title: Depression and pregnancy stressors affect the association between abuse and postpartum depression.
abstract: To determine how psychosocial factors affect the association between a history of abuse and postpartum depression (PPD). Women at four urban hospitals in Utah were enrolled ≤ 48 h of delivering a live-born infant. At enrollment, pregravid history of physical or sexual abuse was obtained via self-report. Psychosocial covariates such as pregnancy stressors and depression were also collected. Pregnancy stressors were categorized using "stressor" questions from the Pregnancy Risk Assessment Monitoring System. The primary outcome measure, a pre-specified Edinburgh Postnatal Depression Scale score of ≥ 12 was obtained 6-8 weeks postpartum. Among the 1,038 women studied, psychosocial risk factors were common: abuse history 11.7%, pregnancy stressors-financial 49.1%, emotional 35.0%, partner-associated 19.8%, and traumatic 10.3% and depression history 16.7%. While abuse was associated with a +PPD screen in a preliminary model [aOR 2.05 (1.28, 3.26)], adding psychosocial covariates reduced the unadjusted association of abuse and PPD [aOR 1.12 (0.66, 1.91)]. After adjustment, PPD was associated with depression history [aOR 2.85 (1.90, 4.28)], prepregnancy BMI [aOR 1.04 (1.01, 1.07)] multiple stressors [3 categories aOR 4.35 (2.00, 9.46)]; 4 categories [aOR 6.36 (2.07, 19.49)] and sum of stressors * history of abuse [aOR 1.50 (0.92, 2.46)]. Interestingly only women with a moderate number of stressors were sensitive to an abuse history. Abuse and pregnancy stressors are common and interact to influence the likelihood of screening positive for PPD.
authors.affiliation: Department of Reproductive Medicine, University of California, San Diego, CA 92103, USA. ylacoursiere@ucsd.edu
authors.forename: D Yvette
authors.initials: DY
authors.lastname: LaCoursiere
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Hirst
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003863:Depression / Q000209:etiology / Q000523:psychology*; D019052:Depression, Postpartum / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008403:Mass Screening; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012307:Risk Factors; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology*; D011795:Surveys and Questionnaires; D014505:Urban Population; D014589:Utah