Antenatal depression (AD) is a specifier in depressive disorders as indicated “with peripartum onset” [1], characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during pregnancy.
Recent data showed that the risk to develop AD is underestimated, in relation to problems about instruments for its assessment because of their insufficient psychometric properties [2–5]. In particular, an untreated depression during the pregnancy is associated to higher levels of suicide, post-partum depression, preeclampsia, preterm births, low birth weight, poor interactions between child and mother and obstetric outcomes (such as the use of epidural analgesia and longer labour) [6-16]. Given the close association between post-partum depression and AD, it appears to be important to study risk factors (socio-demographic and psychological factors) during the pregnancy that can increase the level of AD. Psychological characteristics should be assessed through instruments with adequate psychometric properties that could predict precisely the risk of AD [16-21].
Regards the impact of demographic variables on AD, a recent systematic review showed that the depressive effects of mothers’ age, mothers’ socioeconomic status or life events associated to stress (e.g.: a job loss) during the pregnancy is yet unclear [22-25]. Indeed, some studies showed that divorce, separation or widowhood could predict the AD [16,26-30]. Other researches, on the contrary, found no significant association between marital status and AD [31-38]. Regarding the occupational employment and educational level, there was a general consensus that unemployment and lower education levels were linked to AD [16,26,33,39-47]. However, some studies reported opposite data. Al -Hejji et al. [48] and Chen et al. [49] found that higher levels of AD were associated to higher education levels. Pampaka et al. [44] also found a significantly positive association between AD and secondary education. However, other studies found no significant associations between AD, occupational employment and educational level [33,34,37,50].
There are several studies that reported an association between age and AD. Andersson et al. [8] and Rubertsson et al. [15] found that younger women tended to have higher level of AD. Similar results were provided by Fellenzer and Cibula [26] in women between 18 and 24 years. In addition, younger age resulted to be a predictive factor of the AD especially during the second and the third trimester of pregnancy [51]. Also Rich-Edwards and colleagues [52] found that young pregnant women (≤23 yrs.) had a greater likelihood to develop AD than older ones. These results were confirmed by other studies [41,53]. Recent studies, on the contrary, evidenced that an advanced maternal age (≥ 35 years) is more associated to the AD [54-58]. Additionally, no significant associations between AD and maternal age were found by other researchers [28,31-32,34-39,44,47,49,59-62].
AD is also linked to state psychological factors, in particular to depressive symptoms [63]. Recent studies showed as depressive symptoms were important predictive risk factors of post-partum depression [32,64]. Up to date, only one study [65] concomitantly analysed the role of socio-demographic and state psychological factors on women’s depression during pregnancy. The research showed that only women’s age and depressive symptoms were the most important predictive risks factors of post-partum depression.
The aim of our study is to analyse the predictive power of the principal demographic factors (age, marital status, occupational employment, educational level) and the risk of depression which showed to be relevant for predicting AD. We developed the following hypotheses:
1. H1: only demographic factors are significant predictive risk factors of AD.
2. H2: only the psychological factors are significant predictive risk factors of AD.
3. H3: both demographic and psychological factors are significant predictive risk factors of AD.