Changes in the Relationship Between Socioeconomic Position and Maternal Depressive Symptoms: Results from the Panel Study on Korean Children (PSKC)

Postnatal Depression Beyond 12 Months: A Systematic Review and Meta-Analysis

Traditionally, postnatal depression (PND) has been considered as depression in the first year after giving birth, although it has been argued that the 12-month cut-off may be somewhat arbitrary. Specialist perinatal mental health services in England have recently been extended to include women in their second year postpartum; however, there is no good estimate for the prevalence of PND beyond the first year. This review aimed to obtain the best estimate of the prevalence of PND in the second postpartum year. Eligible studies were those that assessed PND and provided a point prevalence using a validated screening tool or clinical diagnosis at least once beyond the first 12 months in women over the age of 18 years in any country. Studies were excluded if they only included women who were already depressed or had elevated depression scores at baseline. PubMed, Embase, Web of Science, CINAHL and PsychINFO were searched in January 2021 (and updated in February 2024) for studies that included the prevalence of PND beyond the first 12 postnatal months. Study quality was assessed using Cochrane's ROBINS-I and Risk of Bias 2 tools. Prevalence data were combined in meta-analysis using prediction intervals (PIs). A total of 6340 papers were found, and of these, 32 studies including 57210 participants across 18 countries met the inclusion criteria and were meta-analysed. The prevalence of PND in the second year (13-24 months) was 15% (95% confidence interval [CI] 12%, 17%; 95% PI 4%, 30%) and similar to that in the first year, 16% (95% CI 14%, 19%; 95% PI 6%, 31%). Despite considerable heterogeneity, common in meta-analysis of prevalence studies, findings show that a similar proportion of women experience PND in the second year after birth.

A comparison of the outcomes of families with children aged less than 2 who received universal versus sustained nurse home visiting services in Korea: a cross-sectional study

OBJECTIVES

This study aimed to compare maternal outcomes and the home environment between non‑vulnerable families with children under 2 receiving universal home visiting services and vulnerable families receiving sustained home visiting services.

METHODS

This study was conducted in Seoul, Korea, where the country's first nurse‑led early childhood home visiting program was introduced. A total of 551 mother‑child dyads participated in cross‑sectional surveys conducted at various child ages (6±2 weeks, 6±1 months, 12±1 months, and 24±1 months). Universal home visiting services were provided within six weeks postpartum to non‑vulnerable families, while vulnerable families received sustained services consisting of 25 visits over 24 months. Maternal knowledge of sudden infant death syndrome (SIDS) and childcare, maternal distress, and the Korean Infant‑Toddler Home Observation for Measurement of Environment (K‑IT‑HOME) were assessed.

RESULTS

Overall, the universal home visitation group demonstrated higher levels of maternal knowledge regarding SIDS and childcare compared to the sustained home visitation group (all p-values <0.05), while the sustained home visitation group reported higher levels of maternal distress (p<0.001). The total K‑IT‑HOME score was 1.47 points higher in the universal home visitation group than in the sustained home visitation group (p<0.001). No significant differences were observed in the acceptance, organization, or involvement subscales of the K‑IT‑HOME (all p-values >0.05).

CONCLUSIONS

This study demonstrated that disparities in maternal outcomes and home environments persisted in early childhood between the sustained and universal home visitation groups.

Extended Paid Maternity Leave Associated With Improved Maternal Mental Health In Hong Kong

In July 2020, Hong Kong extended statutory paid maternity leave from ten weeks to fourteen weeks to align with International Labour Organization standards. We used the policy enactment as an observational natural experiment to assess the mental health implications of this policy change on probable postnatal depression (Edinburgh Postnatal Depression Scores of 10 or higher) and postpartum emotional well-being. Using an opportunistic observational study design, we recruited 1,414 survey respondents with births before (August 1-December 10, 2020) and after (December 11, 2020-July 18, 2022) policy implementation. Participants had a mean age of thirty-two, were majority primiparous, and were mostly working in skilled occupations. Our results show that the policy was associated with a 22 percent decrease in mothers experiencing postnatal depressive symptoms and a 33 percent decrease in postpartum emotional well-being interference. Even this modest change in policy, an additional four weeks of paid leave, was associated with significant mental health benefits. Policy makers should consider extending paid maternity leave to international norms to improve mental health among working mothers and to support workforce retention.

Analysis of factors contributing to occupational health inequality in Korea: a cross-sectional study using nationally representative survey data

Background

Despite the consensus that higher occupational classes tend to have better health and lower mortality rates, one study has reported reversed occupational gradients in mortality rates among Korean men after the economic crisis in the late 2000s. To examine these patterns of health inequality in more detail, we investigated the tendency of occupational gradients in socioeconomic position and multiple pathway indicators known to affect mortality in Korea.

Methods

We used data from 4176 men aged 35–64 in Korea derived from the 2007–2009 and 2013–2015 Korean National Health and Nutrition Examination Surveys. We compared the age-standardized prevalence and age-adjusted mean values of each contributing factor to health inequality among occupational groups, which are divided into upper non-manual workers, lower non-manual workers, manual workers, and others. Contributing factors included childhood and adulthood socioeconomic position indicators, biological risk factors, health behaviors, psychosocial factors, and work environment.

Results

Upper non-manual workers had prominently higher levels of education, income, parental education, and economic activity than lower non-manual and manual workers. The rates of smoking and high-risk alcohol consumption were lower, and the rate of weight control activities was higher, in the non-manual classes. Further, the rates of depression and suicidal ideation were lower, and perceptions of the work environment were more favorable, among non-manual workers than among their manual counterparts.

Conclusions

We detected occupational inequality in a wide range of socioeconomic positions and pathway indicators in Korea with consistently favorable patterns for upper non-manual workers. These occupational gradients do not support the previously reported reversed pattern of higher mortality rates in non-manual groups versus in the manual job class in Korea.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00638-9.