1. A Population Based Survey of Infant Inconsolability and Postpartum Depression Pamela C. High*, Rachel Cain**, Hanna Kim** and Samara Viner-Brown** Hasbro Children’s Hospital/ Brown Medical School* Division of Family Health RI Department of Health** Providence, RI Presentation for Society of Developmental-Behavioral Pediatrics, Sept. 26, 2005, San Diego, CA

2. Background Excessive and inconsolable crying in the first few months of life has been reported in 2% to 40% of otherwise healthy infants Postpartum depression is reported in 15-20% of new mothers Link between early postpartum depressive symptoms and infant crying has been described

3. Objectives To assess the prevalence of infantile inconsolability and maternal postpartum depressive symptoms in a population based sample To identify demographic and modifiable behavioral risk factors associated with these conditions To determine the co-occurrence and possible relationship between infant inconsolability and maternal depressive symptoms

4. Methods Data was obtained from RI’s Pregnancy Risk Assessment Monitoring System (PRAMS), sponsored by the National Centers for Disease Control and Prevention (CDC) Data was weighted to demographically represent all births in RI in 2002 and 2003 4,214 mothers were sampled 2,947 responded (72% weighted response rate)

5. Data Analysis Chi-squared tests for bivariate analysis Multivariate logistic regression models were used controlling for demographic variability to predict post partum depression SUDANN software was used for this analysis

6. Infant Demographics 62-252 days old (mean 111 days) 90% <152 days (<5 months) 49 % male infants 8.4% <37 weeks gestation 7.2 % <2,500 grams 37 % Breast fed (current); 70% (ever)

7. Maternal Demographics Age: 9.8 % 35 Race: 87.3% White, 8.2% Black, 3.2% Asian 1.1% Amer Indian 0.2% Other non-white Hispanic Ethnicity: 22.1% Income: 27% <$16 K, 10.1% $16-25K 14.2% $25-40 K 48.7 % > $40K Education: 15.2% 12

8. Maternal Demographics Married: 64 % Insurance: 38 % Public 61 % Private Parity: 42% 1 st Birth 58% 2 nd or later Smoking: (Current) 16% (last 3 mo) 12% Unintended pregnancy: 36%

9. Variable: Fussy Baby In general, how easy is it to calm your baby when he or she is crying or fussing? Very easy50.7% Somewhat easy41.0% Somewhat difficult 7.2% Very difficult 1.1%

10. Fussy Babies and Age 2 mo. 3 mo. 4 mo. > 5 mo. 9.6 % 8.0 % 6.8% 8.9% p= NS

11. Fussy Babies and Low Birth Weight 2,500 gm No difference for VLBW <1,500 gm. (8.8% vs. 8.3%) 11.2 % 8.1 % p<0.001

12. Fussy Babies and Maternal Race White Black Other (n=149) 7.7 % 9.4 % 17.1 % p<0.05

13. Fussy Babies Hispanic ethnicity, maternal age, education, marital status, household income, insurance, parity, smoking and breast feeding did not predict inconsolability in these babies

14. Variable: Post Partum Depression In the months after your delivery, would you say that you were……. Not at all depressed43.0% A little depressed37.8% Moderately depressed12.2% Very depressed 3.4% Very depressed and had to get help 3.5%

15. Postpartum Depression and Maternal Education 12 21.9% 22% 16.4% p<0.01

16. Postpartum Depression and Marital Status Unmarried Married 23.9% 16.6% p<0.001

17. Postpartum Depression and Household Income >$40,000 $40,000 24 % 14.4 % p<0.0001

18. Postpartum Depression and Health Insurance Public Private 23.1 % 16.3 % p<0.001

19. Postpartum Depression and Low Birth Weight 2,500 gm 29.2 % 18.4 % p<0.0001

20. Postpartum Depression and Very Low Birth Weight 1,500 gm 48.8 % 18.6 % p<0.0001

21. Postpartum Depression and Unintended Pregnancy Unintended Intended 22.8 % 16.8 % p<0.01

22. Postpartum Depression and Smoking 3 months before last 3 months current pregnancy pregnancy 28.9 % 27.5% 27.4% 16.3 % 17.7% 17.4% p<0.01 smoke no smoke smoke no smoke smoke no smoke

23. Postpartum Depression and Breast Feeding Ever BF Never BF Current BF Not BF now 23 % 22.5% 17.4 % 12.6% p<0.01 p<0.0001

24. Postpartum Depression Maternal age, race, Hispanic ethnicity and parity as well as infant age and sex did not predict report of depressive symptoms in these new mothers

25. Postpartum Depression and Fussy Babies Fussy Consolable 34.7 % 17.4 % p<0.0001

26. Fussy Babies and Postpartum Depression PP Depression No depression 15.3 % 6.7 % p<0.0001

27. Logistic Regression: Fussy Baby AOR (95% CI) Fussy Baby »Post Partum Depression 2.58 (1.74-3.82) *** »Other Race 2.79 (1.48-5.24) ** »Infant < 2,500 grams 1.26 (1.05-1.51) * * p<0.05 **p<0.01 *** p<0.0001 Maternal age, ethnicity, marital status and education, family income, unintended pregnancy, current smoking or breast feeding and infant age did not predict postpartum depressive symptoms in this model

28. Logistic Regression: Postpartum Depression AOR (95% CI) Postpartum Depression »Fussy Baby 2.57 (1.71-3.85) *** »Not currently breast fed 2.28 (1.64-3.16) *** »Family Income < $40,000 1.75 (1.19-2.59) ** »Unintended Pregnancy 1.44 (1.06-1.94) * »Infant < 2,500 grams 1.26 (1.05-1.51) * * p<0.05 **p<0.01 *** p<0.0001 Maternal age, ethnicity, race, education, marital status and current smoking as well as infant age did not predict postpartum depressive symptoms in this model

29. Conclusions In this population based survey, 1 in 12 babies were reported to be difficult to console by their mothers and almost 1 in 5 new mothers acknowledged postpartum depressive symptoms Postpartum depressive symptoms were more prevalent in disadvantaged mothers

30. Conclusions Inconsolability was more prevalent in low birth weight infants and also in those few babies in our small but diverse “other” race category

31. There are definite limitations to this study Infant inconsolability was measured by a single question posed to new mothers. No information on the amount of crying was obtained Maternal depressive symptoms were also measured using a single question The population sampled is that in RI and may not reflect families in other parts of the US

32. Implications Pediatric primary care providers are in a unique position to identify mothers who are experiencing depressive symptoms and may be effective in supporting them, counseling them and referring them for treatment

33. Logistic Regression: Postpartum Depression (w/o child age) AOR (95% CI) Postpartum Depression »Fussy Baby 2.57 (1.72-3.85) *** »Not currently breast fed 2.22 (1.6-3.07) *** »Family Income < $40,000 1.73 (1.17-2.55) ** »Unintended Pregnancy 1.43 (1.06-1.92) * »Infant < 2,500 grams 1.26 (1.05-1.51) * * p<0.05 **p<0.01 *** p<0.0001 Maternal age, ethnicity, race, marital status, current smoking and education did not predict postpartum depressive symptoms