The importance of the cumulation of risk factors for antepartum depression

Pregnancy is a period of heightened vulnerability to mental health problems. This pilot study aims to investigate the association between psychosocial and obstetric risk factors and the onset of depressive and anxious symptoms during pregnancy, with a focus on cumulative risks. Conducted at Ghent University Hospital in Belgium, this prospective observational study involved 378 pregnant women. Participants received a semi-standardized psychosocial assessment at 16 weeks to evaluate potential risk factors, followed by stepped screening protocol for depressive and anxious symptoms at 20 weeks. Due to significant overlap, the analysis focused solely on depressive symptoms. Depressive symptoms were identified in 5.5% of participants with a score ≥ 13 on the Edinburgh Depression Scale. Key psychosocial risk factors that increase the risk of antepartum depression include a history of mental health issues, especially depression (Fisher's exact test (FET), p = .018), experiences of physical (FET, p = .007) or emotional (FET, p = .008) violence, lack of social support (FET, p = .014), and unplanned pregnancy (FET, p = .008). No significant association was found between obstetric factors and depressive symptoms. The study highlights that the accumulation of psychosocial risk factors significantly elevates the risk of depression (Kendall's τ = 0.22, p < .001). These findings underscore the necessity of comprehensive psychosocial assessments in pregnant women, offering deeper insights than mere screenings for depression and anxiety. Recognizing and quantifying these risk factors facilitates targeted interventions. Employing a cumulative risk index effectively identifies women at heightened risk of mental health problems.