Abstract
Little is known about the long-term mental health of women following the birth of an infant. This study describes the 21 year trajectory of women’s depression following the birth of an infant and identifies early predictors of post-birth maternal depression trajectories. The sample comprises 2,991 women from the Mater and University of Queensland Study of Pregnancy. Using the Delusions-Symptoms-States-Inventory, depression was measured at 6 months, 5, 14 and 21 years after the birth. These measures were clustered and in addition bivariate and multivariate analyses were used to test for significant association between the groups and a range of maternal socio-demographic, psychological and pregnancy-related factors. Two depression trajectories were produced, a no-low depression group (79.0 %) and a high-escalating depression group (21.0 %). The strongest predictors for a high-escalating depression group were conflict in the partner-relationship (p < 0.001), anxiety (p < 0.001) and stress (p < 0.001) in the antenatal period, having many pregnancy symptoms (p < 0.001), being younger (p < 0.001) and having poorer social networks (p < 0.001). To a lesser extent not completing high school (p < 0.05), being unsure about wanting the pregnancy (p < 0.05) and not wanting contact with the infant following the birth (p < 0.05) were also predictors for high-escalating depression trajectory. Our findings suggest a sub-sample of mothers experience persistent depressive symptoms over a 21 year period following the birth of their infant. Partner conflict, inadequate social supports and poor mental health during the pregnancy, rather than factors relating to the birth event, contribute to women’s depressive symptoms in the long-term. Given the identification of early markers for persistent depression, there may be opportunities for intervention for at-risk pregnant women.
Similar content being viewed by others
References
Cents, R. A., Diamantopoulou, S., Hudziak, J. J., et al. (2013). Trajectories of maternal depressive symptoms predict child problem behaviour: The generation R study. Psychological Medicine, 43(1), 13–25. doi:10.1017/s0033291712000657.
Campbell, S. B., Morgan-Lopez, A. A., Cox, M. J., et al. (2009). A latent class analysis of maternal depressive symptoms over 12 years and offspring adjustment in adolescence. Journal of Abnormal Psychology, 118(3), 479–493. doi:10.1037/a0015923.
Skipstein, A., Janson, H., Kjeldsen, A., et al. (2012). Trajectories of maternal symptoms of depression and anxiety over 13 years: The influence of stress, social support, and maternal temperament. BMC Public Health, 12, 1120. doi:10.1186/1471-2458-12-1120.
Wang, L., Wu, T., Anderson, J. L., et al. (2011). Prevalence and risk factors of maternal depression during the first three years of child rearing. Journal of Women’s Health, 20(5), 711–718. doi:10.1089/jwh.2010.2232.
Mora, P. A., Bennett, I. M., Elo, I. T., et al. (2009). Distinct trajectories of perinatal depressive symptomatology: Evidence from growth mixture modeling. American Journal of Epidemiology, 169(1), 24–32. doi:10.1093/aje/kwn283.
Schmied, V., Johnson, M., Naidoo, N., et al. (2013). Maternal mental health in Australia and New Zealand: A review of longitudinal studies. Women Birth, 26(3), 167–178. doi:10.1016/j.wombi.2013.02.006.
Manuel, J. I., Martinson, M. L., Bledsoe-Mansori, S. E., et al. (2012). The influence of stress and social support on depressive symptoms in mothers with young children. Social Science and Medicine, 75(11), 2013–2020. doi:10.1016/j.socscimed.2012.07.034.
Fisher, J., Cabral de Mello, M., Patel, V., et al. (2012). Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: A systematic review. Bulletin of the World Health Organization, 90(2), 139G–149G. doi:10.2471/BLT.11.091850.
Rich-Edwards, J. W., Kleinman, K., Abrams, A., et al. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60(3), 221–227. doi:10.1136/jech.2005.039370.
Gavin, A. R., Lindhorst, T., & Lohr, M. J. (2011). The prevalence and correlates of depressive symptoms among adolescent mothers: Results from a 17-year longitudinal study. Women and Health, 51(6), 525–545. doi:10.1080/03630242.2011.606355.
Beck, C. T. (2001). Predictors of postpartum depression: an update. Nursing Research, 50(5), 275–285.
Robertson, E., Grace, S., Wallington, T., et al. (2004). Antenatal risk factors for postpartum depression: A synthesis of recent literature. General Hospital Psychiatry, 26(4), 289–295. doi:10.1016/j.genhosppsych.2004.02.006.
Koutra, K., Vassilaki, M., Georgiou, V., et al. (2013). Antenatal maternal mental health as determinant of postpartum depression in a population based mother-child cohort (Rhea Study) in Crete, Greece. Social Psychiatry and Psychiatric Epidemiology,. doi:10.1007/s00127-013-0758-z.
Blom, E. A., Jansen, P. W., Verhulst, F. C., et al. (2010). Perinatal complications increase the risk of postpartum depression. The Generation R Study. BJOG, 117(11), 1390–1398. doi:10.1111/j.1471-0528.2010.02660.
Verdoux, H., Sutter, A. L., Glatigny-Dallay, E., et al. (2002). Obstetrical complications and the development of postpartum depressive symptoms: A prospective survey of the MATQUID cohort. Acta Psychiatrica Scand., 106(3), 212–219.
Carter, F. A., Frampton, C. M. A., & Mulder, R. T. (2006). Cesarean section and postpartum depression: A review of the evidence examining the link. Psychosomatic Medicine, 68(2), 321–330. doi:10.1097/01.psy.0000204787.83768.0c.
Parker, J. (2004). Does traumatic birth increase the risk of postnatal depression? British Journal of Community Nursing, 9(2), 74–79.
Gulamani, S. S., Premji, S. S., Kanji, Z., et al. (2013). A review of postpartum depression, preterm birth, and culture. The Journal of Perinatal & Neonatal Nursing., 27(1), 52–59. doi:10.1097/JPN.0b013e31827fcf24.
Singer, L., Salvator, A., Guo, S., Collin, M., Lilien, L., & Baley, J. (1999). Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. The Journal of the American Medical Association, 281(9), 799–805.
DeMier, R. L., Hynan, M. T., Hatfield, R. F., et al. (2000). A measurement model of perinatal stressors: Identifying risk for postnatal emotional distress in mothers of high-risk infants. Journal of Clinical Psychology, 56(1), 89–100.
Vigod, S. N., Villegas, L., Dennis, C. L., et al. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: A systematic review. BJOG: An International Journal of Obstetrics & Gynaecology., 117, 540–550.
Singer, L. T., Salvator, A., Guo, S., et al. (1999). Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA, 281(9), 799–805.
Bedford, A., Foulds, G. A., & Sheffield, B. F. (1976). A new personal disturbance scale (DSSI/sAD). British Journal of Social and Clinical Psychology, 15(4), 387–394.
Bedford, A., & Foulds, G. A. (1977). Validation of the Delusions-Symptoms-States Inventory. British Journal of Medical Psychology, 50(2), 163–171.
Morey, L. C. (1985). A comparative validation of the Foulds and Bedford hierarchy of psychiatric symptomatology. British Journal of Psychiatry, 146, 424–428.
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.
Najman, J. M., Andersen, M. J., Bor, W., et al. (2000). Postnatal depression-myth and reality: Maternal depression before and after the birth of a child. Social Psychiatry and Psychiatric Epidemiology, 35(1), 19–27.
Spanier, G. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and Family, 38, 15–28.
Reeder, L. G., Schrama, P. G., & Dirken, J. M. (1973). Stress and cardiovascular health: An international cooperative study. Social Science & Medicine, 7(8), 573–584.
Metcalfe, C., Smith, G. D., Wadsworth E., et al. (2003). A contemporary validation of the Reeder stress inventory. British Journal of Health Psychology, 8(Pt 1), 83–94.
Henderson, S., Byrne, G., Duncan-Jones, P., et al. (1980). Social relationships, adversity and neurosis: A study of associations in a general population sample. British Journal of Psychiatry, 136, 574–583.
Henderson, S., Duncan-Jones, P., Byrne, D. G., et al. (1980). Measuring social relationships. The interview schedule for social interaction. Psychological Medicine, 10(4), 723–734.
Henderson, S. (1981). Social relationships, adversity and neurosis: An analysis of prospective observations. British Journal of Psychiatry, 138, 391–398.
Najman, J. M., Morrison, J., Keeping, J. D., et al. (1990). Social factors associated with the decision to relinquish a baby for adoption. Community Health Studies, 14(2), 180–189.
Halkidi, M., Batistakis, Y., & Vazirgiannis, M. (2001). On clustering validation techniques. Journal of Intelligent Information Systems., 17(2–3), 107–145. doi:10.1023/A:1012801612483.
Tryfos, P. (1998). Cluster analysis. In Methods for business analysis and forecasting: Text & cases (chap 15, pp. 1–23). London: Wiley. http://www.yorku.ca/ptryfos/methods.htm.
Schonlau, M. (2004). Visualizing non-hierarchical and hierarchical cluster analyses with clustergrams. Computational Statistics, 19(1), 95–111. doi:10.1007/BF02915278.
StataCorp. Stata: Release 12. Statistical Software. Release 12. College Station, Texas: StataCorp LP; 2011.
Brennan, P. A., Hammen, C., Andersen, M. J., et al. (2000). Chronicity, severity, and timing of maternal depressive symptoms: Relationships with child outcomes at age 5. Developmental Psychology, 36(6), 759–766.
Barker, E. D., Copeland, W., Maughan, B., et al. (2012). Relative impact of maternal depression and associated risk factors on offspring psychopathology. British Journal of Psychiatry, 200(2), 124–129. doi:10.1192/bjp.bp.111.092346.
Grace, S. L., Evindar, A., & Stewart, D. E. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Womens Mental Health, 6(4), 263–274. doi:10.1007/s00737-003-0024-6.
Burke, L. (2003). The impact of maternal depression on familial relationships. International Review of Psychiatry, 15(3), 243–255. doi:10.1080/0954026031000136866.
Campbell, S. B., Matestic, P., von Stauffenberg, C., et al. (2007). Trajectories of maternal depressive symptoms, maternal sensitivity, and children’s functioning at school entry. Developmental Psychology, 43(5), 1202–1215. doi:10.1037/0012-1649.43.5.1202.
Dennis, C. L., & Ross, L. (2006). Women’s perceptions of partner support and conflict in the development of postpartum depressive symptoms. Journal of Advanced Nursing, 56(6), 588–599. doi:10.1111/j.1365-2648.2006.04059.x.
Akincigil, A., Munch, S., & Niemczyk, K. C. (2010). Predictors of maternal depression in the first year postpartum: Marital status and mediating role of relationship quality. Social Work in Health Care, 49(3), 227–244. doi:10.1080/00981380903213055.
Balaji, A. B., Claussen, A. H., Smith, D. C., et al. (2007). Social support networks and maternal mental health and well-being. Journal of Women’s Health, 16(10), 1386–1396. doi:10.1089/jwh.2007.CDC10.
Australian Bureau of Statistics. ABS National Survey of Mental Health and Wellbeing: Summary of Results 2007. Canberra 2008.
Mercier, R. J., Garrett, J., Thorp, J., et al. (2013). Pregnancy intention and postpartum depression: Secondary data analysis from a prospective cohort. BJOG, 120(9), 1116–1122. doi:10.1111/1471-0528.12255.
Najman, J. M., Morrison, J., Williams, G., et al. (1991). The mental health of women 6 months after they give birth to an unwanted baby: A longitudinal study. Social Science & Medicine, 32(3), 241–247. doi:10.1016/0277-9536(91)90100-Q.
Josefsson, A., Angelsioo, L., Berg, G., et al. (2002). Obstetric, somatic, and demographic risk factors for postpartum depressive symptoms. Obstetrics and Gynecology, 99(2), 223–228.
Gutke, A., Josefsson, A., & Oberg, B. (2007). Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms. Spine, 32(13), 1430–1436. doi:10.1097/BRS.0b013e318060a673.
Khatun, M., Clavarino, A. M., Callaway, L., et al. (2009). Common symptoms during pregnancy to predict depression and health status 14 years post partum. International Journal of Gynaecology and Obstetrics, 104(3), 214–217. doi:10.1016/j.ijgo.2008.10.019.
Skalkidou, A., Hellgren, C., Comasco, E., et al. (2012). Biological aspects of postpartum depression. Womens Health (Lond Engl)., 8(6), 659–672. doi:10.2217/whe.12.55.
Johnstone, S. J., Boyce, P. M., Hickey, A. R., et al. (2001). Obstetric risk factors for postnatal depression in urban and rural community samples. Australian and New Zealand Journal of Psychiatry, 35(1), 69–74.
Bedford, A., Foulds, G. A., & Sheffield, B. F. (1976). A new personal disturbance scale (DSSI/sAD). British Journal of Social and Clinical Psychology, 15(4), 387–394.
Najman, J. M., Bor, W., O’Callaghan, M., et al. (2005). Cohort profile: The Mater-University of Queensland Study of Pregnancy (MUSP). International Journal of Epidemiology, 34(5), 992–997. doi:10.1093/ije/dyi119.
Najman, J. M., Khatun, M., Mamun, A., et al. (2013). Does depression experienced by mothers leads to a decline in marital quality: A 21-year longitudinal study. Social Psychiatry and Psychiatric Epidemiology,. doi:10.1007/s00127-013-0749-0.
Conflict of interest
On behalf of all authors, the corresponding author states that no conflicts of interest exist.
Author information
Authors and Affiliations
Corresponding author
Appendix
Appendix
See Table 6.
Rights and permissions
About this article
Cite this article
Kingsbury, A.M., Hayatbakhsh, R., Mamun, A.M. et al. Trajectories and Predictors of Women’s Depression Following the Birth of an Infant to 21 Years: A Longitudinal Study. Matern Child Health J 19, 877–888 (2015). https://doi.org/10.1007/s10995-014-1589-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-014-1589-6