A Comprehensive Analysis of Post-partum Depression Risk Factors: The Role of Socio-Demographic, Individual, Relational, and Delivery Characteristics

Abstract

Postpartum depression is a common and complex phenomenon that can cause relevant negative outcomes for children, women and families. Existing literature highlights a wide range of risk factors. The main focus of this paper is to jointly investigate different types of risk factors (socio-demographic, psychopathological, relational, and related to labor and birth experience) in post-partum depression onset in women during first-child pregnancy, identifying which of these are the most important predictors. A cohort longitudinal study was conducted on 161 Italian nulliparous low-risk women (Mage = 31.63; SD = 4.88) without elective cesarean. Data was collected at three different times: Socio-demographic, prenatal anxiety and depression, and quality of close relationship network (with mother, father and partner, and the prenatal attachment to child) were assessed at T1 (week 31–32 of gestation); clinical data on labor and childbirth (mode and typology of delivery, duration of labor, duration of eventual administration of epidural analgesia, and child's APGAR index at birth) were registered at T2 (the day of childbirth); and the degree of post-natal depression symptomatology was measured at T3 (1 month after birth). Postpartum depression is associated with several risk factors (woman's age, woman's prenatal psychopathological characteristics, the level of prenatal attachment to child, the quality of romantic relationship, and some clinical delivery difficulties). Overall, the level of prenatal attachment to child was the most important predictor of post-partum depression. These findings emphasize the very important role of prenatal attachment for the onset of postpartum depression and the need to promote adequate and targeted prevention interventions. Limitations, strengths, and theoretical and clinical implications are discussed.

Prenatal Attachment and Perinatal Depression: A Systematic Review

“…The included studies were mainly conducted in the US (10 papers) [80,[84][85][86][87][88][89][90][91][92] and in Europe (nine papers in Italy [93][94][95][96][97][98][99][100][101], four in Sweden [76,[102][103][104], two in Germany [105,106], one in the Netherlands [22], one in France [107], one in England [79], one in Belgium [108], and one in Portugal [75]). Four studies were carried out in Japan [81,[109][110][111], two in Australia [112,113], two in Iran [74,114], two in Turkey [78,115], one in India [116], one in Israel [117], one in Chile [118], one in Brazil [119], and one in Korea [120] (Figure 2).…”

“…Thirteen studies [76,[78][79][80]85,87,93,96,100,103,109,113] did not observe significant results. Ten papers reported that lower levels of prenatal attachment were associated with higher postnatal depression scores [74,81,95,99,101,105,110,111,116,117]; however, one study [85] did not support the association between these two variables. Four studies analyzed the influence between partner's depressive symptoms and own prenatal attachment [75,87,97,102].…”

“…Considering the 45 studies included in the current review, 31 found a negative association between prenatal attachment and perinatal depression [22,74,75,81,84,86,[89][90][91][92]95,[97][98][99]101,102,[104][105][106][107][108][110][111][112][114][115][116][117][118][119][120], while a positive relation between perinatal depression and some dimensions of antenatal attachment was identified in three studies [94,102,106]. Thirteen studies did not highlight significant associations between these variables [76,[78][79][80]85,87,88,93,96,100,103,109,113].…”

“…Nineteen of the 29 studies that administered prenatal attachment instruments in the second or the third trimester of gestation underlined a significant association between the two considered variables [22,74,84,86,[90][91][92]95,97,98,101,102,[104][105][106]112,[115][116][117]: 16 studies confirmed a negative association between prenatal attachment and prenatal depression [22,84,86,[90][91][92]97,98,102,[104][105][106]112,[115][116][117] and six studies identified a negative association between prenatal attachment and postnatal depression [74,95,101,105,116,117], while a positive relation was found between prenatal depression and some factors of prenatal attachment in two studies [102,106]. Even if they assessed prenatal attachment in the recommended gestational period, ten articles did not demonstrate a significant association between prenatal attachment and prenatal depression…”

“…Of the 41 articles that focused on pregnant women [ [74,81,95,99,101,105,110,111,116,117]. Three articles observed a positive association between prenatal depression and some dimensions of prenatal attachment [94,102,106].…”