Psychosocial risk factors for postpartum depression in Chinese women: a meta-analysis

Background: Postpartum depression (PPD) has been identified as a recognized public health problem that may adversely affect mothers, infants, and family units. Recent studies have identified risk factors for PPD in Westerners; however, societal and cultural differences between China and the West could, potentially, lead to differences in risk factors for PPD. No comprehensive study has been conducted to collect all the evidence to provide estimates of psychological and social risk factors in China. Therefore, this study aimed to quantitatively assess all studies meeting the review's eligibility criteria and identify the psychological and social risk factors for PPD in Chinese women.

Methods: The following databases were used in the literature search from their inception until December 2020: PubMed, Embase, Foreign Medical Literature Retrieval Service (FMRS), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and China Biology Medicine disc (CBM). The quality was assessed through Newcastle-Ottawa quality assessment scale. The I²statistic was used to quantify heterogeneity. We extracted data for meta-analysis and generated pooled-effect estimates from a fixed-effects model. Pooled estimates from a random-effects model were also generated if significant heterogeneity was present. Funnel plot asymmetry tests were used to check for publication bias. Statistical analysis was conducted using Review Manager version 5.3 software.

Results: From a total of 1175 identified studies, 51 were included in the analysis. Prenatal depression (OR 7.70; 95% CI 6.02-9.83) and prenatal anxiety (OR 7.07; 95% CI 4.12-12.13) were major risk factors for PPD. A poor economic foundation (OR 3.67; 95% CI 3.07-4.37) and a poor relationship between husband and wife (OR 3.56; 95% CI 2.95-4.28) were moderate risk factors. Minor risk factors included a poor relationship between mother-in-law and daughter-in-law (OR 2.89; 95% CI 2.12-3.95), a lack of social support (OR 2.57; 95% CI 2.32-2.85), unplanned pregnancy (OR 2.55; 95% CI 2.08-3.14), and poor living conditions (OR 2.44; 95% CI 1.92-3.10), mother-in-law as the caregiver (1.95; 95% CI 1.54-2.48) .

Conclusions: This study demonstrated a number of psychological and social risk factors for PPD in Chinese women. The major and moderate risk factors are prenatal depression, prenatal anxiety, a poor economic foundation, and a poor relationship between husband and wife. These findings have potential implications for informing preventive efforts and modifying screening to target at-risk populations.