Factors associated with depressive symptoms among 1,502 couples in the immediate puerperium

Abstract

Background:

Historically, perinatal depression has predominantly focussed on the mother-baby dyad, often neglecting the crucial role of fathers.

Aim:

To determine the prevalence and associated factors of depressive symptoms in the immediate puerperium (PDS) in both mothers and fathers, individually and concurrently.

Method:

This study employed a cross-sectional design. The presence of PDS was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score of ⩾11 for mothers and ⩾9 for fathers. Logistic regression analyses were conducted to identify factors independently associated with PDS. Robustness of findings was verified through sensitivity analyses among participants without prior psychiatric conditions.

Results:

Among 1,502 partnered mothers and fathers aged ⩾18 years who met the inclusion criteria, PDS were present in 13.0% of mothers, 10.5% of fathers and 3.5% of both parents. Mother-baby skin-to-skin contact and the father’s pregnancy planning were associated with a lower likelihood of PDS in mothers. For fathers, financial difficulties increased the likelihood of experiencing PDS threefold. The presence of PDS in mothers quadrupled the likelihood of PDS in fathers, and vice versa; their EPDS scores demonstrated a moderate correlation (r_s = .38). Among participants without prior psychiatric conditions, the odds of co-occurring PDS nearly tripled if the mother had a history of abortion or miscarriage. Fathers who had increased potentially addictive behaviours showed a six-fold increase in the likelihood of experiencing PDS.

Conclusions:

Identifying depressive symptoms in both parents and incorporating fathers into clinical practice, research and health policy could enhance mental health outcomes in vulnerable populations.

Keywords

Couple parents perinatal depression postnatal depression postpartum depression puerperium

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References

Aftab

Ahmed

Ali

S. M.

Amenga-Etego

Ariff

Bahl

Baqui

A. H.

Begum

Bhutta

A. Z.

Biemba

Cousens

Das

Deb

Dhingra

Dutta

Edmond

Esamai

Ghosh

A. K.

… Zaidi

A. K.

(2021). Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries. PLoS Medicine, 18(6), e1003644. http://doi.org/10.1371/journal.pmed.1003644

Alexopoulos

Tmej

Naderer

Grussmann

Tordy

Stammler-Safar

Feichtinger

Gipperich

Leithner

(2024). Men don’t cry: The supporting role as necessary for women’s well-being after termination of pregnancy. International Journal of Gynaecology and Obstetrics, 164(3), 1205–1211. https://doi.org/10.1002/ijgo.15234

Anding

J. E.

Rohrle

Grieshop

Schucking

Christiansen

(2016). Couple comorbidity and correlates of postnatal depressive symptoms in mothers and fathers in the first two weeks following delivery. Journal of Affective Disorders, 190, 300–309. https://doi.org/10.1016/j.jad.2015.10.033

Ascaso-Terrén

Garcia-Esteve

Navarro

Aguado

Ojuel

Tarragona

M. J.

(2003). Prevalence of postpartum depression in Spanish mothers: Comparison of estimation by mean of the structured clinical interview for DSM-IV with the Edinburgh Postnatal Depression Scale. Medicina Clínica, 120, 326–329. https://pubmed.ncbi.nlm.nih.gov/12646107/

Bauer

Pawlby

Plant

D. T.

King

Pariante

C. M.

Knapp

(2015). Perinatal depression and child development: Exploring the economic consequences from a South London cohort. Psychological Medicine, 45(1), 51–61. https://doi.org/10.1017/s0033291714001044

Bhadsavle

S. S.

Golding

M. C.

(2022). Paternal epigenetic influences on placental health and their impacts on offspring development and disease. Frontiers in Genetics, 13, Article 1068408. https://doi.org/10.3389/fgene.2022.1068408

Bowlby

(1988). A secure base: Clinical applications of attachment theory. Routledge.

Brockington

(1996). Motherhood and mental health. Oxford University Press.

Brockington

(2004). Diagnosis and management of post-partum disorders: A review. World Psychiatry, 3(2), 89–95. https://pubmed.ncbi.nlm.nih.gov/16633463/

10.

Cox

J. L.

Holden

J. M.

Sagovsky

(1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786. https://doi.org/10.1192/bjp.150.6.782

11.

Escribà-Agüir

Artazcoz

(2011). Gender differences in postpartum depression: A longitudinal cohort study. Journal of Epidemiology and Community Health, 65(4), 320–326. https://doi.org/10.1136/jech.2008.085894

12.

Fergusson

D. M.

Horwood

L. J.

Boden

J. M.

(2008). Abortion and mental health disorders: Evidence from a 30-year longitudinal study. British Journal of Psychiatry, 193(6), 444–451. https://doi.org/10.1192/bjp.bp.108.056499

13.

Garcia-Esteve

Ascaso-Terrén

Ojuel

Navarro

(2003). Validation of the Edinburgh Postnatal Depression Scale (EPDS) in Spanish mothers. Journal of Affective Disorders, 75(1), 71–76. https://doi.org/10.1016/s0165-0327(02)00020-4

14.

Goldstein

Borelli

J. L.

Shai

(2023). In her shoes: Partner reflective functioning promotes family-level resilience to maternal depression. Development and Psychopathology, 35(2), 958–971. https://doi.org/10.1017/s0954579422000189

15.

Goodman

S. H.

Lusby

C. M.

Thompson

Newport

D. J.

Stowe

Z. N.

(2014). Maternal depression in association with fathers’ involvement with their infants: Spillover or compensation/buffering? Infant Mental Health Journal, 35(5), 495–508. https://doi.org/10.1002/imhj.21469

16.

Gregoire

(2023, June 16). People and organisations working together for better maternal mental health [Conference session]. Global Alliance for Maternal Mental Health. Conecta Perinatal document presentation. https://www.youtube.com/watch?v=D9hFHbthD2g

17.

Khan

R. A.

Drudy

Sheehan

Harrison

R. F.

Geary

(2004). Early pregnancy loss: How do men feel? Irish Medical Journal, 97(7), 217–218. https://pubmed.ncbi.nlm.nih.gov/15491001/

18.

Kirca

Adibelli

(2021). Effects of mother-infant skin-to-skin contact on postpartum depression: A systematic review. Perspectives in Psychiatric Care, 57(4), 2014–2023. https://doi.org/10.1111/ppc.12727

19.

Lamb

E. H.

(2002). The impact of previous perinatal loss on subsequent pregnancy and parenting. The Journal of Perinatal Education, 11(2), 33–40. https://doi.org/10.1624/105812402x88696

20.

Leung

B. M.

Letourneau

N. L.

Giesbrecht

G. F.

Ntanda

Hart

Team

A. P.

(2017). Predictors of postpartum depression in partnered mothers and fathers from a longitudinal cohort. Community Mental Health Journal, 53(4), 420–431. https://doi.org/10.1007/s10597-016-0060-0

21.

Linner

Almgren

(2020). Epigenetic programming – The important first 1000 days. Acta Paediatrica, 109(3), 443–452. https://doi.org/10.1111/apa.15050

22.

Matsumura

Hamazaki

Tsuchida

Kasamatsu

Inadera

(2019). Education level and risk of postpartum depression: Results from the Japan Environment and Children’s Study (JECS). BMC Psychiatry, 19(1), Articlem419. https://doi.org/10.1186/s12888-019-2401-3

23.

Matthey

Barnett

Kavanagh

D. J.

Howie

(2001). Validation of the Edinburgh Postnatal Depression Scale for men, and comparison of item endorsement with their partners. Journal of Affective Disorders, 64(2–3), 175–184. https://doi.org/10.1016/s0165-0327(00)00236-6

24.

Moreno-Peral

Luna

Marston

King

Nazareth

Motrico

GildeGómez-Barragán

M. J.

Torres-González

Montón-Franco

Sánchez-Celaya

Díaz-Barreiros

M. Á.

Vicens

Muñoz-Bravo

Bellón

J. Á

. (2014). Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The predictA-Spain study. PLOS ONE, 9(9), Article e106370. https://doi.org/10.1371/journal.pone.0106370

25.

Nakamura

Sutter-Dallay

A. L.

El-Khoury Lesueur

Thierry

Gressier

Melchior

van der Waerden

(2020). Informal and formal social support during pregnancy and joint maternal and paternal postnatal depression: Data from the French representative ELFE cohort study. International Journal of Social Psychiatry, 66(5), 431–441. https://doi.org/10.1177/0020764020911409

26.

Nguyen

Temple-Smith

Bilardi

(2019). Men’s lived experiences of perinatal loss: A review of the literature. Australian and New Zeland Journal of Obstetrics Gynaecology, 59(6), 757–766. https://doi.org/10.1111/ajo.13041

27.

Obst

K. L.

Due

Oxlad

Middleton

(2020). Men’s grief following pregnancy loss and neonatal loss: A systematic review and emerging theoretical model. BMC Pregnancy Childbirth, 20(1), Article 11. https://doi.org/10.1186/s12884-019-2677-9

28.

Paulson

J. F.

Bazemore

S. D.

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

29.

Pawlby

Hay

D. F.

Sharp

Waters

C. S.

O’Keane

(2009). Antenatal depression predicts depression in adolescent offspring: Prospective longitudinal community-based study. Journal of Affective Disorders, 113(3), 236–246. https://doi:org/10.1016/j.jad.2008.05.018

30.

Philpott

L. F.

Leahy-Warren

FitzGerald

Savage

(2017). Stress in fathers in the perinatal period: A systematic review. Midwifery, 55, 113–127. https://doi.org/10.1016/j.midw.2017.09.016

31.

Pierce

Hope

H. F.

Kolade

Gellatly

Osam

C. S.

Perchard

Kosidou

Dalman

Morgan

Di Prinzio

Abel

K. M.

(2020). Effects of parental mental illness on children’s physical health: Systematic review and meta-analysis. British Journal of Psychiatry, 217(1), 354–363. https://doi.org/10.1192/bjp.2019.216

32.

Place

J. M. S.

Allen-Leigh

Billings

D. L.

Dues

K. M.

de Castro

(2017). Detection and care practices for postpartum depressive symptoms in public-sector obstetric units in Mexico: Qualitative results from a resource-constrained setting. Birth, 44(4), 390–396. https://doi.org/10.1111/birt.12304

33.

Rajyaguru

Kwong

A. S. F.

Braithwaite

Pearson

R. M.

(2021). Maternal and paternal depression and child mental health trajectories: Evidence from the Avon Longitudinal Study of Parents and Children. BJPsych Open, 7(5), Article e166. https://doi.org/10.1192/bjo.2021.959

34.

Rao

W. W.

Zhu

X. M.

Zong

Q. Q.

Zhang

Hall

B. J.

Ungvari

G. S.

Xiang

Y. T.

(2020). Prevalence of prenatal and postpartum depression in fathers: A comprehensive meta-analysis of observational surveys. Journal of Affective Disorders, 263, 491–499. https://doi.org/10.1016/j.jad.2019.10.030

35.

Santos

I. S.

Blumenberg

Munhoz

T. N.

Matijasevich

Santos Júnior

H. G.

Dos Santos

L. M.

Correia

L. L.

de Souza

M. R.

Lira

P. I.

Bortolotto

C. C.

Barcelos

Altafim

Chicaro

M. F.

Macana

E. C.

da Silva

R. S.

Victora

C. G.

(2023). Course of depression during the first 2 years postpartum among Brazilian women enrolled in a conditional cash transfer program. International Journal of Social Psychiatry, 69(5), 1193–1201. http://doi.org/10.1177/00207640231154376

36.

Shafian

A. K.

Mohamed

Nasution Raduan

N. J.

Hway Ann

A. Y.

(2022). A systematic review and meta-analysis of studies validating Edinburgh Postnatal Depression Scale in fathers. Heliyon, 8(5), Article e09441. https://doi.org/10.1016/j.heliyon.2022.e09441

37.

Smith

Gemmill

A. W.

Milgrom

(2019). Perinatal anxiety and depression: Awareness and attitudes in Australia. International Journal of Social Psychiatry, 65(5), 378–387. http://doi.org/10.1177/0020764019852656

38.

Smythe

K. L.

Petersen

Schartau

(2022). Prevalence of perinatal depression and anxiety in both parents: A systematic review and meta-analysis. JAMA Network Open, 5(6), Article e2218969. https://doi.org/10.1001/jamanetworkopen.2022.18969

39.

Sundström Poromaa

Comasco

Georgakis

M. K.

Skalkidou

. (2017). Sex differences in depression during pregnancy and the postpartum period. Journal of Neuroscience Research, 95(1–2), 719–730. https://doi.org/10.1002/jnr.23859

40.

Takehara

Suto

Kato

(2020). Parental psychological distress in the postnatal period in Japan: A population-based analysis of a national cross-sectional survey. Scientific Reports, 10(1), Article 13770. https://doi.org/10.1038/s41598-020-70727-2

41.

Taybeh

E. O.

(2022). A focus on postpartum depression among Jordanian mothers. International Journal of Social Psychiatry, 68(2), 403–410. http://doi.org/10.1177/00207640211000100

42.

Usmani

Greca

Javed

Sharath

Sarfraz

Salari

S. W.

Hussaini

S. S.

Mohammadi

Chellapuram

Cabrera

Ferrer

(2021). Risk Factors for postpartum depression during COVID-19 pandemic: A systematic literature review. Journal of Primary Care Community Health, 12, 1–9. https://doi.org/10.1177/21501327211059348

43.

Volgsten

Jansson

Svanberg

A. S.

Darj

Stavreus-Evers

(2018). Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage. Midwifery, 64, 23–28. https://doi.org/10.1016/j.midw.2018.05.003

44.

Wang

Y. L.

Qiu

Xiao

S. Y.

(2021). Factors influencing paternal postpartum depression: A systematic review and meta-analysis. Journal of Affective Disorders, 293, 51–63. https://doi.org/10.1016/j.jad.2021.05.088

45.

Wang

Liu

Shuai

Cai

Liu

Xiao

Zhang

Krabbendam

Liu

Yang

B. X.

(2021). Mapping global prevalence of depression among postpartum women. Translational Psychiatry, 11(1), Article 640. https://doi.org/10.1038/s41398-021-01663-6

46.

Xavier

M. J.

Roman

S. D.

Aitken

R. J.

Nixon

(2019). Transgenerational inheritance: How impacts to the epigenetic and genetic information of parents affect offspring health. Human Reproduction Update, 25(5), 518–540. https://doi.org/10.1093/humupd/dmz017

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