Research report
Employment, income, and education and risk of postpartum depression: The Osaka Maternal and Child Health Study

https://doi.org/10.1016/j.jad.2010.10.024Get rights and content

Abstract

Background

Epidemiological evidence regarding the associations of employment, income, and education with the risk of postpartum depression is inconsistent. This prospective study investigated the association between employment, type of job, household income, and educational level and the risk of postpartum depression.

Methods

Subjects were 771 Japanese women. Postpartum depression was defined as present when subjects had an Edinburgh Postnatal Depression Scale score of 9 or higher between 3 and 4 months postpartum. Adjustment was made for age, gestation, parity, cigarette smoking, family structure, medical problems during pregnancy, baby's sex, and baby's birth weight.

Results

The prevalence of postpartum depression was 13.8%. Compared with unemployment, employment was significantly associated with a reduced risk of postpartum depression: the adjusted OR was 0.55 (95% CI: 0.32–0.91). When employment was classified into 2 categories, full-time, but not part-time, employment was independently inversely associated with postpartum depression: the adjusted OR was 0.52 (95% CI: 0.26–0.96). Regarding the type of job held, women with a professional or technical job had a significantly reduced risk of postpartum depression: the adjusted OR was 0.29 (95% CI: 0.09–0.72). Clerical or related occupation and other occupations including sales, service, production, and construction were not associated with postpartum depression. There were no relationships between household income or maternal and paternal educational levels and postpartum depression.

Limitations

Personal and family psychiatric history, sociocultural factors, and personal and family relations were not controlled for.

Conclusions

Employment, especially full-time employment and holding a professional or technical job, may reduce the risk of postpartum depression.

Introduction

Depression in the postpartum period is a serious mental health disorder that confers great disability on women and has been associated with negative effects on the marital relationship and cognitive, social, and emotional development of offspring (O'Hara, 2009). In a meta-analysis in 2001, the following 13 predictors of postpartum depression were revealed: prenatal depression, self esteem, childcare stress, prenatal anxiety, life stress, social support, marital relationship, history of previous depression, infant temperament, maternity blues, marital status, socioeconomic status, and unplanned/unwanted pregnancy; however, the relationship with socioeconomic status was in the range of a small effect size (Beck, 2001). In fact, epidemiological evidence regarding the associations of employment, income, and education with the risk of postpartum depression is inconsistent. In Japan, such evidence is nonexistent. To our knowledge, no epidemiological study has examined the relationship between type of job and the risk of postpartum depression. Here, we investigated the association between employment, type of job, household income, and educational level and the risk of postpartum depression using data from the Osaka Maternal and Child Health Study (OMCHS).

Section snippets

Study population

The OMCHS is a prospective cohort study that investigates preventive and risk factors for maternal and child health problems such as partum depression and allergic disorders. Pregnant women were recruited for the baseline survey of the OMCHS. Eligible pregnant women were those who lived in Neyagawa City, which is one of the 43 municipalities in Osaka Prefecture, a metropolis in Japan with a total population of approximately 8.8 million. In Japan, when women become pregnant, they notify the

Results

The prevalence of postpartum depression was 13.8% among the 771 women who participated in the second survey at 3–4 months postpartum. The mean age of the 771 women was 29.9 years at baseline (Table 1).

Table 2 provides ORs and the 95% CIs for the risk of postpartum depression associated with selected socioeconomic variables. Compared with unemployment, employment was significantly related to a reduced risk of postpartum depression. Adjustment for age, gestation, parity, cigarette smoking, family

Comparison with other studies

The current study showed that compared with unemployment, employment, especially full-time employment and holding a professional or technical job, was significantly associated with a reduced risk of postpartum depression. There were no relationships between household income or maternal and paternal educational levels and the risk of postpartum depression.

In a cross-sectional study in the United States, significantly higher percentages of moderate-severe depression symptoms were found among

Conflict of Interest

All authors declare that they have no conflicts of interest.

Role of the funding source

Funding for this study was provided by KAKENHI (13770206, 16790351, and 22119507) and Health and Labour Sciences Research Grants, Research on Allergic Disease and Immunology from the Ministry of Health, Labour, and Welfare, Japan.

Contributors

Author Yoshihiro Miyake contributed to the study design, data collection, statistical analysis, data interpreting, and manuscript writing. Author Keiko Tanaka contributed to the data collection and data management. Author Satoshi Sasaki contributed to the study design. Author Yoshio Hirota contributed to the supervision of the design and execution of the study.

Acknowledgements

The authors would like to acknowledge the Neyagawa City Government, Hirakata City Government, Katano City Government, Shijonawate City Government, Kaizuka City Government, Takaishi City Government, Hannan City Government, Neyagawa City Medical Association, Hirakata City Medical Association, and the Kadoma City Medical Association for their valuable support.

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