Factors associated with postpartum depressive symptomatology in Brazil: The Birth in Brazil National Research Study, 2011/2012

Background: Depression is one of the most common postpartum mental disorders. Many sociodemographic and individuals risk factors are associated with maternal depression but the impact of high levels of birth intervention is unclear. The Brazilian context is characterized by excessive intervention and frequent non-compliance with recommended obstetric protocols. This study therefore examined the impact of sociodemographic, individual, and obstetric risk factors in postpartum depression. Methods: The Birth in Brazil research study is a national study of 23,894 postpartum women. Information about depression was obtained by telephone interview at 6 to 18 months after birth and was measured using the Edinburgh Postnatal Depression Scale. Results: The prevalence of probable cases of depression was 26.3%. A multivariate model identified significant sociodemographic and individual risk factors as: brown skin color (OR = 1.15 CI 1.01-1.31), lower economic class (OR=1.70 CI 1.41-2.06), alcohol use (OR= 1.41 CI 1.09-1.84) and a history of mental disorders (OR= 3.13 CI 1.80-5.44). Significant obstetric factors were unplanned pregnancy (OR=1.22 CI 1.05-1.43 for wanted later and OR= 1.38 CI 1.20-1.60 for never wanted), multiparity (OR=1.97 CI 1.58-2.47 for 3 or more children), and poor care during birth (OR= 2.02 CI 1.28-3.20) or of the newborn (OR=2.16 CI 1.51-3.10). Obstetric interventions and complications were not associated with maternal depression. Limitations: Depression was measured only once so we are not able to examine the course over time. The associational and reverse causality cannot be ruled out for some variables. Conclusions: The prevalence of postpartum depression is high in Brazilian women six months after birth. Poor care of women and babies during birth is more important in postpartum depression than physical obstetric or neonatal intervention and complications