Factors associated with postpartum depression: a cluster analysis

Abstract

Introduction: Postpartum depression (PPD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a multifactorial disease, which occurs during pregnancy until the fourth week postpartum. Objective: To assess whether family support, depression and/or anxiety before or during pregnancy, alcohol consumption and/or smoking during pregnancy, and age (<20 or >35 years), together or separately, in puerperal women influence the occurrence of PPD. Methods: A longitudinal and multicenter study, called “Projeto Viver”, with 3435 women who gave birth in three maternity hospitals in Espírito Santo. At the last follow-up, at the end of the neonatal period, 1818 puerperae were interviewed by telephone (52.9%). Poisson analysis with robust variance adjustment was performed for one, two, three and even four grouped factors, and adjusted for covariates. Results: The prevalence of PPD was 7.3% (95% CI 6.1% - 8.5%) in the first month after delivery. Most puerperae with PPD were between 20 and 34 years old (71.2%; 95%CI 62.8% - 78.3%), more than 12 years of education (60.7%; 95%CI 51.5% - 69.2%), non-white skin color (77.3%; 95%CI 69.2% - 83.8%) and social class C (51.5%; 95%CI 42.9% - 60.0%). The most prevalent risk factor in puerperae with PPD was the lack of family support (34.1%; 95%CI 26.4% - 42.6%) and the least was depression and/or anxiety before or during pregnancy (3.8%; 95%CI 1.6% - 8.8%). Women without family support, who smoked and/or drank during pregnancy had 98% and 60% risk for PPD, respectively. The presence of two and three risk factors doubled and tripled the risk for PPD among puerperae, respectively. In puerperae with two concurrent factors, such as lack of family support and smoking/ethylism, as well as those with depression and/or anxiety before or during pregnancy and age extremes, the risk for PPD was 2.1 (95% CI 1.2 - 3.9) and 3.7 (95% CI 1.2 - 11.7), respectively. Conclusion: The result of this study allowed the knowledge of the risk of aggregate factors, and can contribute to public health actions that minimize them in pregnant women, in order to reduce the occurrence of depression after childbirth.