generation R (n = 4941) stwierdzili, że stan przedrzucawkowy , hospitalizacja w czasie ciąży, cięcie cesarskie wykonane w trybie pilnym, podejrzenie stanu zagrożenia płodu, przyspieszanie akcji porodowej oraz hospitalizacja noworodka wiążą się z około dwukrotnie większym ryzykiem wystąpienia PPD (Blom i wsp. 2010). Na "
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    ABSTRACT: The aim of this paper is to highlight the up-to-date knowledge on postpartum mood disorders: postpartum depression (PPD), postpartum psychosis (PP), postpar- tum hypomania (PH), and maternal blues (MB). Postpartum depression (characterized by the features of a moderate or severe major depressive episode) affects about 7-20% of postpartum women. Current evidence suggest that women are susceptible to developing PPD during the entire first year following delivery. The core clinical features of PPD are low self-esteem, tension, and hypochondria. The Edinburgh Postnatal Depression Scale is a standard tool used in screening for PPD. PPD has been included in the Ghaemi et al.’s diagnostic cri- teria for bipolar spectrum disorders. Postpartum psychosis is a psychiatric emergency condi- tion, characterized by high severity and rapid deterio- ration of symptoms, once described as ‘psychosis of delir- ium-like appearance’. It affects 0.1-0.2% of postpartum women. 72-80% of PP cases are due to bipolar disorder (BD) or schizoaffective disorder. The condition is an obligatory indication for hospitalization. Mood stabiliz- ers (usually in combination with atypical antipsychotics) are a mainstay of therapy for subjects with ‘bipolar’ PP. Typically PH develops on the first day postpartum. Its prevalence has been estimated at 10-20%. The disorder is a significant risk factor for developing PPD. The ‘Highs’ Questionnaire is a validated tool used in screening for PH. Maternal blues is a syndrome of mild, self-restricting mood disorders, usually developing in the early post- partum period. Although often considered to be a phys- iological phenomenon, it is an established risk factor for developing PPD or postpartum anxiety disorders.
    Full-text · Article · Sep 2012 · Neuropsychiatria i Neuropsychologia
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