title: Psychosocial risk factors and treatment of new onset and recurrent depression during the post-partum period.
abstract: BACKGROUND
  When developing maternity care services, it is important to know how psychosocial factors affect the course of post-partum depression (PPD), and how depressed mothers are treated.
  
  
  OBJECTIVE
  The aim of this study is to assess how adverse childhood experiences, poor present support and violence, and low socioeconomic status (SES) associate with PPD, specifically in new onset and recurrent post-partum depression. The second aim is to assess the treatment received for PPD.
  
  
  METHODS
  This is a cross-sectional study. The study group comprises 104 mothers with a current episode of PPD, and a control group of 104 mothers without an episode. The Structured Clinical Interview for DSM-IV Axis I Disorders was used for data collection. Psychosocial risk factors, treatment issues, and the course of depression were assessed with a structured self-report questionnaire.
  
  
  RESULTS
  In age-adjusted multivariate analyses, adverse childhood experiences, a low level of present support in close relationships, and a poor SES were associated significantly with PPD. Childhood adversity was associated with both new onset and recurrent depression. Nevertheless, a low level of support and a poor SES were also associated with recurrent depression. A quarter of mothers with a major depressive episode in the post-partum period attended psychiatric services. In mothers with new onset depression, the proportion was only 5%.
  
  
  CONCLUSIONS
  There is an urgent need to develop the diagnostics of depression in maternity care services. An awareness of psychosocial risk factors might help in this. More depressed mothers should be referred to psychiatric services.
authors.affiliation: a Department of General Hospital Psychiatry , North Karelia Central Hospital , Joensuu , Finland.
authors.forename: Pirjo
authors.initials: P
authors.lastname: Kettunen
authors.affiliation: b Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland.|c Department of Psychiatry , Päijät Häme Central Hospital , Lahti , Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Hintikka
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D009035:Mothers / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology*; D012008:Recurrence; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult
keywords: Postpartum depression; maternity care; risk factor; violence