Relation between place of residence and postpartum depression

Simone N. Vigod; Lesley A. Tarasoff; Barbara Bryja; Cindy-Lee Dennis; Mark H. Yudin; Lori E. Ross

doi:10.1503/cmaj.122028

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Table 1:

Baseline characteristics of 6126 new mothers who completed the Maternity Experiences Survey, by location

Characteristic	Location; weighted % (95% CI)^*
Characteristic	Rural n = 1362	Semirural n = 1225	Semiurban n = 2187	Urban n = 1352
Maternal age, yr, mean (95% CI)	29.7 (29.5–30.0)	29.5 (29.2–29.8)	29.5 (29.3–29.7)	31.1 (31.0–31.3)
Parity, primiparous	39.6 (37.0–42.2)	40.8 (37.9–43.6)	49.4 (46.9–51.9)	47.0 (45.5–48.6)
Marital status, married or common-law	92.7 (91.2–94.2)	91.0 (89.4–92.6)	88.6 (87.0–90.3)	93.2 (92.2–94.2)
Born in Canada	89.0 (87.0–91.0)	88.1 (86.0–90.2)	87.2 (85.3–89.2)	61.9 (59.9–63.9)
Household income^†
Lowest	10.5 (8.85–12.2)	9.9 (8.12–11.6)	12.0 (10.1–13.8)	11.2 (9.82–12.5)
Lower-middle	23.9 (21.4–26.3)	18.8 (16.4–21.3)	21.5 (19.2–23.8)	20.5 (18.7–22.3)
Upper-middle	37.6 (34.7–40.5)	36.9 (33.9–40.0)	36.6 (33.9–39.3)	30.9 (28.9–32.9)
Highest	28.0 (25.2–30.8)	34.4 (31.4–37.4)	29.9 (27.3–32.5)	37.4 (35.5–39.4)
Education level
Less than high school	8.82 (7.3–10.4)	9.87 (8.10–11.6)	7.79 (6.42–9.16)	5.94 (4.98–6.90)
High school	15.5 (13.4–17.6)	16.2 (13.9–18.4)	15.1 (13.0–17.1)	10.8 (9.53–12.0)
Some postsecondary	19.0 (16.7–21.2)	16.2 (14.0–18.3)	16.9 (14.9–19.0)	13.9 (12.5–15.4)
Postsecondary	56.8 (53.8–59.7)	57.8 (54.8–60.8)	60.2 (57.5–62.9)	69.4 (67.5–71.2)
History of depression	16.4 (14.1–18.6)	16.4 (14.2–18.6)	18.7 (16.6–20.9)	13.5 (12.0–14.9)
Maternal health, excellent or very good	73.3 (70.7–75.8)	73.1 (70.4–74.8)	75.1 (72.7–77.5)	70.7 (68.8–72.6)
Stress
No. of life stressors in last 2 yr, mean (95% CI)	1.25 (1.17–1.34)	1.37 (1.27–1.46)	1.38 (1.30–1.47)	1.19 (1.13–1.25)
Abuse in last 2 yr	9.82 (8.21–11.4)	12.6 (10.6–14.5)	13.1 (11.3–14.9)	9.94 (8.79–11.1)
Labour and delivery complications	14.3 (12.2–16.4)	14.4 (12.3–16.5)	14.6 (12.7–16.6)	14.9 (13.4–16.3)
Preterm birth	6.06 (4.62–7.50)	6.49 (4.90–8.08)	6.67 (2.30–8.04)	6.15 (5.13–7.18)
Infant in NICU	10.8 (8.98–12.5)	11.0 (9.06–12.8)	14.8 (12.8–16.8)	13.0 (11.6–14.4)
Social support
Pregnancy
None or a little of the time	4.52 (3.28–5.76)	4.05 (2.82–5.28)	3.52 (2.54–4.51)	6.21 (5.18–7.24)
Some of the time	6.65 (5.21–8.10)	6.87 (5.29–8.46)	6.25 (4.91–7.59)	9.21 (8.00–10.4)
Most of the time	27.9 (25.2–30.6)	30.0 (27.1–32.9)	27.4 (24.9–29.9)	31.4 (29.5–33.4)
All of the time	60.9 (58.0–63.8)	59.1 (56.0–62.1)	62.8 (60.1–65.5)	53.1 (51.1–55.2)
Postpartum
None or a little of the time	4.51 (3.32–5.70)	5.34 (3.89–6.79)	4.82 (3.67–5.96)	6.53 (5.50–7.55)
Some of the time	9.48 (7.74–11.2)	8.51 (6.84–10.2)	8.42 (6.82–10.0)	12.2 (10.8–13.6)
Most of the time	31.8 (29.0–34.5)	33.4 (30.5–36.3)	31.2 (28.6–33.9)	34.1 (32.1–36.1)
All of the time	54.3 (51.4–57.1)	52.8 (49.7–55.9)	55.5 (52.8–58.3)	47.2 (45.1–49.3)

Note: CI = confidence interval, NICU = neonatal intensive care unit.
↵* Unless otherwise stated.
↵† Household income is reported by quartile.

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Table 2:

Postpartum depression among 6126 new mothers who completed the Maternity Experiences Survey, by score on the Edinburgh Postnatal Depression Scale^*

Characteristic	EPDS ≥ 13,^† weighted % (95% CI)	EPDS score, weighted mean (95% CI)
Location^‡
Rural, n = 1362	6.07 (4.66–7.48)	4.94 (4.68–5.20)
Semirural, n = 1225	6.96 (5.39–8.53)	5.05 (4.78–5.33)
Semiurban, n = 2187	5.31 (4.01–5.61)	5.00 (4.77–5.24)
Urban, n = 1352	9.16 (7.50–10.40)	5.61 (5.41–5.81)
Census metropolitan and census agglomeration areas
Rural and small town, n = 1248	6.98 (5.48–8.48)	5.03 (4.77–5.30)
Large urban centre n = 4878	7.56 (6.75–8.37)	5.33 (5.19–5.46)
Rural and small-town areas, by metropolitan influence
Strong, n = 316	5.50 (2.94–8.06)	5.18 (4.73–5.64)
Moderate, n = 444	7.05 (4.53–9.58)	4.91 (4.47–5.35)
Weak, n = 440	8.31 (5.60–11.00)	5.14 (4.68–5.60)
None, n = 48	NR	4.06 (2.78–5.33)

Note: CI = confidence interval, EPDS = Edinburgh Postnatal Depression Scale, NR = not reportable.
↵* Differences between groups were evaluated using χ²tests for categorical variables and independent t test or analysis of variance (ANOVA) for continuous variables.
↵† EPDS ≥ 13 represents likelihood that a woman has postpartum depression.
↵‡ p < 0.05 for differences between groups for both EPDS ≥ 13 and EPDS mean score.

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Table 3:

Multivariable model for the relationship between population area size and postpartum depression (EPDS ≥ 13)

Main exposure variable	Odds ratio (95% CI)
	Unadjusted
Population area size
Urban	Ref
Semiurban	0.56 (0.41–0.75)
Semirural	0.74 (0.56–0.99)
Rural	0.64 (0.48–0.85)
	Adjusted^*
Population area size
Urban	Ref
Semiurban	0.60 (0.42–0.84)
Semirural	0.90 (0.65–1.24)
Rural	0.80 (0.57–1.11)
Parity, primiparous	0.82 (0.64–1.05)
Country of origin (Canadian-born v. non-Canadian-born)	0.51 (0.39–0.67)
Household income
Low	Ref
Low-middle	0.88 (0.57–1.20)
Middle-high	0.82 (0.60–1.29)
High	0.80 (0.54–1.17)
History of depression (v. no history)	2.11 (1.60–2.79)
Life stressors	1.29 (1.20–1.38)
Interpersonal abuse	1.46 (1.06–2.00)
Maternal health
Good/fair/poor	Ref
Excellent/very good	0.40 (0.31–0.51)
Postpartum social support
Low	Ref
Low-middle	0.67 (0.45–1.00)
Middle-high	0.36 (0.25–0.52)
High	0.15 (0.10–0.23)

Note: CI = confidence interval, EPDS = Edinburgh Postnatal Depression Scale, ref = reference.
↵* All variables were adjusted for all covariates in the model. We included variables that are known predictors of postpartum depression (history of depression, life stressors in past 2 yr, interpersonal abuse in last 2 yr, social support, maternal self-reported health) or those for which there were major differences between groups for possible prognostic variables (parity, country of origin, household income). Hosmer–Lemeshow for goodness of fit of the multivariable model X² = 8.43, p = 0.4. All variance inflation factors < 1.30.