Psychosocial predictors of disappointment with delivery and puerperal depression

A longitudinal study


Address for correspondence: Terhi Saisto, M.D.
Helsinki University Central Hospital
Department of Obstetrics and Gynecology
Haartmaninkatu 2
FIN-00290 Helsinki


Background. To examine the extent to which personality characteristics, depression, fear and anxiety about pregnancy and delivery, and socio-economic background, predict disappointment with delivery and the risk of puerperal depression.

Methods. Two hundred and eleven women filled in questionnaires measuring personality traits, socio-economic factors, and marital satisfaction once before and once after the 30th week of pregnancy, and 2–3 months after delivery, when obstetric data about pregnancy and delivery was also collected.

Results. The women who were disappointed with their delivery or suffered from puerperal depression had been more depressed already in early pregnancy. Regression analysis showed that the strongest predictors of disappointment with delivery were labor pain (increase in R2=0.14, p<0.001) and emergency Cesarean (increase in R2=0.18, p<0.001).

Puerperal depression was predicted by depression (increase in R2=0.16, p<0.001), and by personal traits such as general anxiety, vulnerability and neuroticism (increase in R2=0.32, p<0.001), both before 30 weeks of pregnancy and prior to the delivery (for depression increase in R2=0.05, p<0.001, and for anxiety and vulnerability increase in R2=0.04, p<0.01). The strongest predictors were depression at both time points before delivery (beta=0.51, p<0.001, and beta=0.39, p<0.001). Pregnancy- and delivery-related anxiety prior to the delivery also predicted puerperal depression, but complications of the pregnancy and delivery did not.

Conclusions. Depression in early pregnancy predicts disappointment with the delivery and is a strong predictor of puerperal depression.