Background Low social support is consistently associated with postpartum depression. Previous studies do not always control for previous mental health and do not consider what type of support (tangible, emotional, informational or positive social interaction) is most important. The objectives are: to examine if low social support contributes to subsequent risk of depressive or anxiety symptoms and to determine which type of support is most important.
Methods Data from the All Our Families longitudinal pregnancy cohort were used (n=3057). Outcomes were depressive or anxiety symptoms at 4 months and 1 year postpartum. Exposures were social support during pregnancy and at 4 months postpartum. Log binomial models were used to calculate risk ratios (RRs) and absolute risk differences, controlling for past mental health.
Results Low total social support during pregnancy was associated with an increased risk of depressive symptoms (RR 1.50, 95% CI 1.24 to 1.82) and anxiety symptoms (RR 1.63, 95% CI 1.38 to 1.93) at 4 months postpartum. Low total social support at 4 months was associated with an increased risk of anxiety symptoms (RR 1.65, 95% CI 1.31 to 2.09) at 1 year. Absolute risk differences were largest among women with previous mental health challenges resulting in a number needed to treat of 5 for some outcomes. Emotional/informational support was the most important type of support for postpartum anxiety.
Conclusion Group prenatal care, prenatal education and peer support programmes have the potential to improve social support. Prenatal interventions studies are needed to confirm these findings in higher risk groups.
- mental health
- social and life-course epidemiology
- cohort studies
- social capital
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Contributors EH developed the idea, analysed the data and drafted the manuscript. SCT and SM conceived, implemented and managed the AOF study, assisted in interpretation and provided critical input to the manuscript. TW provided statistical expertise. TW and SBP assisted in interpretation and provided critical input to the manuscript.
Funding This study was funded by Alberta Children’s Hospital Foundation, Alberta Innovates Health Solutions, Interdisciplinary Team Grant #200700595, Canadian Institutes of Health Research.
Competing interests EH receives scholarship funding from the University of Calgary, Alberta Innovates Health Solutions and the Canadian Institutes for Health Research Vanier scholarship.
Patient consent Not required.
Ethics approval Conjoint Health Research Ethics Board—University of Calgary.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The All Our Families questionnaires is stored at Secondary Analysis for Generating Evidence (SAGE), a secure data repository managed by PolicyWise for Children and Families. Requests for data and collaborations are welcome. For further information, please visit: https://policywise.com/initiatives/sage/