title: Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study.
abstract: OBJECTIVE
  To examine the relationship between delivery mode and postpartum depression at 6 weeks following hospital discharge.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Eleven hospitals in Ontario, Canada.
  
  
  METHODS
  A total of 2560 women ≥16 years of age who delivered singleton, live infants at term.
  
  
  METHODS
  Women completed a questionnaire in hospital and 74% (n = 1897) participated in a structured telephone interview 6 weeks after discharge. Additional data were extracted from labour and delivery records. Generalised estimating equations (GEEs) were used to investigate factors associated with postpartum depression.
  
  
  METHODS
  Women were screened for depression at 6 weeks following hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). A score of ≥12 on the EPDS was used as a measure of the primary outcome, depression.
  
  
  RESULTS
  Mode of delivery was not independently associated with postpartum depression, and did not factor into the main-effects model. The multivariable analysis identified 11 predictor variables for depression: young maternal age (OR 5.27; 95% CI 2.73-10.15); maternal hospital readmission (OR 3.02; 95% CI 1.46-6.24); non-initiation of breastfeeding (OR 2.02; 95% CI 0.99-4.11); good, fair, or poor self-reported postpartum health (OR 1.82; 95% CI 1.19-2.80); urinary incontinence (OR 1.79; 95% CI 1.06-3.03); multiparity (OR 1.59; 95% CI 1.22-2.08); low mental health functioning (OR 1.20; 95% CI 1.15-1.25); low subjective social status (OR 1.16; 95% CI 1.02-1.33); high number of unmet learning needs in hospital (OR 1.12; 95% CI 1.03-1.22); low social support (OR 1.06; 95% CI 1.03-1.09); and low physical health functioning (OR 1.03; 95% CI 1.003-1.055). An exploratory interaction model revealed that caesarean section was associated with higher odds of becoming depressed in Canadian-born women, but that in women born outside of Canada it was associated with a lower risk of becoming depressed.
  
  
  CONCLUSIONS
  Delivery mode had no significant impact on the development of postpartum depression in the main-effects model. However, it may interact with place of birth and other unmeasured factors to create a risk for depression.
authors.affiliation: School of Nursing, McMaster University, Hamilton, ON, Canada. sword@mcmaster.ca
authors.forename: W
authors.initials: W
authors.lastname: Sword
authors.forename: C Kurtz
authors.initials: CK
authors.lastname: Landy
authors.forename: L
authors.initials: L
authors.lastname: Thabane
authors.forename: S
authors.initials: S
authors.lastname: Watt
authors.forename: P
authors.initials: P
authors.lastname: Krueger
authors.forename: D
authors.initials: D
authors.lastname: Farine
authors.forename: G
authors.initials: G
authors.lastname: Foster
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods* / Q000706:statistics & numerical data*; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009864:Ontario / Q000453:epidemiology; D011247:Pregnancy; D011446:Prospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires