Associations between social capital and maternal depression: results from a follow-up study in China

Inverse Association Between Mothers' Cognitive Social Capital During Pregnancy and Postpartum Depression: The Japan Environment and Children's Study

Purpose

Several studies have reported an apparent inverse association between cognitive social capital and depression in various groups, but insights into this association in perinatal mothers are fairly limited. Therefore, we explored the possible associations between expectant mothers' cognitive social capital (ie, neighborhood trust and reciprocity and generalized trust and reciprocity) and postpartum depression at 1 and 6 months after delivery.

Patients and Methods

As part of an ongoing cohort study, the Japan Environment and Children's Study, cognitive social capital was evaluated using a questionnaire survey during mid-late pregnancy and postpartum depression was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale. This study analyzed data from 81,670 mothers. Logistic regression analysis was performed to calculate the odds ratios (ORs) for postpartum depression by the degree of neighborhood and generalized trust and reciprocity (high, relatively high, neutral, relatively low, and low) using the high category as a reference.

Results

Regardless of the measurement time point, prevalence gradually increased as the degree of neighborhood trust decreased (all p < 0.001), suggesting a higher likelihood of postpartum depression with less neighborhood trust. A comparable tendency was also observed for the other three variables of cognitive social capital (all p < 0.001). Moreover, the inverse association of postpartum depression with generalized trust and reciprocity was markedly stronger (ORs for low category ≥ 2.70) than that with neighborhood trust and reciprocity (ORs for low category ≤ 1.96).

Conclusion

Our findings highlight a statistically significant inverse association between cognitive social capital during pregnancy and postpartum depression at both time points.

Nutritional factors and cross-national postpartum depression prevalence: an updated meta-analysis and meta-regression of 412 studies from 46 countries

Background

Postpartum depression (PPD) is the most common complication associated with childbirth and can lead to adverse outcomes for both mothers and their children. A previous meta-analysis found that PPD prevalence varies widely across countries. One potential underexplored contributor to this cross-national variation in PPD is diet, which contributes to mental health and varies significantly around the world. Here, we sought to update the global and national estimates of PPD prevalence using systematic review and meta-analysis. Further, we examined whether cross-national variation in PPD prevalence is associated with cross-national variation in diet using meta-regression.

Methods

To estimate national rates of PPD prevalence, we conducted an updated systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale between 2016-2021 and combined our findings with a previous meta-analysis of articles published between 1985-2015. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To examine dietary predictors, we extracted data on sugar-sweetened beverage, fruit, vegetable, total fiber, yogurt, and seafood consumption from the Global Dietary Database. Random effects meta-regression was used to test whether between-country and within-country variation in dietary factors predicted variation in PPD prevalence, controlling for economic and methodological variables.

Results

412 studies of 792,055 women from 46 countries were identified. The global pooled prevalence of PPD was 19.18% (95% confidence interval: 18.02 to 20.34%), ranging from 3% in Singapore to 44% in South Africa. Countries that consumed more sugar-sweetened beverages (SSBs) had higher rates of PPD (Coef. = 0.325, p = 0.044, CI:0.010-0.680); Moreover, in years when higher rates of sugar-sweetened beverages were consumed in a country, there were correspondingly higher rates of PPD in that country (Coef. = 0.129, p = 0.026, CI: 0.016-0.242).

Conclusion

The global prevalence of PPD is greater than previous calculations, and drastically varies by country. Sugar-sweetened beverage consumption explained some of the national variation in PPD prevalence.

Association of social capital with mental health and quality of life among low- and high-risk pregnant women

INTRODUCTION

Social capital means having resources and support in relationships and social ties. It can affect the individual's quality of life and mental health. The present study investigated the association between social capital with psychological status and quality of life among low-risk and high-risk pregnant women.

METHODS

The present cross-sectional study was conducted with the participation of 394 pregnant women receiving prenatal care in urban comprehensive health centers in Qazvin, Iran. Two-stage sampling was used to select comprehensive health centers by random cluster sampling and then pregnant women randomly. Social capital, quality of life (QoL), psychological status, and demographic and obstetric characteristics were assessed. Uni-variable and multivariable linear regression models were used to analyze the data.

RESULTS

Among the participants, 267 had low-risk pregnancies (67.77%) and the remainder were high-risk. The mean age of participants was 27.94 years (SD=5.86), the mean gestational age was 23.63 weeks (SD=7.71). The mean overall quality of life score among low-risk pregnant women was 32.00 (SD=5.27) and among high-risk pregnant women was 29.70 (SD=3.65). High-risk pregnant women experienced significantly higher anxiety and depression and fear of COVID-19. Social capital had a significant and weak relationship with anxiety among low-risk pregnant women (r = 0.22, p < 0.001). Also, a weak and significant relationship between social capital and anxiety (r = 0.24, p = 0.007), depression (r = 0.24, p = 0.007) and fear of COVID-19 (r = 0.27, p = 0.002) was found among high-risk pregnant women.

CONCLUSION

Women with high-risk pregnancies experienced lower quality of life, higher anxiety and depression, and greater fear of COVID-19. There was also a weak relationship between social capital and the aforementioned variables among high-risk pregnant women. Designing and implementing interventions to increase quality of life and reduce anxiety and stress among high-risk pregnant women appears to be warranted.

Temporal trend and subgroup disparities in the prevalence and treatment of those who screen positive for depression in China: A population-based study

Background

In China, improving mental health has been far behind its accomplishments for other diseases. With depression as one of the most prevalent mental disorders, the aim of this study was to evaluate temporal trends in the prevalence and treatment of those who screen positive for depression in China, by age, gender, and province.

Methods

We used data from three nationally representative sample surveys: the China Health and Retirement Longitudinal Study (CHARLS), the China Family Panel Studies (CFPS), and the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression was judged by the Centre for Epidemiologic Studies Depression Scale. Access to treatment was judged by two items: if respondents received any treatment like anti-depressants, or if respondents received counselling from a mental health professional. Survey-specific weighted regressions were fitted to estimate the temporal trend and subgroup disparities, and then pooled by meta-analysis.

Results

In total 168,887 respondents were investigated. The overall prevalence of China populations who screen positive for depression was 25.7% (95% CI 25.2-26.2) during 2016-2018, decreased from 32.2% (95% CI 31.6-32.8) during 2011-2012. The gender gap increased with age and had no significant improvement from 2011-2012 to 2016-2018. The prevalence of depression in developed areas is more likely to show a lower value and decreasing trend, while the prevalence in underdeveloped areas is more likely to show a higher value and increasing trend, from 2011-2012 to 2016-2018. The overall proportion of those who received any needed treatment or counselling from a mental health professional slightly increased from 2011 (0.5%, 95% CI 0.4-0.7) to 2018 (0.9%, 95% CI 0.7-1.2), and mainly occurred for older adults aged 75 and above.

Conclusion

The prevalence of those who screen positive for depression decreased by about 6.5% from 2011-2012 to 2016-2018 in China, but only tiny improvements were made in accessibility to mental health care. Corresponding disparities were identified in age, gender, and province.

Effect of the mHealth-supported Healthy Future programme delivered by community health workers on maternal and child health in rural China: study protocol for a cluster randomised controlled trial

INTRODUCTION

Millions of young rural children in China still suffer from poor health and malnutrition, partly due to a lack of knowledge about optimal perinatal and child care among rural mothers and caregivers. Meanwhile, there is an urgent need to improve maternal mental health in rural communities. Comprehensive home visiting programmes delivered by community health workers (CHWs) can bridge the caregiver knowledge gap and improve child health and maternal well-being in low-resource settings, but the effectiveness of this approach is unknown in rural China. Additionally, grandmothers play important roles in child care and family decision-making in rural China, suggesting the importance of engaging multiple caregivers in interventions. The Healthy Future programme seeks to improve child health and maternal well-being by developing a staged-based curriculum that CHWs deliver to mothers and caregivers of young children through home visits with the assistance of a tablet-based mHealth system. This protocol describes the design and evaluation plan for this programme.

METHODS AND ANALYSIS

We designed a cluster-randomised controlled trial among 119 rural townships in four nationally designated poverty counties in Southwestern China. We will compare the outcomes between three arms: one standard arm with only primary caregivers participating in the intervention, one encouragement arm engaging primary and secondary caregivers and one control arm with no intervention. Families with pregnant women or infants under 6 months of age are invited to enrol in the 12-month study. Primary outcomes include children's haemoglobin levels, exclusive breastfeeding rates and dietary diversity in complementary feeding. Secondary outcomes include a combination of health, behavioural and intermediate outcomes.

ETHICS AND DISSEMINATION

Ethical approval has been provided by Stanford University, Sichuan University and the University of Nevada, Reno. Trial findings will be disseminated through national and international peer-reviewed publications and conferences.

TRIAL REGISTRATION NUMBER

ISRCTN16800789.

The relationship between social capital and postpartum depression symptoms of lactating women in minority areas—A cross-sectional study from Guangxi, China

Background

Postpartum depression (PPD) is the most common mental illness affecting women during lactation, and good social capital is considered a protective factor. This study aimed to investigate PPD symptoms, and explore the relationships between social capital and PPD symptoms of lactating women in southwest minority areas in China.

Materials and methods

This cross-sectional study was conducted among 413 lactating women in Guangxi, China. Data were collected using the Edinburgh Postnatal Depression Scale and the Chinese version of the Social Capital Assessment Questionnaire. Hierarchical regression analysis was conducted to explore the factors influencing PPD symptoms, and a structural equation model was used to examine how social participation and cognitive social capital mediated PPD symptoms.

Results

The total prevalence of PPD symptoms (score &gt; 12) was 16.46%, and that of mild depression symptoms (9–12 score) was 22.03%. Nine variables predicted PPD symptoms and explained 71.6% of the variance in the regression model: higher age, lack of medical security, fixed occupation, breastfeeding time, self-caregiver, maternity leave, social participation, social trust, and social reciprocity. Furthermore, cognitive social capital mediated the relationship between social participation and PPD symptoms, with a mediation effect rate was 44.00%.

Conclusion

The findings of this study highlight that social capital, support from family members, maternity leave, and medical insurance play protective roles in the PPD symptoms of lactating women. It is necessary to improve social capital as a key strategy for interventions for PPD symptoms, and active social participation activities are critical to reducing PPD symptoms among lactating women in minority areas.

The mediation role of psychological capital between family relationship and antenatal depressive symptoms among women with advanced maternal age: a cross sectional study

Background

Due to changes in family policy in China, pregnancy at advanced age (30 years old or above) is prevalent. Advanced maternal age is known to be related to a variety of negative health outcomes, including antenatal depression. Family relationship quality might be an important factor for antenatal depressive symptoms among Chinese women with advanced maternal age. However, the underlying mechanisms in which family relationship quality can affect antenatal depressive symptoms among this population and how positive psychological capital (PsyCap) intervenes in this impact are not clear.

Objectives

To describe the prevalence and demographic characteristics of antenatal depressive symptoms among Chinese pregnant women with advanced maternal age, and to explore the mediation effect of PsyCap in the associations between family relationship quality and antenatal depressive symptoms.

Methods

We conducted a cross-sectional survey at a tertiary hospital in China. A total of 192 women with maternal age of 30 years or older completed the questionnaires. Data on antenatal depressive symptoms, PsyCap, family relationship quality and demographic characteristics were collected. The multiple mediation models in SPSS’s PROCESS macro were used to test whether PsyCap mediated the relationship between family relationship quality and antenatal depressive symptoms.

Results

Approximately 28.6% of participants had antenatal depressive symptoms and 6.8% reported poor family relationship quality. Participants with higher education (p = .02) and better family relationship quality (p = .00) were less likely to have antenatal depressive symptoms. PsyCap collectively (β = 1.14, p < .05), or more specifically resilience (β = 0.61, p < .05) significantly mediated the relationship between poor family relationship quality and antenatal depressive symptoms.

Discussion

The relationship between family relationship quality and antenatal depressive symptoms can be mediated by PsyCap collectively or via resilience specifically. It is important to screen antenatal depressive symptoms among pregnant women with advanced age, especially those who have poor family relationship quality. Counseling and psychotherapy initiatives for resilience-enhancing training for pregnant women at advanced age may provide a promising target to break the link between poor family relationship quality and antenatal depressive symptoms.

Association of Paternal Workplace and Community Social Capital With Paternal Postnatal Depression and Anxiety: A Prospective Study

OBJECTIVE

The aim of this study is to examine the association between workplace and community social capital and fathers' postpartum depression and anxiety at 3 months after delivery in Japan.

METHODS

Fathers who had babies delivered in two obstetric clinics in Tokyo, Japan were recruited to take part in the study (response rate = 76.2%). Participants completed questionnaires measuring workplace and community social capital, depression, and anxiety at 1 week and a follow-up at 3 months post-delivery (N = 398). Multiple linear regression analyses were performed with multiple imputation for missing data (at most, N = 60, 15.1%).

RESULTS

Community social capital was inversely associated with both depressive symptoms (β = -0.21, 95%CI = -0.33 to -0.08) and anxiety (β = -0.38, 95%CI = -0.66 to -0.11) at 3 months, after adjusting for covariates. No association was found between workplace social capital and depressive symptoms and anxiety.

CONCLUSION

Paternal community social capital, but not workplace social capital, was shown to be a preventive factor for paternal depression and anxiety up to 3 months post-delivery. To prevent paternal mental health problems during the postpartum period, an intervention to promote paternal community, rather than workplace, social capital may be warranted.

Association Between Dietary Quality and Postpartum Depression in Lactating Women: A Cross-Sectional Survey in Urban China

Background: Evidence on the effects of dietary quality on the risk of postpartum depression in the Chinese population is limited. This study aimed to examine the association between dietary quality and postpartum depression in Chinses lactating women. Methods: A total of 939 participants from 10 cities were included in this analysis. A one-time 24-h dietary recall was used to obtain the data on food consumption and dietary quality was assessed based on Diet Balance Index. The Edinburgh postnatal depression scale was considered at a cutoff point of 10 to detect postpartum depression. Poisson regression models were used to explore the association of dietary quality with postpartum depression. Results: Depressed women tended to have a more inadequate intake of vegetables and have more insufficient food variety. The median (25th, 75th) of the overall high bound score (HBS), low bound score (LBS), and diet quality distance (DQD) was 9 (5, 14), 30 (25, 37), and 40 (34, 47), respectively. Compared with subjects with the lowest quartile of LBS, those with the highest quartile of LBS had a higher risk of postpartum depression [adjusted prevalence ratio (aPR), 1.08; 95% confidence interval (95% CI), 1.01, 1.15; P for trend, 0.043]. We also observed a significant association between DQD and postpartum depression (Q4 vs. Q1: aPR, 1.07; 95% CI: 1.00, 1.14; P for trend, 0.036). Conclusion: Poor dietary quality was associated with postpartum depression in Chinese lactating women.

Social capital, depressive symptoms, and perceived quality of care among hypertensive patients in primary care

Background

Depression is an important issue in the management of hypertension. However, little attention has been paid to addressing such aspects of psychological health among patients with hypertension. We aimed to estimate the prevalence of depressive symptoms among patients with hypertension in primary care settings and to identify the potential role of social capital in predicting depressive symptoms. The influence of psychological well-being on the perceived quality of hypertensive care was also examined.

Methods

In Shenzhen, China, an on-site cross-sectional study was conducted from March to September 2017. In total, 1046 respondents completed a face-to-face survey interview. We examined the associations between social capital, depressive symptoms, and perceived quality of care.

Results

The results showed that 10.7% of patients with hypertension who attended primary care facilities had depressive symptoms. Two components of social capital—social ties (9.63 vs. 10.67; OR = 1.314, 95% CI 1.165–1.483; P < .001) and trust (3.46 vs. 3.89; OR = 2.535, 95% CI 1.741–3.691; P < .001)—were protective factors for depression among patients with hypertension in primary care settings. We also found that depressive symptoms were negatively associated with perceived quality of care (30.5 vs. 32.5; β = 1.341, 95% CI 0.463–2.219; P = .003)..

Conclusions

We found inverse associations between depressive symptoms and perceived quality of care and between social capital and the occurrence of symptoms of depression. Our findings suggest that strategies addressing both hypertension and depressive symptoms should be implemented to better manage hypertension. Appropriate social interventions should be designed and implemented.

Disease causing poverty: adapting the Onyx and Bullen social capital measurement tool for China

Background

Disease-causing poverty is a serious problem in rural China, where social capital can mediate the disease—poverty relationship. However, there is no generally accepted reliable, robust and viable measure of social capital for China’s unique socio-cultural context. This study adapts for China the widely used Onyx and Bullen social capital measurement scale and tests the validity and reliability of a modified Chinese Onyx-Bullen general scale, the Chinese Onyx-Bullen health scale, for a disease-causing-poverty subpopulation in rural China.

Methods

We conducted the forward and backward translation procedure and cross-cultural adaptation process to derive the 34 item Chinese Onyx-Bullen general scale. Next we collected through face-to face interviews a sample of disease-causing poverty population in rural Shandong province in China to test a 29 item modified Chinese Onyx-Bullen general scale for a health subpopulation. Most of the rural respondents had no formal work, so 5 work-related items in the Onyx-Bullen general scale were deleted in the Chinese Onyx-Bullen health scale. Exploratory factor analysis was conducted to evaluate the structure, validity, internal consistency and reliability of the Chinese Onyx-Bullen health scale. SPSS21.0 software was used for data analysis.

Results

A total of 467 people completed the scale. For the 29-item scale, a better simple structure was found when the number of factors was limited to 8. The absolute values of inter-factor correlations were in the range of 0.004 to 0.213 and the Kaiser-Meyer-Olkin value was 0.834. All the eight factors explain a total of 59.51% of the variance. The total scale had a Cronbach’s alpha = 0.868, in which seven of the eight factors had Cronbach’s α greater than 0.5.

Conclusion

The Chinese health version of the Onyx-Bullen general social capital scale showed an adequate reliability and validity in a rural disease-causing poverty subpopulation in Shandong province, providing the first general, robust, consistent and reliable measure of social capital in China. The Chinese Onyx-Bullen general social capital scale provides a scale for testing social capital in China or for modification along the lines of the Chinese Onyx-Bullen health scale.

Employing Position Generators to Assess Social Capital and Health: A Scoping Review of the Literature and Recommendations in Future Population Health Surveillance

Beneficial social connections are critical to individual-level health. These connections increase access to social support/resources that can be used to avoid or minimize the risks and consequences associated with diseases. How to best measure beneficial social connections to inform social network-level health interventions remains poorly understood. A scoping review of empirical health research studies was conducted to highlight the utility of employing position generators to assess how access to beneficial social connections was associated with population health and disparities. Our review yielded 39 articles of studies conducted between 2006-2018 across 14 predominantly high-income countries. Most studies (77%) with composite measures for beneficial social connections exhibited health-protective associations. Of the remaining articles, half found that greater diversity within one's network was associated with positive health outcomes. Only eight articles accounted for differences by advantaged statuses, indicating that beneficial connections elicited greater health-protective associations among disadvantaged groups. Employing position generators may inform interventions that seek to reduce health disparities by enhancing social capital in individuals from disadvantaged backgrounds.

Social capital and depression among migrant hypertensive patients in primary care

This study was to investigate prevalence of depression among migrant hypertensive patients in primary care and to examine hypertensive patients' social capital and its relationship with the prevalence of depression. An on-site-based cross-sectional study was performed in Shenzhen, China. A total of 830 migrant hypertensive patients completed the survey by using systematic sampling design. A questionnaire including information of depressive symptoms and social capital was administered by face-to-face interview surveys. We found that the prevalence of depression was 11.0% among migrant hypertensive patients in primary care. Social ties (odds ratio = 1.197, 95% confidence interval: 1.034, 1.387) and trust (odds ratio = 2.061, 95% confidence interval: 1.342, 3.165) were statistically significant associated with the prevalence of depression. Our study shows that the prevalence of depression is high among migrant hypertensive patients in primary care. It also suggests an inverse association between social capital and depression among migrant hypertensive patients. Although causal pathways between social capital and depression cannot be established by the present study, it is plausible to design and implement social interventions to improve mental health of migrant hypertensive patients in primary care.