Social inequalities of postpartum depression: the mediating role of social support during pregnancy

Abstract

Abstract Introduction A disadvantaged socioeconomic position (SEP), as well as insufficient social support during pregnancy (SSP) increase the probability of subsequent postpartum depression (PPD). The aim of this study was to quantify the part of social inequalities in PPD due to insufficient SSP and in particular assess the impact relative to women’s migrant status. Methods The sample included 15,000 women from the nationally representative French ELFE birth cohort study. Depressive symptoms were assessed at two months postpartum by the EPDS. SEP was constructed as a latent factor explaining educational level, occupational grade, employment during pregnancy, household income and financial difficulties. SSP was characterized by informal support (partner perceived support, frequency of quarrels and paternal leave) and formal support (early prenatal psychosocial risk assessment and antenatal classes’ attendance). Causal mediation analyses between SEP, dimensions of SSP and PPD were conducted and stratified on migrant status (categorized as native French, first or second generation migrant or immigrant). Results A disadvantaged SEP and a lack of informal SSP during pregnancy were both associated with an increased risk for postpartum depressive symptoms and a disadvantaged SEP was positively associated with lack of SSP. In immigrant women, a larger proportion of social inequalities in PPD could be attributed to lack of SSP, in comparison to native French women (17.5% vs. 8.8%). Conclusions Both disadvantaged SEP and SSP are risk factors for PPD. We found evidence that disadvantaged women’s increased risk for PPD can partly be attributed to limited social support. Key messages PPD in disadvantaged groups, especially in migrant women, could possibly be prevented early in pregnancy by increasing support from partner and larger family. Access to social support health care systems directed towards pregnant women remains low for women with a disadvantaged SEP, especially in migrant women.