title: Antenatal depression in a multi-ethnic, community sample of Canadian immigrants: psychosocial correlates and hypothalamic-pituitary-adrenal axis function.
abstract: OBJECTIVE
  Immigrant women living in Canada present with higher rates of prenatal depressive symptomatology than Canadian-born women; however, the associated psychosocial correlates remain understudied. Antenatal depression and stress negatively affect maternal health and infant development, in part through changes in maternal hypothalamic-pituitary-adrenal (HPA) axis activity. We aimed to examine the factors associated with prenatal depressive symptoms, including altered HPA axis function, in an ethnically diverse community sample of Canadian immigrant women.
  
  
  METHODS
  Seventy-eight pregnant immigrant women were recruited from the community at 19 weeks' gestation and provided information on health, mood, stressful life events (SLEs), and social support. Fifty-seven of these women also provided saliva samples for measurement of the cortisol awakening response and nighttime cortisol levels.
  
  
  RESULTS
  Seventeen per cent of the sample had a high level of prenatal depressive symptoms, and these women reported more perceived stress, more somatic symptoms, lower social support, and were less often working or attending school during pregnancy. Controlling for wake time, parity, and region of origin, high levels of prenatal depressive symptoms were associated with elevated nighttime cortisol levels, whereas SLEs were not associated with any measures of HPA axis activity.
  
  
  CONCLUSIONS
  High levels of prenatal depressive symptoms are common in immigrant women living in Canada, and are associated with identifiable factors. Preliminary evidence suggests a similar pattern of HPA axis activity characterizing depressive symptomatology in this subpopulation as previously seen in clinically depressed patients.
authors.affiliation: Student, Institute of Medical Science, University of Toronto, Toronto, Ontario; Student, Women's Health Concerns Clinic, St Joseph's Healthcare Hamilton, Hamilton, Ontario.
authors.forename: Miki
authors.initials: M
authors.lastname: Peer
authors.forename: Claudio N
authors.initials: CN
authors.lastname: Soares
authors.forename: Robert D
authors.initials: RD
authors.lastname: Levitan
authors.forename: David L
authors.initials: DL
authors.lastname: Streiner
authors.forename: Meir
authors.initials: M
authors.lastname: Steiner
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D012463:Saliva / Q000737:chemistry; D012944:Social Support; D013315:Stress, Psychological / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D055815:Young Adult
chemical_list: D006854:Hydrocortisone
keywords: cortisol; depression; hypothalamic–pituitary–adrenal axis; immigration; pregnancy