Postpartum depression: identification of women at risk

Objective To identify and test the predictive power of demographic, obstetr ic, 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. Obst etric files were collected at time of birth. Setting Antenatal care clinic and delivery ward, Aarhus University Hospital , Denmark. Population 6790 women giving birth between 1 January 1994 and 31 December 1 995, who attended the antenatal clinic during pregnancy; 5252 (78%) complet ed all questionnaires. The validation population comprised 528 women enroll ed immediately prior to and after the study period. Main outcome measure Postpartum depression four months after giving birth a ssessed by the Edinburgh Postnatal Depression Scale. Results 5.5% of the women suffered from postpartum depression, correspondin g to a score of 13 or higher on the Edinburgh Postnatal Depression Scale. R isk factors identified by multivariate logistic regression analysis include d psychological distress in late pregnancy (OR 6.3 [95% CT 4.4-9.1]), perce ived social isolation during pregnancy (OR 3.6 [95% CI 1.9-7.0]); high pari ty (OR 3.8 [95% CI 1.8-8.0]); and a positive history of prepregnant psychia tric disease (OR 2.1 [95% CI 1.4-3.2]). No association was found between pr egnancy or delivery complications, and postpartum depression. The maximum p redictive 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 depr ession. Conclusion Antenatal focus on psychosocial wellbeing may help to identify w omen at risk of postpartum depression.