Aurélie Nakamura1, Fabienne El-Khoury Lesueur2, Anne-Laure Sutter-Dallay3, Jeanna-Ève Franck2, Xavier Thierry4, Maria Melchior5, Judith van der Waerden2. 1. Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; French School of Public Health (EHESP), Doctoral Network, Rennes, France. Electronic address: aurelie.nakamura@iplesp.upmc.fr. 2. Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France. 3. INSERM, UMR 1219, Bordeaux Population Health, Bordeaux University, France; University Department of Adult Psychiatry, Charles-Perrens Hospital, 33000, Bordeaux, France. 4. UMS Elfe Team, Institut National d'Etudes Démographiques (INED), F75000 Paris, France. 5. Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Department of Social Epidemiology, F75012 Paris, France; French collaborative Institute on Migration (ICM), Paris, France.
Abstract
BACKGROUND: An advantaged socioeconomic position (SEP) and satisfying social support during pregnancy (SSP) have been found to be protective factors of maternal postpartum depression (PDD). An advantaged SEP is also associated with satisfying SSP, making SSP a potential mediator of social inequalities in PPD. SEP, SSP and PPD are associated with migrant status. The aim of this study was to quantify the mediating role of SSP in social inequalities in PPD regarding mother's migrant status. METHODS: A sub-sample of 15,000 mothers from the French nationally-representative ELFE cohort study was used for the present analyses. SEP was constructed as a latent variable measured with educational attainment, occupational grade, employment, financial difficulties and household income. SSP was characterized as perceived support from partner (good relation, satisfying support and paternal leave) and actual support from midwives (psychosocial risk factors assessment and antenatal education). Mediation analyses with multiple mediators, stratified by migrant status were conducted. RESULTS: Study population included 76% of non-migrant women, 12% of second and 12% of first generation migrant. SEP was positively associated with support from partner, regardless of migrant status. Satisfying partner support was associated with a 8 (non-migrant women) to 11% (first generation migrant women) reduction in PPD score. LIMITATIONS: History of depression was not reported. CONCLUSIONS: Partner support could reduce social inequalities in PPD. This work supports the need of interventions, longitudinal and qualitative studies including fathers and adapted to women at risk of PPD to better understand the role of SSP in social inequalities in PPD.
BACKGROUND: An advantaged socioeconomic position (SEP) and satisfying social support during pregnancy (SSP) have been found to be protective factors of maternal postpartum depression (PDD). An advantaged SEP is also associated with satisfying SSP, making SSP a potential mediator of social inequalities in PPD. SEP, SSP and PPD are associated with migrant status. The aim of this study was to quantify the mediating role of SSP in social inequalities in PPD regarding mother's migrant status. METHODS: A sub-sample of 15,000 mothers from the French nationally-representative ELFE cohort study was used for the present analyses. SEP was constructed as a latent variable measured with educational attainment, occupational grade, employment, financial difficulties and household income. SSP was characterized as perceived support from partner (good relation, satisfying support and paternal leave) and actual support from midwives (psychosocial risk factors assessment and antenatal education). Mediation analyses with multiple mediators, stratified by migrant status were conducted. RESULTS: Study population included 76% of non-migrant women, 12% of second and 12% of first generation migrant. SEP was positively associated with support from partner, regardless of migrant status. Satisfying partner support was associated with a 8 (non-migrant women) to 11% (first generation migrant women) reduction in PPD score. LIMITATIONS: History of depression was not reported. CONCLUSIONS: Partner support could reduce social inequalities in PPD. This work supports the need of interventions, longitudinal and qualitative studies including fathers and adapted to women at risk of PPD to better understand the role of SSP in social inequalities in PPD.
Authors: Maria Melchior; Katharine Barry; David Cohen; Sabine Plancoulaine; Jonathan Y Bernard; Karen Milcent; Malamine Gassama; Ramchandar Gomajee; Marie-Aline Charles Journal: BMC Public Health Date: 2022-04-30 Impact factor: 4.135