Risk factors of perinatal depression in women: a systematic review and meta-analysis

Abstract

Background Perinatal depression in women is associated with high morbidity and mortality, and has attracted increasing attention. The investigation of risk factors of perinatal depression in women may contribute to the early identification of depressed or depression-prone women in clinical practice. Material and Methods A computerized systematic literature search was made in Cochrane Library, PubMed, Web of Science, and EMBASE from January 2009 to October 2021. All included articles were published in English, which evaluated factors influencing perinatal depression in women. Based on the recommendations of the Cochrane Collaboration protocols, Review Manager 5.3 was used as a statistical platform. Results Thirty-one studies with an overall sample size of 79,043 women were included in the review. Educational level (P = 0.0001, odds ratio [OR]: 1.40, 95% CI: [1.18,1.67]), economic status of families (P = 0.0001, OR: 1.69, 95%CI: [1.29,2.22]), history of mental illness (P < 0.00001, OR: 0.29, 95% CI: [0.18, 0.47]), domestic violence (P < 0.00001, OR: 0.24, 95% CI: [0.17,0.34]), perinatal smoking or drinking (P = 0.005, OR: 0.63; 95% CI [0.45, 0.87]; P = 0.008, OR: 0.43, 95% CI, [0.23 to 0.80]; respectively), and multiparity(P = 0.0003, OR: 0.74, 95% CI: [0.63, 0.87]) were correlated with perinatal depression in women. The stability of our pooled results was verified by sensitivity analysis and publication bias was not observed based on funnel plot results. Conclusion Lower educational level, poor economic status of families, history of mental illness, domestic violence, perinatal smoking or drinking, and multiparity serve as risk factors of perinatal depression in women.

Prevalence and correlates of perinatal depression

“…Medium to large significant effect sizes were reported in meta-analyses between perinatal depression and the following risk factors: personal history of mental illness (e.g., anxiety, depression, etc. ), with mean r ranging from 0.30 to 0.51; childcare stress ( r = 0.48–0.49) or infant temperament (0.33–0.34); experiencing stressful life events ( r = 0.36–0.40); lack of social support ( r = 0.37–0.45); maternity blues ( r = 0.35–0.37); and marital conflicts or dissatisfaction ( r = 0.37–0.39) [ 6 , 11 , 36 , 37 ].…”

“…Lifetime history of abuse (e.g., childhood/adult abuse, maternal violence, or intimate partner violence) was found to conclusively and consistently lead to a developed risk of perinatal depression, sourced from nine systematic reviews and five meta-analyses [36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Women who had experienced intimate partner violence during pregnancy had increased odds of both antenatal and postnatal depression, 1.69-3.76 and 1.46-7.04, respectively [41].…”

Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy

“…We found higher levels of neuroticism among n = 131 at risk for PD than in the rest of the sample (n = 1,407), with a significant positive correlation between neuroticism levels and depressive symptoms; this may strongly confirm that neuroticism is a specific risk factor for PD as suggested by the literature (55-57). It is of interest that some authors consider neuroticism as a psychological endophenotype of affective disorders (58) as well as a personality characteristic independently leading to PD with adjunctive vulnerability to stressful life events, sleep disorders, and hormonal changes (13)(14)(15). These pieces of evidence suggested the inclusion of neuroticism assessment in our screening program (16).…”

“…The mean score in healthy adult women was reported to be around 16.77 ± 7.91 (35). As already discussed, this personality trait was considered among personality-related risk factors for PD (13)(14)(15)(16).…”

“…PD risk factors among pregnant women include low level of education, lower socioeconomic status, poorly supportive partner, low social support, a higher number of stressful life events, and previous history of depression and anxiety (12). Yang et al (13) reported the personality trait of neuroticism as an additional risk factor for PD, as it may lead to psychological vulnerability to stressful events, sleep deprivation, and hormonal changes (14,15): neuroticism has been described as an independent risk factor for PD, and many authors suggest the psychological assessment of this factor in the clinical screening of pregnant women (16). The Edinburgh Postnatal Depression Scale (EPDS) by Cox et al (17) is a validated tool for the clinical detection of PD and depressive symptoms during pregnancy (see description in the "Materials and methods" section).…”