Different Pathways to Pospartum Depression: Early-onset versus Late-onset Depression

Objectives:  To determine the demographic, psychosocial and depression characteristics distinguishing women experiencing early-onset versus late-onset postpartum depression (PPD).

Method: This was a prospective, longitudinal telephone survey of 249 women, recruited on the postpartum hospital floor and contacted at two-weeks, two-months, six-months and eighteen-months following delivery.  Depression was measured using the Edinburgh Postnatal Depression Scale (EPDS). Two-tailed statistical analyses with significance levels set at p≤.05  were conducted using Pearson Chi Square and ANOVA with Bonferroni correction to compare no-PPD-onset, early-PPD-onset and late-PPD-onset women.

Results: Compared to the no-PPD-onset group(n=212), both early-PPD-onset(n=22) and late-PPD-onset(n=15) women were more likely to be minority race, single, have prior history of depression, history of adult trauma, prenatal smoking and other substance use.  Additionally, the early-PPD-onset group was more likely to have low socioeconomic-status(45.5%vs.20.8%), have housing problems(27.3%vs.2.4%), be adolescent(18.2%vs.3.3%), have “not very/not at all helpful” family/friends(18.2%vs.1.0%) and enter prenatal care late(27.3%vs.8.5%) compared to the no-PPD-onset group.  In contrast, the late-PPD-onset group was uniquely different from the no-PPD-onset group on a single characteristic, having delivered a low birth weight infant(13.3%vs.1.9%).

Implications: The early-onset group, with more severe depression, fit the traditional psychosocial risk profile for postpartum depression, while the late-onset group shared characteristics with both non-depressed women (higher socioeconomic status, family/friend support, healthcare access) as well as with early-onset depressed women (minority, lack of supportive partner, history of depression, prenatal smoking and drug use). We speculate that the late-PPD-onset group included more women whose children may have been experiencing delays or disabilities related to their low birth weight.