Peripartum depression and its predictors: A longitudinal observational hospital-based study

Table 1 Demographic, social, and obstetric characteristics of screened women with symptoms of depression

Demographic and social characteristics	n = 200
Age, yr	17–34 (27.35 ± 6.42)
17-22 yr, n (%)	36 (18)
23-34 yr, n (%)	164 (82)
Residence
Urban	40 (20)
Rural	160 (80)
Maternal education
None (can't read)	145 (72.5)
Can read (or can read and write)	18 (9)
Primary	6 (3)
Secondary	12 (6)
High	19 (9.5)
Socio-economic status
Low	36 (18)
Middle	132 (66)
High	32 (16)
Obstetric characteristics
Parity
Primipara	97 (48.5)
Multipara	103 (51.5)
History of fetal loss
Abortions	74 (37)
Still births	6 (3)
Mode of previous deliveries
Vaginal	168 (84)
Cesarean	30 (15)
Both vaginal and cesarean	2 (1)
History of in vitro fertilization in the current pregnancy	1 (0.5)
Gestational age of the first antenatal care visit
First trimester	17 (8.5)
Second trimester	27 (13.5)
Third trimester	156 (78)
Type of delivery in the current pregnancy
Vaginal	168 (84)
CS	32 (16)
Indications of CS (i.e. antenatal complications)	32 (16)
Placenta previa	22 (11)
Accidental hemorrhage	8 (4)
Obstructed labor	2 (1)
Postpartum complications of current pregnancy	8 (4)

CS: Cesarean.

Table 2 Results of the women's reactions to the recent life circumstances, events, and stresses related to recent pregnancy

Psychiatric characteristics	n = 200, n (%)
I was unhappy with the current pregnancy	10 (5)
My husband was unhappy with the current pregnancy	0
Reaction to the current baby’s sex
Happy	182 (91)
Indifference	18 (9)
Past history of loss of a living child	14 (7)
Past history of mental illness unrelated to pregnancy	9 (4.5)
Depression and/or anxiety
Treated	2 (1)
Untreated	7 (3.5)
Past history of postpartum depression	0
History of premenstrual dysphoric disorder	86 (43)
Past history of post-abortive depression	16 (8)
Past history of depression unrelated to pregnancies	9 (4.5)
Family history of mental illness	0
Past history of being a victim of one of the followings
Sexual abuse during childhood	1 (0.5)
Physical abuse during childhood	32 (16)
Physical abuse by a known person	2 (1)
Physical abuse by an unknown person	0
Physical aggression during pregnancy	2 (1)
Emotional/verbal abuse	22 (11)
Current psychosocial stressors	31 (15.5)
Divorce	0
Loss of a job	0
Death of spouse	1 (0.5)
Family argument	24 (12)
Financial problems	6 (3)

Table 3 Comparative statistical results of symptoms of depression during pregnancy according to social, demographic, and obstetric variable

Socio-demographic and obstetric variables	The severity of depression symptoms				P value
	Minimal, n = 54, 27%	Mild, n = 41, 20.5%	Moderate, n = 33, 16.5%	Severe, n = 72, 36%
Age, n (%)					0.452
17-22 yr (n = 36)	7 (19.4)	8 (22.2)	9 (25)	12 (33.3)
23-34 yr (n = 164)	47 (28.7)	33 (20.1)	24 (14.6)	60 (36.6)
Maternal education, n (%)					0.326
Low (n = 181)	29 (16)	40 (22.1)	44 (24.3)	68 (37.6)
High (n =19)	4 (10.5)	1 (5.3)	9 (47.4)	5 (26.3)
Socio-economic status, n (%)					0.482
Low (n = 36)	9 (25)	5 (13.9)	3 (8.3)	19 (52.8)
Middle (n = 132)	25 (18.9)	33 (26.8)	26 (19.7)	48 (36.4)
High (n = 32)	20 (62.5)	3 (9.4)	4 (12.5)	5 (15.6)
Gestational age, n (%)					0.0001
1st trimester (n = 17)	2 (11.8)	1 (5.9)	5 (29.4)	9 (52.9)
2nd trimester (n = 27)	2 (7.4)	5 (18.5)	9 (33.3)	11 (40.7)
3rd trimester (n = 156)	50 (32.1)	35 (22.4)	19 (12.2)	52 (33.3)

Table 4 Hormonal results in the antepartum period

Laboratory investigations	Participants, n = 200		P value1	P value2
	Antepartum	Postpartum
T3 in ng/dL, range	106–305 (184.22 ± 38.13)	49.06–296 (164.70 ± 45.72)	0.05	0.678
High, n (%)	98 (49)	80 (40)	-	-
T4 in ng/dL, range	5.2–28 (12.40 ± 2.38)	4.5–19.1 (11.19 ± 2.67)	0.05	0.845
High, n (%)	63 (31.5)	82 (41)	-	-
TSH in mIU/mL, range	0.02–8.50 (1.70 ± 0.11)	0.01–8.44 (1.64 ± 0.32)	0.435	0.760
High, n (%)	5 (2.5)	22 (11)	-	-
Low, n (%)	1 (0.5)	-	-	-
Borderline, n (%)	15 (7.5)	-	-	-

¹Pregnant women vs reference.

²Antepartum vs postpartum.

Data are presented as mean ± SD. Reference values: T3: 106.32 ± 15.80 (81–178) ng/dL; T4: 9.32 ± 2.44 (4.5-12.5) ng/dL; TSH: 1.56 ± 0.32 (0.4–4) mIU/mL. T3: Triiodothronine; T4: Thyroxine; TSH: Thyroid stimulating hormone.

Table 5 Comparative statistics between antepartum and postpartum manifestations of depression

Psychiatric manifestations	Participants, n = 200		P value
	Antepartum	Postpartum
BDI-II score, range	1–38 (26.13 ± 8.85)	2–46 (22.27 ± 6.74)	0.455
Severity of depression, n (%)			0.0001
Minimal	33 (16.5)	104 (52)
Mild	41 (20.5)	64 (32)
Moderate	54 (27)	27 (13.5)
Severe	72 (36)	5 (2.5)
STAI score, range	21–78 (53.31 ± 11.82)	-	-
PSI-SF score, range	-	36–18 (136.57 ± 45.86)	-
Women with clinically significant stress, n (%)	-	130 (65)	-

Data are presented as mean ± SD. BDI: Beck Depression Inventory; PSI-SF: Parenting Stress Index-Short Form; STAI: State-Trait Anxiety Inventory.

Table 6 Predictors for antepartum and postpartum depression in pregnant women

Predictor variables	B1	β2	t	P value
Age	-0.020	-0.015	-0.287	0.774
	0.0463	0.0583	1.1933	0.2343
Socio-economic scale	-0.015	-0.070	-1.286	0 .200
	-0.0103	-0.0743	-1.4973	0.1363
Education	0.011	0.067	1.187	0.2
History of postpartum depression	-0.834	-0.083	-1.647	0.101
	-0.8573	-0.0913	-2.6473	0.1213
Antepartum anxiety trait	0.469	0.514	8.507	0.001
	0.0213	0.0403	0.5733	0.0413
Antepartum T3 level	-0.036	-0.045	-1.673	0.513
	0.0333	0.0653	2.8673	0.5783
Antepartum T4 level	-0.046	-0.056	-1.893	0.654
	0.0223	0.0783	2.8673	0.7453
Antepartum TSH level	-0.045	-0.089	-1.654	0.607
	0.0493	0.0373	2.8673	0.4253
Antepartum depression	-0.0863	-0.1483	-2.7503	0.0073
Parenting stress index	0.0803	0.6973	14.343	0 .00013
R = 0.843; R = 0.8063
R2 = 0.711; R2 = 0.6493
Adjusted R2 = 0.701; Adjusted R2 = 0.6413
Standard error = 6.094; Standard error = 7.2543
ANOVA < 0.001; ANOVA < 0.0013

¹Unstandardized regression coefficients.

²Standardized regression coefficients.

³Post-partum results.

ANOVA: Analysis of variance; T3: Triiodothronine; T4: Thyroxine; TSH: Thyroid stimulating hormone.