Are Worries and Postpartum Depression Influenced by Early Depressive Symptoms and Mothers’ Lack of Confidence? A Prospective Study

Abstract

Background: It is estimated that around 20% of women experience mental health problems during the perinatal period, including depression and anxiety, which negatively affect both the mother and the baby’s development. Although previous mental health problems have been identified as important predictors, it is relevant to further explore the role of other psychosocial variables of interest such as coping with worries or maternal confidence in caring for the baby, in order to design effective preventive actions to promote perinatal mental health. This study analyzed the effect of maternal lack of confidence in caring for her infant and depressive symptoms on pregnancy worries (PW) and postpartum depression (PPD) using a multifactorial and prospective approach.

Methods: A prospective cohort study (with three points in time) was conducted with 120 pregnant women recruited from a public hospital in Madrid, Spain. Women were evaluated for pregnancy worries in the first trimester of pregnancy, for depressive symptoms in the third trimester, and for PPD and mothers’ lack of confidence 4 months after childbirth. Parallel and serial mediation analyses were conducted using PROCESS (SPSS tool for estimating regression models with mediation and/or moderation effects). According to the Enhancing the Quality and Transparency Of health Research (EQUATOR) checklist, the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement was chosen for this study.

Results: A parallel multiple model showed that while depressive symptoms significantly mediated the relationship between pregnancy worries and postpartum depression (a1b1 = 1.4733, [95% confidence interval (95% CI) = 0.7105, 2.2309]), mothers’ lack of confidence did not (a2b2 = 0.2404, [95% CI = –0.0569, 0.5826]). However, when both mediators were analyzed together, a significant indirect effect of depressive symptoms on postpartum depression was found through the effect of depressive symptoms on mothers’ lack of confidence (d21 = 0.2144, [95% CI = 0.0595, 0.4562]).

Conclusions: It is necessary to analyze factors related to postpartum depression from a multifactorial approach focused on the analysis of depression during pregnancy, but also including other variables such as mothers’ lack of confidence as possible risk factors of postpartum depression. The associations found between worries, depressive symptoms, and maternal insecurity with postpartum depression could allow professionals to develop preventive interventions of postpartum depression.