image: Fig. 1 (a) Prevalence of antenatal depression and GDP per capita of the participating sites by area during 2019–2023 (Xinjiang: Karamay; Guangdong: Shenzhen; Shanghai; Hunan: Changsha; Anhui: Wuhu; Zhejiang: Hangzhou, Huzhou, Jiaxing, Ningbo, Quzhou, Shaoxing, Shengzhou, Taizhou and Wenzhou; Liaoning: Dalian; Jiangxi: Nanchang; Henan: Zhengzhou; Shaanxi: Yan’an; Hainan: Haikou and Wenchang). (b) Prevalence of antenatal depression in all participants and in those with moderate to high partner support during 2019–2023.
Credit: ©Science China Press
This study is led by Prof. Hefeng Huang and Prof. Yanting Wu (Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University).
Antenatal depression represents a major contributor to maternal morbidity during the perinatal period. This condition often persists into the postnatal period and may escalate in severity, thereby exacerbating negative outcomes for both mothers and infants. Current prevalence data in China remain limited, underscoring the urgent need for large-scale multi-center studies. To develop effective preventive and management strategies for mental health across the perinatal period from pregnancy to the first year postpartum, a clear understanding of antenatal depression prevalence rates and related factors that are culturally specific is required.
This study was a cross-sectional study incorporating 100,200 pregnant women across four geographical regions of China (27 public hospitals from 11 provinces, metropolises, and autonomous areas) including the East (Shanghai, Zhejiang, Jiangxi, and Anhui), the South (Guangdong, Hunan, and Hainan), the North (Liaoning and Henan), and the West (Xinjiang and Shaanxi) from December 2019 to March 2023. The survey included questions related to demographic factors, lifestyle behaviors, and supportive resources. Antenatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) in the third trimester of pregnancy. Odds ratios (ORs) and 95% confidence intervals (CIs) were derived from the multiple logistic regression analysis to examine the association between various exposures and depressive symptoms outcome, where an EPDS score>9 was classified as possible depression for screening activities and an EPDS >12 was classified as probable depression for management.
The total prevalence of possible depression was 25.8% and 11.4% for probable depression. The highest prevalence of possible depression was in the North region at 30.8% and 15.7% for probable depression. The lowest possible and probable depression prevalence rates were in the East region at 24.5% and 10.6%, respectively. Young maternal age, low education levels and family income, unemployment, living alone, unmarried/divorced status, unintended pregnancy, multiple pregnancy, insufficient social support, tobacco/alcohol use, and poor sleep quality were related factors for antenatal depression. Notably, adequate partner support may have a modifying effect on the relationship between depressive symptoms and those non-modifiable risk factors, including maternal educational levels, employment status, age, and family income.
This study is the largest and first to provide a detailed analysis of antenatal depression, making significant contributions to the epidemiological literature on antenatal depression in China. The findings indicate that over one-quarter of pregnant women in China experience depressive symptoms. Socioeconomic factors play a crucial role in the development of antenatal depression, while family support—particularly from partners—exhibits protective effects. Partner support emerges as a key intervention target for reducing the risk of antenatal depression.
Journal
Science Bulletin