Social and obstetric risk factors of antenatal depression: A cross-sectional study in China

BACKGROUND Antenatal depression is a disabling mental disorder among pregnant women and may cause adverse outcomes for both the mother and the offspring. Early identification and intervention of antenatal depression can help to prevent adverse outcomes. However, there have been few population-based studies focusing on the association of social and obstetric risk factors with antenatal depression in China. AIM To assess the sociodemographic and obstetric factors of antenatal depression and compare the network structure of depressive symptoms across different risk levels based on a large Chinese population. METHODS The cross-sectional survey was conducted in Shenzhen, China from 2020 to 2024. Antenatal depression was assessed using the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), with a score of >= 13 indicating the presence of probable antenatal depression. The chi 2 test and binary logistic regression were used to identify the factors associated with antenatal depression. Network analyses were conducted to investigate the structure of depressive symptoms across groups with different risk levels. RESULTS Among the 44220 pregnant women, the prevalence of probable antenatal depression was 4.4%. An age <= 24 years, a lower level of education (<= 12 years), low or moderate economic status, having a history of mental disorders, being in the first trimester, being a primipara, unplanned pregnancy, and pregnancy without pre-pregnancy screening were found to be associated with antenatal depression (all P < 0.05). Depressive symptom networks across groups with different risk levels revealed robust interconnections between symptoms. EPDS8 ("sad or miserable") and EPDS4 ("anxious or worried") showed the highest nodal strength across groups with different risk levels. CONCLUSION This study suggested that the prevalence of antenatal depression was 4.4%. Several social and obstetric factors were identified as risk factors for antenatal depression. EPDS8 ("sad or miserable") and EPDS4 ("anxious or worried") are pivotal targets for clinical intervention to alleviate the burden of antenatal depression. Early identification of high-risk groups is crucial for the development and implementation of intervention strategies to improve the overall quality of life for pregnant women.