A Population Based Survey of Infant Inconsolability and Postpartum Depression

A Population Based Survey of Infant Inconsolability and Postpartum Depression

Pamela C. High*, Rachel Cain**,

Hanna Kim** and Samara Viner-Brown**

Hasbro Children’s Hospital/ Brown Medical School*

Division of Family Health RI Department of Health**

Providence, RI

Presentation for Society of Developmental-Behavioral Pediatrics, Sept. 26, 2005, San Diego, CA

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

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

Methods

Data was obtained from RI’s 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 sampled2,947 responded (72% weighted response rate)

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

Infant Demographics

62-252 days old (mean 111 days)90% <152 days (<5 months)49 % male infants8.4% <37 weeks gestation7.2 % <2,500 grams37 % Breast fed (current); 70% (ever)

Maternal Demographics

Age: 9.8 % <20yo 46.5 % 20-29yo 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-whiteHispanic Ethnicity: 22.1% Income: 27% <$16 K, 10.1% $16-25K

14.2% $25-40 K 48.7 % > $40KEducation: 15.2% <12, 30.1% 12, 54.7% >12

Maternal Demographics

Married: 64 % Insurance: 38 % Public 61 % PrivateParity: 42% 1st Birth 58% 2nd or laterSmoking: (Current) 16% (last 3 mo) 12%Unintended pregnancy: 36%

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%

Fussy Babies and Age

2 mo. 3 mo. 4 mo. > 5 mo.

9.6 % 8.0 % 6.8% 8.9%

p= NS

Fussy Babies and Low Birth Weight

<2,500 gm >2,500 gm

No difference for VLBW <1,500 gm. (8.8% vs. 8.3%)

11.2 %

8.1 %

p<0.001

Fussy Babies and Maternal Race

White Black Other (n=149)

7.7 % 9.4 %

17.1 %

p<0.05

Fussy Babies

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

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%

Postpartum Depression and Maternal Education

<12 12 >12

21.9% 22%

16.4%p<0.01

Postpartum Depression and Marital Status

Unmarried Married

23.9%

16.6%p<0.001

Postpartum Depression and Household Income

>$40,000

<$40,000 >$40,000

24 %

14.4 %p<0.0001

Postpartum Depression and Health Insurance

Public Private

23.1 %

16.3 %p<0.001

Postpartum Depression and Low Birth Weight

< 2,500 gm > 2,500 gm

29.2 %

18.4 %p<0.0001

Postpartum Depression and Very Low Birth

Weight

< 1,500 gm > 1,500 gm

48.8 %

18.6 %

p<0.0001

Postpartum Depression and Unintended

Pregnancy

Unintended Intended

22.8 %

16.8 %p<0.01

Postpartum Depression and Smoking

3 months before last 3 months current pregnancy pregnancy

28.9 % 27.5% 27.4%

16.3 % 17.7% 17.4%p<0.01

smoke no smoke smoke no smoke smoke no smoke

Postpartum Depression and Breast Feeding

Ever BF Never BF Current BF Not BF now

23 % 22.5%

17.4 % 12.6%p<0.01 p<0.0001

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

Postpartum Depression and Fussy Babies

Fussy Consolable

34.7 %

17.4 %p<0.0001

Fussy Babies and Postpartum Depression

PP Depression No depression

15.3 %

6.7 %

p<0.0001

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 < 2,500 grams 1.26 (1.05-1.51) *

*p<0.05 **p<0.01 ***p<0.0001

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

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 < $40,000 1.75 (1.19-2.59)**» Unintended Pregnancy 1.44 (1.06-1.94) *» Infant < 2,500 grams 1.26 (1.05-1.51)*

*p<0.05 **p<0.01 ***p<0.0001

Maternal age, ethnicity, race, education, marital status and current smoking as well as infant age did not predict postpartum depressive symptoms in this model

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

Conclusions

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

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

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

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 < $40,000 1.73 (1.17-2.55) **» Unintended Pregnancy 1.43 (1.06-1.92) *» Infant < 2,500 grams 1.26 (1.05-1.51) *

*p<0.05 **p<0.01 ***p<0.0001

Maternal age, ethnicity, race, marital status, current smoking and education did not predict postpartum depressive symptoms