Longitudinal effects of perinatal social support on maternal depression: a marginal structural modelling approach

Abstract

BackgroundDepression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child’s life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes.MethodsThis study leverages marginal structural models to evaluate associations between longitudinal patterns of perinatal social support and subsequent maternal depression at 6 and 12 months postpartum. In a cohort of women in rural Pakistan (n=780), recruited in the third trimester of pregnancy and followed up at 3, 6 and 12 months postpartum, we assessed social support using two well-validated measures: the Multidimensional Scale of Perceived Social Support (MSPSS) and the Maternal Social Support Index (MSSI). Major depressive disorder was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM IV).ResultsHigh and sustained scores on the MSPSS through the perinatal period were associated with a decreased risk of depression at 12 months postpartum (0.35, 95% CI: 0.19 to 0.63). Evidence suggests the recency of support also matters, but estimates are imprecise. We did not find evidence of a protective effect for support based on the MSSI.ConclusionsThis study highlights the protective effect of sustained social support, particularly emotional support, on perinatal depression. Interventions targeting, leveraging and maintaining this type of support may be particularly important for reducing postpartum depression.

Perceived social support on postpartum mental health: An instrumental variable analysis

“…We also found evidence that past mental health (i.e., the pre-pregnancy and pregnancy periods) is associated with postpartum mental health. This result is consistent with longitudinal studies that reported women experiencing depressive symptoms during pregnancy are at high risk of postpartum depression [ 27 , 60 , 61 ].…”

Social connectedness as a determinant of mental health: A scoping review

“…Sample sizes varied from 54 participants in a follow-up of a previous randomized trial [ 51 ] to 12,386 couples in a study with findings on both maternal and paternal depression [ 53 ]. Most of the included studies [ 38 – 41 , 43 , 44 , 47 , 50 , 51 , 58 – 60 , 62 , 63 , 68 ] in the mid or late pregnancy, four [ 45 , 54 – 56 ] started in early pregnancy, and ten studies [ 42 , 46 , 48 , 49 , 53 , 61 , 64 , 65 , 67 , 70 ] started after birth. Women were on average aged between 18 and 40 years old.…”

“…The significant protective factor of social support against postpartum depression was also highlighted in another study through a mediating effect of good clinical delivery. 46 Hagaman et al [ 46 ] employed multiple time-varying measures of social support to evaluate the causal effect of longitudinal patterns on perinatal depression outcomes at six and twelve months postpartum. The authors found that women who had sustained high scores on the MSPSS had reduced prevalence of depression at one-year post-partum [ 46 ].…”

Does Parental Investment Shape Adult Children’s Fertility Intentions? Findings From a German Family Panel

“…Moreover, support received from parents can substantially help to reconcile work and family life among those individuals who already have children (Arpino and Luppi, 2020). Finally, parental investment may also increase the health and wellbeing of younger adults; for instance, after the child has been born, support from older parents may help to decrease maternal depression (Hagaman et al, 2021).…”