Abstract
Background and objectivesThe perinatal period presents a high-risk time for development of mood disorders. Australia-wide universal perinatal care, including depression screening, make this stage amenable to population-level preventative approaches. In a large cohort of women receiving public perinatal care in Sydney, Australia, we examined: (1) the psychosocial and obstetric determinants of women who signal distress on EPDS screening (scoring 10–12) compared with women with probable depression (scoring 13 or more on EPDS screening); and (2) the predictive ability of identifying women experiencing distress during pregnancy in classifying women at higher risk of probable postnatal depression.MethodsWe analysed routinely collected perinatal data from all live-births within public health facilities from two health districts in Sydney, Australia (N = 53,032). Perinatal distress was measured using the EPDS (scores of 10–12) and probable perinatal depression was measured using the EPDS (scores of 13 or more). Logistic regression models that adjusted for confounding variables were used to investigate a range of psychosocial and obstetric determinants and perinatal distress and depression.ResultsEight percent of this cohort experienced antenatal distress and about 5 % experienced postnatal distress. Approximately 6 % experienced probable antenatal depression and 3 % experienced probable postnatal depression. Being from a culturally and linguistically diverse background (AOR = 2.0, 95% CI 1.8–2.3, P < 0.001), a lack of partner support (AOR = 2.9, 95% CI 2.3–3.7) and a maternal history of childhood abuse (AOR = 1.9, 95% CI 1.6–2.3) were associated with antenatal distress. These associations were similar in women with probable antenatal depression. Women who scored 10 to12 on antenatal EPDS assessment had a 4.5 times higher odds (95% CI 3.4–5.9, P < 0.001) of experiencing probable postnatal depression compared with women scoring 9 or less.ConclusionAntenatal distress is more common than antenatal depressive symptoms and postnatal distress or depression. Antenatal maternal distress was associated with probable postnatal depression. Scale properties of the EPDS allows risk-stratification of women in the antenatal period, and earlier intervention with preventively focused programs. Prevention of postnatal depression could address a growing burden of illness and long-term complications for mothers and their infants.
Highlights
Background and objectivesThe perinatal period presents a high-risk time for development of mood disorders
Maternal age of < years (AOR = 1.7, 95% CI 1.01–2.85, P = 0.045) was associated with antenatal distress compared with women aged between and 34
Antenatal distress was not associated with maternal age ≥ 40, “medium” socioeconomic status, report of psychological Intimate partner violence (IPV) or if a previous pregnancy was known to child protective services
Summary
Background and objectivesThe perinatal period presents a high-risk time for development of mood disorders. Anxiety and depression are the most common complications of the perinatal period, affecting approximately 10–15% of women [1,2,3], with a global trajectory of increasing burden [4]. This pooled estimate varies widely between and within countries [5]. When undetected these disorders pose a range of risks to the mother’s health, psychosocial wellbeing, relationships and her infant’s development [6]. Maternal distress has been shown to contribute to the amplification of parenting stress, birth complications such as premature labour [13] and low birth weight [14], and lead to adverse consequences for child growth and development [15]
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