RT Journal Article
SR Electronic
T1 Longitudinal effects of perinatal social support on maternal depression: a marginal structural modelling approach
JF Journal of Epidemiology and Community Health
JO J Epidemiol Community Health
FD BMJ Publishing Group Ltd
SP 936
OP 943
DO 10.1136/jech-2020-215836
VO 75
IS 10
A1 Ashley Hagaman
A1 Katherine LeMasters
A1 Paul N. Zivich
A1 Siham Sikander
A1 Lisa M. Bates
A1 Sonia Bhalotra
A1 Esther O. Chung
A1 Ahmed Zaidi
A1 Joanna Maselko
YR 2021
UL http://jech.bmj.com/content/75/10/936.abstract
AB Background Depression in the perinatal period, during pregnancy or within 1 year of childbirth, imposes a high burden on women with rippling effects through her and her child’s life course. Social support may be an important protective factor, but the complex bidirectional relationship with depression, alongside a paucity of longitudinal explorations, leaves much unknown about critical windows of social support exposure across the perinatal period and causal impacts on future depressive episodes.Methods This study leverages marginal structural models to evaluate associations between longitudinal patterns of perinatal social support and subsequent maternal depression at 6 and 12 months postpartum. In a cohort of women in rural Pakistan (n=780), recruited in the third trimester of pregnancy and followed up at 3, 6 and 12 months postpartum, we assessed social support using two well-validated measures: the Multidimensional Scale of Perceived Social Support (MSPSS) and the Maternal Social Support Index (MSSI). Major depressive disorder was assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM IV).Results High and sustained scores on the MSPSS through the perinatal period were associated with a decreased risk of depression at 12 months postpartum (0.35, 95% CI: 0.19 to 0.63). Evidence suggests the recency of support also matters, but estimates are imprecise. We did not find evidence of a protective effect for support based on the MSSI.Conclusions This study highlights the protective effect of sustained social support, particularly emotional support, on perinatal depression. Interventions targeting, leveraging and maintaining this type of support may be particularly important for reducing postpartum depression.Data are available upon reasonable request directed to JM, senior author.