Obstetric risk factors for depression during the postpartum period in South Korea: a nationwide study
Introduction
Women experience psychological and hormonal changes during pregnancy and childbirth [1]. This period is known as one of the most susceptible times to develop depression over the entire life of women [2], [3]. The prevalence of postpartum depression (PPD) is estimated at 10–15%, but can range between 5.5% and 33.1% depending on studies, cultures, samples, and diagnostic criteria [4], [5], [6], [7]. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a specifier of ‘with peripartum onset’ encompasses only the first 4 weeks of postpartum [8]. However, many clinicians and researchers have recommended a broader timeframe, such as the first 6 to 12 months postpartum, because the symptoms of PPD can develop even after the first 4 weeks [9], [10], [11].
PPD is known to develop more likely with poor social support, previous depression/anxiety history, family history of psychiatric illness, previous abortion, substance abuse, discontinuation of breastfeeding, and marital relationship [12], [13], [14], [15], [16]. However, previous studies have reported conflicting results on some of the risk factors for PPD. For example, Silverman et al. reported that advanced maternal age increases the likelihood of PPD [17], however, Liu et al., on the other hand, reported that younger maternal age might contribute to PPD [18]. Robertson et al. found maternal age as a non-associative factor [12]. Likewise, in the case of cesarean delivery, some studies regarded it as a risk factor [19], [20], [21], while others did not [13], [22]. There have been few studies on other obstetric risk factors such as placenta previa, placental abruption, and induced labor.
The consequences of PPD are linked to adverse effects in both mothers and their children [12], [23], [24], [25], [26]. PPD affects the marital relationship, quality of life, and mental health of mothers. It also influences children's emotional, behavioral, and cognitive development [23]. Furthermore, PPD has negative effects on mother-infant bonding as well [23]. Proper screening and early interventions are crucial in preventing these problems [27]. Most women visit obstetricians or gynecologists during their pregnancy and postpartum period on a regular basis [28]. Thus, the role of obstetricians and gynecologists is crucial for both mothers and infants.
Therefore, the aim of this study is to identify the obstetric risk factors of depression during the postpartum period. We also added previous depression as a variable, since previous depression has been known as a strong predictor of PPD [7], [12], [29]. Furthermore, we examined the timeframe from delivery to the first depression diagnosis during the postpartum period.
Section snippets
Data source
We extracted the data from the database of Korean National Health Insurance Service. South Korea has national health insurance system which covers all the health services, including admission, emergency room visit, ambulatory care, and pharmaceutical services of approximately 50 million Koreans. 97% of the population is enrolled in this service, and the remaining 3% is covered by Medical Aid Program [30]. Under these national health insurance systems, medical institutions in South Korea are
Results
A total of 17,483 (1.4%) women had depression during the postpartum period. The mean age of women with depression was 30.57 (SD = 4.60), while the mean age of women without depression was 30.86 (SD = 4.10). Table 1 shows the basic characteristics of the subjects. Fig. 1 shows the timeframe from delivery to the first depression diagnosis during the postpartum period. The result from our study indicates that the number of women who are diagnosed with depression keeps increasing from the first month
Discussion
We investigated the association between obstetric and gynecological factors and depression during the postpartum period using the nationwide database. Firstly, our major findings indicated previous history of depression, maternal age and parity (younger and advanced maternal age and primiparity), comorbidities and surgical intervention (preeclampsia, peripartum hysterectomy, and uterine artery embolization), delivery mode (cesarean delivery and induced labor), and obstetric complications
Conflict of interest
The authors declare that there are no conflicts of interest regarding this manuscript.
References (78)
- et al.
Prevalence and correlates of major depressive episode in pregnant and postpartum women in the United States
J. Affect. Disord.
(2011) - et al.
Postpartum depression
Am. J. Obstet. Gynecol.
(2009) - et al.
Antenatal risk factors for postpartum depression: a synthesis of recent literature
Gen. Hosp. Psychiatry
(2004) - et al.
The synergistic effect of breastfeeding discontinuation and cesarean section delivery on postpartum depression: a nationwide population-based cohort study in Korea
J. Affect. Disord.
(2017) - et al.
Risk factors for postpartum depression among Chinese women: path model analysis
BMC Pregnancy Childbirth
(2017) Postpartum depression effects on early interactions, parenting, and safety practices: a review
Infant Behav. Dev.
(2010)- et al.
Maternal postnatal depression and the development of depression in offspring up to 16 years of age
J. Am. Acad. Child Adolesc. Psychiatry
(2011) - et al.
Predictors of postpartum depression: prospective study of 264 women followed during pregnancy and postpartum
Psychiatry Res.
(2014) - et al.
Pathophysiology of preeclampsia and the role of serotonin
Eur. J. Obstet. Gynecol. Reprod. Biol.
(2001) - et al.
Maternal morbidities and postpartum depression: an analysis using the 2007 and 2008 pregnancy risk assessment monitoring system
Womens Health Issues
(2014)
Low hemoglobin level is a risk factor for postpartum depression
J. Nutr.
Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women
Midwifery
The impact of very premature birth on the psychological health of mothers
Early Hum. Dev.
Pain and distress reactivity and recovery as early predictors of temperament in toddlers born preterm
Early Hum. Dev.
Factors associated with post-traumatic symptoms in mothers of preterm infants
Arch. Psychiatr. Nurs.
Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions
Am. J. Obstet. Gynecol.
Prenatal maternal depression associates with microstructure of right amygdala in neonates at birth
Biol. Psychiatry
Williams Obstetrics
Predictors of postpartum depression
J. Women's Health
The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R)
JAMA
Perinatal depression: a systematic review of prevalence and incidence
Obstet. Gynecol.
Maternal depressive symptomatology: 16-month follow-up of infant and maternal health-related quality of life
J. Am. Board Fam. Med.
Rates and risk of postpartum depression—a meta analysis
Int. Rev. Psychiatr.
Diagnostic and Statistical Manual of Mental Disorders
Risk for postpartum depression associated with assisted reproductive technologies and multiple births: a systematic review
Hum. Reprod. Update
Postpartum depression: an update
Womens Health (Lond.)
Obstetric risk factors for postnatal depression in urban and rural community samples
Aust. N Z J. Psychiatry
The relationship between postpartum depression, domestic violence, childhood violence, and substance use: epidemiologic study of a large community sample
Violence Against Women
Effect of previous miscarriage on depressive symptoms during subsequent pregnancy and postpartum in the first baby study
Matern. Child Health J.
The risk factors for postpartum depression: a population-based study
Depress Anxiety
Perinatal complications increase the risk of postpartum depression. The generation R study
BJOG Int. J. Obstet. Gynaecol.
Increased risk of postnatal depression after emergency
Med. J. Australia
Links between early post-partum mood and post-natal depression
Br. J. Psychiatry
Postpartum depression: identification of women at risk
BJOG
Postpartum depression: current status and future directions
Annu. Rev. Clin. Psychol.
Screening for postpartum depression in well-baby care settings: a systematic review
Matern. Child Health J.
The Basic Investigation for Establishing Prenatal Tests Guidelines
Predictors of postpartum depression: an update
Nurs. Res.
Pregnancy-associated risk factors of postpartum breast cancer in Korea: a Nationwide health insurance database study
PLoS One
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The first two authors contributed equally to this article.