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Socioeconomic status and depression during and after pregnancy in the Franconian Maternal Health Evaluation Studies (FRAMES)

  • Maternal-Fetal Medicine
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Depression during and after pregnancy can have a negative impact on women’s quality of life and on the development of the newborn child. Interventions have been shown to have a positive influence on both mothers and children. Predictive factors for depressive symptoms might possibly be able to identify groups that are at high risk. The aim of this study was to investigate the value of socioeconomic factors in predicting depressive symptoms during and after pregnancy.

Methods

Depressiveness was measured using the German version of the 10-item Edinburgh Postnatal Depression Scale (EPDS) at three time-points, in a prospective cohort study (n = 1,100). Visit 1 (Q1) was at study entry in the third trimester of the pregnancy, visit 2 (Q2) was shortly after birth, and visit 3 (Q3) was 6–8 months after birth. Depression scores were associated with socioeconomic factors and time in linear mixed models.

Results

Parity status, education status, monthly income, residential property status, and partnership status, as well as interactions between them, were found to be predictive factors for EPDS scores. The strongest factor influencing depressive symptoms was partnership status. Women who did not have an intact partnership had EPDS scores that were on average four points higher than in women with a partner at all three study visits (P < 0.000001).

Conclusions

Socioeconomic factors define subgroups that have different depression scores during and after pregnancy. Partnership status appears to be one of the most important influencing factors and could be useful for identifying women who should be offered an intervention to prevent possible negative effects on the mother or child.

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References

  1. Gawlik S, Reck C, Kuelkens S, Waldeier L, Sohn C, Schlehe B, Maul H (2010) Prenatal depression and anxiety: what is important for the obstetrician? Geburtsh Frauenheilkd 70(5):361–368. doi:10.1055/s-0030-1249842

    Article  Google Scholar 

  2. Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC (2005) Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evid Rep Technol Assess (Summ) 119:1–8

    Google Scholar 

  3. Alder J, Fink N, Bitzer J, Hosli I, Holzgreve W (2007) Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 20(3):189–209. doi:10.1080/14767050701209560

    Article  PubMed  Google Scholar 

  4. Bansil P, Kuklina EV, Meikle SF, Posner SF, Kourtis AP, Ellington SR, Jamieson DJ (2010) Maternal and fetal outcomes among women with depression. J Womens Health 19(2):329–334. doi:10.1089/jwh2009.1387

    Article  Google Scholar 

  5. Lancaster CA, Flynn HA, Johnson TRB, Marcus SM, Davis MM (2010) Peripartum length of stay for women with depressive symptoms during pregnancy. J Womens Health 19(1):31–37. doi:10.1089/jwh2009.1383

    Article  Google Scholar 

  6. Deave T, Heron J, Evans J, Emond A (2008) The impact of maternal depression in pregnancy on early child development. BJOG 115(8):1043–1051. doi:10.1111/j.1471-0528.2008.01752.x

    Article  CAS  PubMed  Google Scholar 

  7. Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D (2011) Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 14(1):1–27. doi:10.1007/s10567-010-0080-1

    Article  PubMed  Google Scholar 

  8. Agnafors S, Sydsjo G, Dekeyser L, Svedin CG (2012) Symptoms of depression postpartum and 12 years later-associations to child mental health at 12 years of age. Matern Child Health J. doi:10.1007/s10995-012-0985-z

    Google Scholar 

  9. Poobalan AS, Aucott LS, Ross L, Smith WC, Helms PJ, Williams JH (2007) Effects of treating postnatal depression on mother-infant interaction and child development: systematic review. Br J Psychiatry 191:378–386. doi:10.1192/bjp.bp.106.032789

    Article  CAS  PubMed  Google Scholar 

  10. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14. doi:10.1016/j.ajog.2009.09.007

    Article  PubMed Central  PubMed  Google Scholar 

  11. Suda S, Segi-Nishida E, Newton SS, Duman RS (2008) A postpartum model in rat: behavioral and gene expression changes induced by ovarian steroid deprivation. Biol Psychiatry 64(4):311–319. doi:10.1016/j.biopsych.2008.03.029

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Green AD, Barr AM, Galea LA (2009) Role of estradiol withdrawal in ‘anhedonic’ sucrose consumption: a model of postpartum depression. Physiol Behav 97(2):259–265. doi:10.1016/j.physbeh.2009.02.020

    Article  CAS  PubMed  Google Scholar 

  13. Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR (2000) Effects of gonadal steroids in women with a history of postpartum depression. Am J Psychiatry 157(6):924–930

    Article  CAS  PubMed  Google Scholar 

  14. Binder EB, Jeffrey Newport D, Zach EB, Smith AK, Deveau TC, Altshuler LL, Cohen LS, Stowe ZN, Cubells JF (2010) A serotonin transporter gene polymorphism predicts peripartum depressive symptoms in an at-risk psychiatric cohort. J Psychiatr Res 44(10):640–646. doi:10.1016/j.jpsychires.2009.12.001

    Article  PubMed Central  PubMed  Google Scholar 

  15. Doornbos B, Dijck-Brouwer DA, Kema IP, Tanke MA, van Goor SA, Muskiet FA, Korf J (2009) The development of peripartum depressive symptoms is associated with gene polymorphisms of MAOA, 5-HTT and COMT. Prog Neuropsychopharmacol Biol Psychiatry 33(7):1250–1254. doi:10.1016/j.pnpbp.2009.07.013

    Article  CAS  PubMed  Google Scholar 

  16. Forty L, Jones L, Macgregor S, Caesar S, Cooper C, Hough A, Dean L, Dave S, Farmer A, McGuffin P, Brewster S, Craddock N, Jones I (2006) Familiality of postpartum depression in unipolar disorder: results of a family study. Am J Psychiatry 163(9):1549–1553. doi:10.1176/appi.ajp.163.9.1549

    Article  PubMed  Google Scholar 

  17. Kohl C, Walch T, Huber R, Kemmler G, Neurauter G, Fuchs D, Solder E, Schrocksnadel H, Sperner-Unterweger B (2005) Measurement of tryptophan, kynurenine and neopterin in women with and without postpartum blues. J Affect Disord 86(2–3):135–142. doi:10.1016/j.jad.2004.12.013

    Article  CAS  PubMed  Google Scholar 

  18. Mahon PB, Payne JL, MacKinnon DF, Mondimore FM, Goes FS, Schweizer B, Jancic D, Coryell WH, Holmans PA, Shi J, Knowles JA, Scheftner WA, Weissman MM, Levinson DF, DePaulo JR Jr, Zandi PP, Potash JB (2009) Genome-wide linkage and follow-up association study of postpartum mood symptoms. Am J Psychiatry 166(11):1229–1237. doi:10.1176/appi.ajp.2009.09030417

    Article  PubMed Central  PubMed  Google Scholar 

  19. Murphy-Eberenz K, Zandi PP, March D, Crowe RR, Scheftner WA, Alexander M, McInnis MG, Coryell W, Adams P, DePaulo JR Jr, Miller EB, Marta DH, Potash JB, Payne J, Levinson DF (2006) Is perinatal depression familial? J Affect Disord 90(1):49–55. doi:10.1016/j.jad.2005.10.006

    Article  PubMed  Google Scholar 

  20. Payne JL, MacKinnon DF, Mondimore FM, McInnis MG, Schweizer B, Zamoiski RB, McMahon FJ, Nurnberger JI Jr, Rice JP, Scheftner W, Coryell W, Berrettini WH, Kelsoe JR, Byerley W, Gershon ES, DePaulo JR Jr, Potash JB (2008) Familial aggregation of postpartum mood symptoms in bipolar disorder pedigrees. Bipolar Disord 10(1):38–44. doi:10.1111/j.1399-5618.2008.00455.x

    Article  PubMed  Google Scholar 

  21. Sanjuan J, Martin-Santos R, Garcia-Esteve L, Carot JM, Guillamat R, Gutierrez-Zotes A, Gornemann I, Canellas F, Baca-Garcia E, Jover M, Navines R, Valles V, Vilella E, de Diego Y, Castro JA, Ivorra JL, Gelabert E, Guitart M, Labad A, Mayoral F, Roca M, Gratacos M, Costas J, van Os J, de Frutos R (2008) Mood changes after delivery: role of the serotonin transporter gene. Br J Psychiatry 193(5):383–388. doi:10.1192/bjp.bp.107.045427

    Article  CAS  PubMed  Google Scholar 

  22. Scheid JM, Holzman CB, Jones N, Friderici KH, Nummy KA, Symonds LL, Sikorskii A, Regier MK, Fisher R (2007) Depressive symptoms in mid-pregnancy, lifetime stressors and the 5-HTTLPR genotype. Genes Brain Behav 6(5):453–464. doi:10.1111/j.1601-183X.2006.00272.x

    Article  CAS  PubMed  Google Scholar 

  23. Llewellyn AM, Stowe ZN, Nemeroff CB (1997) Depression during pregnancy and the puerperium. J Clin Psychiatry 58(Suppl 15):26–32

    PubMed  Google Scholar 

  24. O’Hara MW (2009) Postpartum depression: what we know? J Clin Psychol 65(12):1258–1269. doi:10.1002/jclp.20644

    Article  PubMed  Google Scholar 

  25. Hopkins J, Campbell SB (2008) Development and validation of a scale to assess social support in the postpartum period. Archives of women’s mental health 11(1):57–65. doi:10.1007/s00737-008-0212-5

    Article  CAS  PubMed  Google Scholar 

  26. Cheng D, Schwarz EB, Douglas E, Horon I (2009) Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception 79(3):194–198. doi:10.1016/j.contraception.2008.09.009

    Article  PubMed  Google Scholar 

  27. Quelopana AM, Champion JD, Reyes-Rubilar T (2011) Factors associated with postpartum depression in Chilean women. Health Care Women Int 32(10):939–949. doi:10.1080/07399332.2011.603866

    Article  PubMed  Google Scholar 

  28. Melo EF Jr, Cecatti JG, Pacagnella RC, Leite DF, Vulcani DE, Makuch MY (2012) The prevalence of perinatal depression and its associated factors in two different settings in Brazil. J Affect Disord 136(3):1204–1208. doi:10.1016/j.jad.2011.11.023

    Article  PubMed  Google Scholar 

  29. Mautner E, Egger JW, Daghofer F, Lang U, Greimel E (2010) Medical and psychosocial risk factors for depression and decreased quality of life in pregnancy and postpartum. Geburtsh Frauenheilk 70(4):298–303. doi:10.1055/s-0029-1241021

    Article  Google Scholar 

  30. Zelkowitz P, Schinazi J, Katofsky L, Saucier JF, Valenzuela M, Westreich R, Dayan J (2004) Factors associated with depression in pregnant immigrant women. Transcult Psychiatry 41(4):445–464

    Article  PubMed  Google Scholar 

  31. Seguin L, Potvin L, St-Denis M, Loiselle J (1995) Chronic stressors, social support, and depression during pregnancy. Obstet Gynecol 85(4):583–589. doi:10.1016/0029-7844(94)00449-N

    Article  CAS  PubMed  Google Scholar 

  32. Pajulo M, Savonlahti E, Sourander A, Helenius H, Piha J (2001) Antenatal depression, substance dependency and social support. J Affect Disord 65(1):9–17

    Article  CAS  PubMed  Google Scholar 

  33. Larsson C, Sydsjo G, Josefsson A (2004) Health, sociodemographic data, and pregnancy outcome in women with antepartum depressive symptoms. Obstet Gynecol 104(3):459–466. doi:10.1097/01.AOG.0000136087.46864.e4

    Article  PubMed  Google Scholar 

  34. Hoffman S, Hatch MC (2000) Depressive symptomatology during pregnancy: evidence for an association with decreased fetal growth in pregnancies of lower social class women. Health Psychol Off J Div Health Psychol Am Psychol Assoc 19(6):535–543

    CAS  Google Scholar 

  35. Hobfoll SE, Ritter C, Lavin J, Hulsizer MR, Cameron RP (1995) Depression prevalence and incidence among inner-city pregnant and postpartum women. J Consult Clin Psychol 63(3):445–453

    Article  CAS  PubMed  Google Scholar 

  36. Lindgren K (2001) Relationships among maternal-fetal attachment, prenatal depression, and health practices in pregnancy. Res Nurs Health 24(3):203–217

    Article  CAS  PubMed  Google Scholar 

  37. Lermann J, Schott S, Dorr A, Grupe C, Lattrich C (2011) Is a Rdefinement in courses of “psychosomatic basic care in gynecology” absolutely necessary? Geburtsh Frauenheilk 71(6):550–551

    Article  Google Scholar 

  38. Siedentopf F, Rauchfuss M, Kentenich H (2011) Is further education in ‘basic psychosomatic care in gynecology’ urgently required? Geburtsh Frauenheilk 71(10):889–890

    Article  Google Scholar 

  39. Bakdash A, Burger P, Goecke TW, Fasching PA, Reulbach U, Bleich S, Hastedt M, Rothe M, Beckmann MW, Pragst F, Kornhuber J (2010) Quantification of fatty acid ethyl esters (FAEE) and ethyl glucuronide (EtG) in meconium from newborns for detection of alcohol abuse in a maternal health evaluation study. Anal Bioanal Chem 396(7):2469–2477. doi:10.1007/s00216-010-3474-5

    Article  CAS  PubMed  Google Scholar 

  40. Fasching PA, Faschingbauer F, Goecke TW, Engel A, Haberle L, Seifert A, Voigt F, Amann M, Rebhan D, Burger P, Kornhuber J, Ekici AB, Beckmann MW, Binder EB (2012) Genetic variants in the tryptophan hydroxylase 2 gene (TPH2) and depression during and after pregnancy. J Psychiatr Res. doi:10.1016/j.jpsychires.2012.05.011

    PubMed  Google Scholar 

  41. Mehta D, Menke A, Binder EB (2010) Gene expression studies in major depression. Curr Psychiatry Rep 12(2):135–144. doi:10.1007/s11920-010-0100-3

    Article  PubMed Central  PubMed  Google Scholar 

  42. Reulbach U, Bleich S, Knorr J, Burger P, Fasching PA, Kornhuber J, Beckmann MW, Goecke TW (2009) Pre-, peri- and postpartal depression. Fortschr Neurol Psychiatr 77(12):708–713. doi:10.1055/s-0028-1109822

    Article  CAS  PubMed  Google Scholar 

  43. Okano T, Nomura J (1992) Endocrine study of the maternity blues. Prog Neuropsychopharmacol Biol Psychiatry 16(6):921–932

    Article  CAS  PubMed  Google Scholar 

  44. Nagata M, Nagai Y, Sobajima H, Ando T, Nishide Y, Honjo S (2000) Maternity blues and attachment to children in mothers of full-term normal infants. Acta Psychiatr Scand 101(3):209–217

    Article  CAS  PubMed  Google Scholar 

  45. Mitchell AM, Mittelstaedt ME, Schott-Baer D (2006) Postpartum depression: the reliability of telephone screening. MCN Am J Matern Child Nurs 31(6):382–387

    Article  PubMed  Google Scholar 

  46. Bergant AM, Nguyen T, Heim K, Ulmer H, Dapunt O (1998) German language version and validation of the Edinburgh postnatal depression scale. Dtsch Med Wochenschr 123(3):35–40. doi:10.1055/s-2007-1023895

    Article  CAS  PubMed  Google Scholar 

  47. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150(6):782–786

    Article  CAS  PubMed  Google Scholar 

  48. Reck C, Struben K, Backenstrass M, Stefenelli U, Reinig K, Fuchs T, Sohn C, Mundt C (2008) Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatr Scand 118(6):459–468. doi:10.1111/j.1600-0447.2008.01264.x

    Article  CAS  PubMed  Google Scholar 

  49. Mehta D, Quast C, Fasching PA, Seifert A, Voigt F, Beckmann MW, Faschingbauer F, Burger P, Ekici AB, Kornhuber J, Binder EB, Goecke TW (2012) The 5-HTTLPR polymorphism modulates the influence on environmental stressors on peripartum depression symptoms. J Affect Disord 136(3):1192–1197. doi:10.1016/j.jad.2011.11.042

    Article  CAS  PubMed  Google Scholar 

  50. Dennis CL, Janssen PA, Singer J (2004) Identifying women at-risk for postpartum depression in the immediate postpartum period. Acta Psychiatr Scand 110(5):338–346. doi:10.1111/j.1600-0447.2004.00337.x

    Article  PubMed  Google Scholar 

  51. Navarro P, Ascaso C, Garcia-Esteve L, Aguado J, Torres A, Martín-Santos R (2007) Postnatal psychiatric morbidity: a validation study of the GHQ-12 and the EPDS as screening tools. Gen Hosp Psychiatry 29(1):1–7. doi:10.1016/j.genhosppsych.2006.10.004

    Article  PubMed  Google Scholar 

  52. Sit DWK (2009) Identification of postpartum depression. Clin Obstet Gynecol 52(3):456–468

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Universitaetsstrasse 21–23, 91054, Erlangen, Germany

    Alexander Hein, Claudia Rauh, Anne Engel, Lothar Häberle, Ulf Dammer, Franziska Voigt, Peter A. Fasching, Florian Faschingbauer, Matthias W. Beckmann & Tamme W. Goecke

  2. Department of Gynecology and Obstetrics, Medical Faculty, University of Technology Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Franziska Voigt & Tamme W. Goecke

  3. Department of Psychiatry and Psychotherapy, Erlangen University Hospital, Friedrich-Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Pascal Burger & Johannes Kornhuber

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  1. Alexander Hein
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  2. Claudia Rauh
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  3. Anne Engel
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  4. Lothar Häberle
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  9. Pascal Burger
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  10. Matthias W. Beckmann
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Correspondence to Peter A. Fasching.

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Hein, A., Rauh, C., Engel, A. et al. Socioeconomic status and depression during and after pregnancy in the Franconian Maternal Health Evaluation Studies (FRAMES). Arch Gynecol Obstet 289, 755–763 (2014). https://doi.org/10.1007/s00404-013-3046-y

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