Stress and Maternal Postpartum Depression: The Importance of Stress Type and Timing

Abstract

Interest in identifying social risk factors for maternal postpartum depression has increased, with a growing emphasis placed on stress exposure. Despite increased interest, questions about the importance of lifetime stress exposure relative to stress surrounding childbirth, along with the importance of different types of stressful events, remain unanswered. The stress process model has gained prominence as a guiding framework for examining stress type and timing in studies of major depression and poor pregnancy outcomes, suggesting that this framework has the potential to advance our understanding of the relationship between stress exposure and depressive symptoms in postpartum women. Using in-person interviews and medical record data from the Fragile Families and Child Well-being Study (N = 4362), we draw on a stress process framework to examine: (1) whether lifetime acute stress exposure prior to pregnancy and birth is a risk factor for postpartum depression net of more proximate acute stressors occurring after pregnancy and birth, and (2) which types of stress (acute, chronic) are most salient for this outcome. Our results show that both acute stressors and chronic strains are independently associated with postpartum depression and acute stressors occurring prior to pregnancy and birth have long-lasting effects on postpartum mental health even when more proximate acute stressors are considered. Our findings underscore the need to more fully capture stressors and strains occurring throughout a woman’s life course with regard to postpartum depression, and suggest the importance of rooting postpartum research and screening in a stress process framework.