Events after Stillbirth in Relation to Maternal Depressive Symptoms: A Brief Report

Authors

  • Pamela J Surkan PhD, ScD,

    Corresponding author
    1. 1Pamela J. Surkan is a Research Fellow and 5Paul W. Dickman is an Associate Professor at the Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, and 3Sven Cnattingius is a Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; 2Ingela Rådestad is a Professor at the Department of Caring Sciences and Public Health, Mälardalen University, Eskilstuna; and 4Gunnar Steineck is a Professor at the Department of Oncology, Division of Clinical Cancer Epidemiology, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.
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  • 1 Ingela Rådestad PhD,

    1. 1Pamela J. Surkan is a Research Fellow and 5Paul W. Dickman is an Associate Professor at the Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, and 3Sven Cnattingius is a Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; 2Ingela Rådestad is a Professor at the Department of Caring Sciences and Public Health, Mälardalen University, Eskilstuna; and 4Gunnar Steineck is a Professor at the Department of Oncology, Division of Clinical Cancer Epidemiology, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.
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  • 2 Sven Cnattingius MD, PhD,

    1. 1Pamela J. Surkan is a Research Fellow and 5Paul W. Dickman is an Associate Professor at the Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, and 3Sven Cnattingius is a Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; 2Ingela Rådestad is a Professor at the Department of Caring Sciences and Public Health, Mälardalen University, Eskilstuna; and 4Gunnar Steineck is a Professor at the Department of Oncology, Division of Clinical Cancer Epidemiology, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.
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  • 3 Gunnar Steineck MD, PhD,

    1. 1Pamela J. Surkan is a Research Fellow and 5Paul W. Dickman is an Associate Professor at the Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, and 3Sven Cnattingius is a Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; 2Ingela Rådestad is a Professor at the Department of Caring Sciences and Public Health, Mälardalen University, Eskilstuna; and 4Gunnar Steineck is a Professor at the Department of Oncology, Division of Clinical Cancer Epidemiology, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.
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  • and 4 Paul W. Dickman PhD 5

    1. 1Pamela J. Surkan is a Research Fellow and 5Paul W. Dickman is an Associate Professor at the Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, and 3Sven Cnattingius is a Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm; 2Ingela Rådestad is a Professor at the Department of Caring Sciences and Public Health, Mälardalen University, Eskilstuna; and 4Gunnar Steineck is a Professor at the Department of Oncology, Division of Clinical Cancer Epidemiology, Sahlgrenska Academy, Sahlgrenska University Hospital, Göteborg, Sweden.
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  • This study was supported by a grant from the Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.

Pamela J. Surkan, PhD, ScD, Exposure, Epidemiology and Risk Program, Harvard School of Public Health, Landmark Center, 401 Park Drive, 4th Floor West, Room 415, Boston, MA 02215, USA.

Abstract

ABSTRACT: Background: Actions taken after a stillbirth can affect long-term psychological morbidity. Our objective was to study how infant bonding and maternal actions after stillbirth are associated with ensuing depressive symptoms. Methods: Using the population-based Swedish Medical Birth Register, we identified all 380 Swedish-speaking women who gave birth to singleton stillborn infants in Sweden in 1991. Of these, 314 (83%) completed a postal questionnaire 3 years after the stillbirth. Items included actions taken to bond with the baby and demographics. The association between care-related factors and later maternal depressive symptoms was quantified using relative risks estimated using multivariable regression. Results: We observed an almost sevenfold increased risk of depressive symptoms for mothers who reported not being with their babies as long as they wished (adjusted risk ratio [RR] 6.9, 95% CI 2.4–19.8). Compared with women who became pregnant again within 6 months, those with no later pregnancy were at higher risk of depressive symptoms (adjusted RR 2.8, 95% CI 0.9–8.4). In addition, compared with women who experienced a stillbirth in their first pregnancy, stillbirth occurring with an infant who was third in the birth order was related to a twofold risk of elevated depressive symptoms (adjusted RR 2.2, 95% CI 0.8–6.4). Furthermore, stillbirth occurring in a fourth or later pregnancy was associated with an almost sevenfold risk of depressive symptomatology (adjusted RR 6.7, 95% CI 2.2–20.5). No evidence of an association was found between other care-related actions and subsequent maternal depressive symptoms. Conclusions: Our results suggest that a mother being with the stillborn baby for as long as desired and the birth order of the stillbirth may influence her later depressive symptomatology. Compared with mothers who became pregnant again within 6 months, those who did not have a subsequent pregnancy were at higher risk of depressive symptoms at 3 years’ follow-up. (BIRTH 35:2 June 2008)

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