Antenatal Depression in a Multi-Ethnic, Community Sample of Canadian Immigrants: Psychosocial Correlates and Hypothalamic-Pituitary-Adrenal Axis Function

Key Words: pregnancy, depression, immigration, cortisol, hypothalamicpituitary-adrenal axisObjectives: Immigrant women living in Canada present with higher rates of prenatal depressive symptomatology than Canadian-born women; however, the associated psychosocial correlates remain understudied. Antenatal depression and stress negatively affect maternal health and infant development, in part through changes in maternal hypothalamic-pituitary-adrenal (HPA) axis activity. We aimed to examine the factors associated with prenatal depressive symptoms, including altered HPA axis function, in an ethnically diverse community sample of Canadian immigrant women.Methods: Seventy-eight pregnant immigrant women were recruited from the community at 19 weeks' gestation and provided information on health, mood, stressful life events (SLEs), and social support. Fifty-seven of these women also provided saliva samples for measurement of the cortisol awakening response and nighttime cortisol levels.Results: Seventeen per cent of the sample had a high level of prenatal depressive symptoms, and these women reported more perceived stress, more somatic symptoms, lower social support, and were less often working or attending school during pregnancy. Controlling for wake time, parity, and region of origin, high levels of prenatal depressive symptoms were associated with elevated nighttime cortisol levels, whereas SLEs were not associated with any measures of HPA axis activity.Conclusions: High levels of prenatal depressive symptoms are common in immigrant women living in Canada, and are associated with identifiable factors. Preliminary evidence suggests a similar pattern of HPA axis activity characterizing depressive symptomatology in this subpopulation as previously seen in clinically depressed patients.Depression prenatale dans un echantillon communautaire multiethnique d'immigrantes canadiennes : correlats psychosociaux et fonction de l'axe hypothalamo-hypophyso-surrenalienObjectifs : Les femmes immigrantes habitant le Canada presentent des taux plus eleves de Symptomatologie depressive prenatale que les femmes canadiennes de naissance; cependant, les correlats psychosociaux associes demeurent sous-etudies. La depression prenatale et le stress influent negativement sur la sante maternelle et le developpement du bebe, en partie a cause de changements d'activite de l'axe hypothalamo-hypophysosurrenalien (HHS) maternel. Nous cherchions a examiner les facteurs associes aux symptomes depressifs prenataux, notamment la fonction alteree de l'axe HHS, dans un echantillon communautaire ethniquement diversifie de femmes immigrantes canadiennes.Methodes : Soixante-dix-huit immigrantes enceintes ont ete recrutees dans la communaute a 19 semaines de gestation et ont recu de l'information sur la sante, l'humeur, les evenements stressants de la vie (ESV), et le soutien social. Cinquantesept d'entre elles ont aussi fourni des echantillons de salive afin de mesurer la reponse du cortisol a l'eveil et les niveaux de cortisol le soir.Resultats : Dix-sept pour cent de l'echantillon avait un taux eleve de symptomes depressifs prenataux, et ces femmes declaraient avoir plus de stress percu, plus de symptomes somatiques, un soutien social plus faible, et elles travaillaient ou allaient a l'ecole moins souvent durant la grossesse. Apres controle pour la duree de l'eveil, pour la parite, et la region d'origine, les niveaux eleves de symptomes depressifs prenataux etaient associes aux taux eleves de cortisol le soir, alors que les ESV n'etaient associes a aucune mesure de l'activite de l'axe HHS.Conclusions : Les niveaux eleves de symptomes depressifs prenataux sont communs chez les femmes immigrantes habitant le Canada, et ils sont associes a des facteurs identifiables. Les donnees probantes preliminaires suggerent un modele semblable d'activite de l'axe HHS caracterisant la Symptomatologie depressive dans cette souspopulation comme il a ete vu precedemment chez des patients cliniquement deprimes. …