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Causal Model of the Association of Social Support With Antepartum Depression: A Marginal Structural Modeling Approach.

ABSTRACT: We used marginal structural models to evaluate associations of social support with antepartum depression in late pregnancy, if everyone had had high social support both before pregnancy and during early pregnancy, compared with having low social support at one of the 2 time points or low social support at both time points. In 2012-2014, pregnant Peruvian women (n = 3,336) were recruited into a prospective cohort study (at a mean gestational age of 9 weeks). A follow-up interview (n = 2,279) was conducted (at 26-28 weeks of gestation). Number of available support providers and satisfaction with social support were measured using Sarason Social Support Questionnaire-6. Depression was measured using the Edinburgh Postnatal Depression Scale. Low number of support providers at both time points was associated with increased risk of depression (odds ratio = 1.62, 95% confidence interval: 1.12, 2.34). The association for low satisfaction at both time points was marginally significant (odds ratio = 1.41, 95% confidence interval: 0.99, 1.99). Depression risk was not significantly higher for women who reported high social support at one of the 2 time points. Our study reinforces the importance of assessing social support before and during pregnancy and underscores the need for future interventions targeted at increasing the number of support providers to prevent antepartum depression.

SUBMITTER: Zhong QY

PROVIDER: S-EPMC6118064 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Causal Model of the Association of Social Support With Antepartum Depression: A Marginal Structural Modeling Approach.

Zhong Qiu-Yue QY Gelaye Bizu B VanderWeele Tyler J TJ Sanchez Sixto E SE Williams Michelle A MA

American journal of epidemiology 20180901 9

We used marginal structural models to evaluate associations of social support with antepartum depression in late pregnancy, if everyone had had high social support both before pregnancy and during early pregnancy, compared with having low social support at one of the 2 time points or low social support at both time points. In 2012-2014, pregnant Peruvian women (n = 3,336) were recruited into a prospective cohort study (at a mean gestational age of 9 weeks). A follow-up interview (n = 2,279) was ...[more]

PMID: 29617921

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Project description:BackgroundRecent analyses have described metabolomic markers for depression and suicidal ideation in non-pregnant adults. We examined the metabolomic profile of antepartum depression and suicidal ideation during mid-pregnancy, a time of high susceptibility to mood disorders.MethodsWe collected fasting blood from 100 pregnant Peruvian women and profiled 307 plasma metabolites using liquid chromatography-mass spectrometry. We used the Patient Health Questionnaire 9 to define antepartum depression (score  ≥ 10) and suicidal ideation (having thoughts that you would be better off dead, or of hurting yourself). Logistic regression was used to calculate odds ratios (ORs).ResultsThree triacylglycerol metabolites (C48:5 triacylglycerol [OR = =1.89; 95% confidence interval (CI): 1.14-3.14], C50:6 triacylglycerol [OR = =1.88; 95%CI: 1.13-3.14], C46:4 triacylglycerol [OR = =1.89; 95%CI: 1.11-3.21]) were associated with higher odds of antepartum depression and 4 metabolites (betaine [OR = =0.56; 95%CI:0.33-0.95], citrulline [OR = =0.58; 95%CI: 0.34-0.98], C5 carnitine [OR = =0.59; 95%CI: 0.36-0.99], C5:1 carnitine [OR = =0.59; 95%CI: 0.35-1.00]) with lower odds of antepartum depression. Twenty-six metabolites, including 5-hydroxytryptophan (OR = =0.52; 95%CI: 0.30-0.92), phenylalanine (OR = =0.41; 95%CI: 0.19-0.91), and betaine (OR = =0.53; 95%CI: 0.28-0.99) were associated with lower odds of suicidal ideation.LimitationsOur cross-sectional study could not determine whether metabolites prospectively predict outcomes. No metabolites remained significant after multiple testing correction; these novel findings should be replicated in a larger sample.ConclusionsAntepartum suicidal ideation metabolomic markers are similar to markers of depression among non-pregnant adults, and distinct from markers of antepartum depression. Findings suggest that mood disorder in pregnancy shares metabolomic similarities to mood disorder at other times and may further understanding of these conditions' pathophysiology.

Project description:ImportanceMental health problems are common during the transition from adolescence to young adulthood. Although perceived social support and mental health problems have been shown to be concurrently associated, longitudinal studies are lacking to document the directionality of this association, especially in emerging adulthood (late teens to late 20s).ObjectiveTo test whether social support in emerging adulthood protects against later depression, anxiety, and suicidal ideation and suicide attempts after adjusting for a range of confounders, including prior mental health problems and family characteristics.Design, setting, and participantsThis population-based cohort study included 1174 participants from the Quebec Longitudinal Study of Child Development. Participants underwent yearly or biennial assessment (starting from age 5 months to age 20 years). Data were collected from March 16, 1998, through June 1, 2018.Main outcomes and measuresSelf-reported perceived social support was measured at age 19 years using the 10-item Social Provision Scale. Mental health problems, including depressive and anxiety symptoms as well as suicidal ideation and attempts, were measured at age 20 years. Social support and mental health problem raw scores were converted to z-scores to ease interpretation. Depressive and anxiety symptoms were categorized using validated cutoffs to determine clinical significance.ResultsThe study consisted of 1174 participants (574 female [48.89%] and 600 male [51.11%] individuals). Emerging adults with higher levels of perceived social support at age 19 years reported fewer mental health problems 1 year later, even after adjusting for a range of mental health problems in adolescence at ages 15 and 17 years (eg, depressive and anxiety symptoms and suicidal ideation and attempts) and family characteristics (eg, socioeconomic status and family functioning and structure). Higher perceived social support was associated with fewer symptoms of depression (β = -0.23; 95% CI, -0.26 to -0.18; P = <.001 and odds ratio [OR], 0.53; 95% CI, 0.42-0.66 for severe depression) and anxiety (β = -0.10; 95% CI, -0.15 to -0.04; P < .001 and OR, 0.78; 95% CI, 0.62-0.98 for severe anxiety). Higher perceived social support was associated with a lower risk for suicide-related outcomes (OR, 0.59 [95% CI, 0.50-0.70] for suicidal ideation and OR, 0.60 [95% CI, 0.46-0.79] for suicide attempts).Conclusions and relevanceIn this cohort study, emerging adults who perceived higher levels of social support reported experiencing fewer mental health problems 1 year later. These findings suggest that perceived social support may protect against mental health problems during the transition into adulthood, even in those who experience mental health problems in adolescence. Leveraging social support in prevention and treatment options may protect against mental health symptoms during this transition period.

Dataset Information

Causal Model of the Association of Social Support With Antepartum Depression: A Marginal Structural Modeling Approach.

Publications

Causal Model of the Association of Social Support With Antepartum Depression: A Marginal Structural Modeling Approach.

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