Psychosocial stratification of antenatal indicators to guide population-based programs in perinatal depression

John Eastwood,Alicia Montgomery,Andy Wang,Jean Yee Hwa Yang,Sarah Khanlari

doi:10.1186/s12884-021-03722-8

John Eastwood, Alicia Montgomery + Show 3 more

Open Access

https://doi.org/10.1186/s12884-021-03722-8

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Abstract

BackgroundThere is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. To maximise the impact of population-based interventions for optimising perinatal wellbeing, health services can utilise empirical methods to identify subgroups at highest risk of poor outcomes relative to the overall population.MethodsThis study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. This study sought to identify sub-groups using latent class analysis within a population of mothers in Sydney, Australia, based on their differing experience of self-reported indicators of psychosocial adversity. Subgroup differences in antenatal and postnatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale.ResultsLatent class analysis identified four distinct subgroups within the cohort, who were distinguished empirically on the basis of their native language, current smoking status, previous involvement with Family-and-Community Services (FaCS), history of child abuse, presence of a supportive partner, and a history of intimate partner psychological violence. One group consisted of socially supported ‘local’ women who speak English as their primary language (Group L), another of socially supported ‘migrant’ women who speak a language other than English as their primary language (Group M), another of socially stressed ‘local’ women who speak English as their primary language (Group Ls), and socially stressed ‘migrant’ women who speak a language other than English as their primary language (Group Ms.). Compared to local and not socially stressed residents (L group), the odds of antenatal depression were nearly three times higher for the socially stressed groups (Ls OR: 2.87 95%CI 2.10–3.94) and nearly nine times more in the Ms. group (Ms OR: 8.78, 95%CI 5.13–15.03). Antenatal symptoms of depression were also higher in the not socially stressed migrant group (M OR: 1.70 95%CI 1.47–1.97) compared to non-migrants. In the postnatal period, Group M was 1.5 times more likely, while the Ms. group was over five times more likely to experience suboptimal mental health compared to Group L (OR 1.50, 95%CI 1.22–1.84; and OR 5.28, 95%CI 2.63–10.63, for M and Ms. respectively).ConclusionsThe application of empirical subgrouping analysis permits an informed approach to targeted interventions and resource allocation for optimising perinatal maternal wellbeing.

Highlights

There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course
The public health importance of this perinatal adversity is related to its demonstrated impact on multiple domains of childhood and adult outcomes across the life course [5, 6]
There is an association between adverse childhood experiences and increased risk of parental mental illness and substance abuse in pregnancy [8], and there is increasing interest in the role that maternal mental health plays in the intergenerational transmission of experienced adversity [9, 10]

Summary

Introduction

There is increasing awareness that perinatal psychosocial adversity experienced by mothers, children, and their families, may influence health and well-being across the life course. The public health importance of this perinatal adversity is related to its demonstrated impact on multiple domains of childhood and adult outcomes across the life course [5, 6]. There is an increasing understanding of the impact of exposure to adverse childhood experiences (such as child maltreatment and exposure to domestic violence), on health and well-being outcomes across the life course. There is an intergenerational impact and a strong dose-response relationship between exposure to adversity and poor health outcomes, including depression, anxiety, substance use, sexually transmitted diseases, suicide attempts, and a range of chronic diseases [7]. There is an association between adverse childhood experiences and increased risk of parental mental illness and substance abuse in pregnancy [8], and there is increasing interest in the role that maternal mental health plays in the intergenerational transmission of experienced adversity [9, 10]

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