J Korean Acad Nurs.  2013 Apr;43(2):225-235. 10.4040/jkan.2013.43.2.225.

Predictors of Postpartum Depression: Prospective Cohort Study

• Youn JH
• Jeong IS

• KMID: 1739486
• DOI: http://doi.org/10.4040/jkan.2013.43.2.225

Abstract

PURPOSE
This prospective cohort study was done to investigate recall bias to antepartum variables measured at postpartum periods and predictors of postpartum depression.
METHODS
Participants were 215 women who answered a self-administered questionnaire which included demographics, Postpartum Depression Predictors Inventory-Revised and Korean version of Edinburgh Postpartum Depression Scale at antepartum 36-40 weeks and postpartum 2 weeks and 6 weeks. Data were analyzed using kappa, and hierarchical multiple logistic regression.
RESULTS
Agreement between antepartum variables at both antepartum and two postpartum periods was relatively high (kappa=.55-.95). Postpartum depression rates were 36.3% and 36.7% at two follow-up points. In hierarchical multiple logistic regression analysis, prenatal depression (OR=4.32, 95% CI: 1.41-13.19; OR=5.19, 95% CI: 1.41-19.08), social support (OR=1.40, 95% CI: 1.18-1.66; OR=1.27, 95% CI: 1.06-1.53) and maternity blues (OR=4.75, 95% CI: 1.89-11.98; OR=4.22, 95% CI: 1.60-11.12) were commonly associated with postpartum depression at two follow-up points. Child care stress (OR=1.85, 95% CI: 1.01-3.37) was only associated with postpartum depression at 2 weeks postpartum and pregnancy intendedness (OR=1.57, 95% CI: 1.09-2.27) was only associated with postpartum depression at 6 weeks postpartum.
CONCLUSIONS
The results indicate a need to apply nursing interventions such as prenatal education and counseling with families from antenatal period.

Keyword

Postpartum depression; Prospective studies; Cohort studies; PPDI-R; K-EPDS

MeSH Terms

Adult
Anxiety
Cohort Studies
Demography
Depression, Postpartum/*psychology
Female
Follow-Up Studies
Humans
Logistic Models
Odds Ratio
Postpartum Period
Pregnancy
Prospective Studies
Questionnaires

Reference

1. Ahn OS, Oh WO. Relationship among postpartum depression, parenting stress and self-esteem in mothers during puerperium. J Korean Soc Matern Child Health. 2006. 10(1):58–68.

2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR®). 2000. Washington, DC: Author.

3. Avan B, Richter LM, Ramchandani PG, Norris SA, Stein A. Maternal postnatal depression and children's growth and behaviour during the early years of life: Exploring the interaction between physical and mental health. Arch Dis Child. 2010. 95(9):690–695. http://dx.doi.org/10.1136/adc.2009.164848.

4. Bae JI. Construction of a postpartum depression model. J Korean Acad Psychiatr Ment Health Nurs. 2002. 11(4):572–587.

5. Beck CT. Predictors of postpartum depression: An update. Nurs Res. 2001. 50(5):275–285.

6. Beck CT. Revision of the postpartum depression predictors inventory. J Obstet Gynecol Neonatal Nurs. 2002. 31(4):394–402.

7. Beck CT, Records K, Rice M. Further development of the postpartum depression predictors inventory-revised. J Obstet Gynecol Neonatal Nurs. 2006. 35(6):735–745. http://dx.doi.org/10.1111/j.1552-6909.2006.00094.x.

8. Centers for Disease Control and Prevention. Prevalence of self-reported postpartum depressive symptoms-17 states, 2004-2005. MMWR Morb Mortal Wkly Rep. 2008. 57(14):361–366.

9. Chaudron LH, Pies RW. The relationship between postpartum psychosis and bipolar disorder: A review. J Clin Psychiatry. 2003. 64(11):1284–1292.

10. Corwin EJ, Kohen R, Jarrett M, Stafford B. The heritability of postpartum depression. Biol Res Nurs. 2010. 12(1):73–83. http://dx.doi.org/10.1177/1099800410362112.

11. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item edinburgh postnatal depression scale. Br J Psychiatry. 1987. 150:782–786.

12. Gjerdingen DK, Froberg DG, Chaloner KM, McGovern PM. Changes in women's physical health during the first postpartum year. Arch Fam Med. 1993. 2(3):277–283.

13. Gupta R, Kar BR. Attention and memory biases as stable abnormalities among currently depressed and currently remitted individuals with unipolar depression. Front Psychiatry. 2012. 3:99. http://dx.doi.org/10.3389/fpsyt.2012.00099.

14. Han KW, Kim MJ, Park JM. The edinburgh postnatal depression scale, Korean version: Reliability and validity. J Korean Soc Biol Ther Psychiatry. 2004. 10(2):201–207.

15. Jang EJ. Psychosocial and obstetric factors associated with postpartum depressive symptoms. 2008. Gyeong-ju: Dongguk University;Unpublished master's thesis.

16. Josefsson A, Berg G, Nordin C, Sydsjö G. Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand. 2001. 80(3):251–255.

17. Jung MH, Kim JI. A study on the relationship among prenatal emotional status, preparation for delivery, postpartum social support and postpartum blues. Korean J Women Health Nurs. 2005. 11(1):38–45.

18. Kim JW, Kim JH, Kim BJ. Psychosocial and obstetric factors associated with postpartum depressive symptoms. J Korean Neuropsychiatr Assoc. 2005. 44(2):213–220.

19. Kim MW, Yang HS, Kim JR. A study on agreements among screening tests and related factors with postpartum depression. Korean J Obstet Gynecol. 2009. 52(11):1133–1143.

20. Kim SO. Postpartum depression and maternal identity of the high risk women. 2009. Gangneung: Kwandong University;Unpublished master's thesis.

21. Kim YK, Hur JW, Kim KH, Oh KS, Shin YC. Clinical application of Korean version of edinburgh postnatal depression scale. J Korean Neuropsychiatr Assoc. 2008. 47(1):36–44.

22. Kwon M, Kim H, Kim N, Jang J. Postpartum depression and maternal role confidence, parenting stress, and infant temperament in mothers of young infants. J Korean Acad Child Health Nurs. 2006. 12(3):314–321.

23. Meadows SO, McLanahan SS, Brooks-Gunn J. Parental depression and anxiety and early childhood behavior problems across family types. J Marriage Fam. 2007. 69(5):1162–1177.

24. 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(1-2):133–137. http://dx.doi.org/10.1016/j.jad.2010.10.024.

25. Moses-Kolko EL, Berga SL, Kalro B, Sit DK, Wisner KL. Transdermal estradiol for postpartum depression: A promising treatment option. Clin Obstet Gynecol. 2009. 52(3):516–529. http://dx.doi.org/10.1097/GRF.0b013e3181b5a395.

26. Oppo A, Mauri M, Ramacciotti D, Camilleri V, Banti S, Borri C, et al. Risk factors for postpartum depression: The role of the postpartum depression predictors inventory-revised (PDPI-R). Results from the perinatal depression-research & screening unit (PNDReScU) study. Arch Womens Ment Health. 2009. 12(4):239–249. http://dx.doi.org/10.1007/s00737-009-0071-8.

27. Paulson JF, Bazemore SD. Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA. 2010. 303(19):1961–1969. http://dx.doi.org/10.1001/jama.2010.605.

28. Rubertsson C, Wickberg B, Gustavsson P, Rådestad I. Depressivesymptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Arch Womens Ment Health. 2005. 8(2):97–104. http://dx.doi.org/10.1007/s00737-005-0078-8.

29. Ryu JM. Postpartum depression and its predictors at 1 to 6 months postpartum in Korea. 2008. Seoul: Hanyang University;Unpublished master's thesis.

30. Viera AJ, Garrett JM. Understanding interobserver agreement: The kappa statistic. Fam Med. 2005. 37(5):360–363.

31. Yeo JH. Postpartum depression and its predictors at six months postpartum. Korean J Women Health Nurs. 2006. 12(4):355–362.

32. Youn JH, Jeong IS. Predictive validity of the postpartum depression predictors inventory-revised. Asian Nurs Res. 2011. 5(4):210–215. http://dx.doi.org/10.1016/j.anr.2011.11.003.