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Contextual-relationship and stress-related factors of postpartum depression symptoms in nulliparas: a prospective study from Ljubljana, Slovenia
Reproductive Health ( IF 3.4 ) Pub Date : 2019-09-18 , DOI: 10.1186/s12978-019-0810-x
Polona Rus Prelog , Marijana Vidmar Šimic , Tanja Premru Sršen , Maja Rus Makovec

For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas in Slovenia and to examine vulnerability to developing depressive symptoms, with an emphasis on contextual and stress-related characteristics. The sample consisted of 156 nulliparas in the third trimester of pregnancy enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpartum Depression Scale (EPDS), the Zung Anxiety Scale and a question battery designed by the research team including questions about emotional support and work-related stress. Logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS ≥10), controlling for baseline (prepartum) depression score. A multivariable linear regression model was built with the postpartum EPDS continuous score as a dependent variable. 28/156 (17,9%) were evaluated as being at risk for depression (EPDS≥10) in the last trimester and 25/156 (16%) at six weeks postpartum. The results of the logistic regression model controlled for prepartum depression score showed that increased risk for developing PPDS was associated with anxiety level postpartum, intimate-partner-attachment anxiety postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. The results of the multivariable regression model, however, showed the association with education and postpartum anxiety with PPDS continuous score; EPDS after giving birth was higher for more educated and more anxious primiparas. Our findings demonstrate the importance of anxiety symptoms and higher education level in assessments of nulliparas’ mental health. The results of our study show and confirm the results of previous research that anxiety symptoms in the immediate postpartum period are likely to be associated with depressive symptoms in nulliparas. The results also suggest that higher level of education of first-time mothers might not be a protective factor, especially for nulliparas with the university level of education. Further studies on larger samples should be considered.

中文翻译:

空腹产后抑郁症状的情境关系和压力相关因素:来自斯洛文尼亚卢布尔雅那的前瞻性研究

对于相当大比例的女性,产后抑郁症(PPD)是她们一生中的第一个情绪发作,但其病因仍不清楚。成人亲密关系中的不安全依恋被认为是抑郁症状的危险因素。这项研究的目的是进一步了解斯洛文尼亚nulliparas产后抑郁症状(PPDS)的危险因素,并研究易发性抑郁症状的脆弱性,重点是情境和与压力相关的特征。该样本由参加分娩准备计划的妊娠中期三个156例原产妇组成。应用了以下工具:经修订的亲密关系经验,爱丁堡产后抑郁量表(EPDS),《 Zung焦虑量表》和研究小组设计的问题电池,包括有关情绪支持和与工作相关的压力的问题。Logistic回归用于检验人口统计学,社会,环境,性格和依恋变量与原产妇的PPD(EPDS≥10)之间的关联,以控制基线(产前)抑郁评分。建立了以产后EPDS连续评分作为因变量的多变量线性回归模型。在最后三个月中有28/156(17,9%)被评估为有抑郁风险(EPDS≥10),而在产后六周则被评估为有抑郁的风险(25/156(16%))。控制产前抑郁评分的逻辑回归模型的结果显示,PPDS发生的风险增加与产后焦虑水平,亲密伙伴关系产后焦虑,以及由于上一年失业或求职失败而增加的压力。然而,多元回归模型的结果显示,PPDS连续评分与教育程度和产后焦虑有关。受过良好教育和焦虑的初产妇出生后的EPDS较高。我们的研究结果证明了焦虑症状和较高的教育水平在评估原产妇的心理健康方面的重要性。我们的研究结果表明并证实了先前的研究结果,即产后即刻的焦虑症状很可能与原产妇的抑郁症状有关。研究结果还表明,初次母亲的较高教育水平可能不是保护因素,尤其是对于大学教育程度较高的初产妇。
更新日期:2019-09-18
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