Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigation
Next article
Originalarbeit

Eine meta-analytische Untersuchung des sozioökonomischen Status als Risikofaktor für postpartale Depression

Published Online:January 10, 2019https://doi.org/10.1026/1616-3443/a000491

Abstract

Zusammenfassung.Theoretischer Hintergrund: 13 % aller Gebärenden leiden an postpartalen Depressionen (PPD), einer Krankheit mit bedeutsamen gesundheitlichen und sozialen Konsequenzen für die Betroffenen. Zurzeit werden PPD jedoch häufig spät erkannt und behandelt. Eine Früherkennung könnte durch die Identifikation spezifischer Vulnerabilitätsfaktoren erleichtert werden. Niedriger sozioökonomischen Status (SES) wurde als potenzieller Risikofaktor für Depressionen diskutiert (Lorant et al., 2003). Fragestellung: Das Ziel der vorliegenden Meta-Analyse ist die systematische Untersuchung, ob niedriger SES mit einem erhöhten Risiko für die Entwicklung einer PPD einhergeht. Methode: Um die Vergleichbarkeit der eingeschlossenen Studien zu gewährleisten, werden die internationalen Empfehlungen zur Erfassung des SES von Jöckel et al. (1998) als Inklusionskriterium herangezogen. Die identifizierten Studien werden meta-analytisch zusammengefasst. Ergebnisse: Weder Bildung mit einem relativen Risiko (RR) = 1.14 (95 % KI = 0.95, 1.45) noch Einkommen mit RR = 1.32 (95 % KI = 0.99, 1.74) waren signifikant mit der Entwicklung einer PPD assoziiert. Schlussfolgerung: Es wurde kein Zusammenhang zwischen dem erhöhten Risiko eine PPD zu entwickeln und dem Bildungsniveau oder dem Einkommen gefunden. Die vorliegende Studie macht auf die gravierenden methodischen Mängel im Bereich der Forschung von PPD und dem SES aufmerksam.


A Meta-Analytic Investigation of Socioeconomic Status as a Risk Factor for Postpartum Depression

Abstract.Background: Of all parturient mothers, 13 % suffer from postnatal depression, a disease with important clinical and social consequences for the persons concerned. However, postpartum depression (PPD) is currently diagnosed and treated rather late. To increase early detection, it is helpful to identify specific risk factors for PPD. Social disparity (i. e., socioeconomic status [SES]) has been found to increase the vulnerability for psychological illness. In line with this, individuals with a lower SES have been shown to be at risk of developing a depression. Objective: The goal of the current meta-analysis was to investigate whether SES can predict the development of PPD. Method: The meta-analysis includes studies focusing on this specific topic and synthesizes their statistical results to investigate whether SES has an effect on the development of PPD. Results: Analysis indicated nonsignificant results for education (RR = 1.14, 95 % CI = 0.95 – 1.45, p = 0.14) as well as income (RR = 1.32, (95 % CI = 0.99 – 1.74, p = 0.05). Conclusion: In summary, the results reflect that education and income do not predict the risk of developing PPD. The study was able to uncover serious methodical shortcomings when it comes to research in the field of PPD and SES.

Literatur

  • Adewuya, A. O., Fatoye, F. O., Ola, B. A., Ijaodola, O. R. & Ibigbami, S.-M. O. (2005). Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women. Journal of Psychiatric Practice, 11, 353 – 358. First citation in articleCrossref, Google Scholar

  • American Psychiatric Assocation. (2013). Diagnostic and Statistical Manual of Mental Disorders DSM-V. Washington, DC: American Psychiatric Publishing. First citation in articleCrossref, Google Scholar

  • Arteche, A., Joormann, J., Harvey, A., Craske, M., Gotlib, I. H., Lehtonen, A. et al. (2011). The effects of postnatal maternal depression and anxiety on the processing of infant faces. Journal of Affective Disorders, 133, 197 – 203. First citation in articleCrossref, Google Scholar

  • Beck, C. T. (2001). Predictors of postpartum depression an update. Nursing Research, 50, 275 – 285. First citation in articleCrossref, Google Scholar

  • Beeghly, M., Olsen, K. L., Weinberg, M. K., Pierre, S. C., Downey, N. & Tronick, E. Z. (2003). Prevalence, stability, and socio-demographic correlates of depressive symptoms in black mothers during the first 18 months postpartum. Maternal and Child Health Journal, 7, 157 – 168. First citation in articleCrossref, Google Scholar

  • Boath, E. H., Pryce, A. J. & Cox, J. L. (1998). Postnatal depression: The impact on the family. Journal of Reproductive and Infant Psychology, 16, 199 – 203. First citation in articleCrossref, Google Scholar

  • Brown, G. W. & Harris, T. (1978). Social origins of depression: A study of psychiatric disorder in women. London: Tavistock Publications. First citation in articleGoogle Scholar

  • Cooper, P. J., Murray, L., Wilson, A. & Romaniuk, H. (2003). Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. British Journal of Psychiatry, 182, 412 – 419. First citation in articleCrossref, Google Scholar

  • Cox, J. L., Holden, J. & Sagovsky, R. (1987). Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782 – 786. First citation in articleCrossref, Google Scholar

  • Cuijpers, P., Brännmark, J. G. & Straten, A. van (2008). Psychological treatment of postpartum depression: A meta-analysis. Journal of Clinical Psychology, 64, 103 – 118. First citation in articleCrossref, Google Scholar

  • Del Re, A. C. (2015). A practical tutorial on conducting meta-analysis in R. The Quantitative Methods of Psychology, 11 (1), 37 – 50. First citation in articleCrossref, Google Scholar

  • Dietz, L. J., Jennings, K. D., Kelley, S. A. & Marshal, M. (2009). Maternal depression, paternal psychopathology, and toddlers’ behavior problems. Journal of Clinical Child & Adolescent Psychology, 38, 48 – 61. First citation in articleCrossref, Google Scholar

  • Dohrenwend, B. P. & Dohrenwend, B. S. (1965). The problem of validity in field studies of psychological disorder. Journal of Abnormal Psychology, 70 (1), 52 – 69. First citation in articleCrossref, Google Scholar

  • Duval, S. & Tweedie, R. (2000). A nonparametric “trim and fill“ method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association, 95, 89 – 98. First citation in articleGoogle Scholar

  • Elliott, S. A., Leverton, T. J., Sanjack, M., Turner, H., Cowmeadow, P., Hopkins, J. et al. (2000). Promoting mental health after childbearth: A controlled trial of primary prevention of postpartum depression. British Journal of Clinical Psychology, 39, 223 – 241. First citation in articleCrossref, Google Scholar

  • Fallahpour, M. H., Zinkernagel, C., Frisch, U., Neuhofer, C., Stieglitz, R.-D. & Riecher-Rössler, A. (2005). Was Mütter depressiv macht … und wodurch sie wieder Zuversicht gewinnen. Ein Therapiehandbuch. Bern: Huber. First citation in articleGoogle Scholar

  • Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M. & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14 (1), 1 – 27. First citation in articleCrossref, Google Scholar

  • Goyal, D., Gay, C. & Lee, K. A. (2010). How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first time mothers? Women Health Issues 20 (2), 96 – 104. First citation in articleCrossref, Google Scholar

  • Hautzinger, M., Bailer, M., Worall, H. & Keller, F. (1995). Beck-Depression-Inventar (BDI). Testhandbuch. Bern: Huber. First citation in articleGoogle Scholar

  • Jöckel, K.-H., Babitsch, B., Bellach, B.-M., Bloomfield, K., Hoffmeyer-Zlotnik, J. H. P. & Winkler, J. (1998). Messung und Quantifizierung soziodemographischer Merkmale in epidemiologischen Studien. In W. AhrenB.-M. BellachK.-H. Jöckel (Hrsg.), Messung soziodemographischer Merkmale in der Epidemiologie (S. 7 – 38). München: MMV Medizin Verlag. First citation in articleGoogle Scholar

  • Kettunen, P. & Hintikka, J. (2017). Psychosocial risk factors and treatment of new onset and recurrent depression during post-partum period. Nordic Journal of Psychiatry, 71, 355 – 361. First citation in articleCrossref, Google Scholar

  • Kozinszky, Z., Dudas, R. B., Csatordai, S., Devosa, I., Tóth, É., Szabó, D. et al. (2011). Social dynamics of postpartum depression: a population-based screening in South-East Hungary. Social Psychiatry and Psychiatric Epidemiology, 46, 413 – 423. First citation in articleCrossref, Google Scholar

  • Lampert, T. & Kroll, L. E. (2006). Die Messung des sozioökonomischen Status in sozialepidemiologischen Studien. In M. RichterK. Hurrelman (Hrsg.), Gesundheitliche Ungleichheit. Grundlagen, Probleme, Perspektiven (S. 309 – 334). Wiesbaden: VS Verlag für Sozialwissenschaften. First citation in articleGoogle Scholar

  • Lampert, T. & Kroll, L. E., Robert Koch-Institut. (2010). Armut und Gesundheit. GBE kompakt 5/2010. Berlin: Robert Koch-Institut. First citation in articleGoogle Scholar

  • Lorant, V., Deliège, D., Eaton, W., Robert, A., Philippot, P. & Ansseau, M. (2003). Socioeconomic inequalities in depression: a meta-analysis. American Journal of Epidemiology, 157 (2), 98 – 112. First citation in articleCrossref, Google Scholar

  • Mielck, A. (2000). Soziale Ungleichheit und Gesundheit. Empirische Ergebnisse, Erklärungsansätze, Interventionsmöglichkeiten. Bern: Huber. First citation in articleGoogle Scholar

  • Miyake, Y., Tanaka, K., Sasaki, S. & Hirota, Y. (2011). Employment, income, and education and risk of postpartum depression: the osaka maternal and child health study. Journal of Affective Disorders, 130, 133 – 137. First citation in articleCrossref, Google Scholar

  • Moher, D., Liberati, A., Tetzlaff, J. & Altman, D. G., The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med, 6 (7), e1000097. First citation in articleCrossref, Google Scholar

  • Moncrieff, J., Chruchill, R., Drummond, D. C. & McGuire, H. (2006). Development of a quality assessment instrument for trials of treatments for depression and neurosis. Psychiatric Research, 10 (3), 126 – 133. First citation in articleGoogle Scholar

  • Mosse, M. & Tugendreich, G. (1913). Krankheit und soziale Lage. München: J. F. Lehmanns Verlag. First citation in articleGoogle Scholar

  • Mukherjee, S., Coxe, S., Fennie, K., Madhivanan, P. & Trepka, M. J. (2017). Antenatal stressful life events and postpartum depressive symptoms in the united states: The role of women’s socioeconomic status indices at the state level. Journal of Women’s Health, 26, 276 – 285. First citation in articleCrossref, Google Scholar

  • Norhayati, M. N., Nik Hazlinab, N. H., Asreneec, A. R & Wan Emilind, W. M. A. (2015). Magnitude and risk factors for postpartum symptoms: A literature review. Journal of Affective Disorders, 175, 34 – 52. First citation in articleCrossref, Google Scholar

  • Neises, M. & Weidner, K. (2011). Frauenheilkunde. In R. H. AdleW. HerzoP. JoraschkK. KöhlW. LangewitW. Söllneret al. (Hrsg.), Psychosomatische Medizin (S. 1076 – 1092). München: Elsevier. First citation in articleGoogle Scholar

  • Ogbo, F. A., Eastwood, J., Hendry, A., Jalaludin, B., Agho, K. E., Barnett, B. et al. (2018). Determinants of antenatal depression and postnatal depression in Australia. BMC Psychiatry, 18 (49), 2 – 11. First citation in articleGoogle Scholar

  • O’Hara, M. W. & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379 – 407. First citation in articleCrossref, Google Scholar

  • O’Hara, M. W. & Swain, A. M. (1996). Rates and risk of postpartum depression – a meta-analysis. International Review of Psychiatry, 8 (1), 37 – 54. First citation in articleCrossref, Google Scholar

  • Ozdemir, H., Ergin, N., Selimoglu, K. & Bilgel, N. (2005). Postnatal mood in turkish women. Psychology, Health & Medicine, 10 (1), 96 – 107. First citation in articleCrossref, Google Scholar

  • Patel, M., Bailey, K. R., Jabeen, S., Ali, S., Baker, C. N. & Osiezagha, K. (2012). Postpartum depresssion: A review. Journal of Health Care for the Poor and Underserved, 23, 534 – 542. First citation in articleCrossref, Google Scholar

  • R Core Team (2013). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. First citation in articleGoogle Scholar

  • Radloff, L. (1977). A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385 – 401. First citation in articleCrossref, Google Scholar

  • Rich-Edwards, J. W., Kleinman, K., Abrams, A., Harlow, B. L., McLaughlin, T. J., Joffe, H. et al. (2006). Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. Journal of Epidemiology and Community Health, 60, 221 – 227. First citation in articleCrossref, Google Scholar

  • Rubertsson, C., Wickberg, B., Gustavsson, P. & Radestad, I. (2005). Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Archives of Womens Mental Health, 8 (2), 97 – 104. First citation in articleCrossref, Google Scholar

  • Siegrist, J. & Marmot, M. (Hrsg.). (2008). Soziale Ungleichheit und Gesundheit: Erklärungsansätze und gesundheitspolitische Folgerungen. Bern: Hans Huber. First citation in articleGoogle Scholar

  • Stein, A., Arteche, A., Lehtonen, A., Craske, M., Harvey, A., Counsell, N. et al. (2010). Interpretation of infant facial expression in the context of maternal postnatal depression. Infant Behavior and Development, 33, 273 – 278. First citation in articleCrossref, Google Scholar

  • Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36 (3), 1 – 47. First citation in articleCrossref, Google Scholar

  • World Health Organization (WHO). (2009). ICD-10 – International Statistical Classification of Diseases and Related Health Problems (10th Revision). World Health Organization, Geneva. First citation in articleGoogle Scholar

  • Zung, W. W. K. (1965). A self rating depression scale. Archives of General Psychiatry, 12, 63 – 70. First citation in articleCrossref, Google Scholar