Author

Marika Wolfe

Date

March 2008

Document Type

Thesis

Degree Name

M.S.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Postpartum depression is defined as a major depressive episode that is temporally associated with childbirth, having onset generally within four weeks of delivery and lasting up to one year postpartum. Affecting 12-17% of women, it is an important maternal and child health concern and early recognition of symptoms can help prevent adverse health outcomes for mother and child. Several studies have identified risk factors for postpartum depression but few of these studies have used population-based data. Utilizing population-based data may provide additional information about identified risk factors and increase generalizability to other communities and states. Better data on risk factors can improve early recognition and screening for postpartum depressive symptoms and, ultimately, improve health outcomes for mothers, children and families. This study had three objectives. The first was to determine the prevalence of postpartum depressive symptoms among Oregon women by risk factors that were selected from prior literature and studies. The second objective was to determine which of the risk factors selected based on prior literature were significant in this sample of Oregon women through multivariate analysis. Finally, the third objective was to evaluate the relationship of individual race and ethnic groups and income on postpartum depressive symptoms. Methods This cross-sectional study utilized the Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) 2004 data; the statistical software STATA (version 8.2) was used for data analysis. Data analysis included descriptive statistics, bivariate and multivariate logistic regression. A backward progression model was followed and variables were removed one at a time based on highest insignificant p-values >0.05. For 2004, a total of 2,814 surveys were sent and 1,968 completed surveys were returned, for an unweighted response rate of 69.9% and a weighted response of 74.8%. Results The prevalence of postpartum depressive symptoms among Oregon women was 13.2%. In multivariate logistic regression, the following risk factors were statistically significant: Asian/Pacific Islander race/ethnicity (ORa 1.90; 95% CI 1.16, 3.13), maternal pre-pregnancy body mass index ≥25 m/kg2 (ORa 1.70; 95% CI 1.07, 2.70), partner-related stress (ORa 3.44; 95% CI 2.14, 5.54) income level ≤ 49% FPL (ORa 3.01; 95% CI 1.53, 5.93) and insufficient dental care (ORa 1.93; 95% CI 1.08, 3.45). Conclusion The results for objective 1 found that the prevalence of postpartum depressive symptoms in Oregon was 13.2% and was similar to other estimates. Objective 2 found that three of the risk factors for postpartum depressive symptoms among Oregon women were similar to what has been found in prior literature: maternal pre-pregnancy BMI ≥ 25 m/kg2, partner-related stress and low income. Objective 3 found that only the odds ratio for Asian/Pacific Islander women (compared to Non-Hispanic White women) was significant, after adjusting for income, maternal pre-pregnancy BMI, insufficient dental care and partner-related stress. There have been few studies evaluating the relationship between Asian/Pacific Islander women and postpartum depression. Qualitative studies of Chinese, Korean and Japanese women and PPD done abroad suggest that there may be cultural factors contributing to postpartum depressive symptoms among Asian women. Further epidemiological research that includes identifying and understanding culturally relevant risk factors for Asian and Pacific Islander women would provide additional information to improve targeted screening and intervention. With a better understanding of risk factors in this population of women, public health recommendations can be made for improved screening, thereby improving the experience for new mothers and preventing adverse outcomes for Oregon women, children and families. KEY WORDS: Postpartum Depression, Postpartum Depressive Symptoms, Asian/Pacific Islander, Race and Ethnicity, Depression, Asian

Identifier

doi:10.6083/M4VQ30M1

School

School of Medicine

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