A Population Based Survey of Infant Inconsolability and Postpartum Depression

1
A Population Based Survey of Infant
Inconsolability and Postpartum Depression

• Pamela C. High, Rachel Cain,
• Hanna Kim and Samara Viner-Brown
• Hasbro Childrens Hospital/ Brown Medical School
• Division of Family Health RI Department of
  Health
• Providence, RI
• Presentation for Society of Developmental-Behavior
  al Pediatrics, Sept. 26, 2005, San Diego, CA

2
Background

• Excessive and inconsolable crying in the first
  few months of life has been reported in 2 to 40
  of otherwise healthy infants
• Postpartum depression is reported in 15-20 of
  new mothers
• Link between early postpartum depressive symptoms
  and infant crying has been described

3
Objectives

• To assess the prevalence of infantile
  inconsolability and maternal postpartum
  depressive symptoms in a population based sample
• To identify demographic and modifiable behavioral
  risk factors associated with these conditions
• To determine the co-occurrence and possible
  relationship between infant inconsolability and
  maternal depressive symptoms

4
Methods

• Data was obtained from RIs Pregnancy Risk
  Assessment Monitoring System (PRAMS), sponsored
  by the National Centers for Disease Control and
  Prevention (CDC)
• Data was weighted to demographically represent
  all births in RI in 2002 and 2003
• 4,214 mothers were sampled
• 2,947 responded (72 weighted response rate)

5
Data Analysis

• Chi-squared tests for bivariate analysis
• Multivariate logistic regression models were used
  controlling for demographic variability to
  predict post partum depression
• SUDANN software was used for this analysis

6
Infant Demographics

• 62-252 days old (mean 111 days)
• 90
• 49 male infants
• 8.4
• 7.2
• 37 Breast fed (current) 70 (ever)

7
Maternal Demographics

• Age 9.8 27.3 30-34yo 16.5 35
• Race 87.3 White, 8.2 Black, 3.2 Asian
  1.1 Amer Indian 0.2 Other non-white
• Hispanic Ethnicity 22.1
• Income 27
• 14.2 25-40 K 48.7 40K
• Education 15.2 12

8
Maternal Demographics

• Married 64
• Insurance 38 Public 61 Private
• Parity 42 1st Birth 58 2nd or later
• Smoking (Current) 16 (last 3 mo) 12
• Unintended pregnancy 36

9
Variable Fussy Baby

• In general, how easy is it to calm your baby when
  he or she is crying or fussing?
• Very easy 50.7
• Somewhat easy 41.0
• Somewhat difficult 7.2
• Very difficult 1.1

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Fussy Babies and Age
9.6 8.0 6.8 8.9
p NS
2 mo. 3 mo. 4 mo. 5 mo.
11
Fussy Babies and Low Birth Weight
11.2
8.1
p
2,500
gm No difference for VLBW 8.3)
12
Fussy Babies and Maternal Race
17.1
p
7.7 9.4
White Black Other (n149)
13
Fussy Babies

• Hispanic ethnicity, maternal age, education,
  marital status, household income, insurance,
  parity, smoking and breast feeding did not
  predict inconsolability in these babies

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Variable Post Partum Depression

• In the months after your delivery, would you say
  that you were.
• Not at all depressed 43.0
• A little depressed 37.8
• Moderately depressed 12.2
• Very depressed 3.4
• Very depressed and
• had to get help 3.5

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Postpartum Depression and Maternal Education
21.9 22
16.4
p 12
16
Postpartum Depression and Marital Status
23.9
16.6
p Unmarried Married
17
Postpartum Depression and Household Income
40,000
24
p 14.4
40,000
18
Postpartum Depression and Health Insurance
23.1
16.3
p Public Private
19
Postpartum Depression and Low Birth Weight
29.2
p 18.4
2,500 gm
20
Postpartum Depression and Very Low Birth Weight
48.8
p 18.6
1,500 gm
21
Postpartum Depression and Unintended Pregnancy
22.8
16.8
p Unintended Intended
22
Postpartum Depression and Smoking
28.9 27.5 27.4
p 16.3 17.7 17.4
smoke no smoke smoke no smoke
smoke no smoke
3 months before last 3 months
current pregnancy pregnancy

23
Postpartum Depression and Breast Feeding
23 22.5
17.4 12.6
p p Ever BF Never BF Current BF Not BF now
24
Postpartum Depression

• Maternal age, race, Hispanic ethnicity and parity
  as well as infant age and sex did not predict
  report of depressive symptoms in these new
  mothers

25
Postpartum Depression and Fussy Babies
34.7
p
17.4
Fussy Consolable
26
Fussy Babies and Postpartum Depression
15.3
p
6.7
PP Depression No depression
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Logistic Regression Fussy Baby

• AOR (95 CI)
• Fussy Baby
• Post Partum Depression 2.58 (1.74-3.82)
• Other Race 2.79 (1.48-5.24)
• Infant
• p
• Maternal age, ethnicity, marital
  status and education, family income, unintended
  pregnancy, current smoking or breast feeding and
  infant age did not predict postpartum depressive
  symptoms in this model

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Logistic Regression Postpartum Depression

• AOR (95 CI)
• Postpartum Depression
• Fussy Baby 2.57 (1.71-3.85)
• Not currently breast fed 2.28 (1.64-3.16)
• Family Income (1.19-2.59)
• Unintended Pregnancy 1.44 (1.06-1.94)
• Infant
• p
• Maternal age, ethnicity, race,
  education, marital status and current smoking as
  well as infant age did not predict postpartum
  depressive symptoms in this model

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Conclusions

• In this population based survey, 1 in 12 babies
  were reported to be difficult to console by their
  mothers and almost 1 in 5 new mothers
  acknowledged postpartum depressive symptoms
• Postpartum depressive symptoms were more
  prevalent in disadvantaged mothers

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Conclusions

• Inconsolability was more prevalent in low birth
  weight infants and also in those few babies in
  our small but diverse other race category

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There are definitelimitations to this study

• Infant inconsolability was measured by a single
  question posed to new mothers. No information on
  the amount of crying was obtained
• Maternal depressive symptoms were also measured
  using a single question
• The population sampled is that in RI and may not
  reflect families in other parts of the US

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Implications

• Pediatric primary care providers are in a unique
  position to identify mothers who are experiencing
  depressive symptoms and may be effective in
  supporting them, counseling them and referring
  them for treatment

33
Logistic Regression Postpartum Depression (w/o
child age)

• AOR (95 CI)
• Postpartum Depression
• Fussy Baby 2.57 (1.72-3.85)
• Not currently breast fed 2.22 (1.6-3.07)
• Family Income (1.17-2.55)
• Unintended Pregnancy 1.43 (1.06-1.92)
• Infant
• p
• Maternal age, ethnicity, race,
  marital status, current smoking and education did
  not predict postpartum depressive symptoms