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Re‐conceptualising Prenatal Life Stressors in Predicting Post‐partum Depression: Cumulative‐, Specific‐, and Domain‐specific Approaches to Calculating Risk
Author(s) -
Liu Cindy H.,
Tronick Ed
Publication year - 2013
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12072
Subject(s) - stressor , medicine , odds ratio , depression (economics) , odds , confidence interval , pregnancy , population , prenatal stress , risk factor , demography , clinical psychology , logistic regression , environmental health , gestation , genetics , sociology , biology , economics , macroeconomics
Background Prenatal life stress predicts post‐partum depression ( PPD ); however, studies generally examine individual stressors (a specific approach) or the summation of such exposure (a cumulative approach) and their associations with PPD . Such approaches may oversimplify prenatal life stress as a risk factor for PPD . We evaluated approaches in assessing prenatal life stress as a predictor of PPD 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. Methods The Pregnancy Risk Assessment Monitoring System, a population‐based survey, was used to analyse the association of prenatal life stressors with PPD diagnoses among 3566 N ew Y ork City post‐partum women. Results Specific stressors were not associated with PPD diagnosis after controlling for sociodemographic variables. Exposure to a greater number of stressors was associated with PPD diagnosis, even after adjusting for both sociodemographic variables and specific stressors [odds ratio ( OR ) = 3.1, 95% confidence interval ( CI ) = 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 PPD ( OR = 4.2, 95% CI = 1.2, 15.3); those with a moderate‐to‐high number of problems in all three domains were at over fivefold increased odds of PPD ( OR = 5.5, CI = 1.1, 28.5). Conclusions In assessing prenatal stress, clinicians should consider the extent to which stressors occur across different life domains; this association appears stronger with PPD diagnosis than simple assessments of individual stressors, which typically overestimate risk or cumulative exposures.