Trajectory of Postpartum Depression and Coping Style Among Chinese Women in Hong Kong: A Prospective Longitudinal Study

Abstract

Background and Purpose: Past studies in the West show that the time of postpartum depression (PPD) onset varies among women, and that the level of PPD changes over time. However, most studies on Chinese women documented depression levels up to 6 weeks postpartum only, and often with single time point. The current study attempted to examine the trajectories of PPD among Chinese women by (a) examining their depression from first trimester to 6 months postpartum; and (b) investigating whether coping style predicts PD trajectories. Methods This was a prospective longitudinal study. Predominantly ethnic Chinese pregnant women at first trimester of pregnancy (N = 361) were recruited at a public hospital in Hong Kong. Upon giving consent, they were asked to complete the questionnaire at the clinic (T0), and to return mail-in questionnaires at 6 weeks postpartum (T1) and 6 months postpartum (T2). Depression was measured by the Edinburgh Postnatal Depression Scale (EPDS), and coping style was measured by Ways of Coping Questionnaire (WCQ). By the end of the study, 104 women completed all three questionnaires. Results The prevalence of PPD, indicated by EPDS cutoff score of 10 or greater, was 18% at T0, 28% at T1 and 24% at T2. Among them, 63% displayed no PPD at both postpartum time points (non-depressed), 13% displayed PPD at T1 but not T2 (recovery), 9% displayed PPD at T2 but not T1 (late onset), and 15% displayed PPD at both time points (sustained). Logistic regression showed that controlling for depression at T0, distancing, seeking social support and wishful thinking were related to sustained PPD group (odds ratio: 0.58, 0.66 and 1.71 respectively; 95% CI: 0.34-0.97, 0.49-0.88 and 1.16-2.53 respectively, all ps < .05) but not recovery nor late onset group. Conclusion and Implications The study showed women displayed different trajectories of PPD, namely non-depressed, recovery, late onset and sustained. The current PPD prevalence findings were comparable to past studies in Hong Kong, but higher compared to other Chinese populations in Beijing and Taiwan. The study also suggested coping style may predict the trajectory of postpartum depression. Early identification of maladaptive coping style could be conducive in preventing postpartum depression.