Can Stress During Pregnancy Affect Postpartum Depression?

Source: Photo from Tubarones Photography on Pexels.

Postpartum depression—the depression that occurs in a mother after a child is born—is common. CDC statistics suggest postpartum depression affects around one in eight women. Research has also found that rates are higher among minority women. For example, one study found that, compared to white American women, the rate of postpartum depression was 80 percent higher among African American women and 40 percent higher among Hispanic-American women. Other research has suggested even higher disparities in postpartum depression symptoms. This may be related to the amount of stress that mothers experience. Experiencing more stress before childbirth predicts the likelihood of postpartum distress, and low-income and minority women experience more stress.

A long-term research study in Arizona has been examining the mental health of Mexican American mothers. This study has led to numerous insights about maternal mental health, particularly among minority populations in the U.S. One article explores more deeply the role of stress on postpartum depression in this population—and the way that support from friends and family can help to prevent mothers from slipping into that depression.

This study, led by researcher Shayna Coburn, conducted assessments of women just before the birth of their child (on average, at about 35 weeks into pregnancy), and then again six weeks after the birth. Several different sources of stress were measured before mothers gave birth:

• Daily hassles included things like shopping, meal preparation, and house cleaning.
• Family interpersonal stress measures criticism and negativity coming from family members.
• Partner interpersonal stress measures problems or dissatisfaction with a spouse or romantic partner. This asks about things like frequent arguments or whether divorce or separation has been discussed.
• Culture-specific stressors measured concerns that tend to be particularly strong among Hispanic individuals. These include things like concerns over not knowing enough English to deal with day-to-day situations and concerns over the immigration of family members.

One potential buffering factor was measured: Social support. The social support measure asked questions about whether there were people the soon-to-be mothers could rely on for companionship, advice, and help. Previous research found that, for people with good social support, stress tended not to have as many negative effects.

The results of this assessment showed that each of the forms of stress was related to postpartum depression symptoms. As expected, mothers who were more stressed before birth felt more depressed after birth. Daily hassles and stress from a romantic partner had particularly strong relationships with depression symptoms.

The study also examined whether these sources of stress were all basically the same, or whether they each contributed uniquely to postpartum depression. In other words, if you know about one source of stress, do you not need to bother measuring the others, because you basically know how stressed the soon-to-be mother is? Results suggest that three of four forms of stress had a unique effect: daily hassles, partner stress, and family stress. Each of those was contributing in its own way to the mother’s postpartum depression symptoms. If you wanted to predict how bad a mother’s postpartum depression would be, culture-specific stressors weren’t adding any new information.

There were also several background factors that predicted how bad postpartum depression symptoms would be.

• Women in poorer households had worse symptoms.
• Older mothers had worse symptoms.
• Mothers with fewer years of education had worse symptoms.
• Mothers who had emigrated from Mexico had better symptoms.

These results confirm and replicate previous results. More money and better education buffer against depression, while it is generally thought to be harder to be an older mother. Being a recent immigrant also predicted better outcomes. This was in line with previous research suggesting that it’s actually second-generation immigrants that have the hardest time fitting in with a new culture. Compared with the second generation, the first generation did slightly better.

The final question that the study addressed was how social support could help offset the impact of stress. Statistical tests found that social support could only buffer against family stress, and not any of the other kinds of stress. Among women with high social support, more family stress didn’t lead to worse depression. Among women with low social support, more family stress did lead to worse depression.

Postpartum Depression Essential Reads

The Potential Cost of Honesty in Perinatal Screening

Maternal Minds Matter

These results suggest that the way we think about stress and social support is not nuanced enough. Mothers can be stressed by lots of things, and it may be that different things are needed to offset the effects of these stressors. Having friends you can rely on appears to be a good way to offset having a negative or critical family. Friends can step in and fill some of the support roles that family might otherwise have. On the other hand, supportive friends don’t offset the stress of having lots of daily hassles, or the stress of having a difficult romantic relationship. It may be that other factors—like having practical help to deal with hassles or couples counseling to strengthen relationships—are needed to offset the other stressors.

The overall message of this study, then, is that postpartum depression is related to the stress mothers experience before the birth of the child. However, we may need to be more specific in how we think about stress and what best helps new mothers deal with it.