Re-conceptualising prenatal life stressors in predicting post-partum depression: cumulative-, specific-, and domain-specific approaches to calculating risk.
BACKGROUND
Prenatal life stress predicts post-partum depression (PPD); however, studies generally examine individual stressors (a specific approach) or the summation of such exposure (a cumulative approach) and their associations with PPD. Such approaches may oversimplify prenatal life stress as a risk factor for PPD. We evaluated approaches in assessing prenatal life stress as a predictor of PPD diagnosis, including a domain-specific approach that captures cumulative life stress while accounting for stress across different life stress domains: financial, relational, and physical health.


METHODS
The Pregnancy Risk Assessment Monitoring System, a population-based survey, was used to analyse the association of prenatal life stressors with PPD diagnoses among 3566 New York City post-partum women.


RESULTS
Specific stressors were not associated with PPD diagnosis after controlling for sociodemographic variables. Exposure to a greater number of stressors was associated with PPD diagnosis, even after adjusting for both sociodemographic variables and specific stressors [odds ratio (OR) = 3.1, 95% confidence interval (CI) = 1.5, 6.7]. Individuals reporting a moderate-to-high number of financial problems along with a moderate-to-high number of physical problems were at greater odds of PPD (OR = 4.2, 95% CI = 1.2, 15.3); those with a moderate-to-high number of problems in all three domains were at over fivefold increased odds of PPD (OR = 5.5, CI = 1.1, 28.5).


CONCLUSIONS
In assessing prenatal stress, clinicians should consider the extent to which stressors occur across different life domains; this association appears stronger with PPD diagnosis than simple assessments of individual stressors, which typically overestimate risk or cumulative exposures.
Child Development Unit, Beth Israel Deaconess Medical Center, Harvard Medical School, University of Massachusetts, Boston, MA 02115, USA. cliu@bidmc.harvard.edu
Cindy H
CH
Liu
Ed
E
Tronick
D000328:Adult; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D009519:New York City / Q000453:epidemiology; D011247:Pregnancy; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology; D055815:Young Adult
cumulative risk; life stress; post-partum depression; postpartum depression screening; prenatal assessment; prenatal stress