Women’s mental health following the birth of a child: a life course approach

Abstract

Does the experience of being pregnant, giving birth and becoming a mother affect women’s mental health over their reproductive life course? Much of the research on maternal mental health has focused on the perinatal period. In recent times, research has extended to patterns of women’s mental health over the years following the birth of their baby. In this thesis, associations between women’s experiences around pregnancy and giving birth, and patterns of their mental health impairment in the years following the baby’s birth, are examined. Participants: Three datasets were used for this thesis. The primary dataset was the Mater and University of Queensland Study of Pregnancy (MUSP) longitudinal birth cohort which recruited 6753 pregnant women between 1981 and 1984. Data-collection phases occurred at women’s first clinic visit, at three to five days, six months and five, 14, 21 and 27 years post-birth. The second dataset was accessed from Brisbane’s Mater Mothers’ Hospital (MMH) public obstetric database and consisted of routinely collected data from women attending MMH. Six years of de-identified data from 19699 women, from 2001 to 2006, were analysed. The third dataset comprised a cohort of women from the ‘Thirty year study of the health and lifestyle of pregnant women’ project. These 2156 pregnant women were recruited at their MMH booking visit between 2011 and 2012. Methods: Six studies are the core contribution of this body of research. These studies, five cohort studies and one cross-sectional study, addressed the thesis’ aims and objectives. Studies’ outcome measures generally related to women’s mental health, rated by the Delusions-Symptoms-States-Inventory: state of Anxiety and Depression (DSSI/sAD) (Bedford et al., 1976) and assessed at time-points post-birth. In three studies, women’s DSSI depression measures at various time-points were combined to create depressive-symptoms trajectories. The Mental Disorder Screening Tool (MDST), constructed from women’s DSSI/sAD responses (Saiepour et al., 2014) and measuring mental health impairment, was an outcome measure for one study. Another study’s outcomes were based on women’s reported alcohol consumption before pregnancy and at their first clinic visit. A broad range of predictor and potential confounding variables, taken at different MUSP survey phases, were included in the studies’ analyses. Descriptive and inferential analyses were used. Univariate and multivariable regression analysis derived odds ratios and relative risk ratios with 95% confidence intervals. Findings: The majority of women studied experienced few mental health problems during pregnancy and over their reproductive life course (spanning 30 years), while a sub-group of women continued to experience symptoms of depression in the years following their baby’s birth. Patterns of women’s depressive symptoms over 21 and 27 years were identified. Pregnancy and birth events were found to contribute little to women’s experience of depression. Pregnant women who experienced stressful life events (that is, financial, housing and relational events), were at higher risk of having depressive symptoms over the 27-year period. The proportion of women with mental health impairment was higher at 21 years post birth than at six months post birth. Women whose offspring had behaviour problems were themselves at risk of mental health impairment at 21 years post birth. As well, mental health problems in pregnancy; young motherhood; not completing high school and low family income; and having poor social networks around baby’s birth, and marital discord in pregnancy, predicted women’s poorer mental health over time. Today’s pregnant women are more likely to be older and have higher body mass indexes, more likely to be anxious but not depressed, and more are sure about wanting to be pregnant, compared to pregnant women from previous decades. Today’s pregnant women are also less likely to be smokers but are more often consuming alcohol prior to pregnancy, though they substantially reduce their alcohol consumption in pregnancy. Socio-economic disadvantage and psychosocial problems in pregnancy increase women’s risk of long-term mental health problems. Conclusions: Being pregnant and giving birth per se triggered few long-term mental health consequences for women. Rather, pregnant women’s characteristics and psychosocial factors (that is, measures of poor mental and physical health, socioeconomic disadvantage and disturbed social environments) were associated with mental health consequences over time. Having strong support networks and positive partner relationships could abrogate the negative social-environments that arise from women experiencing stressful events, mental health impairment and poor social economy. These findings add to what is already known by showing that factors impacting on the mental health of pregnant women are more extensive in duration than has been previously reported. These findings provide maternity services with further evidence of the need for comprehensive, perinatal screening to identify women at risk and the prospect of disrupting patterns of mental health impairment over their life course. Midwifery researchers are well-placed to study the perinatal risks associated with women’s long-term mental health problems, causal pathways, and the interplay between pregnant women’s physical and mental health, and their biological responses to social adversity.