Re‐conceptualising Prenatal Life Stressors in Predicting Post‐partum Depression: Cumulative‐, Specific‐, and Domain‐specific Approaches to Calculating Risk
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Medientyp:
E-Artikel
Titel:
Re‐conceptualising Prenatal Life Stressors in Predicting Post‐partum Depression: Cumulative‐, Specific‐, and Domain‐specific Approaches to Calculating Risk
Beteiligte:
Liu, Cindy H.;
Tronick, Ed
Erschienen:
Wiley, 2013
Erschienen in:Paediatric and Perinatal Epidemiology
Beschreibung:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Prenatal life stress predicts post‐partum depression (<jats:styled-content style="fixed-case">PPD</jats:styled-content>); however, studies generally examine individual stressors (a specific approach) or the summation of such exposure (a cumulative approach) and their associations with <jats:styled-content style="fixed-case">PPD</jats:styled-content>. Such approaches may oversimplify prenatal life stress as a risk factor for <jats:styled-content style="fixed-case">PPD</jats:styled-content>. We evaluated approaches in assessing prenatal life stress as a predictor of <jats:styled-content style="fixed-case">PPD</jats:styled-content> diagnosis, including a domain‐specific approach that captures cumulative life stress while accounting for stress across different life stress domains: financial, relational, and physical health.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The Pregnancy Risk Assessment Monitoring System, a population‐based survey, was used to analyse the association of prenatal life stressors with <jats:styled-content style="fixed-case">PPD</jats:styled-content> diagnoses among 3566 <jats:styled-content style="fixed-case">N</jats:styled-content>ew <jats:styled-content style="fixed-case">Y</jats:styled-content>ork City post‐partum women.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Specific stressors were not associated with <jats:styled-content style="fixed-case">PPD</jats:styled-content> diagnosis after controlling for sociodemographic variables. Exposure to a greater number of stressors was associated with <jats:styled-content style="fixed-case">PPD</jats:styled-content> diagnosis, even after adjusting for both sociodemographic variables and specific stressors [odds ratio (<jats:styled-content style="fixed-case">OR</jats:styled-content>) = 3.1, 95% confidence interval (<jats:styled-content style="fixed-case">CI</jats:styled-content>) = 1.5, 6.7]. Individuals reporting a moderate‐to‐high number of financial problems along with a moderate‐to‐high number of physical problems were at greater odds of <jats:styled-content style="fixed-case">PPD</jats:styled-content> (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 4.2, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 1.2, 15.3); those with a moderate‐to‐high number of problems in all three domains were at over fivefold increased odds of <jats:styled-content style="fixed-case">PPD</jats:styled-content> (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 5.5, <jats:styled-content style="fixed-case">CI</jats:styled-content> = 1.1, 28.5).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In assessing prenatal stress, clinicians should consider the extent to which stressors occur across different life domains; this association appears stronger with <jats:styled-content style="fixed-case">PPD</jats:styled-content> diagnosis than simple assessments of individual stressors, which typically overestimate risk or cumulative exposures.</jats:p></jats:sec>