Surveillance for Maternal Mental Health Should Be Extended

May 28, 2014

The extent and timing of maternal depression is being underestimated, according to new research, highlighting the need for improvement in maternal depression screening.

[[{"type":"media","view_mode":"media_crop","fid":"24700","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_6029183971695","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"2178","media_crop_rotate":"0","media_crop_scale_h":"105","media_crop_scale_w":"160","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"line-height: 1.538em; float: right;","title":" ","typeof":"foaf:Image"}}]]Depression among women is more common at four years postpartum than at any time in the first 12 months after delivery, researchers reported in BJOG: An International Journal of Obstetrics and Gynaecology.

The findings reveal a need to enhance the current surveillance and services for maternal mental health, the authors stressed. 

Pertinent Points

- Women are more likely to experience depression at four years postpartum than at any time in the first 12 months postpartum.

- Women who didn’t have subsequent children were more likely to report depressive symptoms at four years postpartum than those who did have additional children.

- Predictors of depression included reporting depressive symptoms during pregnancy, young maternal age, stress, low income levels, and intimate partner violence.

"It is likely that current systems of maternal mental health surveillance in Australia and the UK will miss more than half the women experiencing depression in the early years of parenting,” said coauthor Hannah Woolhouse, DPsych, senior research officer from the Murdoch Childrens Research Institute, Victoria, Australia, in a statement. “In particular, women who do not have subsequent children may be especially vulnerable to falling through the gaps as they will not be reconnected back into primary care services.”

The study, conducted in Melbourne, Australia, included 1,507 nulliparous women recruited from six public hospitals during pregnancy (mean gestational age, 15 weeks). The women completed questionnaires at recruitment and then at 3, 6, 12, and 18 months postpartum, and again at 4 years postpartum.

Nearly one in three women reported depression symptoms at least once during the course of the study, revealed the findings. Furthermore, the prevalence of depressive symptoms at 4 years postpartum was 14.5%.

At nearly 23%, women with only one child at 4 years postpartum were more likely to report depressive symptoms. Among women who had more than 1 child, 11.3% reported depressive symptoms at 4 years postpartum. This association remained significant in adjusted models (adjusted odds ratio, 1.71; 95% confidence interval, 1.12–2.63), the authors reported.

Still the strongest predictor of depressive symptoms at the four-year mark was having previously reported depressive symptoms early in pregnancy or during the first year after childbirth. Younger mothers (those under 25 years), stress, low income levels, and intimate partner violence were also factors associated with depressive symptoms.