Postpartum Depression Risk in Mothers According to Infant Level of Care: A Cross-Sectional Study

Öz

Postpartum depression is a common maternal mental health problem. This study aimed to compare postpartum depression risk among mothers of healthy infants, mothers of infants evaluated as outpatients, and mothers of hospitalized infants, and to identify factors independently associated with elevated risk. This cross-sectional study included 240 mothers of infants aged 1–3 months recruited from three clinical settings at a single children's hospital. Postpartum depression risk was assessed using the Edinburgh Postnatal Depression Scale (EPDS >12). Associated factors were evaluated using univariate and multivariable logistic regression analyses. A total of 120 mothers of healthy infants, 61 mothers of infants evaluated as outpatients, and 59 mothers of hospitalized infants were included. Overall, 30.4% of participants had elevated postpartum depression risk. The proportion with elevated risk differed significantly across the three groups (chi-square test, p=0.020): 44.1% among mothers of hospitalized infants, versus 28.3% among mothers of healthy infants and 21.3% among mothers of infants evaluated as outpatients. In multivariable analysis, infant hospitalization (adjusted OR=2.22, 95% CI 1.09–4.56), having more than three children (OR=5.27, 95% CI 2.02–14.54), lower self-reported marital satisfaction (OR=6.75, 95% CI 2.45–20.71), and smoking during pregnancy (OR=2.95, 95% CI 1.19–7.46) were independently associated with elevated risk. Infant hospitalization, lower self-reported marital satisfaction, having more than three children, and smoking during pregnancy were independently associated with elevated postpartum depression risk. Routine psychosocial assessment during postpartum follow-up may facilitate early identification of mothers requiring additional support.

Anahtar Kelimeler

• postpartum depression
• infant
• multiparity
• child, hospitalized
• marital satisfaction

Destekleyen Kurum

The authors declared that this study received no financial support.

Etik Beyan

The study protocol was approved by the Ethics Committee of Health Sciences University, Dr. Behçet Uz Children's Hospital, İzmir, Türkiye (Approval No. 2018/189).

Teşekkür

The authors gratefully acknowledge Dr. Esin Erdoğan for her valuable contributions and support during the conduct of this study.

Bebeğin Bakım Düzeyine Göre Annelerde Postpartum Depresyon Riski: Kesitsel Bir Çalışma

Öz

Postpartum depresyon, hem anneyi hem de bebeği olumsuz etkileyebilen yaygın bir anne ruh sağlığı sorunudur. Bu çalışmada sağlıklı bebek anneleri, ayaktan değerlendirilen bebek anneleri ve hastanede yatan bebek anneleri arasında postpartum depresyon riskinin karşılaştırılması ve artmış postpartum depresyon riski ile bağımsız olarak ilişkili faktörlerin belirlenmesi amaçlanmıştır. Bu kesitsel çalışmaya, tek bir çocuk hastanesinin üç farklı klinik biriminden alınan 1–3 aylık bebeğe sahip 240 anne dahil edilmiştir. Postpartum depresyon riski Edinburgh Doğum Sonrası Depresyon Ölçeği (EPDÖ >12) ile değerlendirilmiştir. Artmış riskle ilişkili faktörler tek değişkenli ve çok değişkenli lojistik regresyon analizleri ile incelenmiştir. Çalışmaya 120 sağlıklı bebek annesi, 61 ayaktan değerlendirilen bebek annesi ve 59 hastanede yatan bebek annesi dahil edilmiştir. Katılımcıların %30,4'ünde artmış postpartum depresyon riski saptanmıştır. Artmış postpartum depresyon riski oranı üç grup arasında anlamlı farklılık göstermiştir (ki-kare testi, p=0,020); bu oran hastanede yatan bebek annelerinde en yüksekti (%44,1; sağlıklı bebek anneleri %28,3, ayaktan değerlendirilenler %21,3). Çok değişkenli analizde bebeğin hastanede yatması (düzeltilmiş OR=2,22; %95 GA 1,09–4,56), üçten fazla çocuk sahibi olma (OR=5,27; %95 GA 2,02–14,54), öz bildirime dayalı düşük evlilik doyumu (OR=6,75; %95 GA 2,45–20,71) ve gebelikte sigara kullanımı (OR=2,95; %95 GA 1,19–7,46) artmış postpartum depresyon riski ile bağımsız olarak ilişkili bulunmuştur. Bebeğin hastanede yatması, öz bildirime dayalı düşük evlilik doyumu, üçten fazla çocuk sahibi olma ve gebelikte sigara kullanımı artmış postpartum depresyon riski ile bağımsız olarak ilişkiliydi. Doğum sonrası izlemde rutin psikososyal değerlendirme, ek desteğe gereksinim duyan annelerin erken dönemde belirlenmesine katkı sağlayabilir.

Anahtar Kelimeler

• bebek
• hastaneye yatırılmış çocuk
• multiparite
• evlilik doyumu
• doğum sonrası depresyon

Kaynakça

1. 1. Wang Z, Liu J, Shuai H, Cai Z, Fu X, Liu Y, et al. Mapping global prevalence of depression among postpartum women. Transl Psychiatry. 2021;11(1):543.
2. 2. Fish-Williamson A, Hahn-Holbrook J. Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries. Front Psychiatry. 2023;14:1193490. doi:10.3389/fpsyt.2023.1193490.
3. 3. Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and health predictors of national postpartum depression prevalence: A systematic review, meta-analysis, and meta-regression of 291 studies from 56 countries. Front Psychiatry. 2018;8:248.
4. 4. Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289-95.
5. 5. Yang K, Wu J, Chen X. Risk factors of perinatal depression in women: a systematic review and meta-analysis. BMC Psychiatry. 2022;22:63.
6. 6. Trost MJ, Molas-Torreblanca K, Man C, Casillas E, Sapir H, Schrager SM. Screening for maternal postpartum depression during infant hospitalizations. J Hosp Med. 2016;11(12):840-6.
7. 7. Wyatt T, Shreffler K, Ciciolla L. Neonatal intensive care unit admission and maternal postpartum depression. J Reprod Infant Psychol. 2019;37(3):267-76.
8. 8. Lin YH, Chen CP, Sun F, Chen CY. Risk and protective factors related to immediate postpartum depression in a baby-friendly hospital of Taiwan. Taiwan J Obstet Gynecol. 2022;61(6):977-83.

9. 9. Ozdil M. Postpartum depression among mothers of infants hospitalized in the neonatal intensive care unit during the COVID-19 pandemic. Cureus. 2023;15:e44380.
10. 10. Shovers SM, Bachman S, Popek L, Turchi R. Maternal postpartum depression: risk factors, impacts, and interventions for the NICU and beyond. Curr Opin Pediatr. 2021;33(3):331-41.
11. 11. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-5.
12. 12. Engindeniz AN, Küey L, Kültür S. Edinburgh Doğum Sonrası Depresyon Ölçeği Türkçe formu geçerlilik ve güvenilirlik çalışması. Bahar Sempozyumları 1 Kitabı. Ankara: Psikiyatri Derneği Yayınları; 1996. p. 51-52.
13. 13. Danacı AE, Dinç G, Deveci A, Sen FS, İçelli İ. Postnatal depression in Turkey: epidemiological and cultural aspects. Soc Psychiatry Psychiatr Epidemiol. 2002;37(3):125-9.
14. 14. Durukan E, İlhan MN, Bumin MA, Aycan S. İki hafta-18 aylık bebeği olan annelerde postpartum depresyon sıklığı ve yaşam kalitesi. Balkan Med J. 2011;28:385-93.
15. 15. Kırpınar İ, Gözüm S, Pasinlioğlu T. Prospective study of postpartum depression in eastern Turkey: prevalence, socio-demographic and obstetric correlates, prenatal anxiety and early awareness. J Clin Nurs. 2010;19:422-431.
16. 16. Ayvaz S, Hocaoğlu Ç, Tiryaki A, Ak İ. Trabzon il merkezinde doğum sonrası depresyon sıklığı ve gebelikteki ilişkili demografik risk etmenleri. Türk Psikiyatri Derg. 2006;17(4):243-251.
17. 17. Dennis CL, McQueen K. Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatr. 2007;96(4):590-4.
18. 18. Zubaran C, Foresti K. The correlation between breastfeeding self-efficacy and maternal postpartum depression in southern Brazil. Sex Reprod Healthc. 2013;4(1):9-15.
19. 19. Mercan Y, Selçuk KT. Association between postpartum depression level, social support level and breastfeeding attitude and breastfeeding self-efficacy in early postpartum women. PLoS One. 2021;16(4):e0249538.
20. 20. Hammond M, Brooker RJ, Mistry-Patel S, Schlegel RJ, Vess M, Wines M, et al. Feelings of parental authenticity moderate concurrent links between breastfeeding experience and symptoms of postpartum depression. Front Glob Womens Health. 2021;2:651244.
21. 21. Ahmadinezhad GS, Karimi FZ, Abdollahi M, NaviPour E. Association between postpartum depression and breastfeeding self-efficacy in mothers: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2024;24(1):273.
22. 22. Wei M, Qin Y, Niu X, Niu S, Mu F, Yang L, et al. Marriage and postpartum major depressive disorder: a systematic review and meta-analysis of cohort studies. J Psychiatr Res. 2025;182:83-91.
23. 23. Dindar I, Erdogan S. Screening of Turkish women for postpartum depression within the first postpartum year: the risk profile of a community sample. Public Health Nurs. 2007;24(2):176–83.
24. 24. Knysak K, Maj A, Domosud K, et al. The impact of prenatal smoking on postpartum depression: a systematic review. Arch Womens Ment Health. 2025;28:741-50.
25. 25. Cui M, Kimura T, Ikehara S, Dong JY, Ueda K, Kawanishi Y, et al. Prenatal tobacco smoking is associated with postpartum depression in Japanese pregnant women: the Japan Environment and Children's Study. J Affect Disord. 2020;264:76-81.