title: Antenatal depressive symptoms as a predictor of deterioration in perceived social support across the perinatal period: a four-wave cohort study in Turkey.
abstract: BACKGROUND
  In a perinatal cohort of women in urban and rural Turkey, we investigated associations between antenatal depressive symptoms and subsequent changes in perceived quality of key family relationships.
  
  
  METHODS
  Of 730 women recruited in their third trimester (94.6% participation), 578 (79.2%) were reassessed at a mean of 4.1 (s.d. = 3.3) months after childbirth, 488 (66.8%) were reassessed at 13.7 (s.d. = 2.9) months, and 448 (61.4%) at 20.8 (s.d. = 2.7) months. At all four examinations, self-reported quality of relationship with the husband, mother and mother-in-law was ascertained using the Close Persons Questionnaire with respect to emotional support, practical support and negative aspects of the relationship. Antenatal depressive symptoms were defined using the Edinburgh Postnatal Depression Scale. A range of covariates in mixed models was considered including age, education, number of children, family structure, physical health, past emotional problems and stressful life events.
  
  
  RESULTS
  Key findings were as follows: (i) reported emotional and practical support from all three relationships declined over time in the cohort overall; (ii) reported emotional support from the husband, and emotional and practical support from the mother-in-law, declined more strongly in women with antenatal depressive symptoms; (iii) associations between depressive symptoms and worsening spouse relationship were more pronounced in traditional compared with nuclear families.
  
  
  CONCLUSIONS
  Antenatal depressive symptoms predicted marked decline in the quality of key relationships over the postnatal period. This may account for some of the contemporaneous associations between depression and worse social support, and may compound the risk of perinatal depression in subsequent pregnancies.
authors.affiliation: Department of Psychiatry,Ankara University Faculty of Medicine,Ankara,Turkey.
authors.forename: V
authors.initials: V
authors.lastname: Senturk
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: M
authors.initials: M
authors.lastname: Abas
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: M
authors.initials: M
authors.lastname: Dewey
authors.affiliation: Department of Psychiatry,Ankara University Faculty of Medicine,Ankara,Turkey.
authors.forename: O
authors.initials: O
authors.lastname: Berksun
authors.affiliation: King's College London, Institute of Psychiatry,London,UK.
authors.forename: R
authors.initials: R
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000208:ethnology / Q000523:psychology; D003866:Depressive Disorder / Q000208:ethnology / Q000523:psychology*; D005195:Family Relations / Q000208:ethnology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000208:ethnology / Q000523:psychology*; D012944:Social Support; D014421:Turkey / Q000208:ethnology; D055815:Young Adult
keywords: Cohort studies; family structure; perinatal depression; social support