Research report
Evaluation of a social support measure that may indicate risk of depression during pregnancy

https://doi.org/10.1016/j.jad.2008.07.015Get rights and content

Abstract

Background

Strong social support has been linked with positive mental health and better birth outcomes for pregnant women. Our aim was to replicate the psychometric properties of the Kendler Social Support Interview modified for use in pregnant women and to establish the inventory's relationship to depression in pregnancy.

Methods

The modified Kendler Social Support Interview (MKSSI) was evaluated using principal components analysis. The association with depression was used as an indicator of external validity and was assessed by logistic regression.

Results

Data from 783 subjects were analyzed. One large principal component, termed “global support,” (eigenvalue = 6.086) represented 22.5% of the total variance. However, 6 of the 27 items (frequency of contact with spouse, siblings, other relatives, and friends, and attendance at church and clubs) had low levels of association (< 0.4) and thus were excluded from suggested items for a total score. Varimax rotation of the remaining 21 items resulted in subscales that fell into expected groupings: mother, father, siblings, friends, etc. One unit and two unit increases in the global support score were associated with 58.3% (OR = 0.417, 95% CI = 0.284–0.612) and 82.6% (OR = 0.174, 95% CI = 0.081–0.374) reductions in odds for depression, respectively.

Limitations

The ability of this social support scale to predict future depression in pregnancy has not yet been established due to cross-sectional design.

Conclusion

The MKSSI is reliable and valid for use in evaluating social support and its relationship to depression in pregnant women.

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.

References (41)

  • BarnetB. et al.

    Depressive symptoms, stress, and social support in pregnant and postpartum adolescents

    Arch. Pediatr. Adolesc. Med.

    (1996)
  • BrughaT.S. et al.

    The Leicester 500 Project. Social support and the development of postnatal depressive symptoms, a prospective cohort survey

    Psychol. Med.

    (1998)
  • CollinsN.L. et al.

    Social support in pregnancy: psychosocial correlates of birth outcomes and postpartum depression

    J. Pers. Soc. Psychol.

    (1993)
  • CutronaC.E.

    Social support and stress in the transition to parenthood

    J. Abnorm. Psychol.

    (1984)
  • DietzP.M. et al.

    Clinically Identified Maternal Depression Before, During, and After Pregnancies Ending in Live Births

    Am. J. Psychiatry

    (2007)
  • FalsettiS. et al.

    A brief self-report measure of postraumatic stress disorder

    Behav. Ther.

    (1993)
  • FarmerA.E. et al.

    A comparison between the present state examination and the composite international diagnostic interview

    Arch. Gen. Psychiatry

    (1987)
  • Fechner-BatesS. et al.

    The relationship of self-reported distress to depressive disorders and other psychopathology

    J. Consult. Clin. Psychol.

    (1994)
  • FieldsT. et al.

    Prenatal depression effects on the fetus and newborn: a review

    Infant Behav. Dev.

    (2006)
  • HatcherL. et al.

    Principal component analysis

  • Cited by (45)

    • Causal model of the association of social support during pregnancy with a perinatal and postpartum depressive state: A nationwide birth cohort – the Japan Environment and Children's Study

      2022, Journal of Affective Disorders
      Citation Excerpt :

      Among the well-known predictors of postpartum depression (Beck, 2001; Norhayati et al., 2015; Robertson et al., 2004), social support is a basis for practical intervention strategies. Poor social support has been associated with increased postpartum depression in both cross-sectional studies (Jeong et al., 2013; Rahman et al., 2003; Spoozak et al., 2009) and cohort studies (Dennis and Ross, 2006; Husain et al., 2012; Webster et al., 2011; Xie et al., 2009). However, few epidemiological studies have explored this association using a causal model of risk that accounts for various levels of social support and is based on modern statistical methods for causal inference in observational studies (Hernán and Robins, 2020; Pearl et al., 2016).

    • Particulate air pollution, fetal growth and gestational length: The influence of residential mobility in pregnancy

      2016, Environmental Research
      Citation Excerpt :

      Women were recruited at <16 weeks gestation for the Nutrition in Pregnancy study (Bracken et al., 2003) (NIP; 1996–1999; N=2344) and Environmental Tobacco Smoke study (Sadler et al., 1999) (ETS; 1988–1991; N=2781). Further details of the cohorts have been published previously (Triche et al., 2004; Spoozak et al., 2009; Bracken et al., 2003; Sadler et al., 1999). We excluded women with at least one address that could not be geocoded (N=182).

    View all citing articles on Scopus
    View full text