Research reportEvaluation of a social support measure that may indicate risk of depression during pregnancy
Introduction
Low levels of social support have been linked to the risk of developing depression in pregnancy or in the postpartum period (Barnet et al., 1996; Brugha et al., 1998; Collins et al., 1993; Cutrona, 1984; McKee et al., 2001; McKenry et al., 1990; O'Hara and Swain, 1996; Seguin et al., 1995; Stuchberry et al., 1998; Turner et al., 1990; Verkerk et al., 2003; Webster et al., 2000), although the strength of this risk factor varies among studies (c.f. O'Hara and Swain, 1996 for review (O'Hara and Swain, 1996)). In part, inconsistencies may be a result of the characteristics of the social support scales. For example, some investigations used scales that assessed only a few domains of support (Collins et al., 1993; Da Costa et al., 2000; Lee et al., 2005; McKenry et al., 1990; Norbeck et al., 1983; Norbeck and Tilden, 1983; Stuchberry et al., 1998; Turner et al., 1990; Webster et al., 2000), while others explored domains inconsistently through the use of open-ended, rather than structured questions about sources of support (Brugha et al., 1998; Norbeck et al., 1983; Seguin et al., 1995; Stuchberry et al., 1998). To our knowledge, no prior study of social support and depression in pregnant women has utilized a diagnostic interview for depression rather than a continuous measure of symptom severity or a screening questionnaire. Given the potential health risks of low social support in pregnancy and the need for an accurate and feasible social support instrument, this study evaluated the reliability and validity of the Kendler Social Support Interview modified for use in pregnant women (Kendler et al., 2005). A depressive disorder diagnosis was generated using the Composite International Diagnostic Interview (WHO, 1997) and the relationship between the social support interview score and depressive diagnosis in the first trimester of pregnancy was examined.
Section snippets
Methods
Pregnant women were recruited from obstetrical and psychiatric settings throughout Connecticut and Western Massachusetts. Women were eligible if they spoke English or Spanish, to their knowledge were having a singleton pregnancy and did not require insulin for diabetes. Subjects were interviewed face-to-face prior to completion of 16 weeks of pregnancy and were then re-interviewed by phone at 28 weeks of pregnancy and 2 months postpartum. They were reimbursed $20 per interview and an additional
Sample
There were 2758 subjects screened on or before August 18, 2006. Of those, 510 were women with probable current or recent depression, PTSD or antidepressant treatment, who were considered “exposed” and selected. From the remaining “non-exposed” women, 423 (32%) were randomly selected to participate in the study.
Of the 933 total subjects eligible, 791 successfully completed the home interview in the specified time frame of pregnancy. Eight additional subjects were excluded due to improper
Discussion
After item reduction, the Modified Kendler Social Support Interview (MKSSI) was internally consistent and demonstrated construct and external validity in a large cohort of pregnant women. Additionally, a high MKSSI score was significantly correlated to decreased odds of depression in the first trimester of pregnancy, providing excellent external validation of this interview.
While the relationship between social support and depression was significant in both the Kendler (Kendler et al., 2005)
Role of funding source
This study was supported by a NICHD grant entitled, “Effects of Perinatal Depression on PTD and LBW,” # 5 R01HD045735 to K.B. and K.A.Y. L.S. was supported by a Doris Duke Clinical Research Fellowship from the Doris Duke Charitable Foundation. M.V.S. was supported by grant T32MH014235. None of the funding sources had any role in study design, data collection, analysis, or interpretation or in writing the report or in the decision to submit the paper for publication.
Conflict of interest
K.A.Y. received research grants from Eli Lilly and Wyeth, royalties from “Up-To-Date” and speaking honoraria from Wyeth and Berlex within the last 2 years. All other authors declare that they have no conflicts of interest.
Acknowledgements
The authors would like to warmly thank Janneane Gent, Ph.D. and Haiqun Lin, Ph.D. for assistance with analyses. We also appreciate the strong work of the Yale PMS, Perinatal, and Postpartum Research Program and the Yale Center for Perinatal, Pediatric and Environmental Epidemiology in data collection and data management.
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