Document Type : Original Article

Authors

1 Women Health Research Centre, 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

BACKGROUND AND AIM: Prenatal mental health has been shown to be related with postpartum
depression. However, the role of mental and psychological factors in postpartum depression requires
especial attention. Furthermore, the relationship between demographic factors and postpartum
depression is contradictory. The study was aimed to identify role of prenatal anxiety and depression
and demographic factors with postpartum depression.
MATERIALS AND METHODS: A prospective cohort study was conducted with 303 pregnant women
who have gestational age from 28 to 36 weeks and referred to health‑care centers in Isfahan city
and follow‑up for 6–12 weeks after postpartum. Data were collected using the demographic form,
Edinburgh depression, and anxiety Spielberger questionnaire during pregnancy and Edinburgh
depression inventory in the 6th and 12th weeks after childbirth. Descriptive statistics and linear logistic
regression were used to analyze the data. In demographic factors, data were analyzed using the
Student’s t‑test, Chi‑square, Pearson and Spearman test and after the meaningfulness of regression
was used.
RESULTS: Results showed that the 6 and 12 weeks after childbirth, 61 patients (20/1%) and
33 patients (10/9%) had postpartum depression. The most important risk factors for depression
in the first 6 weeks were history of infertility (confidence interval [CI]: 0.56–0.767) (P = 0.018) and
history of depression (CI: 1.155–1.369) (P = 0.000) and in 12 weeks, postpartum were history of
depression (CI: 0.072–1.305) (P = 0.001).
CONCLUSION: Infertility and history of depression during pregnancy were two risk factors of
postpartum depression which should be taken into consideration during prenatal care.

Keywords

  1. Gibson J, McKenzie‑McHarg K, Shakespeare J, Price J, Gray R.
    A systematic review of studies validating the Edinburgh postnatal
    depression scale in antepartum and postpartum women. Acta
    Psychiatr Scand 2009;119:350‑64.
    2. 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.
    3. Norhayati MN, Hazlina NH, Asrenee AR, EmilinWM. Magnitude
    and risk factors for postpartum symptoms: A literature review.
    J Affect Disord 2015;175:34‑52.
    4. Da Costa D, Dritsa M, Rippen N, Lowensteyn I, Khalifé S.
    Health‑related quality of life in postpartum depressed women.
    Arch Womens Ment Health 2006;9:95‑102.
    5. Josefsson A, Larsson C, Sydsjö G, Nylander PO. Temperament and
    character in women with postpartum depression. Arch Womens
    Ment Health 2007;10:3‑7.
    6. Cooper P, Murray L. Prediction, detection, and treatment of
    postnatal depression. Arch Dis Child 1997;77:97‑9.
    7. Osborne LM, Gispen F, Sanyal A, Yenokyan G, Meilman S,
    Payne JL, et al. Lower allopregnanolone during pregnancy
    predicts postpartum depression: An exploratory study.
    Psychoneuroendocrinology 2017;79:116‑21.
    8. Halbreich U, Karkun S. Cross‑cultural and social diversity of
    prevalence of postpartum depression and depressive symptoms.
    J Affect Disord 2006;91:97‑111.
    9. Veisani Y, Delpisheh A, Sayehmiri K, Rezaeian S. Trends
    of postpartum depression in Iran: A systematic review and
    meta‑analysis. Depress Res Treat 2013;2013:291029.
    10. Goker A, Yanikkerem E, Demet MM, Dikayak S, Yildirim Y,
    Koyuncu FM, et al. Postpartum depression: Is mode of delivery
    a risk factor? ISRN Obstet Gynecol 2012;2012:616759.
    11. Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk
    factors for postpartum depression: A synthesis of recent literature.
    Gen Hosp Psychiatry 2004;26:289‑95.
    12. Gunduz S, Kosger H, Aldemir S, Akcal B, Tevrizci H, Hizli D,
    et al. Sleep deprivation in the last trimester of pregnancy and
    inadequate Vitamin D: Is there a relationship? J Chin Med Assoc
    2016;79:34‑8.
    13. 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.
    14. Ghaedrahmati M, Kazemi A, Kheirabadi G, Ebrahimi A,
    Bahrami M. Postpartum depression risk factors: A narrative
    review. J Educ Health Promot 2017;6:60.
    15. Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the
    women at risk of antenatal anxiety and depression: A systematic
    review. J Affect Disord 2016;191:62‑77.
    16. AlipourZ, Lamyian M, Hajizadeh E. Anxiety and fear of childbirth
    as predictors of postnatal depression in nulliparous women.
    Women Birth 2012;25:e37‑43.
    17. Abedian Z, Soltani N, Mokhber N, Esmaily H. Depression and
    anxiety in pregnancy and postpartum in women with mild and
    severe preeclampsia. Iran J Nurs Midwifery Res 2015;20:454‑9.
    18. Kheirabadi GR, Maracy MR. Perinatal depression in a cohort
    study on Iranian women. J Res Med Sci 2010;15:41‑9.
  2. 19. Park JH, Karmaus W, Zhang H. Prevalence of and risk factors for
    depressive symptoms in Korean women throughout pregnancy
    and in postpartum period. Asian Nurs Res (Korean Soc Nurs Sci)
    2015;9:219‑25.
    20. Carroll JC, Reid AJ, Biringer A, Midmer D, Glazier RH,
    Wilson L, et al. Effectiveness of the antenatal psychosocial health
    assessment (ALPHA) form in detecting psychosocial concerns:
    A randomized controlled trial. CMAJ 2005;173:253‑9.
    21. Deng AW, Xiong RB, Jiang TT, Luo YP, Chen WZ. Prevalence
    and risk factors of postpartum depression in a population‑based
    sample of women in Tangxia community, Guangzhou. Asian Pac
    J Trop Med 2014;7:244‑9.
    22. Cox JL, Holden JM, SagovskyR. Detection of postnatal depression.
    Development of the 10‑item Edinburgh postnatal depression scale.
    Br J Psychiatry 1987;150:782‑6.
    23. Montazeri A, Torkan B, Omidvari S. The Edinburgh postnatal
    depression scale (EPDS): Translation and validation study of the
    Iranian version. BMC Psychiatry 2007;7:11.
    24. Kheirabadi GR, Maracy MR, Akbaripour S, Masaeli N.
    Psychometric properties and diagnostic accuracy of the
    Edinburgh postnatal depression scale in a sample of Iranian
    women. Iran J Med Sci 2012;37:32‑8.
    25. Sharifi F, Nouraei S, Shahverdi E. The relation of pre and postnatal
    depression and anxiety with exclusive breastfeeding. Electron
    Physician 2016;8:3234‑9.
    26. KumarR, Robson KM. A prospective study of emotional disorders
    in childbearing women. Br J Psychiatry 1984;144:35‑47.
    27. Austin MP, Tully L, Parker G. Examining the relationship between
    antenatal anxiety and postnatal depression. J Affect Disord
    2007;101:169‑74.
    28. Dennis CL, Brown HK, Falah‑Hassani K, Marini FC, Vigod SN.
    Identifying women at risk for sustained postpartum anxiety.
    J Affect Disord 2017;213:131‑7.
    29. Silverman ME, Reichenberg A, Savitz DA, Cnattingius S,
    Lichtenstein P, Hultman CM, et al. The risk factors for
    postpartum depression: A population‑based study. Depress
    Anxiety 2017;34:178‑87.
    30. Stewart DE, Vigod S. Postpartum depression. N Engl J Med
    2016;375:2177‑86.
    31. Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA,
    Hughes CL, et al. Onset timing, thoughts of self‑harm, and
    diagnoses in postpartum women with screen‑positive depression
    findings. JAMA Psychiatry 2013;70:490‑8.
    32. Bloch M, Daly RC, Rubinow DR. Endocrine factors in the etiology
    of postpartum depression. Compr Psychiatry 2003;44:234‑46.
    33. Priest SR, Austin MP, Barnett BB, Buist A. A psychosocial risk
    assessment model (PRAM) for use with pregnant and postpartum
    women in primary care settings. Arch Womens Ment Health
    2008;11:307‑17.
    34. Małus A, Szyluk J, Galińska‑Skok B, Konarzewska B. Incidence of
    postpartum depression and couple relationship quality. Psychiatr
    Pol 2016;50:1135‑46.
    35. Ross LE, Campbell VL, Dennis CL, Blackmore ER. Demographic
    characteristics of participants in studies of risk factors, prevention,
    and treatment of postpartum depression. Can J Psychiatry
    2006;51:704‑10.
    36. 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.
    37. Akyuz A, Seven M, Devran A, Demiralp M. Infertility history: Is
    it a risk factor for postpartum depression in Turkish women? J
    Perinat Neonatal Nurs 2010;24:137‑45.
    38. Ross LE, McQueen K, Vigod S, Dennis CL. Risk for postpartum
    depression associated with assisted reproductive technologies
    and multiple births: A systematic review. Hum Reprod Update
    2011;17:96‑106.
    39. Zaidi F, Nigam A, Anjum R, Agarwalla R. Postpartum depression
    in women: A Risk factor analysis. J Clin Diagn Res 2017;11:QC13‑6.
    40. Pereira PK, Lovisi GM, Pilowsky DL, Lima LA, Legay LF.
    Depression during pregnancy: Prevalence and risk factors among
    women attending a public health clinic in Rio de Janeiro, Brazil.
    Cad Saude Publica 2009;25:2725‑36.