University of North Carolina at Chapel Hill Graduate School
Doi
Abstract
Background. Despite current screening practices and known risk factors, perinatal mental health is a leading public health concern. Several key gaps remain in the perinatal mental health literature. First, despite the higher prevalence of anxiety, anxiety and its comorbidity with depression during pregnancy receives less clinical and research attention. Second, the accumulation of psychosocial factors in relation to antepartum mental health has been understudied. Third, research of postpartum mental health has infrequently focused on new-onset symptoms. Fourth, while psychosocial and obstetric risk factors don’t necessarily occur in isolation, exposure to the cumulative occurrence of these factors and mental health is understudied. Methods. Using cross-sectional data from pregnant women (n=1,797), we examined the association between eight psychosocial factors and antepartum mental health. Specifically, we estimated the association between a psychosocial adversity index on 1) the persistence of depression and anxiety, individually, and on 2) the comorbid occurrence, throughout the second and third trimesters of pregnancy. In our second analysis, we utilized longitudinal data from women (n=378) without elevated mental health symptoms in pregnancy to estimate the relationship between nine pregnancy and delivery complications and the new onset symptoms of depression and/or anxiety at 3 or 12 months postpartum. Results. Compared to women with a low psychosocial adversity index score, women reporting a high level of psychosocial adversities (43% of sample) had 2.06 (95% Confidence Interval:1.51-2.82) times higher adjusted odds of endorsing only depressive symptoms or anxiety, and 5.57 (95% Confidence Interval:3.95-7.85) times higher the odds of endorsing comorbid symptoms at either the second or third trimester. The associations for persistent symptoms of depression and anxiety were of similar direction and magnitude. Women with high pregnancy and delivery complications (23% of sample) had 1.71 (95% Confidence Interval:1.13-2.59) times the risk of incident mental health symptoms postpartum, compared to women with low complications.Conclusion. Women with high psychosocial adversities during pregnancy may be at higher risk of elevated depressive symptoms and anxiety in pregnancy. Even in absence of mental health symptoms in pregnancy, women with an accumulation of pregnancy and delivery complications may be at higher risk of mental health symptoms during postpartum.Doctor of Philosoph
