Social inequalities in maternal depressive symptomatology after childbirth: Comparison across birth cohorts in Brazil

Abstract

• Depressive symptomatology increased amongst southern women in the postpartum period;. • Depressive symptomatology amongst women residents in the north decreased over time;. • Black/brown women showed higher frequencies of depressive symptomatology;. • Poor mothers showed the highest frequencies of depressive symptomatology;. • Socioeconomic and skin colour inequalities remained stable over the studied period. Approximately 40% of women experience their first depressive episode during the postpartum period. In Brazil, several maternal health outcomes are affected by profound social inequalities. Investigating inequalities in maternal depressive symptomatology in two different regions of the country in the first 24 months after childbirth may help clarify these patterns and appropriate support services. Data from three birth cohorts from two Brazilian cities (Cruzeiro do Sul, North region, and Pelotas, South region) were analysed. The baseline of each cohort consisted of 4,231 (2004 Pelotas), 4,275 (2015 Pelotas), and 1,246 (MINA-Brazil) live births. Depressive symptomatology was repeatedly measured using the Edinburgh Postnatal Depression Scale (EPDS) at 3, 12, and 24 months postpartum. Socioeconomic status and skin colour inequalities in depressive symptomatology were analysed at each point. Between the 3rd and 24th months postpartum, maternal depressive symptomatology increased amongst women from the south, but decreased amongst women in the north. Black/brown women and those belonging to the lowest socioeconomic stratum showed the highest frequency of depressive symptomatology. Absolute and relative inequalities remained stable throughout the study period. Depressive symptomatology was most common amongst women with few years of schooling, multiparae, and amongst those who smoked during pregnancy. There was no information regarding any psychological/psychiatric treatment at the time the EPDS was evaluated, and economic status was assessed differently amongst the cohorts. Marked social inequalities were found in postpartum depressive symptoms. Actions aimed at early detection and reducing social inequalities in maternal postpartum depressive symptomatology are vital.