[Note: This article is being published in draft form for use in an active research study. Its contents may be adjusted as we receive feedback from collaborating health care professionals.]
Social support and community, a social determinant of health, is vital for physical and emotional well-being in all individuals, but especially after childbirth.1 It allows new parents to cope with psychological stressors during the postpartum period, especially through instrumental support, defined as practical help in terms of material aid or assistance with tasks. Social support has been shown to reduce stress and postpartum depression while increasing breastfeeding and improving infant care. The World Health Organization (WHO) identifies social support as a risk factor for the development of postpartum depression.2 A 2004 meta-analysis found low levels of social support to be a strong to moderate predictor of postpartum depression.3
A 2013 qualitative analysis identified women’s postpartum views and experiences after giving birth.4 Four focus groups made up of 33 ethnically diverse women in New York City were interviewed to discuss social support postpartum. Across all racial/ethnic groups, participants reported that the major challenges during the postpartum period were fulfilling basic personal care needs such as bathing and eating, household chores such as cooking and cleaning, and getting sleep. Main sources of instrumental and emotional support were identified as partners, friends, and family members. There were differences along racial/ethnic lines regarding access to social support, with Black and Latina participants mentioning that they had to ask for help and educate their loved ones on how to help, whereas white and other racial groups felt they had enough support without needing to ask. White and other racial groups were also the only participants to report having help from hired caregivers.
A 2022 cross-sectional survey employing nationally representative random sampling with 1,654 postpartum South Korean participants examined the relationship between social support and postpartum depression (PPD).5 Social support was defined as the exchange of resources intended to improve the recipient's lifestyle. To quantify perceived social support, participants were asked questions about how much support they received from friends, family, and significant others, using a survey instrument called the Multidimensional Scale of Perceived Social Support (MSPSS). Results showed that women with less perceived social support were more likely to experience PDD, with 20.7% of women with PPD having low levels of perceived social support compared to 14.3% with high perceived social support. Women with high perceived social support had higher levels of breastfeeding (54.6% vs 44.4% low social support) and better subjective health status (75.7% vs 46.5% low social support). This analysis highlights the importance of social support for postpartum women.
A 2019 case-control study examined the relationship between social support and postpartum depression in a racially and ethnically diverse population (n=1,517).6 Diagnosis of postpartum depression was made using the Mini International Neuropsychiatric Interview (MINI), a structured clinical interview used to assess psychiatric disorders. Social support was measured using the Medical Outcomes Study (MOS) social support survey (scored 0-5 with higher scores indicating more social support). Higher levels of perceived social support were significantly associated with less incidence of postpartum depression, with depressed participants scoring an average of 2.5 compared to control participants who scored an average of 3.8 (Odds Ratio [OR] 0.23, 95% Confidence Interval [CI] [0.19-0.27], p<0.0001). This association was the same when accounting for race and ethnicity.
A 2015 analysis of data from the Fragile Families and Child Well-being Study (n=4,150) examined the relationship between having a partner and social support, stress, and depression in postpartum women.7 The study enrolled parents and newborns from 20 US cities. The parents were mostly unmarried, young, and economically disadvantaged. Findings indicated that having a partner and having higher perceived social support was associated with lower stress and depression. On a scale of 0-4, the average intimate partner support was 3.49 for the study population, 3.76 for married women, 3.79 for cohabitating women, and 2.74 for single women. On a scale of 0-6, the average friend and family support was 4.04 for the study population, 4.71 for married women, 3.94 for cohabitating women, and 3.51 for single women. There was a 15% prevalence of postpartum depression among the study population compared to 12% among married women, 14% for cohabitating women, and 20% for single women. On a scale of 0-12, the average parenting-related stress was 4.08 among the study population, 3.85 among married women, 3.97 among cohabitating women, and 4.44 among single women. Social support was independently associated with a significantly lower risk of postpartum depression for all women.
A 2009 prospective cohort study (n=534) of married women in Hunan, China found that social support was significantly related to PPD as assessed by the Edinburgh Postnatal Depression Scale (EPDS, scores 13 or higher indicating depression).8 Participants were divided into four groups based on level of social support postpartum as assessed by the Social Support Rating Scale (SSRS, scored 0-66 with higher scores indicating more support) with scores ranging from 0-38 for the first quartile, 39-43 for the second, 44-46 for the third, and ≥47 for the fourth. A total of 19.3% of the study population had PPD. Among women in the first quartile with the lowest reported level of social support, 44.1% had PPD compared to 5.4% in the fourth quartile who had the highest reported level of social support (adjusted OR 9.64, 95% CI [4.09-22.69].
In a 2009 study, researchers examined the relationships between social support and health among 152 Chinese mothers in the United States less than a year after giving birth.9 Women reported experiencing physical exhaustion (51.1% within two months postpartum and 38.8% after two months) and interrupted sleep (48.2% and 63.8%). Perceived levels of social support as measured by the Postpartum Support Questionnaire (PSQ, scored 0-135 with higher scores indicating greater levels of support) were not high, with a mean score of 75.70. Social support was significantly correlated with physical and mental health. Postpartum depression as assessed by the Center for Epidemiologic Studies Depression Scale (CES-D) was present in 23.7% of participants.
References
- Healthy People 2030: Social Determinants of Health. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed July 25, 2023. https://health.gov/healthypeople/objectives-and-data/social-determinants-health
- Robertson E, Celasun N, Stewart D. Risk factors for postpartum depression. Postpartum depression: Literature review of risk factors and interventions. World Health Organization; 2008.
- Robertson E, Grace S, Wallington T, Stewart DE. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. Jul-Aug 2004;26(4):289-95. doi:10.1016/j.genhosppsych.2004.02.006
- Negron R, Martin A, Almog M, Balbierz A, Howell EA. Social support during the postpartum period: mothers' views on needs, expectations, and mobilization of support. Matern Child Health J. May 2013;17(4):616-23. doi:10.1007/s10995-012-1037-4
- Cho H, Lee K, Choi E, et al. Association between social support and postpartum depression. Sci Rep. Feb 24 2022;12(1):3128. doi:10.1038/s41598-022-07248-7
- Pao C, Guintivano J, Santos H, Meltzer-Brody S. Postpartum depression and social support in a racially and ethnically diverse population of women. Arch Womens Ment Health. Feb 2019;22(1):105-114. doi:10.1007/s00737-018-0882-6
- Reid KM, Taylor MG. Social support, stress, and maternal postpartum depression: A comparison of supportive relationships. Soc Sci Res. Nov 2015;54:246-62. doi:10.1016/j.ssresearch.2015.08.009
- Xie RH, He G, Koszycki D, Walker M, Wen SW. Prenatal social support, postnatal social support, and postpartum depression. Ann Epidemiol. Sep 2009;19(9):637-43. doi:10.1016/j.annepidem.2009.03.008
- Cheng CY, Pickler RH. Effects of stress and social support on postpartum health of Chinese mothers in the United States. Res Nurs Health. Dec 2009;32(6):582-91. doi:10.1002/nur.20356
