Relationship of postnatal depressive symptoms to infant temperament, maternal expectations, social support and other potential risk factors: findings from a large Australian cross-sectional study

Abstract

BackgroundFrom 2000 a routine survey of mothers with newborn infants was commenced in South Western Sydney. The survey included the Edinburgh Postnatal Depression Scale (EPDS). The aim of the study was to determine the prevalence and risk factors for postnatal depressive symptoms in women living in metropolitan Sydney, Australia.MethodsMothers (n=15,389) delivering in 2002 and 2003 were assessed at 2–3 weeks after delivery for risk factors for depressive symptoms. The binary outcome variables were EPDS >9 and >12. Logistic regression was used for the multivariate analysis.ResultsThe prevalence of EPDS >9 was 16.93 per 100 (95% CI: 16.34 to 17.52) and EPDS >12 was 7.73 per 100 (95% CI: 6.96 to 7.78). The final parsimonious logistic regression models included measures of infant behaviour, financial stress, mother’s expectation of motherhood, emotional support, sole parenthood, social support and mother’s country of birth.ConclusionsInfant temperament and unmet maternal expectations have a strong association with depressive symptoms with implications for the design of both preventative and treatment strategies. The findings also support the proposition that social exclusion and social isolation are important determinants of maternal depression.

Magnitude and risk factors for postpartum symptoms: A literature review

“…Several physical and biological factors are related to postpartum depression in developed countries, such as poor physical health (Eilat-Tsanani et al, 2006;Sword et al, 2011;Eastwood et al, 2012;Cheng et al, 2013;Gaillard et al, 2014), negative body image (Green et al, 2006) and body weight (Green et al, 2006). Similarly, poor physical health (Nakku et al, 2006;AndajaniSutjahjo et al, 2007;Barbadoro et al, 2012) was reported in developing countries.…”

“…Other factors, such as lack or non-initiation of breastfeeding (Chien et al, 2006;Green et al, 2006;Mosack and Shore, 2006;Lau and Chan, 2007;Baker and Oswalt, 2008;Davey et al, 2011;Sword et al, 2011;Watkins et al, 2011;Figueiredo et al, 2013;Hahn-Holbrook et al, 2013), parity (Green et al, 2006;Glavin et al, 2009;Hamdan and Tamim, 2011;Kozinszky et al, 2011;Sword et al, 2011;Raisanen et al, 2013;Gaillard et al, 2014) and sex of baby (Boyce and Hickey, 2005;de Tychey et al, 2008;Kim et al, 2008;Koutra et al, 2014) showed mixed findings. Women whose infants had medical illnesses (Green et al, 2006;Ueda et al, 2006;Kim et al, 2008;Raisanen et al, 2013), are born prematurely (Raisanen et al, 2013) and are temperamentally difficult (McGrath et al, 2008;Eastwood et al, 2012) are likely to experience postpartum depression. Abbasi et al (2013) and Christensen et al (2011) did not find any relationship between unintended pregnancy and postpartum depression.…”

Long-term trajectories of maternal depressive symptoms and their antenatal predictors

“…Being anxiously ambivalent (worried or scared) about the pregnancy was associated with antepartum and chronic depressive symptom trajectories in the study by Mora et al (2009) on perinatal depressive symptoms. In an Australian cross-sectional study, however, it was documented that unmet maternal expectations were also a significant predictor of both mild and more severe postnatal depressive symptoms (Eastwood, et al, 2012), so it can be hypothesized that high, possibly unrealistic hopes concerning having a child may also be among the potential risk factors for maternal depressive symptoms (Harwood, et al, 2007).…”

The moral economy of early intervention

“…In a post-demographictransition society, like England, there may not be any nearby relatives upon whom mothers can depend. The link between social isolation and poor health among new mothers has been clearly established (Morgan and Eastwood 2014;Eastwood et al 2012), and so has the correlation between postnatal depression and early child development (Grace, Evindar, and Stewart 2003;Deave et al 2008;Murray et al 1999). Isolation was indeed an issue brought up frequently by the Oxfordshire mothers, which explains why the Children's Centres and Early Intervention Hubs are seen as 'invaluable' resources.…”