ABSTRACT
OBJECTIVE: Women are vulnerable to mood changes during pregnancy and the postpartum period. We set out to empirically test the hypothesis that biological and psychosocial variables interact to result in this vulnerability. METHOD: Using structural equation modeling techniques, we developed an integrative model of perinatal mood changes from clinical, psychosocial, hormone and mood data collected from 150 women in late pregnancy and at 6-weeks postpartum. RESULTS: In the prenatal model, biological variables had no direct effect on depressive symptoms. However, they did act indirectly through their significant effects on psychosocial stressors and symptoms of anxiety. The same model did not fit the postpartum data, suggesting that different causal variables may be implicated in postpartum mood. CONCLUSION: This model demonstrates the importance of considering both biological and psychosocial variables in complex health conditions such as perinatal mood disorders.
Subject(s)
Depression, Postpartum/epidemiology , Mood Disorders/epidemiology , Pregnancy/psychology , Adult , Depression, Postpartum/diagnosis , Depression, Postpartum/psychology , Female , Humans , Mood Disorders/diagnosis , Mood Disorders/psychology , Psychology , Social SupportABSTRACT
Assessment of the somatic symptoms of depression in perinatal women has been debated due to potential overlap with normal physical complaints of pregnancy and childbirth. We investigated the properties of the 17-item Hamilton Rating Scale for Depression (HAMD), which includes somatic items, between 36 weeks gestation and 16 weeks postpartum in 150 women. Scores on the HAMD were highly correlated with scores on measures that avoid somatic items. Scores on somatic items were not well correlated with the total HAMD score in pregnancy, but the correlations increased at 6 weeks postpartum. In contrast, scores on HAMD item 1 ("Depression") were less well correlated with the total score at 6 weeks postpartum than prenatally, suggesting that postpartum women may be less likely to articulate their difficulties as "depression", and more likely to describe somatic complaints such as low energy or insomnia. Implications for the assessment of depression in this population are discussed.
Subject(s)
Depressive Disorder, Major/diagnosis , Somatoform Disorders/diagnosis , Surveys and Questionnaires , Adult , Depressive Disorder, Major/epidemiology , Female , Humans , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness Index , Somatoform Disorders/epidemiologyABSTRACT
We investigated the contribution of anxiety symptoms to scores on the Edinburgh Postnatal Depression Scale (EPDS) between 36 weeks gestation and 16 weeks postpartum in 150 women. The 3-item anxiety subscale of the EPDS accounted for 47% of the total score in late pregnancy, and 38% of the total score in the postpartum period. Two categories of anxiety were common in the perinatal period: subsyndromal, situational anxiety (in particular during the last weeks of pregnancy); and clinically significant comorbid anxiety, which was experienced by nearly 50% of clinically depressed pregnant and postpartum women. The close relationship between anxiety and depression raises questions about whether symptoms of anxiety might be more common in the perinatal period than in other depressions. A strong role for anxiety symptoms in postpartum depression, and implications for its etiology and treatment, are discussed.
