Association of Childbirth Pain with Postnatal Depressive and Anxiety Disorders in Nulliparous Parturients: A Prospective Study

Chin Wen Tan; Hon Sen Tan; Rehena Sultana; Anne Chui; Tze-Ern Chua; Helen Chen; Ban Leong Sng

doi:10.2147/NDT.S321367

Association of Childbirth Pain with Postnatal Depressive and Anxiety Disorders in Nulliparous Parturients: A Prospective Study

Neuropsychiatr Dis Treat. 2021 Aug 13:17:2625-2636. doi: 10.2147/NDT.S321367. eCollection 2021.

Authors

Chin Wen Tan^{1

2}, Hon Sen Tan^{1

2}, Rehena Sultana³, Anne Chui⁴, Tze-Ern Chua^{5

6}, Helen Chen^{5

6}, Ban Leong Sng^{1

2}

Affiliations

¹ Department of Women's Anesthesia, KK Women's and Children's Hospital, Singapore.
² Anesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore.
³ Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.
⁴ Lee Kong Chian School of Medicine, Singapore.
⁵ Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore.
⁶ Pediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore.

Abstract

Purpose: There is limited knowledge on the relationship between postnatal depression and childbirth pain characteristics associated with childbirth. We investigated whether the characteristics of childbirth pain, as assessed by Short-form-McGill Pain Questionnaire-2 (SF-MPQ-2), were associated with postnatal anxiety and depressive disorders.

Patients and methods: Nulliparous parturients who received labor epidural analgesia (LEA) and delivered in our institution were invited to have a Mini-International Neuropsychiatric Interview (MINI) assessment following their 5-9 weeks post-delivery follow-up phone survey of a larger study. Parturients' demographics, pre-delivery questionnaires on pain and psychological vulnerabilities, LEA data, maternal and neonatal outcomes, postnatal follow-up survey on pain and psychological vulnerabilities, pain and breastfeeding were collected accordingly. The primary outcome was the binary variable (yes/no) of the presence of postnatal depression and/or anxiety disorders based on the post-delivery MINI assessment.

Results: Among the 107 parturients who participated in the post-delivery MINI assessment, a total of 40 (42.5%) patients were found to have postnatal anxiety and depressive disorders. A greater pre-delivery SF-MPQ-2 neuropathic pain mean subscale score (adjusted odds ratio (OR) 1.32, 95% CI 1.00-1.73, p=0.0482) and greater post-delivery Edinburgh Postnatal Depression Scale (EPDS) at 5-9 weeks post-delivery (adjusted OR 1.30, 95% CI 1.13-1.50, p=0.0002) were independently associated with the presence of postnatal anxiety and/or depressive disorders (receiver operating characteristic (ROC) = 0.7489).

Conclusion: Patients with greater pre-delivery neuropathic pain and higher EPDS scores at 5-9 weeks post-delivery are more likely to have postnatal depression and/or anxiety disorders, suggesting possible associations between pain and psychological vulnerability in the development of postnatal mental disorders.

Keywords: anxiety; neuropathic pain; pain vulnerability; postnatal depression.

Grants and funding

This work was supported by the funding from the National Medical Research Council Clinical Trials Grant - Investigator-Initiated Trials (CTG13feb013). The aforementioned sponsor was not involved in the study activities.