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Cited by 46Maternal Mental Health During Pregnancy and PostpartumMaternal and Perinatal Health InterventionsAnesthesia and Pain Management

Investigating analgesic and psychological factors associated with risk of postpartum depression development: a case–control study

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Sng, Ban Leong, Suhitharan, Thangavelautham, Pham, Thi Phuong Tu, Chen, Helen, Assam, Pryseley Nkouibert, Sultana, Rehena, Tan, Ene-Choo, Han, Nian-Lin Reena·2016·Neuropsychiatric Disease and Treatment
DOI 10.2147/ndt.s105918PMC PMC4908936
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Abstract

AIM: The aim of this study was to investigate the role of peripartum analgesic and psychological factors that may be related to postpartum depression (PPD). METHODS: This case-control study was conducted in pregnant females who delivered at KK Women's and Children's Hospital from November 2010 to October 2013 and had postpartum psychological assessment. Demographic, medical, and postpartum psychological status assessments, intrapartum data including method of induction of labor, mode of labor analgesia, duration of first and second stages of labor, mode of delivery, and pain intensity on hospital admission and after delivery were collected. PPD was assessed using the Edinburgh Postnatal Depression Scale and clinical assessment by the psychiatrist. RESULTS: There were 62 cases of PPD and 417 controls after childbirth within 4-8 weeks. The odds of PPD was significantly lower (33 of 329 [10.0%]) in females who received epidural analgesia for labor compared with those who chose nonepidural analgesia (29 of 150 [19.3%]) ([odds ratio] 0.47 (0.27-0.8), P=0.0078). The multivariate analysis showed that absence of labor epidural analgesia, increasing age, family history of depression, history of depression, and previous history of PPD were independent risk factors for development of PPD. CONCLUSION: The absence of labor epidural analgesia remained as an independent risk factor for development of PPD when adjusted for psychiatric predictors of PPD such as history of depression or PPD and family history of depression.

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  • Across delivery modes, the relationship between neuraxial anesthesia and postpartum depression is best characterized as neutral at the population level, with potential protective effects in select clinical contexts.

    “Across delivery modes, the relationship between neuraxial anesthesia and postpartum depression (PPD) appears complex but is best characterized as neutral at the population level, with potential protective effects in select clinical contexts has been described as either protective or neutral at various amounts of time postpartum across many studies.37–51”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [39]

    The Results and Discussion report lower odds of PPD among women receiving labor epidural analgesia than among those receiving nonepidural analgesia; the Conclusion likewise describes a protective association. The paper does not establish a neutral relationship at the population level or assess that relationship across delivery modes. Its Discussion also cautions that the case–control study cannot establish causation or generalize beyond its study population. (LLM, conf=0.86)

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  • Across observational studies, cohort analyses, systematic reviews, and meta-analyses, neuraxial anesthesia does not appear to increase the risk of postpartum depression at the population level.

    “Across observational studies, cohort analyses, systematic reviews, and meta-analyses, neuraxial anesthesia does not appear to increase the risk of PPD at the population level.”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [39]

    The Results and Conclusion report lower odds of postpartum depression among women who received labor epidural analgesia than among those who chose nonepidural methods. This supports no observed increase for epidural analgesia in this case–control study, but it does not establish the claim across systematic reviews, meta-analyses, all neuraxial anesthesia, or populations generally. The Discussion cautions that the findings cannot be generalized to other ethnic or socioeconomic groups. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Neuraxial anesthesia is not associated with increased risk of postpartum depression and may have neutral or protective effects, particularly compared with general anesthesia for cesarean delivery.

    “Collectively, available evidence indicates that neuraxial anesthesia likely does not increase the risk of postpartum depression and may exhibit either neutral or modest protective effects in labor.37–51”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [39]

    The Results and Conclusion report that labor epidural analgesia was associated with lower odds of postpartum depression than nonepidural labor analgesia, supporting the citing sentence’s suggestion of a possible protective effect in labor. The study does not establish this for neuraxial anesthesia generally or compare it with general anesthesia for cesarean delivery. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 21

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Authors
Sng, B. L., Suhitharan, T., Pham, T. P. T., Chen, H., Assam, P. N., Sultana, R., Tan, E.-C., & Han, N.-L. R.
Affiliations
  • National University of Singapore (SG)
  • KK Women's and Children's Hospital (SG)
  • Singapore Clinical Research Institute (SG)
  • SingHealth (SG)
Corresponding author
Sng, Ban Leong
ORCID
Venue
Neuropsychiatric Disease and Treatment
Publisher
Informa UK Limited
Published
2016-06
Volume
12
Pages
1333
ISSN
  • 1176-6328 (ISSN-L)
  • 1178-2021
DOI
10.2147/ndt.s105918
PMC
PMC4908936
OpenAlex
W2419397707
Cited by
46
References
2
Citations by year
2026: 2 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 7 · 2021: 4 · 2020: 11 · 2019: 5 · 2018: 3 · 2017: 4 · 2016: 1
FWCI
3.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (acceptedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Medical Research Council (CTG13feb013)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords
postpartum depression, labor analgesia, epidural analgesia, risk factors, family history of depression, history of depression, mode of delivery, intrapartum pain, psychological factors

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