Postpartum depression: identification of women at risk

OBJECTIVE: To identify and test the predictive power of demographic, obstetric, and psychosocial risk factors of postpartum depression. DESIGN: Community-based, prospective follow up study based on questionnaires on past history of psychiatric disease, psychological distress and social support during pregnancy and depression at four months after delivery. Obstetric files were collected at time of birth. SETTING: Antenatal care clinic and delivery ward, Aarhus University Hospital, Denmark. POPULATION: 6,790 women giving birth between 1 January 1994 and 31 December 1995, who attended the antenatal clinic during pregnancy; 5,252 (78%) completed all questionnaires. The validation population comprised 528 women enrolled immediately prior to and after the study period. MAIN OUTCOME MEASURE: Postpartum depression four months after giving birth assessed by the Edinburgh Postnatal Depression Scale. RESULTS: 5.5% of the women suffered from postpartum depression, corresponding to a score of 13 or higher on the Edinburgh Postnatal Depression Scale. Risk factors identified by multivariate logistic regression analysis included psychological distress in late pregnancy (OR 6.3 95% CI 4.4-9.1), perceived social isolation during pregnancy (OR 3.6 95% CI 1.9-7.0); high parity (OR 3.8 95% CI 1.8-8.0); and a positive history of prepregnant psychiatric disease (OR 2.1 95% CI 1.4-3.2). No association was found between pregnancy or delivery complications, and postpartum depression. The maximum predictive power of the identified risk factors was 0.3. According to these results, one out of three women who suffers from psychological distress in late pregnancy with perceived social isolation will develop postpartum depression. CONCLUSION: Antenatal focus on psychosocial wellbeing may help to identify women at risk of postpartum depression.