SSPC Conference

Fariza Yahya

Department of Psychiatry

University of Bristol

SYSTEMATIC REVIEW:

SOCIAL SUPPORT AND POSTNATAL DEPRESSION

Introduction:

Motherhood and the transition to motherhood are critical and often stressful times in the lives of women (Wisner et al., 2002).

Although the birth of a baby is a time of happiness and excitement, for the women who develop postnatal depression, it is the beginning of nightmare (Buultjen & Liamputtong, 2006).

Postnatal Depression (PND)

Depression up to one year after delivery is called postpartum depression or postnatal depression.

Postnatal depression is a mental and behavioural disorder associated with the puerperium, typically commencing within 6 weeks of delivery according to the International Classification of Disease—ICD-10(World Health Organisation, 1992)

PND

Postnatal depression is a major health issue for many women (Dennis et al., 2004).

Longitudinal and epidemiological studies have yielded varying prevalence rates, ranging from 3% to more than 25% of women in the first year postpartum (Dennis et al., 2004).

RISK FACTORS FOR PND

The cause of postpartum depression remains unclear with diverse researchers suggesting a multi-factorial aetiology (Ross et al., 2004).

However, epidemiological studies strongly support the importance of psychosocial variables (O’Hara & Swain 1996, Beck 2001).

In particular, a recent meta-analysis of 84 studies showed several risk factors including low levels of social support, stressful life events, childcare stress, low self esteem, low income, and marital dissatisfaction (Beck 2001).

Buuljen (2007) concluded that one of the most notable explanations for PND was the lack of social support.

SOCIAL SUPPORT AND PND

Based on Barrera’s (1981,2000) theoretical model, social support in the perinatal period can be defined as activities directed at assisting pregnant women and new mothers in mastering emotional distress, sharing tasks, giving advice, and teaching parenting skills, including the provision of material aid.

In order to understand better the relationship between social support and postnatal depression in women, I did a systematic review.

SYSTEMATIC REVIEW

Systematic Literature Review is a method of reviewing and evaluating the scientific literature range from highly formal, quantitative information syntheses to subjective summaries of observational data (Glasziou P. et al, 2001).

Aims:

General Aims The general aim is to obtain the current

evidence of the effect of social support on postnatal depression, using a comprehensive search strategy.

Aims:

Specific Aims To determine what the evidence is that social

support in pregnancy or at postnatal period are associated with the onset of postnatal depression.

To identify whether social support is most important at certain period of time (e.g. antenatal or postnatal) in order to reduce the incidence of postnatal depression.

To find out if emotional support is more important than practical support during antenatal period and practical support is more important than emotional support during postnatal period in order to reduce the incidence of postnatal depression.

Search Strategy:

Three datasets were selected to run the search strategy; EMBASE, Medline and PsychINFO.

Keywords used for my search strategy are derived from: social support and postnatal depression. Keywords (indexing terms and text terms) were derived and used in conjunction with natural language to create a broad search.

Inclusion criteria

Study included postnatal depression as outcome. Social support is at least one risk factor mentioned

and must be measured at least one month before the outcome.

Study outcome must be maternal depression within one to twelve months of postnatal period.

Only longitudinal/cohort studies. Only papers written in English.

Exclusion criteria:

Other than longitudinal study. Outcome only antenatal depression. No social support measures as risk factors

Final paper:

The three databases provided 633 papers, which were reduced to 495 after excluding overlapping. 4 from hand searching and all together 499 papers.

Based on the inclusion and exclusion criteria, only 29 papers selected.

Criteria of selected papers:

A total of 29 studies were included for this systematic review. More than 75% of the papers were published after the year 2000, suggesting that this is a timely topic.

About 71% (22) of the studies had final sample sizes of more than 200, but only 16 studies had drop-out rates of <20%.

Most of the selected studies (75%) had done postnatal depression measurements after two months of postpartum period.

Only 7 studies (23%) had carried out depression measurements between one to two months of postpartum period.

Cont…

Almost 97% of the selected publications had used standard questionnaires commonly used for screening of postnatal depression-EPDS.

Only 2 studies had used psychiatric diagnostic interviews.

Most studies (65%) had measured social support during the antenatal period. The majority (12 studies) had done the measurement at the third trimester of pregnancy; namely between 28 to 40 weeks of gestation.

Another 35% had done social support measurements during postpartum period, and most commonly within the first week of delivery.

What is the evidence that social support in pregnancy or at postnatal period is associated with the onset of postnatal depression?

Most of the studies; 74%(23) found there was a significant association between social support and the onset of postnatal depression.

However most of the study had quite different methodology, used different screening tools, different approach in statistical analysis, different concept of social support and different type of study participants.

Methodological differences may account for discrepant findings in different studies.

Is social support more important at antenatal period than postnatal period or vice versa in order to prevent postnatal depression?

both periods; either antenatal or postnatal do need some form of social support in order to reduce the incidence of postnatal depression.

Both periods is a crucial period that various form or extent of support need to be given to the mothers, especially the mothers that fall under high risk group such as new mothers, mother of young age group, single mother and so on.

Is emotional support more important at antenatal period than postnatal period; and practical support is more important at postnatal period than antenatal period sequentially to reduce incidence of postnatal depression? seven compared to only three studies found

emotional support was more important compare to practical support no matter when was the time they receive the social support.

However most of the studies had inadequate sample size, in order to make a better and definite conclusion we need to explore further the association of emotional support and PND in future with better methodological, adequate sample size and good statistical analysis.

Conclusion:

From this systematic review I can conclude that the study about social support and postnatal depression is still debatable and lots of work needs to be done in order to have a better idea and better understanding about the relationship.

In the absence of agreement between those studies, it is not possible to reach a definite conclusion.

However some important findings from those studies were:1. Husband/partner support in relation to childcare became not

significant when measured during pregnancy but significance for studies that measured after delivery.

2. Emotional support was strongly associated with PND in the study that explored the relationship-specific support either from partner or others.

3. Mother who described they received high support from partner/husband usually if they were living together.

The main limitations are none of the study had used similar methodology, similar statistical analysis, as well as study participants and concept of social support were also varies. With such a different in approach, it is not easy for me to make a definite comparison and therefore it’s difficult to conclude the findings.

I hope my future study using ALSPAC data will give me better idea.