Depressive Symptoms Common in First 3 Years Postpartum

By Lisa Rapaport

October 29, 2020

(Reuters Health) - Approximately one in four women have elevated symptoms of depression at one point in time over the first three years postpartum, a population-based birth cohort study suggests.

Researchers collected medical histories and pregnancy information for 4,866 mothers in New York State and asked them to complete questionnaires about depressive symptoms at 4, 12, 24, and 36 months postpartum. Overall, the majority of women in the study (74.7%) were categorized as having low, stable levels of depressive symptoms at all four points in time.

The remaining women reported elevated depressive symptoms on at least one questionnaire during follow-up. These women had what researchers described as "low-increasing" symptoms (8.2%) that started out low but climbed over time; "medium-decreasing" symptoms (12.6%) that were initially moderate and declined over time; or "high-persistent" symptoms (4.5%).

Several factors were associated with having persistent elevated symptoms of depression, including social factors like marital status, education, and race, as well as pregnancy complications, such as gestational diabetes or preterm birth, said Diane Putnick of the Eunice Kennedy Shriver National Institute of Child Health and Human Development in Bethesda, Maryland, who led the study. Some women may also be predisposed to postpartum depression due to depression history, or may develop the condition due to stress.

"Social factors like not having enough social or material support and pregnancy complications like having a premature infant or experiencing gestational diabetes can contribute to mounting stress which can lead to depression," Putnick said by email. "Reducing stress on the mother by increasing social support, preventing pregnancy complications, and treating depression early may reduce the incidence, duration, or severity of postpartum depression."

Researchers assessed depressive symptoms using the five-item Edinburgh Postnatal Depression Scale (EPDS-5), which asks about emotional experiences over the past seven days. Using a cutoff score of at least 7 out of a total possible score of 15, 11% of women had moderate depressive symptoms at 4 months, 8% at 12 months, 6% at 24 months, and 7% at 36 months.

In addition, researchers looked at factors associated with each of the distinct depression trajectories. Compared with the low-stable group, for example, mothers with a mood disorder history prior to pregnancy were more likely to be in the medium-decreasing group (odds ratio 3.67), low-increasing group (OR 4.12), and high-persistent group (OR 15.38).

Other factors that tended to be more common in the high-persistent group included being younger; having less than a college education; being unmarried, multiracial, or a person of color; being multiparous; having gestational diabetes or a preterm delivery, the study team reports in Pediatrics.

"Women in the persistently high depressive symptoms group tended to have more demographic risk factors than women in other groups," said David Bridgett, a psychology professor at Northern Illinois University in DeKalb who wasn't involved in the study.

"This points to the importance of well-funded social support programs for at-risk women, which may not only benefit their health and well-being through lower risk of depression, but also the health and well-being of their infant," Bridgett said by email.

One limitation of the study is that it wasn't designed to diagnose postpartum depression, and it's possible that a clinical diagnosis of depression might result in different postpartum depression trajectories or different factors that predisposed women to certain groups.

Still, the results underscore the importance of prompt identification and treatment of any depressive symptoms, with medication or psychotherapy as options depending on the severity of symptoms and patient preferences, said Myrna Weissman, chief of the division of translational epidemiology at the New York State Psychiatric Institute in New York City.

"The symptoms should not be trivialized," Weissman, who wasn't involved in the study, said by email. "They are real to the woman, and various levels of evidence-based psychotherapy - there are a number of them - and/or medication should be made readily available."

SOURCE: Pediatrics, online October 27, 2020.