Stressful events during pregnancy and postpartum depressive symptoms.
BACKGROUND
Understanding the influence of perinatal stressors on the prevalence of postpartum depressive symptoms (PDS) and help-seeking for PDS using surveillance data can inform service provision and improve health outcomes.


METHODS
We used Massachusetts Pregnancy Risk Assessment Monitoring System (MA-PRAMS) 2007-2010 data to evaluate associations between selected perinatal stressors and PDS and with subsequent help-seeking behaviors. We categorized 12 stressors into 4 groups: partner, traumatic, financial, and emotional. We defined PDS as reporting "always" or "often" to any depressive symptoms on PRAMS Phase 5, or to a composite score ≥10 on PRAMS Phase 6 depression questions, compared with women reporting "sometimes," "rarely" or "never" to all depressive symptoms. The median response time to MA-PRAMS survey was 3.2 months (interquartile range, 2.9-4.0 months). We estimated prevalence ratios (PRs) and 95% confidence intervals (95% CIs) using modified Poisson regression models, controlling for socioeconomic status indicators, pregnancy intention and prior mental health visits.


RESULTS
Among 5,395 participants, 58% reported ≥1 stressor (partner=26%, traumatic=16%, financial=29% and emotional=30%). Reporting of ≥1 stressor was associated with increased prevalence of PDS (PR=1.68, 95% CI: 1.42-1.98). The strongest association was observed for partner stress (PR=1.90, 95% CI: 1.51-2.38). Thirty-eight percent of mothers with PDS sought help. Mothers with partner-related stressors were less likely to seek help, compared with mothers with other grouped stressors.


CONCLUSIONS
Women who reported perinatal common stressors-particularly partner-related stressors-had an increased prevalence of PDS. These data suggest that women should be routinely screened during pregnancy for a range of stressors and encouraged to seek help for PDS.
1 Department of Epidemiology, Boston University School of Public Health , Boston, Massachusetts.
Sarah Lederberg
SL
Stone
Hafsatou
H
Diop
Eugene
E
Declercq
Howard J
HJ
Cabral
Matthew P
MP
Fox
Lauren A
LA
Wise
D000328:Adult; D019052:Depression, Postpartum / Q000453:epidemiology*; D005260:Female; D000066505:Help-Seeking Behavior; D006801:Humans; D008016:Life Change Events; D008425:Maternal Behavior / Q000523:psychology*; D009035:Mothers / Q000523:psychology*; D015999:Multivariate Analysis; D011159:Population Surveillance; D011247:Pregnancy; D018570:Risk Assessment; D013315:Stress, Psychological; D055815:Young Adult