Depression and Pregnancy Stressors Affect the Association Between Abuse and Postpartum Depression

To determine how psychosocial factors affect the association between a history of abuse and postpartum depression (PPD). Women at four urban hospitals in Utah were enrolled ≤48 h of delivering a live-born infant. At enrollment, pregravid history of physical or sexual abuse was obtained via self-report. Psychosocial covariates such as pregnancy stressors and depression were also collected. Pregnancy stressors were categorized using “stressor” questions from the Pregnancy Risk Assessment Monitoring System. The primary outcome measure, a pre-specified Edinburgh Postnatal Depression Scale score of ≥12 was obtained 6–8 weeks postpartum. Among the 1,038 women studied, psychosocial risk factors were common: abuse history 11.7%, pregnancy stressors–financial 49.1%, emotional 35.0%, partner-associated 19.8%, and traumatic 10.3% and depression history 16.7%. While abuse was associated with a +PPD screen in a preliminary model [aOR 2.05 (1.28, 3.26)], adding psychosocial covariates reduced the unadjusted association of abuse and PPD [aOR 1.12 (0.66, 1.91)]. After adjustment, PPD was associated with depression history [aOR 2.85 (1.90, 4.28)], prepregnancy BMI [aOR 1.04 (1.01, 1.07)] multiple stressors [3 categories aOR 4.35 (2.00, 9.46)]; 4 categories [aOR 6.36 (2.07, 19.49)] and sum of stressors * history of abuse [aOR 1.50 (0.92, 2.46)]. Interestingly only women with a moderate number of stressors were sensitive to an abuse history. Abuse and pregnancy stressors are common and interact to influence the likelihood of screening positive for PPD.