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

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.