Prevalences,Trajectories,and Associated Factors Of Depressive Symptoms In Pregnant Women Before And After Delivery

ObjectivesThe aims of this study were to analyze the prevalences of depressive symptoms in pregnant women from the first trimester to the first year after delivery;to explore the developmental trajectories of prenatal depressive symptoms,postpartum depressive symptoms,and perinatal depressive symptoms;to identify the factors associated with prenatal depressive symptoms and postpartum depressive symptoms;and to clarify the bidirectional relationships of prenatal family function,fear of childbirth,childbirth selfefficacy and prenatal depressive symptoms,as well as the bidirectional relationships of postpartum family function,parenting sense of competence and postpartum depressive symptoms.So as to provide a scientific basis for understanding the epidemiological status of perinatal depressive symptoms,determining the timing of screening and intervention for depressive symptoms,identifying high-risk populations of depressive symptoms and formulating targeted preventive interventions.MethodsIn this study,the longitudinal follow-up design was adapted to collect empirical data from pregnant women in Wuhan,Hubei Province.Participants were recruited in the longitudinal study starting in September 2018,and the baseline survey was conducted on the recruited participants and six follow-up surveys were conducted on the same population.The baseline survey was conducted in the first trimester(within 14 weeks of gestation),and six follow-up surveys were conducted in the second trimester(24-28 weeks of gestation),third trimester(34-38 weeks of gestation),and 1,3,6,and 12 months postpartum,respectively.A total of 1 053 participants were recruited in this study.Among them,856 completed all the three surveys conducted in prenatal period,689 completed all the surveys conducted in prenatal and postpartum period.Based on the survey data of participants,this study firstly used reliability and validity analysis to verify the applicability of the scale used to the study participants.Secondly,descriptive analysis of the prevalence of maternal depressive symptoms in each prenatal and postpartum period was carried out,and latent growth model and latent class growth model were used to analyze the developmental trajectory of maternal depressive symptoms.Then,logistic regression model was used to explore the factors associated with depressive symptoms in each prenatal and postpartum period,and generalized linear mixed model was used to analyze the factors associated with prenatal and postpartum depressive symptoms which were repeatedly measured.Finally,the cross-lagged model was used to test the bidirectional relationships between prenatal family function,fear of childbirth,childbirth self-efficacy and prenatal depressive symptoms,as well as the bidirectional relationships between postpartum family function,parenting sense of competence and postpartum depressive symptoms,to further clarify the direction of the relationships between important social psychological factors and depressive symptoms.Results1.In this study,the reliability and validity tests of the Childbirth Self-efficacy Scale,the Edinburgh Postnatal Depression Scale and the Family Care Index Questionnaire were all conducted in the population investgated at the baseline,as well as the reliability and validity tests of the Parenting Sense of Competence Scale were conducted in the population investgated 1 month postpartum.The results showed that the Cronbach coefficients of the four scales mentioned above were 0.84,0.88,0.89 and 0.89,respectively,which indicated that the four scales used in this study showed good reliability.In addition,the four scales also showed good structural validity and were applicable to the survey population in this study.2.The results of the analysis of the depressive symptoms prevalence showed that the prevalences of depressive symptoms in the first,second and third trimester were 27.73%,23.74% and 28.50%,respectively;The prevalences of depressive symptoms at 1 month,3months,6 months and 12 months postpartum were 37.03%,30.82%,31.36% and 28.88%,respectively.In this study,the participants who completed all the three surveys conducted in prenatal period,all the four surveys conducted in postpartum period,all the seven surveys conducted in the whole perinatal period,were respectively included in the LGM and LCGM for analysis,to identify the trajectories of prenatal depressive symptoms,postpartum depressive symptoms,and perinatal depressive symptoms.The results showed that the trajectories of prenatal depressive symptoms,postpartum depressive symptoms,and perinatal depressive symptoms were relatively consistent,and they all included three trajectory groups: "no depressive symptom group","close to depressive symptom group" and "depressive symptom group".Among them,the proportion of participants in the "close to depressive symptom group" was the highest,and the proportion of participants in the "depressive symptom group" was the lowest.3.In the logistic regression model of factors related to prenatal depressive symptoms conducted in each prenatal period,all the participants who completed the survey performed in the corresponding period were included for analysis.In the generalized linear mixed model of factors related to prenatal depressive symptoms repeatedly measured,1 053 participants who completed at least one survey conducted in prenatal period were included for analysis.The results of logistic regression model and generalized linear mixed model both showed that income level,family function,fear of childbirth,and childbirth selfefficacy were associated with prenatal depressive symptoms.According to the results of the generalized linear mixed model,pregnant women with low or middle income level(a OR=1.98,95%CI: 1.27-3.07),moderate family dysfunction(a OR=2.84,95%CI: 2.19-3.68)or severe family dysfunction(a OR=5.34,95%CI: 3.53-8.09),severer fear of childbirth(a OR=1.16,95%CI: 1.09-1.23)had a higher risk of having depressive symptoms.While,pregnant women whose childbirth self-efficacy was higher were at a lower risk of being depressive.4.In this study,856 participants who completed all the three surveys conducted in prenatal period were included in the prenatal cross-lagged models for analysis.The results of cross-lagged model of prenatal family function and prenatal depressive symptoms showed that during the first trimester to the second trimester and the second trimester to the third trimester periods,previous family function could negatively predict subsequent depressive symptoms,and previous depressive symptoms could also negatively predict subsequent family function.Additionally,the results of cross-lagged models of childbirth fear,childbirth self-efficacy and prenatal depressive symptoms indicated that,during the first trimester to the second trimester period,previous depressive symptoms unidirectionally positively predicted subsequent fear of childbirth and unidirectionally negatively predicted subsequent childbirth self-efficacy,respectively;during the second trimester to the third trimester period,fear of childbirth and depressive symptoms,as well as childbirth selfefficacy and depressive symptoms could predict and influence each other,respectively.5.In the logistic regression model of factors related to postpartum depressive symptoms conducted in each postpartum period,all the participants who completed the survey performed in the corresponding period were included for analysis.In the generalized linear mixed model of factors related to postpartum depressive symptoms repeatedly measured,794 participants who completed at least one survey conducted in postpartum period were included for analysis.The results of logistic regression model and generalized linear mixed model both showed that maternal sleep time,fear of childbirth in the third trimester,depressive symptoms in the third trimester,negative life events,postpartum family function and parenting sense of competence were associated factors of postpartum depressive symptoms.The results of generalized linear mixed model showed that postpartum women who slept 6-8 hours had a lower risk of being depressive compared with those who slept less than 6 hours(a OR=0.64,95%CI: 0.47-0.86).Additionally,severer fear of childbirth in the third trimester(a OR=1.08,95%CI: 1.01-1.16),having depressive symptoms in the third trimester(a OR=4.45,95%CI: 3.22-6.15),occurrence of negative life events(a OR=2.67,95%CI: 1.95-3.65),moderate family dysfunction(a OR=2.48,95%CI:1.87-3.27)and severe family dysfunction(a OR=4.66,95%CI: 3.15-6.89)were risk factors of postpartum depressive symptoms,while higher parenting sense of competence was a protective factor of postpartum depressive symptoms(a OR=0.94,95%CI: 0.93-0.95).6.In this study,689 participants who completed all the four surveys conducted in postpartum period were included in the postpartum cross-lagged models for analysis.The results of the cross-lagged model of postpartum family function and postpartum depressive symptoms showed that during the 1-3 months,3-6 months,and 6-12 months postpartum periods,previous family function could negatively predict subsequent depressive symptoms,and previous depressive symptoms could also negatively predict subsequent family function.The results of the cross-lagged model of parenting sense of competence and postpartum depressive symptoms indicated that postpartum depressive symptoms were mainly negatively predicted by parenting sense of competence during the 1-3 months and 3-6 months postpartum periods;during the 6-12 months postpartum period,parenting sense of competence could negatively predict depressive symptoms,and depressive symptoms could also negatively predict parenting sense of competence.ConclusionsThe prevalences of prenatal and postpartum depressive symptoms were relatively high,and the characteristics of developmental trajectories of prenatal depressive symptoms,postpartum depressive symptoms and perinatal depressive symptoms were stable and persistent.Screening and intervening for depressive symptoms should be carried out in early pregnancy or early postpartum period,so as to change the development process of depressive symptoms.Additionally,prenatal depressive symptoms were mainly related to the demographic characteristics and psychosocial factors of pregnant women,and there were bidirectional relationships between prenatal family function,fear of childbirth,childbirth self-efficacy and prenatal depressive symptoms.Living conditions and psychosocial factors were assocaited with postpartum depressive symptoms.Moreover,postpartum family function and postpartum depressive symptoms,as well as parenting sense of competence and postpartum depressive symptoms could predict and influence each other,respectively.Therefore,it is necessary to formulate targeted interventions based on factors associated with depressive symptoms,as well as the direction of the relationship between family function,fear of childbirth,childbirth self-efficacy,parenting sense of competence and depressive symptoms,so as to relieve the level of depressive symptoms of pregnant women before and after delivery on the one hand,as well as to reduce their fear of childbirth,and improve their family function,childbirth self-efficacy and parenting sense of competence on the other hand.