Longitudinal effects of perinatal social support on maternal depression: a marginal structural modelling approach.
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ABSTRACT: Background
Depression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child's life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes.Methods
This study leverages marginal structural models to evaluate associations between longitudinal patterns of perinatal social support and subsequent maternal depression at 6 and 12 months postpartum. In a cohort of women in rural Pakistan (n=780), recruited in the third trimester of pregnancy and followed up at 3, 6 and 12 months postpartum, we assessed social support using two well-validated measures: the Multidimensional Scale of Perceived Social Support (MSPSS) and the Maternal Social Support Index (MSSI). Major depressive disorder was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM IV).Results
High and sustained scores on the MSPSS through the perinatal period were associated with a decreased risk of depression at 12 months postpartum (0.35, 95% CI: 0.19 to 0.63). Evidence suggests the recency of support also matters, but estimates are imprecise. We did not find evidence of a protective effect for support based on the MSSI.Conclusions
This study highlights the protective effect of sustained social support, particularly emotional support, on perinatal depression. Interventions targeting, leveraging and maintaining this type of support may be particularly important for reducing postpartum depression.
SUBMITTER: Hagaman A
PROVIDER: S-EPMC8434957 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC6118064 | biostudies-literature
Project description:Causal relationships between perinatal bonding failure, depression, and social support among mothers remain unclear. A total of 494 women (mean age 32.4?±?4.5 years) completed the Mother-Infant Bonding Questionnaire (MIBQ), the Edinburgh Postnatal Depression Scale (EPDS), and the Japanese version of the Social Support Questionnaire in early pregnancy before week 25 (T1) and 1 month after delivery (T2). Our model of recursive structured equation modeling (SEM) showed acceptable fit (CMIN/df?=?2.2, CFI?=?0.97, and RMSEA?=?0.05). It was revealed that: (1) a lower number of supportive persons at T1 significantly predicted both MIBQ and EPDS scores at T1 and T2; (2) at T1, poorer satisfaction with the social support received significantly predicted EPDS scores; (3) both MIBQ and EPDS scores at T1 significantly predicted their respective scores at T2. Out cohort study indicates that the number of individuals who are available to provide social support and the degree of satisfaction with the level of social support received during pregnancy have a great influence on bonding failure and depression in the postpartum period. These findings suggest that psychosocial interventions that focus on these two aspects of social support during pregnancy are effective in preventing bonding failure and depression in the postpartum period.
| S-EPMC5572740 | biostudies-literature
Project description:BackgroundPerinatal depression is the most common complication of gestation and childbearing affecting women and their families, and good social support and family function are considered protective and modifiable factors. This study aimed to investigate depression status and explore inter-relationships between social support and perinatal depression considering the influence of family function in rural areas of Southwest China.MethodsThis is a cross-sectional study. The following instruments were used: the Edinburgh Postpartum Depression Scale, the APGAR Family Care Index Scale, and the Social Support Rate Scale. A structural equation modelling was used to test the hypothesis relationships among the variables.ResultsA total of 490 rural antenatal (N = 249) and postpartum (N = 241) women (mean age (standard deviation), 28.17 ± 5.12) participated. We found that the prevalence of depression symptoms was 10.4%. Path analysis showed that family function had a direct negative correlation with depression (β = - 0.251, 95%CI: - 0.382 to - 0.118). Social support had a direct positive correlation with family function (β =0.293, 95%CI: 0.147 to 0.434) and had an indirect negative correlation with depression (β = - 0.074, 95%CI: - 0.139 to - 0.032), family function fully mediated the relationship between social support and depression.ConclusionsFindings of this study highlight that family function should be considered as the key target for interventions aiming to lower the prevalence of perinatal depression. Family members interventions are critical to reduce depression among antenatal and postpartum women.
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| S-EPMC11313952 | biostudies-literature
Project description:Social support is a well-established predictor of improved physical health outcomes among adults. Establishing whether maternal social support may have an inter-generational positive impact on their child's physical health will provide important information for developing potential interventions and policies. Elevated body mass index (BMI) is one indicator of child health that is linked to increased risk for cardiovascular disease and other morbidities later in life. There is some evidence that maternal social support is associated with improved child and adolescent weight status; however, no studies have examined whether specific aspects of social support are more impactful than others or whether support availability is differentially impactful across developmental stages. The present study examined whether maternal perceptions of specific types of social support (i.e., financial support, non-monetary instrumental support, partner emotional support, and having a close supportive contact) were associated with lower adolescent BMI z-scores using longitudinal data collected over a 15-year period from the Future of Families and Child Wellbeing Study (n = 3146), which includes a high proportion of families experiencing socioeconomic disadvantage. Findings from linear regression models using specific types of social support measured across six waves of data collected over a 15-year period indicated that maternal perceptions of greater financial support were associated with lower adolescent BMI z-scores at 15 years (B = -0.05, 95% CI: -0.10, -0.004, P = 0.04), while the other types of support were not. Additional timing analyses demonstrated that perceived financial support during late childhood to adolescence was associated with lower adolescent BMI z-scores (B = -0.06, 95% CI: -0.11, -0.01, P = 0.01), whereas associations between support during infancy and early childhood were not detected. Study findings provide important insights for developing interventions and policies that improve maternal social supports to benefit child health.
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Project description:Purpose Maternal depression and neighborhood characteristics are known to be associated both with each other and with adolescent mental health outcomes. These exposures are also subject to change throughout the life of a child. This study sought to identify multi-trajectories of maternal depression (MD) and self-reported neighborhood collective efficacy (NCE) over a 12-year period and determine whether these trajectories are differentially associated with adolescent mental health. Methods Data from the Fragile Families and Child Wellbeing study, a longitudinal cohort study of new parents and their children, were used. Maternal depression (MD) and self-reported NCE when the child was 3, 5, 9, and 15 years of age were the primary exposures of interest. Adolescent depression and anxiety symptomology when the child was 15 years of age were the primary outcomes. Primary analyses were conducted using multi-trajectory modeling and linear regressions. Results Five multi-trajectories were identified, two of which were characterized by no MD but either high or low NCE, and three of which were characterized by similarly moderate levels of NCE but either increasing, decreasing, or consistently high MD. Children of mothers with increasing or consistently high depressive symptomology and moderate NCE had significantly higher depression and anxiety scores compared to children of mothers with no depressive symptomology and high NCE. Conclusion Adolescents with consistent and proximal exposure to MD are most likely to suffer from adverse mental health and should be provided with appropriate support systems to mitigate these outcomes.
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Project description:OBJECTIVE:Among breast cancer survivors, low social support is associated with adverse clinical and psychosocial outcomes. This study prospectively examined longitudinal trends in perceived social support in women with newly diagnosed breast cancer as a function of depression status prior to initiation of cancer treatment. METHODS:One hundred ten patients with newly diagnosed breast cancer and 59 age-matched noncancer controls completed behavioral measures at four assessments: prior to treatment and at 1 month, 1 year, and 2 years post-treatment. Participants reported their perceived tangible and emotional/informational support using the Medical Outcomes Study Social Support Survey and were categorized as "depressed" or "non-depressed" based on the Brief Symptom Inventory-18 (BSI-18). Analyses first compared longitudinal trends in support between patients and controls and then examined differences in longitudinal trends as a function of depression status in patients only, controlling for key covariates. RESULTS:Both tangible and emotional/informational support decreased among breast cancer patients but increased or remained unchanged among noncancer controls across the assessments. Among patients, depressed individuals experienced a significant decline in both tangible (P = 0.004) and emotional/informational support (P = 0.013) between 1 month and 1 year post-treatment, which remained unchanged between 1 year and 2 years post-treatment. In contrast, nondepressed individuals had stable levels across all assessments. Depressed patients also had lower levels of both support types compared with nondepressed patients across all assessments. CONCLUSIONS:Breast cancer patients with depressive symptomatology have an elevated risk for declines in perceived social support over time.
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Project description:BackgroundHigher socioeconomic position is associated with better birth outcomes and maternal mental health, although this relationship is less consistent for Black women. The literature is limited on the impact of social mobility across the life course on mental health of pregnant women. This study examines the impact of perceived financial status across the life-course on depressive symptoms during pregnancy among Black women.MethodsData were from the Life-course Influences of Fetal Environments (LIFE) retrospective cohort study among pregnant Black women in metropolitan Detroit, Michigan. Depressive symptoms in the two weeks prior to birth were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Social mobility was determined at three intervals over the life course using self-report of financial status during childhood, adolescence, and current age in pregnancy.Results1,410 pregnant women participated, ranging in age from 18 to 45 years old. CES-D scores ranged from 0 to 53 (mean = 15.3) and 26% of the sample reported high depressive symptoms. In each age interval, higher financial status was associated with significant protective effect on depressive symptoms, and the magnitude of the effect increased across the life course. Trajectory analysis demonstrated that both the upward (4.51; 95% CI, 2.43-6.6) and downward (4.04; 95% CI, 2.62-5.46 and 3.09; 95% CI, 1.57-4.62) life-course social mobility groups had increased mean CES-D scores compared to the static social mobility group.ConclusionThis study describes the importance of previous childhood and current financial status effects on mental health in Black pregnant women.
| S-EPMC10491480 | biostudies-literature
Project description:ObjectiveThe authors explored the relationship of cord-maternal antidepressant concentration ratios and maternal depression with perinatal events and preterm birth.MethodThe investigators examined 21 mother-infant pairs that had antidepressant exposure during pregnancy. The antidepressants included serotonin reuptake inhibitors (SRIs) and nortriptyline (a norepinephrine inhibitor and mild SRI). The mothers were evaluated with the Structured Clinical Interview for DSM-IV. Depression ratings were repeated at 20, 30, and 36 weeks' pregnancy. At delivery, investigators assessed cord and maternal antidepressant concentrations, neonatal outcomes on the Peripartum Events Scale (PES), and gestational weeks at birth. The investigators performed this study at the Women's Behavioral HealthCARE Program, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pennsylvania, from April 2003 until September 2006.ResultsMean ± SD cord-to-maternal concentration ratios were 0.52 ± 0.35 (range, 0.00-1.64) for the parent drug and 0.54 ± 0.17 (range, 0.28-0.79) for the metabolite. Nine of 21 mothers (43%) had a major depressive episode. From examining the maximum depression ratings, the mean ± SD Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms Version score was 16.0 ± 7.6. One third (7/21) of infants had at least 1 perinatal event (PES ≥ 1). The frequency of deliveries complicated by any perinatal event was similar in depressed and nondepressed mothers. There was no significant association between perinatal events and cord-to-maternal antidepressant concentration ratios or maternal depression levels. Exposure to short half-life antidepressants compared to fluoxetine resulted in more perinatal events (7/16 = 44% vs 0/5 = 0%; P = .06). Fourteen percent (3/21) of infants were preterm. Preterm birth was not associated with cord-to-maternal metabolite concentration ratios, depression levels, or exposure to fluoxetine.ConclusionsAntidepressant-exposed infants experienced a limited number of transient perinatal events. No association between cord-maternal concentration ratios or maternal depression and perinatal events could be identified. Contrary to other reports, we detected no increased risk for perinatal events with fluoxetine therapy compared to the short half-life antidepressants.Trial registrationclinicaltrials.gov Identifier: NCT00279370.
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Project description:PurposeWhile severely distressing events are known to affect mental health adversely, some survivors develop only short-lived or no psychiatric symptoms in the aftermath of a disaster. In the WTC Health Program General Responder Cohort (WTCHP GRC) we examined whether social support was protective against the development of depression or anxiety symptoms after the 9/11 WTC attacks and explored in a subsample whether trait resilience moderated this relationship.MethodsWe analyzed data from 14,033 traditional and 13,478 non-traditional responders who attended at least three periodic health monitoring visits between 2002 and 2019. Linear mixed-effects models were used to examine depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (Generalized Anxiety Disorder screener; GAD-7) scores. In a subsample of 812 participants, we also assessed if the association between social support and symptoms was moderated by an individual's trait resilience level (Connor-Davidson Resilience Scale, CD-RISC).ResultsFor both traditional and non-traditional responders, perceived social support around 9/11 was associated with lower levels of depressive (β = - 0.24, S.E. = 0.017, z = - 14.29, p < 0.001) and anxiety symptoms (β = - 0.17, S. E. = 0.016, z = - 10.48, p < 0.001). Trait resilience scores were higher in responders with at least one source of social support during the aftermath of 9/11 compared to those without (mean 71.56, SD 21.58 vs mean 76.64, SD 17.06; β = 5.08, S.E. = 0.36, p < 0.001). Trait resilience moderated the association between social support and depressive (p < 0.001) and anxiety trajectories (p < 0.001) for traditional responders.ConclusionOur findings suggest that perceived social support around a severely distressing event may have long-term protective effects on symptoms of depression and anxiety.
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