Antenatal Depression and Anxiety Affect Postpartum Parenting Stress: A Longitudinal, Prospective Study

Article excerpt

Objective: Postpartum depression has been associated with parenting stress, impacting attachment and child development. However, the relation between antenatal depression or anxiety and postpartum parenting stress has not been investigated. We studied the effect of antenatal depression and anxiety and treatment with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors (antidepressants [ADs]) on postpartum parenting stress.

Method: Ninety-four pregnant women (part of a larger study examining prenatal AD exposure on infants) were prospectively monitored for depression and anxiety during the third trimester and 3- and 6-months postpartum using the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale. Parenting stress was assessed using the Parenting Stress Index-Short Form at 3- and 6-months postpartum.

Results: Both antenatal third trimester depression and anxiety were significant predictors of 3- and 6-month postpartum parenting stress, after controlling for maternal age, number of children, and exposure to prenatal ADs (all Ps < 0.001). Third trimester depression accounted for 13% to 22% of the variance in postpartum stress at 3 and 6 months. Prenatal AD use was not a significant predictor in any of the models (all Ps > 0.2). Twenty of 41 mothers on ADs achieved remission (HDRS = 7) in pregnancy and had average parenting stress scores of about 1 standard deviation lower than those who did not at 3- and 6-months postpartum (t = 3.32, df = 32, P = 0.002 and t = 2.52, df = 32, P = 0.02, respectively).

Conclusions: Our findings indicate that antenatal depression and anxiety directly impact postpartum parenting stress, regardless of antenatal AD treatment. Ongoing maternal mental illness in pregnancy is an important predictor of postpartum parenting stress. Early recognition and treatment to remission is key.

Can J Psychiatry. 2010;55(4):222-228.

Clinical Implications

* Early recognition of depression and anxiety in pregnancy is critical.

* The illness directly impacts parenting stress regardless of treatment with ADs.

Limitations

* The study is limited owing to sample size, ethnic distributions, and unaccounted social circumstances.

* Replication of our study is needed to generalize these results.

Key Words: depression, anxiety, parenting stress, pregnancy, postpartum, perinatal

Abbreviations used in this article

AD antidepressant

CBT cognitive-behavioural therapy

HARS Hamilton Anxiety Rating Scale

HDRS Hamilton Depression Rating Scale

PSI-SF Parenting Stress Index-Short Form

SNRI selective norepinephrine reuptake inhibitor

SSRI selective serotonin reuptake inhibitor

Parenting stress is defined as the disparity between the demands associated with parenting and the perceived resources available to meet those demands, according to Abidin's1 model. Parenting stress is considered to be a result of both parent and child characteristics as well as factors associated with caregiver-child interaction.

Postpartum depression has consistently been associated with increased levels of parenting stress.2^*'5 Leigh and Milgrom5 found that antenatal depression was the strongest predictor of postpartum depression, which in turn was the strongest predictor for parenting stress, suggesting that early identification and treatment of perinatal depression is important. Cornish et al2 assessed 1 12 mother-infant dyads and found that mothers who had experienced postpartum depression reported increased levels of parenting stress at 15-months postpartum, compared with mothers who had never been depressed. Depressed mothers have been found to rate their children's temperament as more difficult than nondepressed mothers.3 A study of 23 depressed postpartum mothers found that 78% of the sample reported clinical levels of parenting stress. …