In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
A icle
P e alence o Dep ession du ing P egnancy in Spanish Women:
T ajec o y and Risk Fac o s in Each T imes e
M. Ca men Míguez * and M. Belén Vázquez
Ci a ion: Míguez, M.C.; Vázquez,
M.B. P e alence o Dep ession du ing
P egnancy in Spanish Women:
T ajec o y and Risk Fac o s in Each
T imes e . In . J. En i on. Res. Public
Heal h 2021,18, 6789. h ps://
doi.o g/10.3390/ije ph18136789
Academic Edi o : Paul B. Tchounwou
Recei ed: 20 May 2021
Accep ed: 21 June 2021
Published: 24 June 2021
Publishe ’s No e: MDPI s ays neu al
wi h ega d o ju isdic ional claims in
published maps and ins i u ional a il-
ia ions.
Copy igh : © 2021 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
4.0/).
Depa men o Clinical Psychology and Psychobiology, Facul y o Psychology, Uni e si y o San iago de
Compos ela, 15782 San iago de Compos ela, Spain; [email p o ec ed]
*Co espondence: [email p o ec ed]; Tel.: +34-881-81-3740
Abs ac :
The aims o his esea ch we e o de e mine he ajec o ies o p obable dep ession and
majo dep ession du ing p egnancy and o iden i y he associa ed and p edic o a iables (sociode-
mog aphic, p egnancy- ela ed, and psychological) o bo h condi ions in each imes e o p egnancy.
A longi udinal s udy was ca ied ou wi h 569 p egnan Spanish women who we e assessed in
he i s , second, and hi d imes e s o p egnancy. Dep ession was assessed using he Edinbu gh
Pos na al Dep ession Scale and a clinical in e iew. Measu es o anxie y and s ess we e also in-
cluded. The p e alence o p obable dep ession in he i s , second, and hi d imes e s was 23.4%,
17.0%, and 21.4%, espec i ely, and ha o majo dep ession was 5.1%, 4.0%, and 4.7%. Thus, he
p e alence o bo h condi ions was he highes in he i s and hi d imes e s. The ajec o ies o
p obable dep ession and majo dep ession ollowed he same pa e n h oughou p egnancy. All o
he psychological a iables s udied we e associa ed wi h bo h condi ions in all h ee imes e s, wi h
pe cei ed s ess being a p edic o a all imes. The associa ion be ween he o he a iables and bo h
condi ions o dep ession was simila . Two excep ions s and ou : ha ing had p e ious misca iages,
which was only associa ed wi h p obable dep ession and was also a p edic o , in he i s imes e ;
and complica ions du ing p egnancy, which was only associa ed wi h p obable and majo dep ession
in he hi d imes e . These indings should be aken in o accoun in ou ine p egnancy ollow-ups,
and necessa y in e en ions should be s a ed in he i s imes e .
Keywo ds: p egnancy; an ena al dep ession; p e alence; ajec o y; isk ac o s
1. In oduc ion
Dep ession is one o he mos p e alen psychological diso de s, a ec ing women a
wice he a e o men [
1
]. In women, ulne abili y o dep ession is pa icula ly high du ing
p egnancy and in he pos pa um pe iod [
2
], as he bi h o a child is a li e e en associa ed
wi h nume ous biological, ho monal, psychological, amilial, and social changes.
An ena al dep ession has ecei ed less a en ion han pos pa um dep ession [
3
], as
p egnancy was adi ionally hough o p o ec women agains he onse o elapse o
dep essi e diso de s. Dep ession du ing p egnancy has impo an consequences, bo h o
mo he s and hei child en. In pa icula , he main consequence o an ena al dep ession
o mo he s is a con inua ion o he s a e in o he pos pa um pe iod, as dep ession in
p egnancy is he main isk ac o o pos pa um dep ession [
4
–
6
]. Child en o mo he s
wi h an ena al dep ession ha e been ound o be mo e likely o ha e in au e ine g ow h
e a da ion [
7
], be bo n p e e m [
7
–
10
], and be small o ges a ional age [
9
,
10
], all o which
a e majo causes o neona al and in an mo bidi y and mo ali y.
On he o he hand, he e is a lack o longi udinal esea ch add essing he p e alence
o an ena al dep ession in each imes e o p egnancy, as mos s udies a e c oss-sec ional,
which makes i impossible o de e mine he ajec o y o dep ession h oughou p egnancy.
This can lead o an inaccu a e pic u e o he ac ual si ua ion, as he p e alence o dep ession
o en a ies h oughou p egnancy [
11
–
13
]. The analysis o he ajec o y o dep ession in
he same sample o p egnan women is impo an because i enables he iden i ica ion o
In . J. En i on. Res. Public Heal h 2021,18, 6789. h ps://doi.o g/10.3390/ije ph18136789 h ps://www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2021,18, 6789 2 o 17
he imes o he g ea es ulne abili y since c oss-sec ional s udies p o ide e y di e en
esul s, as hey use di e en assessmen ins umen s.
The ew exis ing longi udinal s udies ha e p o ided mixed esul s ega ding he
ajec o y o dep ession. In pa icula , some s udies ound ha he i s and hi d imes e s
o p egnancy a e he imes o he highes p e alence o p obable dep ession [
13
–
16
] and
majo dep ession [
13
], al hough he alues in he hi d imes e did no each hose
obse ed in he i s imes e . Howe e , in a s udy conduc ed in China [
17
], al hough
p obable dep ession was also he mos p e alen in he i s and hi d imes e s, he
p e alence a e was highe in he la e han in he o me . The same pa e n was obse ed
in I aly o majo dep ession [
18
]. In all cases, he ajec o y o dep ession is V-shaped.
By con as , a s udy in India [
19
] epo ed he opposi e ajec o y (/
), wi h he highes
p e alence occu ing in he second imes e and he lowes p e alence in he hi d imes e .
On he o he hand, a s udy conduc ed in Ko ea [
20
] ound ha he p esence o p obable
dep ession ollowed an ascending pa h (/) be ween he i s and he hi d imes e .
As longi udinal s udies on he p e alence o an ena al dep ession by imes e a e
sca ce, he e is also a lack o knowledge ega ding he associa ed a iables a each poin .
Speci ically, we did no ind any s udies in he exis ing li e a u e ha ha e analysed he
a iables associa ed wi h an ena al dep ession in each imes e . Thus, i is no possible o
know whe he he e a e a iables associa ed wi h dep ession ha emain s able h ough-
ou he p egnancy, o whe he he e a e o he s ha a e speci ic o a pa icula imes e
and hen disappea in he es o he p egnancy. Iden i ying such associa ions would en-
able he implemen a ion o p e en ion and in e en ion measu es adjus ed o each phase.
In his espec , he a iables ha a e he mos equen ly associa ed wi h dep ession in
p egnancy a e sociodemog aphic, obs e ic, and psychological a iables [
21
]. In pa icula ,
an ena al dep ession has been associa ed wi h low educa ional le el [
15
,
22
–
25
] and low
socio-economic le el [
17
,
22
,
24
,
26
–
29
], being unemployed [
22
,
30
,
31
], and no ha ing planned
he p egnancy [
15
,
17
,
19
,
25
,
27
,
29
–
34
]. Rega ding psychological a iables, ha ing a his o y o
dep ession [
17
,
23
,
26
,
31
], as well as anxie y [
26
,
33
–
36
] o s ess [
33
,
34
,
36
] a e he a iables
ha a e he mos equen ly associa ed wi h an ena al dep ession. On he o he hand, in
ega d o a iables such as age and pa i y, he s udies’ indings a e con adic o y. Speci ically,
di e en s udies ha e epo ed a ela ionship wi h younge age [
18
,
37
], while in o he s, i
is ela ed o olde age [
23
,
29
]. Likewise, wi h espec o pa i y, bo h p imipa i y [
36
] and
mul ipa i y [
19
,
23
,
26
,
31
,
32
] ha e been associa ed wi h he p esence o an ena al dep ession.
Moni o ing women o dep ession h oughou p egnancy will enable he iden i ica ion
o he mos ulne able phases and he a iables associa ed wi h he p esence o dep ession
in each imes e . This would lead o mo e e icien help being o e ed in acco dance wi h
he eal needs o u u e mo he s and will p e en he dep essi e s a e and i s associa ed
consequences om ex ending o he pos pa um pe iod.
The e o e, he aims o he p esen esea ch we e i s , o assess he ajec o y o p oba-
ble dep ession, assessed wi h a sel - epo ins umen (EPDS), and o majo dep ession,
assessed wi h a clinical in e iew (SCID), du ing p egnancy; and second, o iden i y he
associa ed and p edic o a iables (sociodemog aphic, p egnancy- ela ed, and psychologi-
cal) o bo h p obable dep ession and majo dep ession in each imes e o p egnancy. The
s udy aimed o answe he ollowing speci ic ques ions:
1.
Is he ajec o y o dep ession h oughou p egnancy he same ega dless o i s se e i y?
2.
Do he same a iables p edic he p esence o p obable dep ession and o majo
dep ession?
3.
Which a iables a e he mos closely associa ed wi h dep ession in each imes e ?
A e hey he same, o a e he e imes e -speci ic p edic o s?
2. Ma e ials and Me hods
2.1. P ocedu e and Pa icipan s
The p esen esea ch was conduc ed in acco dance wi h he Helsinki Decla a ion and
ecei ed p e ious app o al om he e hics commi ees o all o he ins i u ions in ol ed.
In . J. En i on. Res. Public Heal h 2021,18, 6789 3 o 17
I was a longi udinal s udy wi h h ee assessmen wa es: he 1s imes e o p egnancy
(M = 10.87 weeks; SD = 2.36), he 2nd imes e o p egnancy (M = 20.69 weeks; SD = 1.21)
and he 3 d imes e o p egnancy (M = 33.28 weeks; SD = 2.05). P egnan women
a ending he p ima y public heal hca e se ice in no hwes Spain we e ec ui ed in he
1s imes e o p egnancy (n= 620). Women we e eligible o pa icipa e i hey we e a
leas 18 yea s o age, we e in he i s imes e o p egnancy, spoke Spanish, and we e
willing o pa icipa e in subsequen assessmen s h oughou he p egnancy. The exclusion
c i e ia we e: being unde 18 yea s o age, ha ing a ges a ional age equal o o g ea e
han 15 weeks, no eading o speaking Spanish, and no ha ing pa icipa ed in any o he
e alua ions. The aims and p ocedu es we e explained, and he p egnan women who we e
willing o pa icipa e p o ided w i en in o med consen . The inal sample consis ed o 569
women. The p ocedu e and sample acking cha ac e is ics a e shown in Figu e 1.
All women pa icipa ed olun a ily in he s udy. The assessmen s we e ca ied ou
pe sonally and indi idually a he hospi al p io o he women en e ing he p o ocolised
p egnancy ollow-up consul a ion. In each p egnancy imes e , all o he ques ionnai es
and SCID in e iews we e adminis e ed pe sonally by one psychologis who ecei ed SCID
aining and who was blind o he EPDS sco es. The a e age du a ion o each in e iew
was abou 40 min.
Figu e 1. Flow diag am o ec ui men and p og ess h ough he s udy.
2.2. Measu es
2.2.1. Socio-Demog aphic and P egnancy In o ma ion
Th ee ad hoc ques ionnai es including ques ions on socio-demog aphic (e.g., age,
ma i al s a us, educa ional le el, occupa ional s a us, and pe sonal mon hly income),
p egnancy- ela ed (e.g., pa i y, p e ious abo ions, planned p egnancy, p egnancy eac ion,
complica ions, a endance a ma e nal classes), and psychological a iables we e elabo a ed
on speci ically o he s udy.
In . J. En i on. Res. Public Heal h 2021,18, 6789 4 o 17
2.2.2. Dep ession
The Edinbu gh Pos na al Dep ession Scale (EPDS) [
38
] is a sel - epo ed ques ionnai e
consis ing o 10 i ems wi h 4 esponse op ions. The sco es ange be ween 0 and 30, wi h
highe sco es indica ing a g ea e se e i y o dep ession. The Spanish alida ion o he
EPDS o use in p egnancy was used [
13
], which de e mined ha he mos app op ia e
cu -o poin o sc eening o p obable an ena al dep ession was
≥
10. The eliabili y o
he EPDS du ing p egnancy was 0.81 in he i s imes e , 0.82 in he second imes e , and
0.85 in he hi d imes e in he p esen s udy.
The S uc u ed Clinical In e iew o DSM-IV (SCID) [
39
] is a semi-s uc u ed in e -
iew ha de e mines a o mal diagnosis acco ding o he Diagnos ic and S a is ical Manual
o Men al Diso de s (DSM-IV). The use o such in e iews imp o es diagnos ic eliabili y
by s anda dising he assessmen p ocess and inc eases he diagnos ic alidi y by acili a ing
he applica ion o DSM diagnos ic c i e ia and he sys ema ic enqui y o symp oms ha
migh o he wise go unno iced.
2.2.3. S ess
The Spanish alida ion [
40
] o he Pe cei ed S ess Scale (PSS) [
41
] was used. The PSS
is a sel -adminis e ed scale ha measu es he deg ee o which li e si ua ions in he p e ious
mon h a e a ed as s ess ul. I consis s o 14 i ems, wi h 5 esponse op ions. The scale
anges om 0 o 56, wi h highe sco es indica ing a highe le el o pe cei ed s ess. Wi h
his sample, he eliabili y o he PSS du ing p egnancy was 0.86 in he i s imes e , 0.88
in he second imes e , and 0.87 in he hi d imes e .
2.2.4. Anxie y
The S a e-T ai Anxie y In en o y (STAI) [
42
] assesses bo h he cu en le el o anxie y
and he indi idual’s p edisposi ion o su e ing om anxie y. I consis s o 40 i ems, 20 o
which e e o he s a e subscale (STAI-E), wi h o he 20 e e ing o he ai subscale
(STAI-R). The sco e o each subscale anges om 0 o 60, wi h highe sco es indica ing
highe le els o anxie y. Fo he s a e subscale, he ecommended cu -o poin o women
is g ea e han 31, and o ai anxie y, he cu -o poin o woman is g ea e han 32 (75 h
pe cen ile). In ou sample, he eliabili y o he ai anxie y subscale in he i s imes e o
p egnancy was 0.88, and he eliabili y o he s a e subscale, 0.91. In he second and hi d
imes e s, he eliabili y o he s a e anxie y subscale was 0.92.
2.3. Da a Analysis
Da a we e analyzed using SPSS S a is ics, e sion 22 (PASW S a is ics o Windows,
SPSS Inc., Chicago, IL, USA), and a signi icance le el o p< 0.05 was applied. To es he
di e ences be ween he p esence o absence o dep ession, a chi-squa e es o disc e e
a iables and S uden ’s - es s o con inuous a iables we e pe o med. C ame s’s V
coe icien s and Cohen’s d we e calcula ed in o de o es ima e he size o he e ec .
Bina y o wa d s epwise logis ic eg ession analysis was also used o de e mine
he a iables p edic ing dep ession in p egnancy, acco ding o he EPDS, and/o majo
dep ession, acco ding o he SCID, in each imes e o p egnancy. The dependen a iable
was p obable dep ession s a us (EPDS
≥
10, yes/EPDS < 10, no) o majo dep ession s a us
(yes dep ession/no dep ession), and he independen a iables we e hose a iables o
which signi ican di e ences we e ound in he wo-by- wo analyses. Likewise, C onbach’s
alpha (α) was calcula ed in o de o es ima e he eliabili y o he scales.
3. Resul s
3.1. Cha ac e is ics o he Sample
The s udy sample was composed o 569 women anging in age om 18 o 45 yea s,
wi h a mean age o 32.80 yea s (SD = 4.75). Mos o he women we e ma ied o cohabi ing
(94.9%); 46.4% (n= 264) had uni e si y educa ion, and 35.3% (n= 201) had seconda y
educa ion. Rega ding employmen s a us, 75.2% (n= 428) we e wo king. Rega ding
In . J. En i on. Res. Public Heal h 2021,18, 6789 5 o 17
pe sonal mon hly income, 44.6% (n= 254) s a ed ha hey ea ned less han 1000 eu os pe
mon h. P egnancy was planned in 85.9% (n= 489) o cases, 59.4% (n= 338) o he women
we e p imipa ous, and 93.0% (n= 529) epo ed ha ing eac ed posi i ely o con i ma ion
o he p egnancy. Likewise, 63.3% (n= 360) epo ed a ending ma e nal educa ion classes,
wi h he mean a endance being 4.45 classes (SD = 4.33) ou o he 10 classes o e ed on a
egula basis.
3.2. T ajec o y o Dep ession h oughou P egnancy
The p e alence o dep ession a ied acco ding o he ime o he assessmen and he
assessmen ins umen used (Figu e 2). The i s imes e was he pe iod du ing which he
highes pe cen age o women had p obable dep ession (23.4%) o majo dep ession (5.1%).
The p e alence o bo h p obable dep ession (17.0%) and majo dep ession (4.0%) was he
lowes in he second imes e . In he hi d imes e , he p e alence o bo h p obable
dep ession (21.4%) and majo dep ession (4.7%) was highe han in he second imes e
bu did no each he alues obse ed in he i s imes e . Thus, he ajec o ies o p obable
dep ession and majo dep ession ollowed he same pa e n h oughou p egnancy.
Figu e 2.
T ajec o y o he p e alence o p obable dep ession and majo dep ession du ing p egnancy.
3.3. Va iables Associa ed wi h he P esence o Dep ession
3.3.1. Sociodemog aphic Va iables
Rega ding he sociodemog aphic a iables, he cha ac e is ics o he p egnan women
expe iencing p obable dep ession o majo dep ession in each imes e o p egnancy
as well as he a iables associa ed wi h bo h ypes o dep ession a e shown in Table 1.
Rega ding he mean age, signi ican di e ences we e ound in he p e alence o p obable
dep ession in he i s (31.99 s. 33.05; (569) = 2.254, p= 0.025, d Cohen = 0.25) and second
imes e s (31.63 s. 33.04; (569) = 2.686, p= 0.007, d Cohen = 0.28), as hese women
we e younge han he women who did no expe ience p obable dep ession. Fo women
expe iencing majo dep ession, he mean age was s a is ically signi ican ly lowe in he
second ( (569) = 4.158, p< 0.001, d Cohen = 0.82; 28.83 s. 32.97) and hi d imes e s ( (569)
= 4.768, p< 0.001, d Cohen = 0.86; 28.63 s. 33.01).
Ha ing a lowe le el o educa ion was associa ed wi h bo h dep ession condi ions in
all h ee imes e s o p egnancy, while a lowe le el o income was only associa ed wi h
p obable dep ession in he 1s and 2nd imes e s. On he o he hand, no ha ing a pa ne ,
no cohabi ing, o no being ma ied was no associa ed wi h ei he condi ion a any ime.
3.3.2. P egnancy-Rela ed Va iables
In e ms o p egnancy- ela ed a iables, he cha ac e is ics o p egnan women wi h
p obable dep ession and majo dep ession in each imes e o p egnancy as well as he
a iables associa ed wi h bo h condi ions a e shown in Table 2.
In . J. En i on. Res. Public Heal h 2021,18, 6789 6 o 17
Ha ing eac ed nega i ely o he con i ma ion o p egnancy was associa ed wi h bo h
p obable and majo dep ession a all ime poin s. On he o he hand, ha ing had p e ious
misca iages was only associa ed wi h p obable dep ession in he i s imes e , while
ha ing had complica ions a some ime du ing p egnancy was only associa ed wi h he
p esence o majo dep ession in he hi d imes e .
3.3.3. Psychological Va iables
Rega ding he psychological a iables, he cha ac e is ics o p egnan women wi h
p obable dep ession and majo dep ession in each imes e o p egnancy as well as he
a iables associa ed wi h bo h ypes o dep ession a e shown in Table 3.
Rega ding pe cei ed s ess, signi ican ly highe mean sco es we e ound among
women expe iencing p obable dep ession and women expe iencing majo dep ession.
Speci ically, women wi h p obable dep ession had highe mean sco es o pe cei ed s ess
in he i s ( (569) =
−
14.332, p<0.001, d Cohen =
−
1.63; 25.44 s. 16.17), second ( (569) =
−
15.11, p< 0.001, d Cohen =
−
1.81; 25.69 s. 14.55) and hi d imes e s ( (569) =
−
14.946,
p< 0.001, d Cohen =
−
1.59; 25.33 s. 15.08). In addi ion, he mean sco es we e signi ican ly
highe among women wi h majo dep ession in he i s ( (569) =
−
6.234, p< 0.001, d
Cohen =
−
1.30; 26.66 s. 17.89), second ( (569) =
−
7.953, p< 0.001, d Cohen =
−
1.82; 28.52
s. 15.94) and hi d imes e s ( (569) =
−
8.343, p< 0.001, d Cohen =
−
1.74; 29.00 s. 16.69).
All o he psychological a iables s udied we e associa ed wi h bo h p obable and ma-
jo dep ession a all imes. Thus, ha ing a p io his o y o dep ession, ha ing expe ienced
a wo sening o mood in p e ious p egnancies, ha ing ele a ed s a e and ai anxie y as
well as a highe le el o s ess we e signi ican ly associa ed wi h bo h p obable dep ession
and majo dep ession.
Table 1.
Cha ac e is ics o women wi h p obable dep ession and majo dep ession as a unc ion o sociodemog aphic
a iables.
P obable Dep ession Majo Dep ession
Fi s T imes e
No
(n= 436)
Yes
(n= 133)
No
(n= 540)
Yes
(n= 29)
n%n%χ2Vn%n%χ2V
Age 8.825
** 0.13 0.180
≤30 121 27.8 55 41.4 166 30.7 10 34.5
>30 315 72.2 78 58.6 374 69.3 19 65.5
Ma i al S a us
1.001 4.778
Unma ied 20 4.6 9 6.8 25 4.6 4 13.8
Ma ied/Cohabi ing 416 95.4 124 93.2 515 95.4 25 86.2
Le el o Educa ion
13.809
*** 0.16 4.348
*0.09
P ima y/Seconda y 215 49.3 90 67.7 284 52.6 21 72.4
Uni e si y 221 50.7 43 32.3 256 47.4 8 27.6
Employmen S a us 6.419
*0.11 2.835
Wo king 339 77.8 89 66.9 410 75.9 18 62.1
No Wo king 97 22.2 44 33.1 130 24.1 11 37.9
P egnancy In luenced
Employmen
14.979
*** 0.16 8.892
** 0.13
No 365 83.7 91 68.4 439 81.3 17 58.6
Yes 71 16.3 42 31.6 101 18.7 12 41.4
Mon hly Income (Eu os) 9.783
** 0.14 0.413
≤1000 183 48.2 71 65.1 240 51.6 14 58.3
>1000 197 51.8 38 34.9 225 48.4 10 41.7
Second T imes e No
(n= 472)
Yes
(n= 97)
No
(n= 546)
Yes
(n= 23)
Age 8.372
** 0.12
20.727
*** 0.19
≤30 134 28.4 42 43.3 159 29.1 17 73.9
>30 338 71.6 55 56.7 387 70.9 6 26.1
In . J. En i on. Res. Public Heal h 2021,18, 6789 7 o 17
Table 1. Con .
Ma i al S a us
0.287 0.642
Unma ied 23 4.9 6 6.2 27 4.9 2 8.7
Ma ied/Cohabi ing 449 95.1 91 93.8 519 95.1 21 91.3
Le el o Educa ion
16.200
*** 0.17 8.108
** 0.12
P ima y/Seconda y 235 49.8 70 72.2 286 52.4 19 82.6
Uni e si y 237 50.2 27 27.8 260 47.6 4 17.4
Employmen S a us
1.642
12.956
*** 0.15
Wo king 360 76.3 68 70.1 418 76.6 10 43.5
No Wo king 112 23.7 29 29.9 128 23.4 13 56.5
P egnancy In luenced
Employmen
24.166
*** 0.21
11.231
** 0.14
No 367 77.8 52 53.6 409 74.9 10 43.5
Yes 105 22.2 45 46.4 137 25.1 13 56.5
Mon hly Income (eu os) 7.442
** 0.12 1.872
≤1000 199 49.1 55 65.5 243 51.4 11 68.8
>1000 206 50.9 29 34.5 230 48.6 5 31.3
Thi d imes e No
(n= 447)
Yes
(n= 122)
No
(n= 542)
Yes
(n= 27)
Age
3.335
20.637
*** 0.19
≤30 130 29.1 46 37.7 157 29.0 19 70.4
>30 317 70.9 76 62.3 385 71.0 8 29.6
Ma i al S a us
0.132 0.313
Unma ied 22 4.9 7 5.7 27 5.0 2 7.4
Ma ied/Cohabi ing 425 95.1 115 94.3 515 95.0 25 92.6
Le el o Educa ion 8.948
** 0.13 6.661
*0.11
P ima y/Seconda y 225 50.3 80 65.6 284 52.4 21 77.8
Uni e si y 222 49.7 42 34.4 258 47.6 6 22.2
Employmen S a us
3.378
11.145
** 0.14
Wo king 344 77.0 84 68.9 415 76.6 13 48.1
No Wo king 103 23.0 38 31.1 127 23.4 14 51.9
P egnancy In luenced
Employmen 4.066
*0.09 0.626
No 290 64.9 67 54.9 342 63.1 15 55.6
Yes 157 35.1 55 45.1 200 36.9 12 44.4
Mon hly Income (eu os) 1.798
0.996
≤1000 195 50.4 59 57.8 242 51.5 12 63.2
>1000 192 49.6 43 42.2 228 48.5 7 36.8
*p< 0.05, ** p< 0.01, *** p< 0.001.
Table 2.
Cha ac e is ics o women wi h p obable dep ession and majo dep ession as a unc ion o p egnancy- ela ed
a iables.
P obable Dep ession Majo Dep ession
Fi s T imes e
No
(n= 436)
Yes
(n= 133)
No
(n= 540)
Yes
(n= 29)
n%n%χ2Vn%n%χ2V
Pa i y 4.928
*0.09
10.197
** 0.13
P imipa ous 270 61.9 68 51.1 329 60.9 9 31.0
Mul ipa ous 166 38.1 65 48.9 211 39.1 20 69.0
P e ious Abo ions
11.280
** 0.14 0.024
No 336 77.1 83 62.4 398 73.7 21 72.4
Yes 100 22.9 50 37.6 142 26.3 8 27.6
P egnancy Planning
2.282 2.569
No 56 12.8 24 18.0 73 13.5 7 24.1
Yes 380 87.2 109 82.0 467 83.5 22 75.9
P egnancy Reac ion
24.026
*** 0.21
13.684
*** 0.16
Posi i e 418 95.9 111 83.5 507 93.9 22 75.9
In . J. En i on. Res. Public Heal h 2021,18, 6789 8 o 17
Table 2. Con .
Nega i e 18 4.1 22 16.5 33 6.1 7 24.1
P egnancy Complica ion
3.637 0.058
No 406 93.1 117 88.0 496 91.9 27 93.1
Yes 30 6.9 16 12.0 44 8.1 2 6.9
Second T imes e No
(n= 472)
Yes
(n= 97)
No
(n= 546)
Yes
(n= 23)
Pa i y 6.959
** 0.11 1.332
P imipa ous 292 61.9 46 47.4 327 59.9 11 47.8
Mul ipa ous 180 38.1 51 52.6 219 40.1 12 52.2
P e ious Abo ions
0.012 0.001
No 348 73.7 71 73.2 402 73.6 17 73.9
Yes 124 26.3 26 26.8 144 26.4 6 26.1
P egnancy Planning 5.575
*0.10 8.519
** 0.12
No 59 12.5 21 21.6 72 13.2 8 34.8
Yes 413 87.5 76 78.4 474 86.8 15 65.2
P egnancy Reac ion 7.265
** 0.11 7.935
** 0.12
Posi i e 445 94.3 84 86.6 511 93.6 18 78.3
Nega i e 27 5.7 13 13.4 35 6.4 5 21.7
P egnancy Complica ion
2.407 3.480
No 400 84.7 76 78.4 460 84.2 16 69.6
Yes 72 15.3 21 21.6 86 15.8 7 30.4
Thi d T imes e No
(n = 447)
Yes
(n= 122)
No
(n= 542)
Yes
(n= 27)
Pa i y
1.295 0.001
P imipa ous 271 60.6 67 54.9 322 59.4 16 59.3
Mul ipa ous 176 39.4 55 45.1 220 40.6 11 40.7
P e ious Abo ions
0.251 0.003
No 327 73.2 92 75.4 399 73.6 20 74.1
Yes 120 26.8 30 24.6 146 26.4 7 25.9
P egnancy Planning 4.048
*0.08 5.687
*0.10
No 56 12.5 24 19.7 72 13.3 8 29.6
Yes 391 87.5 98 80.3 470 86.7 19 70.4
P egnancy Reac ion
11.328
** 0.14
10.010
** 0.13
Posi i e 424 94.9 105 86.1 508 93.7 21 77.8
Nega i e 23 5.1 17 13.9 34 6.3 6 22.2
P egnancy Complica ion 4.380
*0.09
10.698
** 0.14
No 355 79.4 86 70.5 427 78.8 14 51.9
Yes 92 20.6 36 29.5 115 21.2 13 48.1
A endance a Ma e nal
Classes
10.357
** 0.14 6.190
*0.10
No 149 33.3 60 49.2 193 35.6 16 59.3
Yes 298 66.7 62 50.8 349 64.4 11 40.7
*p< 0.05, ** p< 0.01, *** p< 0.001.
Table 3. Cha ac e is ics o women wi h p obable dep ession and majo dep ession ega ding psychological a iables.
P obable Dep ession Majo Dep ession
Fi s T imes e
No
(n= 436)
Yes
(n= 133)
No
(n= 540)
Yes
(n= 29)
n%n%χ2Vn%n%χ2V
His o y o Dep ession 9.610
** 0.13
18.247
*** 0.19
No 412 94.5 115 86.5 506 93.7 21 72.4
Yes 24 5.5 18 13.5 34 6.3 8 27.6
Wo sening Mood in P e ious
P egnancies (n= 234) 4.908
*0.15 6.049
*0.16
No 147 87.5 50 75.8 184 86.0 13 65.0
Yes 21 12.5 16 24.4 30 14.0 7 35.0
In . J. En i on. Res. Public Heal h 2021,18, 6789 9 o 17
Table 3. Con .
T ai Anxie y
50.455
*** 0.30
10.463
*** 0.14
No 428 98.2 109 82.0 491 90.9 21 72.4
Yes 8 1.8 24 18.0 49 9.1 8 27.6
S a e Anxie y
77.467
*** 0.37 7.770
** 0.12
No 419 96.1 93 69.9 513 95.0 24 82.8
Yes 17 3.9 40 30.1 27 5.0 5 17.2
Second T imes e No
(n= 472)
Yes
(n= 97)
No
(n= 546)
Yes
(n= 23)
His o y o Dep ession
14.206
*** 0.16
12.267
*** 0.15
No 446 94.5 81 83.5 510 93.4 17 73.9
Yes 26 5.5 16 16.5 36 6.6 6 26.1
Wo sening Mood in P e ious
P egnancies (n= 234)
15.040
*** 0.25
11.106
** 0.22
No 163 89.1 34 66.7 191 86.0 6 50.0
Yes 20 10.9 17 33.3 31 14.0 6 50.0
T ai Anxie y
42.958
*** 0.28
38.396
*** 0.26
No 459 97.2 78 80.4 522 95.6 15 65.2
Yes 13 2.8 19 19.6 24 4.4 8 34.8
S a e Anxie y
70.950
*** 0.35
30.385
*** 0.23
No 464 98.3 75 77.3 523 95.8 16 69.6
Yes 8 1.7 22 22.7 23 4.2 7 30.4
Thi d T imes e No
(n= 447)
Yes
(n= 122)
No
(n= 542)
Yes
(n= 27)
His o y o Dep ession
12.348
*** 0.15
14.259
*** 0.16
No 423 94.6 104 85.2 507 93.5 20 74.1
Yes 24 5.4 18 14.8 35 6.5 7 25.9
Wo sening Mood in P e ious
P egnancies (n= 234) 5.246
*0.16 7.619
*0.18
No 155 87.6 42 73.7 191 85.7 6 54.5
Yes 22 12.4 15 26.3 32 14.3 5 45.5
T ai Anxie y
39.298
*** 0.26
41.005
*** 0.27
No 436 97.5 101 82.8 519 95.8 18 66.7
Yes 11 2.5 21 17.2 23 4.2 9 33.3
S a e Anxie y
84.056
*** 0.38
28.939
*** 0.23
No 438 98.0 90 73.8 510 94.1 18 66.7
Yes 9 2.0 32 26.2 32 5.9 9 33.3
*p< 0.05, ** p< 0.01, *** p< 0.001.
3.4. P edic o s o Dep ession in Each T imes e
P edic o s o he p esence o p obable dep ession and majo dep ession in each o he
imes e s a e shown in Tables 4and 5.
Age, p e ious misca iages, s a e anxie y, and pe cei ed s ess we e p edic o s o
p obable dep ession in he i s imes e . Speci ically, being aged 30 yea s old o younge
(OR = 2.55), ha ing had p e ious misca iages (OR = 3.28), ha ing a high s a e o anxie y
(OR = 3.97) as well as highe pe cei ed s ess (OR = 1.24) inc eased he likelihood o
p obable dep ession in he i s imes e .
In he second imes e , ha ing had p obable dep ession in he i s imes e
(OR = 13.61) as well as highe pe cei ed s ess in he i s (OR = 1.14) and second imes e s
(OR = 1.35) inc eased he likelihood o ha ing p obable dep ession.
In he hi d imes e , he p edic o s o p obable dep ession we e ha ing had majo
dep ession in he i s imes e (OR = 5.43), p obable dep ession in he second imes e
(OR = 6.19), and an ele a ed s a e o anxie y (OR = 4.88) and highe pe cei ed s ess
(OR = 1.16) in he hi d imes e .
In he i s imes e , he p edic o s o majo dep ession we e ha ing pe cei ed ha
p egnancy had a nega i e in luence on employmen (OR = 3.20) and ha ing highe pe -
In . J. En i on. Res. Public Heal h 2021,18, 6789 16 o 17
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