Antepartum Services and Symptoms of Postpartum Depression in At-Risk Women.

OBJECTIVE: To examine which psychosocial risk factors are predictors of symptoms of postpartum depression (PPD) and whether home visit services are associated with decreased reports of symptoms of PPD.

DESIGN: Secondary analysis of observational data from the 2012 to 2013 Pregnancy Risk Assessment Monitoring System (PRAMS).

PARTICIPANTS: A national sample with data from more than 30,000 births from 41 states.

METHODS: To account for unequal probabilities of selection, PRAMS-produced survey weights were incorporated in all percentage estimates, all chi-square tests, and an overall logistic regression model for maternal characteristics as predictors of symptoms of PPD. The effect of interventions on PPD was assessed using statistical techniques that adjusted for the likelihood of receiving the intervention.

RESULTS: Stressors (odds ratio [OR] = 2.6 for three to five stressors; OR = 3.1 for six or more stressors), physical abuse (OR = 1.8), and history of depression (OR = 3.0) were associated with PPD in the logistic regression model. Using propensity score analysis, the average treatment effect of home visiting on PPD, during or after pregnancy, was nonsignificant. However, the propensity score analysis did identify a group of high-risk women for whom receiving a home visit was associated with nearly 40% lower odds (OR = 0.6) of experiencing PPD symptoms.

CONCLUSION: Findings highlight the effect home visits during pregnancy may have on the odds of at-risk women developing symptoms of PPD. Future research is indicated to assess the extent to which targeted interventions during these home visits can enhance effectiveness by mitigating psychosocial stress in pregnancy to prevent PPD.