Researchers examine relationship between multiple births and maternal depressive symptoms

Mothers of multiples have 43 percent increased odds of having moderate to severe depressive symptoms nine months after giving birth compared to mothers of single-born children, according to researchers at the Johns Hopkins Bloomberg School of Public Health.

Researchers examined the relationship between multiple births and maternal depressive symptoms and found that multiple births increased the odds of maternal depression, and that few mothers with depressive symptoms, regardless of the multiple births status, reported talking to a mental health specialist or a general medical provider. The results are published in the April 1, 2009, issue of Pediatrics.

"Our findings suggest that 19 percent of mothers of multiples had moderate to severe depressive symptoms nine months after delivery, compared to 16 percent among mothers of singletons," said Yoonjoung Choi, DrPH, lead author of the study and a research associate with the Bloomberg School's Department of International Health. "Mothers with a history of hospitalization due to mental health problems or a history of alcohol or drug abuse also had significantly increased odds. Non-Hispanic black mothers had higher odds compared to non-Hispanic white mothers. Mothers who were currently married, Hispanic, or with a high household socioeconomic status were less likely to have depressive symptoms."

Choi, along with colleagues, used data from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative sample of children born in 2001. They measured depressive symptoms in mothers using an abbreviated version of the Center for Epidemiologic Studies Depression (CES-D) scale. Researchers examined the association between multiple births and maternal mental health, given the rapidly increasing multiple births rate in the U.S. over the last two decades. They also found that, among the mothers of both singleton and multiples, only 27 percent reported talking to a mental health specialist or a general medical provider when experiencing depressive symptoms. Researchers believe greater attention is needed in pediatric settings to address maternal depression in families with multiple births.

"The low numbers of women receiving mental health counseling despite symptoms reinforces the need for facilitating better referral of patients with depressive symptoms," said Cynthia Minkovitz, MD, MPP, senior author of the study and an associate professor with the Bloomberg School's Department of Population, Family and Reproductive Health. "Pediatric practices should make an additional effort to educate new and expecting parents of multiples regarding their increased risk for maternal postpartum depression. Furthermore, well-child visits are potentially valuable opportunities to provide education, screening and referrals for postpartum depression among mothers of multiples; such efforts require linkages between pediatric and adult systems of care and adequate community mental health resources."