Fetal Sex, Social Support, and Postpartum Depression

Abstract

Objective:To examine the impact of prenatal and postnatal social support on the association between fetal sex and postpartum depression (PPD). Method:We conducted a prospective cohort study in Changsha, China, between February and September 2007. We first compared the sociodemographic and obstetric characteristics, and the prenatal and postnatal social support between women who gave birth to a female infant and those who gave birth to a male infant. We then examined the association between fetal sex and PPD by following logistic regression models: fetal sex as the independent variable; with adjustment for sociodemographic and obstetric factors; with adjustment for sociodemographic, obstetric factors, and prenatal social support; and with adjustment for sociodemographic, obstetric factors, and postnatal social support.Results: Postnatal social support scores were much lower in women who gave birth to a female infant than in those who gave birth to a male infant. The odds ratio of PPD for women who gave birth to a female infant, as compared with those who gave birth to a male infant, was 3.67 (95% CI 2.31 to 5.84). The increased risk of PPD for women who gave birth to a female infant remained after adjustment for sociodemographic and obstetric factors and prenatal social support, but disappeared after adjustment for postnatal social support score. Conclusion:We conclude that increased risk of PPD in Chinese women who give birth to a female infant is caused by lack of social support after childbirth. Can J Psychiatry. 2009;54(11):750-756. Clinical Implications· Lack of social support after childbirth is an important determinant of PPD. · To maximize cost-effectiveness, interventions aiming at reducing the risk of PPD should focus on the postpartum period. · Cultural factors should be taken into consideration in the development of preventive strategies for PPD. Limitations· Our study sample is not sufficiently large, especially for stratified analysis, to assess potential effect modification. · Patients at either end of the emotional spectrum might not have been inclined to participate. · PPD and postnatal Social Support Rating Scale were measured at the same time and they might have interacted with each other. · The Edinburgh Postnatal Depression Scale was used to classify women as depressed or not. It should be noted that this is a screening measure, and it does not constitute a diagnosis of depression.

Social Support, Postpartum Depression, and Professional Assistance: A Survey of Mothers in the Midwestern United States

“…The consensus among researchers is that an increased level of social support is associated with less PPD (Brown et al, 2012;Chien et al, 2012;R. C. Edwards et al, 2012;Shapiro & Fraser, 2013;Xie et al, 2009). This study sought to add to the literature by aiming to investigate the relationship between social support and depression in the Midwestern United States.…”

“…If the "baby blues" continue for longer than 14 days, mothers may experience PPD, which can occur by 4-6 weeks after birth (Appolonio & Fingerhut, 2008;Kathree & Petersen, 2012;Logsdon, Tomasulo, Eckert, Beck, & Lee, 2012). Within the first 2 weeks after birth, 80%-85% of women experience some level of postpartum "blues," and a further 8%-15% will experience a major depressive disorder (Appolonio & Fingerhut, 2008;Ginsburg et al, 2012;Haga, Lynne, Slinning, & Kraft, 2012;Kathree & Petersen, 2012;Ugarriza et al, 2007;Wade, Giallo, & Cooklin, 2012;Xie et al, 2009). Although PPD can affect women in any population, young, minority, low-income mothers face many barriers (lack of knowledge, mental illness stigma, transportation) that make them particularly vulnerable to PPD (R. C. Edwards et al, 2012).…”

“…The EPDS is the most widely used screening tool for PPD (Dennis et al, 2012;Logsdon et al, 2012). The reliability and validity of the EPDS in identifying depressive symptoms in postpartum women has been supported in numerous studies (Xie et al, 2009). The EPDS has 10 multiple-choice questions; each question scored with a 0, 1, 2, or 3 (maximum score 5 30).…”

“…Social support has been described as a three-dimensional construct consisting of emotional support (concern, comfort, and encouragement); instrumental support (money, time, and tangible assistance); and informational support where advice, education, and knowledge sharing takes place (Boothe, Brouwer, Carter-Edwards, & Østbye;2011;Chojenta, Loxton, & Lucke, 2012;Evans, Donelle, & Hume-Loveland, 2012;Leahy-Warren, McCarthy, & Corcoran, 2011). Xie, He, Koszycki, Walker, and Wen (2009) describe social support as subjective, objective, and support availability. Social support can come from society/community or from a professional source.…”

Poverty and postnatal depression: a systematic mapping of the evidence from low and lower middle income countries

“…p.209 (Nakku et al, 2006) "profession, education and income were also recorded to enable classification of socioeconomic status …i.e. high socioeconomic class (HSEC), middle socioeconomic class (MSEC) and low socioeconomic class (LSEC) (Nagpal et al, 2008) Income / Finances/ Assets and housing Household income Black et al, 2007;Chersich et al, 2009;Gao et al, 2009;Nhiwatiwa et al, 1998;Xie et al, 2009) Family income (Chandran et al, 2002{Husain, 2006#4023{Pollock, 2009#119{Savarimuthu, 2009 trading/civil servant/unemployed/student (Nigeria) (Adeyemi et al, 2008) Hunger "Had been hungry during past month because of lack of money" (India) (Patel et al, 2002) 19 Husain et al, 2006b; Financial difficulties (Pollock et al, 2009) (Abiodun, 2006;Alami et al, 2006;Ho-Yen et al, 2007;Patel et al, 2002;Pollock et al, 2009) - (Abiodun, 2006) (Husain et al, 2006b) Human capital Maternal education - (Black et al, 2009;Black et al, 2007;Fisher et al, 2004;Gao et al, 2009;Gausia et al, 2009;Ho-Yen et al, 2007;Patel et al, 2002;Pollock et al, 2009;Savarimuthu et al, 2009) - (Abiodun, 2006) (Agoub et al, 2005;Alami et al, 2006;Mariam & Srinivasan, 2009; Paternal employment Rahman, Iqbal et al 2003) (Fisher et al, 2004Patel et al, 2002 20 …”