Elsevier

Journal of Affective Disorders

Volume 204, 1 November 2016, Pages 174-179
Journal of Affective Disorders

Research paper
The relationship between economic conditions and postpartum depression in Taiwan: a nationwide population-based study

https://doi.org/10.1016/j.jad.2016.06.043Get rights and content

Highlights

  • Economic contraction influences the mental health of Taiwanese women.

  • Postpartum depression is associated with economic indicators.

  • It correlates with the unemployment rate, consumer price index, and gross domestic product.

  • It correlates with inflation rate during the great recession.

  • The impact of the great recession on women is prolonged.

Abstract

Background

Understanding mothers’ economic conditions and postpartum depression (PPD) is important for determining how they will take care of themselves and their infants during the postnatal period, especially for low-income families. This study examined the relationship between economic conditions and PPD to elucidate the effect of economic contraction on PPD.

Methods

Our population-based nationwide study used 2000–2013 the National Health Insurance Research Database of Taiwan. A total of 1240 newly diagnosed PPD patients were recruited. We used the database of the Directorate General of Budget, Accounting, and Statistics of Executive Yuan of Taiwan for national economic indicators. The correlation between economic indicators and PPD was examined.

Results

The PPD incidence was positively correlated with yearly unemployment rate, consumer price index, and gross domestic product. During the great recession of 2008–2009, PPD was positively correlated with inflation rate. Consumer price index had a positive correlation with PPD incidence per month when comparing PPD in 2010 with the economic indicators during the great recession.

Limitations

As this retrospective study evaluated macroeconomic indicators, it is unclear whether the macroeconomic indicators’ effect on PPD totally reflects the effect of true personal economic status on PPD.

Conclusions

There was a significant association between PPD and economic conditions. This study shows that mothers’ familial environment plays an important role in the development of PPD. The impact of the worldwide economic downturn of the great recession on women is persistent. This useful finding may give health policy planners a hint of early discovering and dealing with PPD when worldwide economic downturn

Introduction

Postpartum depression (PPD) is an international public health priority because it is the most common cause of postnatal morbidity. The prevalence of PPD in high-income countries is approximately 13%, and it presents a challenging target for prevention (Almond, 2009, Dennis and Creedy, 2004, Stocky and Lynch, 2000). Postpartum mental health problems are recognized as a suitable focus for preventive approaches with the potential to avert the burden on women, and their children and families, as well as the social and economic costs (Pope et al., 1999).

Economic performance affects the daily life of almost every person in modern society. Economic conditions also have a great impact on mental disorders, including major depressive disorder and anxiety. For example, employment status and personal income are associated with major depressive disorder (Andersen et al., 2009, Zimmerman and Katon, 2005). The stock market is an indicator of economic conditions, and falling stock prices have been reported to increase hospitalizations for mental disorders (Lin et al., 2015).

In the past, most studies assessed the relationship between the economic status and mental disorders by unemployment rate (Catalano et al., 2000, Mandal and Roe, 2008), very few have discussed the effects of other macroeconomic indicators, such as consumer price index (CPI), inflation rate, GDP, and the stock market index, on mental disorders. These macroeconomic indicators reflected other aspects of economic status and might provide a comprehensive assessment of the effect of economic performance on mental disorders.

The increase of mental disorders during economic contraction has been widely discussed (Catalano, 2009, O’Dowd, 2009). A sudden onset of economic crisis occurred in the United States in 2008, called “the great recession.” The great recession stated with rising foreclosures and mortgage payments (Blumberg and O’Neal, 2010) and caused widespread economic decline cause worldwide economic downturn. In addition, Lehman Brothers Holdings Inc. announced bankruptcy in the United States in September 2008, which was followed by a worldwide economic downturn with a dramatic fall in the stock markets, and the crisis spread globally to industrialized and most developing countries. Most of the Far Eastern countries also suffered the impact of the economic recession. The worldwide economic downturn increased the risk of depression in Eastern and Western countries. In Hong Kong, the 12-month prevalence of major depressive disorder was significantly higher in 2009 (12.5%) than in 2007 (8.5%) in both males and females (Lee et al., 2010). In Greece, the 1-month prevalence rate of major depression was also significantly higher in 2011 (8.2%) than in 2008 (3.3%) (Economou et al., 2013).

In Taiwan, the Taiwan Stock Exchange Capitalization Weighted Stock Index (TAIEX) closed down 295.83 points (4.89%) on September 16, 2008, having been affected by the bankruptcy of Lehman Brothers Holdings Inc. The TAIEX continued to decline, being at its lowest of 4242.61 on January 20, 2009. In addition, the unemployment rate rose from 3.8% (January 2008) to 5.74% at the end of 2009. The gross domestic product (GDP) was −1.91% in 2008 and −1.44% in 2009. The economic growth rate of Taiwan was 0.7% in 2008 falling to −1.57% in 2009. The great recession collapsed the Taiwanese economy from 2008 to 2009.

Pregnant women are easily affected by physical, mental, and surrounding changes that cause a depressive mood (Norhayati et al.,2015). The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) defines PPD as a depressive episode occurring during pregnancy or in the 4 weeks following delivery. It usually occurs in the first 6 months after delivery(American Psychiatric Association, 2003). A comparative study of postnatal women in the UK and Taiwan revealed that 19% of Taiwanese women and 18% of British women had PPD (Huang and Mathers, 2001). In developed countries, there are several protective or risk factors for PPD, including marital status, quality of social support, quality of the relationships with women's mother or partner, employment stability, stressful life events, and socioeconomic status (Beck, 2001, Robertson et al., 2004). However, there is a lack of studies investigating the impact of economic change on PPD from the view of the nation's macroeconomy. In addition, there is no study for assessing the effect of economic contraction on PPD so far.

In 2009, Taiwan's economy was still suffering substantial losses and economic contraction that affected the whole population of the country. The economic contraction also had an effect on the mental health of the population. We considered that mental disorders that were affected by economic contraction would not appear immediately.

The aim of our population-based study was to (1) investigate the association between economic conditions and PPD, (2) investigate the association between PPD in 2010 with the economic indicators of 2008–2009 to elucidate the persistent impact of the economic crisis on PPD.

Section snippets

Data source and collection

The National Health Insurance program, which was launched in Taiwan in 1995, covers almost all citizens. There was a 99.9% coverage of the 23 million residents in Taiwan at the end of 2011. The National Health Insurance Research Database (NHIRD) is a national-scale medical library that holds the medical and demographic information of more than 99% of the population in Taiwan (Kang et al., 2009). The NHIRD contains detailed inpatient and outpatient medical records including admission data,

Demographics

A total of 1240 patients newly diagnosed with PPD from January 2000 to December 2013 were used in the study. The annual incidence of PPD in our study was 0.41% in 2000; 1.06% in 2001; 1.02% in 2002,;1.05% in 2003; 1.31% in 2004; 1.20% in 2005; 1.26% in 2006; 1.07% in 2007; 1.28% in 2008, 1.40% in 2009; 1.49% in 2010; 1.36% in 2011; 1.23%in 2012; 1.42% in 2013, respectively.Table 1 shows the demographic characteristics of the patients with PPD. The mean age of the patients with PPD was 29.9±4.8

Discussion

To the best of our knowledge, this is the first study of the relationship between economic conditions and PPD. This study revealed that multiple economic indicators, such as unemployment rate, consumer price index (CPI), CPI of food, CPI of traffic, CPI of medicine, and gross domestic product (GDP )were positively correlated with PPD incidence per year. This finding provides useful information for health policy planning. The government should not only focus on the economy but also pay attention

Conclusions

The economic conditions are associated with PPD. Economic contraction had a substantial influence on women's mental health. The impact of the worldwide economic downturn of great recession may have prolong effect on women's mental health. This useful finding may give health policy planners a hint of early discovering and dealing with PPD when worldwide economic downturn.

Conflict of interest

None.

Role of the funding source

The work was supported by grants from in the analysis and interpretation of data.

This work was supported by grants from the Ministry of Science and Technology Taiwan (MOST 104–2320-B-016-012 -MY3), the Taoyuan General Hospital, Ministry of Health and Welfare (10322), Ministry of Health and Welfare (10402), Chi Mei Hospital (CMNDMC10412) and the Teh-Tzer Study Group for Human Medical Research Foundation (A1021094). The funders had no role in study design, data collection and analysis, decision

Contributors

FWC and WYL wrote the proposal, conducted data analysis and prepared the manuscript. YPL contributed conception and design the manuscript. JJY revised the manuscript. YCL conducted data analysis. SPC and KCC helped data collection and advised the manuscript. TWH conducted data collection and data analysis. RJH oversaw data collection and prepared the manuscript. JML wrote the proposal and revised the manuscript. All authors read and approved the final manuscript.

Acknowledgments

The implications and conclusions do not represent the opinions of the Bureau of National Health Insurance, the Department of Health, or the National Health Research Institute.

References (35)

  • N. Aydin et al.

    Depression and associated factors among women within their first postnatal year in Erzurum Province in Eastern Turkey

    Women Health

    (2005)
  • C.T. Beck

    Predictors of postpartum depression: an update

    Nurs. Res.

    (2001)
  • D., Blumberg, O’Neal, C., 2010.Transunion Finds National Mortgage Delinquencies jumped 10.24 Percent at End of 2009....
  • M.J. Boskin et al.

    Consumer prices, the consumer price index, and the cost of living

    J. Econ. Perspect.

    (1998)
  • R. Catalano et al.

    Job loss and major depression among Mexican Americans

    Soc. Sci. Q

    (2000)
  • R. Catalano

    Health, medical care, and economic crisis

    N Engl. J. Med.

    (2009)
  • A. Demirchyan et al.

    Rate and predictors of postpartum depression in a 22-year follow-up of a cohort of earthquake survivors in Armenia

    Arch. Womens Ment. Health

    (2014)
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    Jui-Ming Liu and Ren-Jun Hsu contributed equally to this work.

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