Antenatal depression, substance dependency and social support

Abstract

Background: The purpose of this study was to explore the prevalence of depression and factors associated with depressive mood among pregnant women. Method: 391 women who were 14–37 weeks pregnant were evaluated with the Edinburgh Postnatal Depression Screen (EPDS), which has also been validated for prenatal use. Four questionnaires were used in order to explore associated factors: a questionnaire on background and pregnancy data, the Substance Abuse Subtle Screening Inventory (SASSI) and two Social Support Questionnaires (SSQ1 and 2). Results: 7.7% of the total sample screened positive on the EPDS with a cut-off point of 12/13 recommended. Substance dependency and experienced difficulties in social environment had an independently significant association with maternal depression. Limitation: The caseness was defined with a self-report instrument. Conclusion: Substance dependency and experienced difficulties, especially in relation to friends, partner and own mother, are associated with antenatal depression. It is important to be aware of this when developing interventions in maternity care primary units.

Introduction

There is relatively less research concerning antenatal maternal mental illness compared to research on the postnatal period. However, depression among pregnant women has lately been considered to be as important a health problem as postnatal depression, although the definition of the antenatal depressive state is still somewhat unclear. There is seen to be a continuity of depression from pregnancy to the postnatal period for some women and not for others, possibly suggesting a different etiology (Green and Murray, 1994). About one-third of postnatal depressions have already started during pregnancy (Murray and Cox, 1990, Green and Murray, 1994). Antenatal and postnatal depressive states, when considered as separate phenomena, seem to be of similar duration (Watson et al., 1984, Kumar and Robson, 1984). Depression during pregnancy is an important phenomenon in its own right. In addition, due to the fact that it often predicts postnatal depression, it may negatively affect the mother–infant relationship and the social and cognitive development of the child (Melhuish et al., 1988, Stein et al., 1991, Green and Murray, 1994).

Antenatal depression poses a danger for the baby, especially when it is associated with poor weight gain, smoking and use of alcohol or other drugs (Zuckerman et al., 1989). Infants born to alcohol- and drug-abusing mothers are at risk of developmental and behavioural problems, resulting from both prenatal exposure and dysfunctional parenting (Zuckerman and Brown, 1993, Grella, 1996, O’Connor, 1996, Young, 1997, Buchi, 1998, Howell et al., 1999, Lester et al., 2000). Excessive use of alcohol is known to cause fetal alcohol syndrome and fetal alcohol effects, including certain craniofacial abnormalities, mental retardation, cognitive and behavioural problems (Autti-Rämö, 1993). Infants of drug abusers are more often born premature and small for gestational age; some evidence also suggests that the childrens’ long-term physical and behavioural development may be impaired due to substance abuse, but results concerning this have been conflicting (Howell et al., 1999). What is crucial to the understanding of substance addiction during pregnancy is that the mother has lost control over her use of substances and is preoccupied with it, and this affects her ability to care for herself and her child/children (Zuckerman and Brown, 1993). The differentiation of substance dependency from substance abuse is not only based on the development of tolerance and symptoms of withdrawal, but also on the degree to which the substance abuser manifests the typical pattern of a disruptive life-style (Miller, 1985, 1994).

The most consistently reported associated factors with ante- and postnatal depression have included previous psychiatric symptomatology (Paykel et al., 1980, Kumar and Robson, 1984), lack of support from the partner (Paykel et al., 1980, Watson et al., 1984, Levitt et al., 1986, Dimitrovsky et al., 1987, Boyce et al., 1991), a weak social network (Paykel et al., 1980, Boyce et al., 1991, Murray, 1992), and pregnancy problems (Field et al., 1985, Dimitrovsky et al., 1987, Murray, 1992). The results have been most conflicting concerning associations with social class, parity, marital status, unplanned pregnancies and the relationship with one’s own mother. The association between depression and substance abuse among pregnant women is under-researched.

Pregnancy is a time of regular contact with health services. Identification of the mothers at risk is essential in order to develop interventions that can prevent or at least alleviate the negative consequences of maternal depressive illness and substance dependency. Considering identification and preventive interventions the situation of prenatal care in Finland is exceptionally good: it takes place in free-of-charge maternity care centres, and is attended by 99.9% of all pregnant women.

The aim of this study was to explore the prevalence of antenatal depression and factors associated with it. On the basis of clinical experience and previous considerations (Levitt et al., 1986; Dimitrovsky et al., 1987, Zuckerman et al., 1989, Zuckerman and Brown, 1993, Howell et al., 1999), substance dependency and experienced difficulties in social relationships were hypothesized to be associated with depression and were of special interest in this study.