Antenatal psychosocial risk factors and depression among women living in socioeconomically disadvantaged suburbs in Adelaide, South Australia

Abstract

Objective: This study reports the prevalence of psychosocial risk factors and the incidence of depression in women presenting for their first antenatal visit at a general hospital in a socioeconomically deprived area. We also investigated the association between specific psychosocial risk factors and antenatal depression.

Method: Four hundred and twenty one women completed the Antenatal Psychosocial Questionnaire (APQ) and the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression analysis was used to identify psychosocial risk factors predictive of EPDS caseness.

Results: 88% of women endorsed at least one psychosocial risk factor. 35.6% had been abused as children, 34.9% had suffered recent major life stresses, 24.5% had thoughts of self harm, 8% admitted to recently hitting or hurting someone in anger and 5.6% had been victims of violence since becoming pregnant. The incidence of depression, measured using an EPDS cut-off score of 10 or more, was 29.7%. The questionnaires were generally acceptable, apart from questions about drug and alcohol abuse which were not completed by one in five subjects. Factors associated with an increased risk of antenatal depression were being hit by someone since becoming pregnant, having recently hit someone else in anger, obsessional traits, previous feelings of depression and anxiety, and requiring both past and current treatment for emotional problems. Protective factors were having someone to talk to and feeling confident.

Conclusion: Our findings suggest that women birthing at the LMHS are a very vulnerable group. Violence (either by or towards the pregnant women) was the strongest predictor of antenatal depression and may be under recognized. Antenatal screening for psychosocial risk factors and depression was useful and was well accepted by the women and the clinic staff. It is important that appropriate services are available once women at risk are identified.