title: Multiple births are a risk factor for postpartum maternal depressive symptoms.
abstract: OBJECTIVE
  The purpose of the study was to assess the relationship between multiple births and maternal depressive symptoms measured 9 months after delivery.
  
  
  METHODS
  Data were derived from the Early Childhood Longitudinal Study-Birth Cohort, a longitudinal study of a nationally representative sample of children born in 2001. Depressive symptoms were measured at 9 months by using an abbreviated version of the Center for Epidemiologic Studies Depression Scale. Logistic regression analyses were conducted to study the association between multiple births and maternal depressive symptoms, with adjustment for demographic and household socioeconomic characteristics and maternal history of mental health problems. A total of 8069 mothers were included for analyses.
  
  
  RESULTS
  The prevalence of moderate/severe depressive symptoms at 9 months after delivery was estimated to be 16.0% and 19.0% among mothers of singletons and multiple births, respectively. Only 27.0% of women who had moderate/severe depressive symptoms reported talking about emotional or psychological problems with a mental health specialist or a general medical provider within the 12 months before the interview. The proportions of women with depressive symptoms who were receiving mental health services did not vary according to plurality status.
  
  
  CONCLUSIONS
  Mothers of multiple births had 43% greater odds of having moderate/severe, 9-month postpartum, depressive symptoms, compared with mothers of singletons. Greater attention is needed in pediatric settings to address maternal depression in families with multiple births.
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe St, E8648, Baltimore, MD 21205, USA. ychoi@jhsph.edu
authors.forename: Yoonjoung
authors.initials: Y
authors.lastname: Choi
authors.forename: David
authors.initials: D
authors.lastname: Bishai
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Minkovitz