Low level of social support is commonly cited as a risk factor for postpartum depression.

For example, an early review by Michael O’hara and Annette Swain in 1996 (1), reported that, among other factors, poor marital relations and low social support were strong predictors of postpartum depression.

However there is still considerable uncertainty about what “social support” actually means when trying to identify moms who may be at risk for postpartum depression.

In particular it is important to know which forms of social support may be especially protective against postpartum depression so that they can be encouraged.

Similarly, by knowing how the particular circumstances of a mom’s social relationships can influence her risk of postpartum depression, it means that at-risk moms can be highlighted early on in a proactive, rather than reactive manner.

Although social support doesn’t act alone as being a risk factor for postpartum depression, the frequency with which it is cited in the scientific literature as a risk factor merits a review of what the science says about it.

One of the greatest controversies relates to whether it is the relationship or marital status of the mom – in other words whether she is living alone as a single mom or in a cohabiting stable relationship with the father – which is important.  Or whether it is more the quality of her social relationships which is more important. Separating out these two concepts, which can be highly  correlated – is not always straightforward and has led to inconsistencies in the findings.

However, there is now starting to be sufficient data on the topic for some trends to emerge within the scientific literature.

In this article we aim to answer the following questions:

• Does marital status affect the likelihood of postpartum depression?

• What matters more, the status or the quality of the relationships?

• Does social support from the extended family and friends protect against postpartum depression?

• How does social support work to protect against postpartum depression?

• Can you use someone’s level of social support as a predictive measure of how at risk the mom is of suffering from postpartum depression

Why is it important to understand the relationship between level of social support and postpartum depression?

Postpartum depression is one of the most common psychiatric challenges that a mom may face in relation to the birth of her child.

Evidence shows that postpartum depression has a negative impact on the mom’s ability to adequately cope with the stresses of motherhood. It can also impair the emotional bond between mom and baby, which can have long lasting effects for the emotional well-being of the child.

Early identification of moms who may be at risk from postpartum depression, even before she starts to show depressive symptoms, could help to ensure that if/when symptoms do develop that the therapeutic systems can readily be put in place to enable her to receive the help and support that she requires as early as possible.

Knowing how the social relationships in a mom’s life can impact her risk of postpartum depression can be used to guide the kind of questions that health professionals ask during the mom’s pregnancy or postpartum to screen for those who are at higher risk.

Key Point: If we know what causes postpartum depression we can act to prevent it. We can also use this information to screen women for postpartum depression during and after pregnancy in order to provide timely treatment.

What exactly do we mean by “social support”?

The imprecise nature of the term “social support” can make it challenging to make comparisons across studies and often explains inconsistencies between studies.

For example what one researcher means by social support might be different from another, but both might still choose to use the term social support.

In addition, social support is a multidimensional concept and only by deconstructing it into its component parts can you start to understand what aspects of social support are important for postpartum depression, rather than seeing it from an umbrella perspective.

For example social support can mean an immediate partner, close family, extended family, or friends. In addition, it can reflect the quality or status of the relationships, the social structure or physical living arrangements.

As it is likely that some types of social support are more important for postpartum depression compared to others, and that this may vary according to circumstance and culture, knowing more about these finer details can help to better inform health policy and guide interventions from health professionals.

Key Point: it’s important to define what social support means, and what kind of social support is important to prevent postpartum depression.

How did we conduct our research?

We searched for terms relating to social support and social relationships combined with postpartum depression using Pubmed, the database of scientific and medical publications.

We identified 12 studies which specifically explored the relationship between social support and postpartum depression, in addition to 3 systematic reviews, one which included 215 studies.

Their findings will be discussed below.

Does Marital Status Affect the Likelihood of Postpartum Depression?

A study in 2006 from the University of York (2) with 18,533 families looked at the parental relationship and postpartum depression and specifically focused on whether the mom was married, cohabiting or single.

Their results suggests that cohabiting and single moms had a greater risk of postpartum depression compared to married moms when controlling for a range of sociodemographic factors.

However large scale studies which show significant correlations like this, and do not include other pieces of social support data to help interpret those correlations, can be misleading. They require further research to help explain this relationship and determine the other contributing factors which are also playing a role (e.g. they do not consider relationship quality in this study, only status).

Key points to this study: This study concluded that married moms had a lower risk of postpartum depression than single or cohabiting moms. However, this result is potentially misleading as the study did not take into account other factors such as relationship quality which are known to be important.

A study in 2011 from the University of New South Wales (3) examined a number of demographic risk factors of postpartum depression in 25,455 moms from the Sydney district.

They found that the marital status of the mom – i.e. whether they were married, single or had a partner was not associated with postpartum depression. They also explored a number of social community factors and revealed that moms who had only lived in a neighbourhood for a short period of time, or who originally were not from the Sydney district (i.e. born in another country) were more at risk of developing postpartum depression. This reveals how the perception of social support extends wider than the family unit.

Key points to this study: This study conducted in Sydney showed that the marital status of the mom was not associated with postpartum depression. It also showed that moms new to a neighborhood were more at risk of developing postpartum depression, revealing how social support extends wider than the family unit.

CONCLUSION

Examining the mom’s relationship status alone, even with large numbers of moms, offers inconsistent results and is not sufficient to understand the relationship between postpartum depression and social support.

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