Stressful Life Events in Pregnancy and Postpartum Depressive Symptoms among Women in Washington State

BACKGROUND

Stressful life events (SLEs) such as job loss or death of a loved one are common in pregnancy. Studies have shown that women with SLEs during pregnancy are more likely to develop postpartum depressive symptoms (PDS). This study examined the association between stressful life events (SLEs) experienced one year before delivery and postpartum depressive symptoms (PDS) among women in Washington (WA) State and whether perceived availability of social support modified this association.

METHODS

A retrospective cohort study of post-partum women who participated in the WA State Pregnancy Risk Assessment Monitoring System (PRAMS) survey from 2009-2013 was performed. Women were classified as having any SLE (>1SLEs) if they reported experiencing at-least one of 12 SLEs one year before delivery. Women were categorized as having PDS if they responded “always” or “often” to at least one of two questions and classified as not having PDS if they responded “never”, “rarely” or “sometimes” to all questions on depressive symptoms. Women having any perceived availability of financial, physical or emotional help were classified as having any social support. Multivariable Poisson regression was performed to estimate relative risks with 95% confidence intervals (CI), adjusting for maternal age, race, education and insurance status. Effect modification by perceived availability of social support was assessed using the Wald test.

RESULTS

Among 6,415 women, 68% reported one or more SLEs (financial=75.5%, partner-related=40.2%, emotional=39.1% and traumatic=25.8%). Nineteen percent of mothers experienced PDS out of whom 79% had > 1 SLEs one year before delivery. Among women with any SLE, most (94.2%) reported having at least one form of social support; 72.3% had all 4 types. Compared to women with no SLEs, women with any SLE were 1.7 times more likely (95% CI 1.4, 2.0) to report PDS. Perceived availability of social support did not modify the association between SLEs experienced one year before delivery and PDS.

CONCLUSIONS

Our study suggests that women should be screened for SLEs during prenatal visits to identify those at increased risk of developing PDS.