Identifying women at risk of postnatal depression: prospective longitudinal study.

Objective: To identify psychosocial risk factors for postnatal depression among Hong Kong Chinese women.
Design: Prospective longitudinal study involving self-report questionnaires and face-to-face interviews.
Setting: University teaching hospital, Hong Kong.
Participants: Two hundred and twenty consecutive Chinese women who were admitted to the postnatal ward of the Department of Obstetrics and Gynaecology from 6 November 1996 to 18 January 1997.
Main Outcome Measures: Psychiatric diagnoses were established using the clinician-administered Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. Psychosocial risk factors were ascertained by conducting face-to-face interviews and using psychometric rating scales.
Results: Of the 330 women who delivered during the study period, 220 (66.7%) agreed to participate in the study. The 220 participants had a mean age of 29 years (range, 16-42 years). Postnatal depression was associated with depression during pregnancy, elevated depression score at delivery, and prolonged postnatal 'blues'. Other correlates of postnatal depression were temporary housing accommodation, financial difficulties, two or more induced abortions, past psychiatric disorders (including depression), and an elevated neuroticism score. Postnatal depression was more likely if the spouse was disappointed with the gender of the newborn.
Conclusion: Some risk factors are similar to those found in the West, whereas others (spouse disappointment and history of abortion) may be unique to the local population. To help identify women who are at particularly high risk of developing postnatal depression, obstetricians and midwives in Hong Kong should consider codifying the identified risk factors into a check-list.