Chronic Perinatal Pain as a Risk Factor for Postpartum Depression Symptoms in Canadian Women

By Gaudet, Caroline; Wen, Shi Wu et al. | Canadian Journal of Public Health, September/October 2013 | Go to article overview

Chronic Perinatal Pain as a Risk Factor for Postpartum Depression Symptoms in Canadian Women


Gaudet, Caroline, Wen, Shi Wu, Walker, Mark C., Canadian Journal of Public Health


ABSTRACT

OBJECTIVE: To examine whether problematic perinatal pain is associated with postpartum depression (PPD) symptoms in a large nationally representative sample of Canadian mothers.

METHODS: We conducted a secondary data analysis using the 2006 Canadian Maternity Experiences Survey data (n=5,614). The main exposures of interest were the presence of problematic perinatal pain at three months postpartum, the duration of problematic perinatal pain, and the number of types of perinatal pain (vagina, caesarean incision site, breasts, back, severe headaches) at the time of interview (mean=7.3 months, range 5-14 months). For each exposure, full multivariate logistic regression models as well as six submodels were fitted.

RESULTS: Odds of screening positive for PPD symptoms for respondents reporting problematic perinatal pain in the first three months postpartum were 1.7 (95% CI 1.2-2.5). Compared to respondents without problematic perinatal pain, the odds of PPD symptoms for women reporting problematic perinatal pain at the time of interview was 2.4 (95% CI 1.6-3.6). A dose-response association between the number of types of perinatal pain at the time of interview and PPD symptoms was also observed.

CONCLUSION: Mothers reporting persistent perinatal pain are at increased risk of developing PPD, and pain control services for these women may be needed.

KEY WORDS: Postpartum depression; chronic pain; perinatal care; risk factors; maternal health

La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2013;104(5):e375-e387.

Postpartum depression (PPD) is a mood disorder that can occur after childbirth. Using the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, PPD is classified as a major depressive disorder with a ''peripartum'' onset specifier if symptoms occur during pregnancy or within 4 weeks postpartum.1 However, research demonstrates that PPD onset can be anywhere from pregnancy to late postpartum.2,3 PPD can be a challenge to detect as its symptoms are similar to normal consequences of childbirth. 4 It is therefore unfortunately often missed by clinicians, and many women may remain undiagnosed.5 Mothers who are diagnosed with PPD may not be treated as adequately as others receiving treatment for depression.5 Leftuntreated, PPD can result in important and pervasive consequences. Depressed mothers are less likely to return to their pre-pregnancy levels of function, partners of depressed mothers may have difficulties adjusting, and their children may have poorer health outcomes.6-8

There is a wide range of estimates of PPD due to the varying methodologies and PPD definitions used in research.2 The most widely reported prevalence of PPD is 13%.9 However, a recent systematic review reveals that the prevalence of depression (minor and major) at three months after childbirth could be as high as 19.2%.10 Data from the Maternity Experience Survey reveal that the national prevalence of PPD symptomatology (undiagnosed PPD) in Canada is approximately 8.7%, and varies from province to province ranging from 5% in New Brunswick to 15.9% in the territories.11

The aetiology of PPD is complex. Many psychological, psychosocial, socio-economic and obstetric risk factors have been reported to be associated with this disorder. Meta-analyses revealed that the psychological and psychosocial risk factors such as prenatal depression, stress, anxiety, and low social support are among the strongest risk factors for PPD.9,12,13 It is surprising that these reviews do not identify pain as a risk factor for PPD as the association between pain and depression is well known and consistently observed across a variety of diagnostics.14 Evidence suggests that the association between pain and depression could be of a causal nature.14

There are three main causal hypotheses to describe the nature of the pain-depression association. In the "antecedent" hypothesis, depression precedes and causes pain whereas in the "consequence" hypothesis, pain precedes and causes depression. …

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