Authors
- . Maryam Ghaedrahmati
- . Ashraf Kazemi 1
- . Gholamreza Kheirabadi 2
- . Amrollah Ebrahimi 2
- . Masood Bahrami 3
1 Women’s Health Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences
2 Behavioral Sciences Research Center, Isfahan University of Medical Sciences
3 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Postpartum depression is a debilitating mental disorder with a high prevalence. The aim of this
study was review of the related studies. In this narrative review, we report studies that investigated
risk factors of postpartum depression by searching the database, Scopus, PubMed, ScienceDirect,
Uptodate, Proquest in the period 2000‑2015 published articles about the factors associated
with postpartum depression were assessed in Farsi and English. The search strategy included a
combination of keywords include postpartum depression and risk factors or obstetrical history, social
factors, or biological factors. Literature review showed that risk factors for postpartum depression
in the area of economic and social factors, obstetrical history, and biological factors, lifestyle and
history of mental illness detected. Data from this study can use for designing a screening tools for
high‑risk pregnant women and for designing a prevention programs.
Keywords
1. Klainin P, Arthur DG. Postpartum depression in Asian cultures:
A literature review. Int J Nurs Stud 2009;46:1355‑73.
2. Beck CT, Records K, Rice M. Further development of the
Postpartum Depression Predictors Inventory‑Revised. J Obstet
Gynecol Neonatal Nurs 2006;35:735‑45.
3. Corwin EJ, Murray‑Kolb LE, Beard JL. Low hemoglobin level is
a risk factor for postpartum depression. J Nutr 2003;133:4139‑42.
4. Aswathi A, Rajendiren S, Nimesh A, Philip RR, Kattimani S,
Jayalakshmi D, et al. High serum testosterone levels during
postpartum period are associated with postpartum depression.
Asian J Psychiatr 2015;17:85‑8.
5. Norhayati MN, Hazlina NH, Asrenee AR, EmilinWM. Magnitude
and risk factors for postpartum symptoms: A literature review.
J Affect Disord 2015;175:34‑52.
6. Youn JH, Jeong IS. Predictive validity of the postpartum
depression predictors inventory‑revised. Asian Nurs Res
(Korean Soc Nurs Sci) 2011;5:210‑5.
7. Chaudron LH. Postpartum depression: What pediatricians need
to know. Pediatr Rev 2003;24:154‑61.
8. Thorsteinsson EB, Loi NM, Moulynox AL. Mental health literacy
of depression and postnatal depression: A community sample.
Open J Depress 2014;2014:101‑11.
9. Spinelli MG. Maternal infanticide associated with mental illness:
Prevention and the promise of saved lives. Am J Psychiatry
2004;161:1548‑57.
10. Mathisen SE, Glavin K, Lien L, Lagerløv P. Prevalence and risk
factors for postpartum depressive symptoms in Argentina: A
cross‑sectional study. Int J Womens Health 2013;5:787‑93.
11. De Crescenzo F, Perelli F, ArmandoM, Vicari S. Selective serotonin
reuptake inhibitors (SSRIs) for post‑partum depression (PPD): A
systematic review of randomized clinical trials. J Affect Disord
2014;152:39‑44.
12. Nardi B, Laurenzi S, Di Nicolò M, Bellantuono C. Is the
cognitive‑behavioural therapy an effective strategy also in the
prevention of post partum depression? a critical review. Riv
Psichiatr 2012;47:205‑13.13. Lee DT, Yip AS, Leung TY, Chung TK. Identifying women at risk
of postnatal depression: Prospective longitudinal study. Hong
Kong Med J 2000;6:349‑54.
14. Davey HL, Tough SC, Adair CE, Benzies KM. Risk factors
for sub‑clinical and major postpartum depression among a
community cohort of Canadian women. Matern Child Health J
2011;15:866‑75.
15. McCoy SJ, Beal JM, Shipman SB, Payton ME, Watson GH. Risk
factors for postpartum depression: A retrospective investigation at
4‑weeks postnatal and a review of the literature. J Am Osteopath
Assoc 2006;106:193‑8.
16. Kheirabadi GR, Maracy MR, Barekatain M, Salehi M, Sadri GH,
Kelishadi M, et al. Risk factors of postpartum depression in rural
areas of Isfahan Province, Iran. Arch Iran Med 2009;12:461‑7.
17. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM.
Risk factors for depressive symptoms during pregnancy: A
systematic review. Am J Obstet Gynecol 2010;202:5‑14.
18. Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology
of postpartum depression. Compr Psychiatry 2003;44:234‑46.
19. Buttner MM, Mott SL, Pearlstein T, Stuart S, Zlotnick C,
O’Hara MW. Examination of premenstrual symptoms as a risk
factor for depression in postpartum women. Arch Womens Ment
Health 2013;16:219‑25.
20. Zinga D, Phillips SD, Born L. Postpartum depression: We
know the risks, can it be prevented? Rev Bras Psiquiatr
2005;27 Suppl 2:S56‑64.
21. Sanjuan J, Martin‑Santos R, Garcia‑Esteve L, Carot JM,
Guillamat R, Gutierrez‑Zotes A, et al. Mood changes after
delivery: Role of the serotonin transporter gene. Br J Psychiatry
2008;193:383‑8.
22. Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal
depression and parenting stress. BMC Psychiatry 2008;8:24.
23. Mayberry LJ, Horowitz JA, Declercq E. Depression symptom
prevalence and demographic risk factors among U.S. women
during the first 2 years postpartum. J Obstet Gynecol Neonatal
Nurs 2007;36:542‑9.
24. Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C.
Predictors of postpartum depression: Prospective study of 264
women followed during pregnancy and postpartum. Psychiatry
Res 2014;215:341‑6.
25. Helle N, Barkmann C, Bartz‑Seel J, Diehl T, Ehrhardt S, Hendel A,
et al. Very low birth‑weight as a risk factor for postpartum
depression four to six weeks postbirth in mothers and fathers:
Cross‑sectional results from a controlled multicentre cohort study.
J Affect Disord 2015;180:154‑61.
26. Houston KA, Kaimal AJ, Nakagawa S, Gregorich SE, Yee LM,
KuppermannM. Mode of delivery and postpartum depression: The
role of patient preferences. Am J Obstet Gynecol 2015;212:229.e1‑7.
27. DingT, WangDX, QuY, ChenQ, Zhu SN. Epidural labor analgesia
is associated with a decreased risk of postpartum depression: A
prospective cohort study. Anesth Analg 2014;119:383‑92.
28. Dørheim SK, Bjorvatn B, Eberhard‑Gran M. Can insomnia in
pregnancy predict postpartum depression? A longitudinal,
population‑based study. PLoS One 2014;9:e94674.
29. Figueiredo B, Canário C, Field T. Breastfeeding is negatively
affected by prenatal depression and reduces postpartum
depression. Psychol Med 2014;44:927‑36.
30. Hamdan A, Tamim H. Psychosocial risk and protective factors
for postpartum depression in the United Arab Emirates. Arch
Womens Ment Health 2011;14:125‑33.
31. Kiernan K, Pickett KE. Marital status disparities in maternal
smoking during pregnancy, breastfeeding and maternal
depression. Soc Sci Med 2006;63:335‑46.
32. Field T, Hernandez‑Reif M, Feijo L. Breastfeeding in depressed
mother‑infant dyads. Early Child Dev Care 2002;172:539‑45.
33. Silva R, Jansen K, Souza L, Quevedo L, Barbosa L, Moraes I,
et al. Sociodemographic risk factors of perinatal depression: A
cohort study in the public health care system. Rev Bras Psiquiatr
2012;34:143‑8.
34. Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J,
et al. Antenatal risk factors for postnatal depression: A large
prospective study. J Affect Disord 2008;108:147‑57.
35. Abdollahi F, Sazlina SG, Zain AM, Zarghami M,
Asghari Jafarabadi M, Lye MS. Postpartum depression and
psycho‑socio‑demographic predictors. Asia Pac Psychiatry
2014;6:425‑34.
36. Huang T, Rifas‑Shiman SL, Ertel KA, Rich‑Edwards J, Kleinman K,
Gillman MW, et al. Pregnancy hyperglycaemia and risk of
prenatal and postpartum depressive symptoms. Paediatr Perinat
Epidemiol 2015;29:281‑9.
37. Aishwarya S, Rajendiren S, Kattimani S, Dhiman P, Haritha S,
Ananthanarayanan PH. Homocysteine and serotonin: Association
with postpartum depression. Asian J Psychiatr 2013;6:473‑7.
38. Sholehvar F, Takhshid MA, Rafiei M. Review of metabolism,
transport and role of serotonin in the body and the relation
between serotonin and diseases. J Fasa Univ Med Sci 2013;3:9‑17.
39. Neumann ID, Landgraf R. Balance of brain oxytocin and
vasopressin: Implications for anxiety, depression, and social
behaviors. Trends Neurosci 2012;35:649‑59.
40. Skrundz M, Bolten M, Nast I, Hellhammer DH, Meinlschmidt G.
Plasma oxytocin concentration during pregnancy is
associated with development of postpartum depression.
Neuropsychopharmacology 2011;36:1886‑93.
41. Yoshida M, Takayanagi Y, Inoue K, Kimura T, Young LJ, Onaka T,
et al. Evidence that oxytocin exerts anxiolytic effects via oxytocin
receptor expressed in serotonergic neurons in mice. J Neurosci
2009;29:2259‑71.
42. Slattery DA, Neumann ID. Oxytocin and major depressive
disorder: Experimental and clinical evidence for links to aetiology
and possible treatment. Pharmaceuticals (Basel) 2010;3:702‑24.
43. Shapiro GD, Fraser WD, Séguin JR. Emerging risk factors for
postpartum depression: Serotonin transporter genotype and
omega‑3 fatty acid status. Can J Psychiatry 2012;57:704‑12.
44. Osterlund MK, Witt MR, Gustafsson JA. Estrogen action in mood
and neurodegenerative disorders: Estrogenic compounds with
selective properties‑the next generation of therapeutics. Endocrine
2005;28:235‑42.
45. Douma SL, Husband C, O’Donnell ME, Barwin BN, Woodend AK.
Estrogen‑related mood disorders: Reproductive life cycle factors.
ANS Adv Nurs Sci 2005;28:364‑75.
46. Tsigos C, Chrousos GP. Hypothalamic‑pituitary‑adrenal
axis, neuroendocrine factors and stress. J Psychosom Res
2002;53:865‑71.
47. Kammerer M, Taylor A, Glover V. The HPA axis and
perinatal depression: A hypothesis. Arch Womens Ment Health
2006;9:187‑96.
48. Pedersen CA, Johnson JL, Silva S, Bunevicius R, Meltzer‑Brody S,
Hamer RM, et al. Antenatal thyroid correlates of postpartum
depression. Psychoneuroendocrinology 2007;32:235‑45.
49. Kuijpens JL, Vader HL, Drexhage HA, Wiersinga WM,
van Son MJ, Pop VJ. Thyroid peroxidase antibodies during
gestation are a marker for subsequent depression postpartum.
Eur J Endocrinol 2001;145:579‑84.
50. Qu M, Tang Q, Li X, Zhao R, Li J, Xu H, et al. Shen‑Qi‑Jie‑Yu‑Fang
has antidepressant effects in a rodent model of postpartum
depression by regulating the immune organs and subsets of T
lymphocytes. Neuropsychiatr Dis Treat 2015;11:1523‑40.
51. Miller AH. Depression and immunity: A role for T cells? Brain
Behav Immun 2010;24:1‑8.
52. Kendall‑Tackett K. A new paradigm for depression in new
mothers: The central role of inflammation and how breastfeeding
and anti‑inflammatory treatments protect maternal mental health.
Int Breastfeed J 2007;2:6.
53. Krause D, Jobst A, Kirchberg F, Kieper S, Härtl K, Kästner R, et al. Prenatal immunologic predictors of postpartum depressive
symptoms: A prospective study for potential diagnostic markers.
Eur Arch Psychiatry Clin Neurosci 2014;264:615‑24.
54. Feng Z, Jones K, Wang WW. An exploratory discrete‑time
multilevel analysis of the effect of social support on the survival
of elderly people in China. Soc Sci Med 2015;130:181‑9.
55. Escribà‑Agüir V, Artazcoz L. Gender differences in postpartum
depression: A longitudinal cohort study. J Epidemiol Community
Health 2011;65:320‑6.
56. Landman‑Peeters KM, Hartman CA, van der Pompe G,
den Boer JA, Minderaa RB, Ormel J. Gender differences in the
relation between social support, problems in parent‑offspring
communication, and depression and anxiety. Soc Sci Med
2005;60:2549‑59.
57. Galvão J. Brazil and access to HIV/AIDS drugs: A question
of human rights and public health. Am J Public Health
2005;95:1110‑6.
58. Ludermir AB, Lewis G, Valongueiro SA, de Araújo TV, Araya R.
Violence against women by their intimate partner during
pregnancy and postnatal depression: A prospective cohort study.
Lancet 2010;376:903‑10.
59. Jansen K, Curra AR, Souza LD, Pinheiro RT, Moraes IG,
Cunha MS, et al. Tobacco smoking and depression during
pregnancy. Rev Psiquiatr Rio Gd Sul 2010;32:44‑7.
60. Gurber S, Baumeler L, Grob A, Surbek D, Stadlmayr W.
Antenatal depressive symptoms and subjective birth experience
in association with postpartum depressive symptoms and acute
stress reaction in mothers and fathers: A longitudinal path
analysis. Eur J Obstet Gynecol Reprod Biol. 2017; 215:68‑74.
61. Miyake Y, Tanaka K, Sasaki S, Hirota Y. Employment, income,
and education and risk of postpartum depression: The Osaka
Maternal and Child Health Study. J Affect Disord 2011;130:133‑7.
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74. Daley AJ, Macarthur C, Winter H. The role of exercise in treating
postpartum depression: A review of the literature. J Midwifery
Womens Health 2007;52:56‑62.
A literature review. Int J Nurs Stud 2009;46:1355‑73.
2. Beck CT, Records K, Rice M. Further development of the
Postpartum Depression Predictors Inventory‑Revised. J Obstet
Gynecol Neonatal Nurs 2006;35:735‑45.
3. Corwin EJ, Murray‑Kolb LE, Beard JL. Low hemoglobin level is
a risk factor for postpartum depression. J Nutr 2003;133:4139‑42.
4. Aswathi A, Rajendiren S, Nimesh A, Philip RR, Kattimani S,
Jayalakshmi D, et al. High serum testosterone levels during
postpartum period are associated with postpartum depression.
Asian J Psychiatr 2015;17:85‑8.
5. Norhayati MN, Hazlina NH, Asrenee AR, EmilinWM. Magnitude
and risk factors for postpartum symptoms: A literature review.
J Affect Disord 2015;175:34‑52.
6. Youn JH, Jeong IS. Predictive validity of the postpartum
depression predictors inventory‑revised. Asian Nurs Res
(Korean Soc Nurs Sci) 2011;5:210‑5.
7. Chaudron LH. Postpartum depression: What pediatricians need
to know. Pediatr Rev 2003;24:154‑61.
8. Thorsteinsson EB, Loi NM, Moulynox AL. Mental health literacy
of depression and postnatal depression: A community sample.
Open J Depress 2014;2014:101‑11.
9. Spinelli MG. Maternal infanticide associated with mental illness:
Prevention and the promise of saved lives. Am J Psychiatry
2004;161:1548‑57.
10. Mathisen SE, Glavin K, Lien L, Lagerløv P. Prevalence and risk
factors for postpartum depressive symptoms in Argentina: A
cross‑sectional study. Int J Womens Health 2013;5:787‑93.
11. De Crescenzo F, Perelli F, ArmandoM, Vicari S. Selective serotonin
reuptake inhibitors (SSRIs) for post‑partum depression (PPD): A
systematic review of randomized clinical trials. J Affect Disord
2014;152:39‑44.
12. Nardi B, Laurenzi S, Di Nicolò M, Bellantuono C. Is the
cognitive‑behavioural therapy an effective strategy also in the
prevention of post partum depression? a critical review. Riv
Psichiatr 2012;47:205‑13.13. Lee DT, Yip AS, Leung TY, Chung TK. Identifying women at risk
of postnatal depression: Prospective longitudinal study. Hong
Kong Med J 2000;6:349‑54.
14. Davey HL, Tough SC, Adair CE, Benzies KM. Risk factors
for sub‑clinical and major postpartum depression among a
community cohort of Canadian women. Matern Child Health J
2011;15:866‑75.
15. McCoy SJ, Beal JM, Shipman SB, Payton ME, Watson GH. Risk
factors for postpartum depression: A retrospective investigation at
4‑weeks postnatal and a review of the literature. J Am Osteopath
Assoc 2006;106:193‑8.
16. Kheirabadi GR, Maracy MR, Barekatain M, Salehi M, Sadri GH,
Kelishadi M, et al. Risk factors of postpartum depression in rural
areas of Isfahan Province, Iran. Arch Iran Med 2009;12:461‑7.
17. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM.
Risk factors for depressive symptoms during pregnancy: A
systematic review. Am J Obstet Gynecol 2010;202:5‑14.
18. Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology
of postpartum depression. Compr Psychiatry 2003;44:234‑46.
19. Buttner MM, Mott SL, Pearlstein T, Stuart S, Zlotnick C,
O’Hara MW. Examination of premenstrual symptoms as a risk
factor for depression in postpartum women. Arch Womens Ment
Health 2013;16:219‑25.
20. Zinga D, Phillips SD, Born L. Postpartum depression: We
know the risks, can it be prevented? Rev Bras Psiquiatr
2005;27 Suppl 2:S56‑64.
21. Sanjuan J, Martin‑Santos R, Garcia‑Esteve L, Carot JM,
Guillamat R, Gutierrez‑Zotes A, et al. Mood changes after
delivery: Role of the serotonin transporter gene. Br J Psychiatry
2008;193:383‑8.
22. Leigh B, Milgrom J. Risk factors for antenatal depression, postnatal
depression and parenting stress. BMC Psychiatry 2008;8:24.
23. Mayberry LJ, Horowitz JA, Declercq E. Depression symptom
prevalence and demographic risk factors among U.S. women
during the first 2 years postpartum. J Obstet Gynecol Neonatal
Nurs 2007;36:542‑9.
24. Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C.
Predictors of postpartum depression: Prospective study of 264
women followed during pregnancy and postpartum. Psychiatry
Res 2014;215:341‑6.
25. Helle N, Barkmann C, Bartz‑Seel J, Diehl T, Ehrhardt S, Hendel A,
et al. Very low birth‑weight as a risk factor for postpartum
depression four to six weeks postbirth in mothers and fathers:
Cross‑sectional results from a controlled multicentre cohort study.
J Affect Disord 2015;180:154‑61.
26. Houston KA, Kaimal AJ, Nakagawa S, Gregorich SE, Yee LM,
KuppermannM. Mode of delivery and postpartum depression: The
role of patient preferences. Am J Obstet Gynecol 2015;212:229.e1‑7.
27. DingT, WangDX, QuY, ChenQ, Zhu SN. Epidural labor analgesia
is associated with a decreased risk of postpartum depression: A
prospective cohort study. Anesth Analg 2014;119:383‑92.
28. Dørheim SK, Bjorvatn B, Eberhard‑Gran M. Can insomnia in
pregnancy predict postpartum depression? A longitudinal,
population‑based study. PLoS One 2014;9:e94674.
29. Figueiredo B, Canário C, Field T. Breastfeeding is negatively
affected by prenatal depression and reduces postpartum
depression. Psychol Med 2014;44:927‑36.
30. Hamdan A, Tamim H. Psychosocial risk and protective factors
for postpartum depression in the United Arab Emirates. Arch
Womens Ment Health 2011;14:125‑33.
31. Kiernan K, Pickett KE. Marital status disparities in maternal
smoking during pregnancy, breastfeeding and maternal
depression. Soc Sci Med 2006;63:335‑46.
32. Field T, Hernandez‑Reif M, Feijo L. Breastfeeding in depressed
mother‑infant dyads. Early Child Dev Care 2002;172:539‑45.
33. Silva R, Jansen K, Souza L, Quevedo L, Barbosa L, Moraes I,
et al. Sociodemographic risk factors of perinatal depression: A
cohort study in the public health care system. Rev Bras Psiquiatr
2012;34:143‑8.
34. Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J,
et al. Antenatal risk factors for postnatal depression: A large
prospective study. J Affect Disord 2008;108:147‑57.
35. Abdollahi F, Sazlina SG, Zain AM, Zarghami M,
Asghari Jafarabadi M, Lye MS. Postpartum depression and
psycho‑socio‑demographic predictors. Asia Pac Psychiatry
2014;6:425‑34.
36. Huang T, Rifas‑Shiman SL, Ertel KA, Rich‑Edwards J, Kleinman K,
Gillman MW, et al. Pregnancy hyperglycaemia and risk of
prenatal and postpartum depressive symptoms. Paediatr Perinat
Epidemiol 2015;29:281‑9.
37. Aishwarya S, Rajendiren S, Kattimani S, Dhiman P, Haritha S,
Ananthanarayanan PH. Homocysteine and serotonin: Association
with postpartum depression. Asian J Psychiatr 2013;6:473‑7.
38. Sholehvar F, Takhshid MA, Rafiei M. Review of metabolism,
transport and role of serotonin in the body and the relation
between serotonin and diseases. J Fasa Univ Med Sci 2013;3:9‑17.
39. Neumann ID, Landgraf R. Balance of brain oxytocin and
vasopressin: Implications for anxiety, depression, and social
behaviors. Trends Neurosci 2012;35:649‑59.
40. Skrundz M, Bolten M, Nast I, Hellhammer DH, Meinlschmidt G.
Plasma oxytocin concentration during pregnancy is
associated with development of postpartum depression.
Neuropsychopharmacology 2011;36:1886‑93.
41. Yoshida M, Takayanagi Y, Inoue K, Kimura T, Young LJ, Onaka T,
et al. Evidence that oxytocin exerts anxiolytic effects via oxytocin
receptor expressed in serotonergic neurons in mice. J Neurosci
2009;29:2259‑71.
42. Slattery DA, Neumann ID. Oxytocin and major depressive
disorder: Experimental and clinical evidence for links to aetiology
and possible treatment. Pharmaceuticals (Basel) 2010;3:702‑24.
43. Shapiro GD, Fraser WD, Séguin JR. Emerging risk factors for
postpartum depression: Serotonin transporter genotype and
omega‑3 fatty acid status. Can J Psychiatry 2012;57:704‑12.
44. Osterlund MK, Witt MR, Gustafsson JA. Estrogen action in mood
and neurodegenerative disorders: Estrogenic compounds with
selective properties‑the next generation of therapeutics. Endocrine
2005;28:235‑42.
45. Douma SL, Husband C, O’Donnell ME, Barwin BN, Woodend AK.
Estrogen‑related mood disorders: Reproductive life cycle factors.
ANS Adv Nurs Sci 2005;28:364‑75.
46. Tsigos C, Chrousos GP. Hypothalamic‑pituitary‑adrenal
axis, neuroendocrine factors and stress. J Psychosom Res
2002;53:865‑71.
47. Kammerer M, Taylor A, Glover V. The HPA axis and
perinatal depression: A hypothesis. Arch Womens Ment Health
2006;9:187‑96.
48. Pedersen CA, Johnson JL, Silva S, Bunevicius R, Meltzer‑Brody S,
Hamer RM, et al. Antenatal thyroid correlates of postpartum
depression. Psychoneuroendocrinology 2007;32:235‑45.
49. Kuijpens JL, Vader HL, Drexhage HA, Wiersinga WM,
van Son MJ, Pop VJ. Thyroid peroxidase antibodies during
gestation are a marker for subsequent depression postpartum.
Eur J Endocrinol 2001;145:579‑84.
50. Qu M, Tang Q, Li X, Zhao R, Li J, Xu H, et al. Shen‑Qi‑Jie‑Yu‑Fang
has antidepressant effects in a rodent model of postpartum
depression by regulating the immune organs and subsets of T
lymphocytes. Neuropsychiatr Dis Treat 2015;11:1523‑40.
51. Miller AH. Depression and immunity: A role for T cells? Brain
Behav Immun 2010;24:1‑8.
52. Kendall‑Tackett K. A new paradigm for depression in new
mothers: The central role of inflammation and how breastfeeding
and anti‑inflammatory treatments protect maternal mental health.
Int Breastfeed J 2007;2:6.
53. Krause D, Jobst A, Kirchberg F, Kieper S, Härtl K, Kästner R, et al. Prenatal immunologic predictors of postpartum depressive
symptoms: A prospective study for potential diagnostic markers.
Eur Arch Psychiatry Clin Neurosci 2014;264:615‑24.
54. Feng Z, Jones K, Wang WW. An exploratory discrete‑time
multilevel analysis of the effect of social support on the survival
of elderly people in China. Soc Sci Med 2015;130:181‑9.
55. Escribà‑Agüir V, Artazcoz L. Gender differences in postpartum
depression: A longitudinal cohort study. J Epidemiol Community
Health 2011;65:320‑6.
56. Landman‑Peeters KM, Hartman CA, van der Pompe G,
den Boer JA, Minderaa RB, Ormel J. Gender differences in the
relation between social support, problems in parent‑offspring
communication, and depression and anxiety. Soc Sci Med
2005;60:2549‑59.
57. Galvão J. Brazil and access to HIV/AIDS drugs: A question
of human rights and public health. Am J Public Health
2005;95:1110‑6.
58. Ludermir AB, Lewis G, Valongueiro SA, de Araújo TV, Araya R.
Violence against women by their intimate partner during
pregnancy and postnatal depression: A prospective cohort study.
Lancet 2010;376:903‑10.
59. Jansen K, Curra AR, Souza LD, Pinheiro RT, Moraes IG,
Cunha MS, et al. Tobacco smoking and depression during
pregnancy. Rev Psiquiatr Rio Gd Sul 2010;32:44‑7.
60. Gurber S, Baumeler L, Grob A, Surbek D, Stadlmayr W.
Antenatal depressive symptoms and subjective birth experience
in association with postpartum depressive symptoms and acute
stress reaction in mothers and fathers: A longitudinal path
analysis. Eur J Obstet Gynecol Reprod Biol. 2017; 215:68‑74.
61. Miyake Y, Tanaka K, Sasaki S, Hirota Y. Employment, income,
and education and risk of postpartum depression: The Osaka
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