Increase of depressive symptomatology during pregnancy over 25 years’ time in four population based cohorts

Abstract

Background: The use of psychotropic drugs for depression during pregnancy has increased over the past decades, but it is unclear whether women are becoming more depressed over time. Methods: We investigated the occurrence of depressive symptoms during pregnancy in four cohorts (N 300–2000) in the same area in the Netherlands over a period of 25 years using a similar study design. Depressive symptoms were assessed using the Edinburgh Depression Scale (EDS) at various time points during pregnancy. Demographics, lifestyle factors, obstetric characteristics and EDS scores were compared between the four cohorts. Results: From 1988 to 2014, Mean EDS scores during the first and third trimester of pregnancy increased significantly (P < 0.001). The number of women with elevated EDS scores doubled from 7% in 1988–1989 to 14% in 2012–2014 (P = 0.001). The number of highly educated women increased from 23% to 66% and those with paid employment from 75% to 95%, while smoking and alcohol use decreased significantly (all Ps < 0.001). These trends were similar to those of the National Statistics. A previous history of depression, multi-parity and paid employment were associated with higher EDS scores. Limitations: Women were highly educated, predominantly Caucasian and had a partner. Conclusions: Paradoxically, there was a significant increase in depressive symptomatology during pregnancy over a period of 25 years, while protective factors for depression during pregnancy improved. Potential explanations could be greater awareness, high societal expectations, use of social media or the stressful combination of paid work and children at home.