Abstract
BackgroundMaternal post-partum depression is one of the most common medical complications around childbirth. One of its consequences is a possible association with children's receipt of preventive health care, including immunization. This study aimed to explore the association between maternal postpartum depression and children's immunization rates.MethodsA retrospective cohort study of Maccabi Healthcare Services (HMO) members comparing immunization rates between children born between 2006 and 2019 to mothers with post-partum depression and children born to mothers with no documented depression. Post-partum depression was assessed by Edinburgh Postnatal Depression Scale, a 10-item questionnaire considered the screening tool of choice in Israel for early Post-partum detection. 1:1 matching was conducted according to criteria: age of the mother ± 2 years, child's year of birth, the newborn baby's gender, the baby's birth order and socioeconomic index. The primary outcome was defined as non-vaccination and the exposure was defined as depression. A sub-analysis was performed, comparing immunization rates of children born to mothers treated with antidepressant medications to rates of children born to untreated mothers.ResultsA total of 709 subjects in the exposed cohort (children born to mothers with post-partum depression symptoms) and 681 subjects in the matched cohort were analyzed. The relative risks among children born to depressed mothers compared with children born to healthy mothers for not receiving any vaccine at 2 months, three doses of pertussis vaccine up to 7 months and four doses of DTaP-Hib-IPV vaccine up to 18 months were 1.15 (95% CI 0.74–1.78), 1.11 (95% CI 0.94–1.31) and 0.82 (95% CI 0.56–1.95), respectively. The relative risks among 139 infants born to treated mothers compared with 570 infants born to untreated mothers for not receiving any vaccine at 2 months, three doses of pertussis vaccine up to 7 months and four doses of DTaP-Hib-IPV vaccine up to 18 months were 1.28 (0.64–2.54), 0.78 (0.57–1.06) and 0.42 (0.17–1.03), respectively.ConclusionWe found no significant association between maternal post-partum depression and uptake of child Immunization.
Highlights
Maternal Post-Partum Depression (PPD), which occurs in the first 12 months after birth [1], is one of the common medical complications associated with childbirth [2, 3]
This study focused on events of maternal depression, anxiety, psychosis, eating disorder, personality disorder and alcohol and substance misuse disorders, and adherence to Diphtheria-TetanusAcellular Pertussis Vaccine pediatric (DTaP)/Inactivated Polio Vaccine (IPV)/Haemophilus influenza b Vaccine (Hib) and first dose Measles-MumpsRubella Vaccine (MMR) vaccines
Regarding the sub-analysis comparing mothers with and without antidepressants, perhaps the mothers who received treatment with antidepressants have a more severe degree of depression and receive more support from the father and their families in caring for the children, which wasn’t considered in the design of the study. This retrospective cohort study shows that PPD in a mother is not associated with a decline in the vaccination rates for routine vaccines
Summary
Maternal Post-Partum Depression (PPD), which occurs in the first 12 months after birth [1], is one of the common medical complications associated with childbirth [2, 3]. According to a recently published systematic survey and meta-analysis that included 291 studies in 56 countries, the prevalence of PPD detected with the Edinburgh Postnatal Depression Scale (EPDS) is 17.7%. This survey included studies in Israel, where the prevalence varied from 5.2 to 43% [6]. EPDS is frequently employed in defining depression in both studies and clinical practice [2, 7] This questionnaire is the screening tool of choice in Israel for early PPD detection. This study aimed to explore the association between maternal postpartum depression and children’s immunization rates
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