title: Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study.
abstract: BACKGROUND
  The relationship between concurrent or previous postnatal pain and depressive symptoms remains controversial. To the best of our knowledge, no previous study has used validated measures and multiple scales to evaluate perineal pain, or examined its relationship with depressive symptoms during the postpartum period.
  
  
  OBJECTIVE
  We investigated the association between pain and previous postnatal pain with depression during the 6-month postpartum period, and the influence of previous postnatal depressive symptoms.
  
  
  METHODS
  A prospective cohort study design was used.
  
  
  METHODS
  Maternity unit of a medical center.
  
  
  METHODS
  This study included 432 participants; data regarding demographic characteristics, perineal pain, and any pain and depression during the 6-month postpartum period were collected.
  
  
  METHODS
  Pain and depressive symptoms were measured using the Short Form-McGill Pain Questionnaire and Center for Epidemiologic Studies Depression Scale, respectively. A generalized estimating equation was used to examine factors associated with postpartum depression.
  
  
  RESULTS
  After adjusting for covariates, women who had perineal pain at 4-6 weeks postpartum showed an increased risk for depression at 4-6 weeks (risk ratio [RR]: 1.9, 95% confidence limits [CL]: 1.2, 3.2) and 6 months (RR: 1.9, 95% CL: 1.1, 3.3) compared to those with no perineal pain. Perineal pain severity, 4-6 weeks postpartum, also predicted depressive symptoms at 6 months postpartum (β=0.63, p=0.02). Any pain intensity score at 3-5 days postpartum predicted depression at 3 months (β=0.01, p=0.04). Women with high depression scores at 3-5 days had a two- or three-fold higher risk for depression at 4-6 weeks and 3 and 6 months, respectively, compared to those with low depression scores (RR: 3.5, 95% CL: 2.2, 5.4; RR: 2.2, 95% CL: 1.3, 3.4; and RR: 2.8, 95% CL: 1.7, 4.8, respectively).
  
  
  CONCLUSIONS
  Our study provides robust evidence that perineal pain 4-6 weeks postpartum is associated with depressive symptoms 4-6 weeks and 6 months postpartum; pain at 3-5 days postpartum predicts depressive symptoms at 3 months postpartum; and previous postnatal depressive symptoms, particularly depressive symptoms 3-5 days postpartum, predict depressive symptoms during the 6-month postpartum period.
authors.affiliation: School of Nursing, National Taiwan University, Taipei, Taiwan; Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: srchang@ntu.edu.tw.
authors.forename: Shiow-Ru
authors.initials: SR
authors.lastname: Chang
authors.affiliation: Central Taiwan University of Science and Technology, Taichung, Taiwan. Electronic address: geneproteins@gmail.com.
authors.forename: Kuang-Ho
authors.initials: KH
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan. Electronic address: leecn@ntu.edu.tw.
authors.forename: Chien-Nan
authors.initials: CN
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan. Electronic address: shyumk@ntu.edu.tw.
authors.forename: Ming-Kwang
authors.initials: MK
authors.lastname: Shyu
authors.affiliation: Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan. Electronic address: m000743@ms.skh.org.tw.
authors.forename: Ming-I
authors.initials: MI
authors.lastname: Lin
authors.affiliation: Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: ogrefoxy@gmail.com.
authors.forename: Wei-An
authors.initials: WA
authors.lastname: Lin
mesh_terms: D019052:Depression, Postpartum / Q000150:complications*; D005260:Female; D006801:Humans; D010146:Pain / Q000150:complications*; D010502:Perineum / Q000473:pathology*; D011247:Pregnancy; D011446:Prospective Studies; D013624:Taiwan
keywords: Any pain; Childbirth; Depression; Maternal-child care; Mental health; Pain; Pain measurement; Perineal care; Postpartum; Vaginal birth