Study Results: Women's Mental Health
Browse research on women's mental health and its influence on parents, children, and families.
Featured Publication
How does Race Predict Depressive Symptoms During Pregnancy?
Compared to White women, racialized women were more likely to have higher levels of depressive symptoms and possible clinical depression.
Women's mental health up to eight years after childbirth and associated risk factors
Role and relationship strain factors and anxiety and depression symptoms were measured at repeated time points from four months to eight years after childbirth.
The prevalence of elevated anxiety and/or depression ranged from 18.8% (at four months) to 26.2% (at eight years). The adjusted odds ratio of anxiety and/or depression was 3.5 (95% CI = 2.9, 4.3) for those juggling family responsibilities and 2.4 (95% CI = 2.0, 3.0) for those with stressful partner relationship compared to their counterparts. Similarly, experiencing financial crunch and poor partner relationship were associated with increased mental health difficulties. Women without challenges in roles or relationships had a 23% lower predicted probability of anxiety and/or depression than those with the challenges.
Conclusions: Monitoring mothers for anxiety and depression beyond the postpartum period and strategies that address role and relationship challenges may be valuable to women at risk of anxiety and depression.
The chronicity and timing of prenatal and antenatal maternal depression and anxiety on child outcomes at age 5
Participants were 1,992 mother–child pairs. Mothers reported on anxiety and depression symptoms at six time points between <25 weeks gestation and 3 years postpartum. Child outcomes were assessed at age 5.
Maternal anxiety/depression during pregnancy, infancy, and toddlerhood predicted all child outcomes, even after controlling for depression/anxiety during the other timepoints. However, maternal anxiety and depression during toddlerhood had a stronger association with child internalizing/externalizing symptoms and communication skills than either prenatal or postpartum depression/anxiety.
Conclusions: Increasing number of exposures to clinical-level anxiety and depression is related to poorer child outcomes. Results highlight the need for continued support for maternal mental health across early childhood.
Patterns of change in anxiety and depression during pregnancy predict preterm birth
Anxiety and depression were measured at 17–24 weeks and again at 32–36 weeks’ gestation. Chronic stress was assessed at 17–24 weeks’ gestation as a potential covariate.
Women who experienced an increase in anxiety scores, (time point 32–36 weeks, compared to the earlier time point 17–24 weeks), had 2.70 times higher odds of preterm delivery, compared to those with a reduction in anxiety scores (95% CI 1.28, 5.69). Consistent low or high depression scores did not significantly influence the odds of preterm birth compared to a decrease in depression scores. A co-occurring increase in anxiety and depression scores was not found to increase the risk of preterm birth, and chronic stress did not modify any of these relationships.
Conclusions: Primary prevention could address anxiety during pregnancy to potentially modify preterm birth outcomes.
Social support and maternal mental health at 4 months and 1 year postpartum
Outcomes were depressive or anxiety symptoms at 4 months and 1 year postpartum. Exposures were social support during pregnancy and at 4 months postpartum.
Low total social support during pregnancy was associated with an increased risk of depressive symptoms (RR 1.50, 95% CI 1.24 to 1.82) and anxiety symptoms (RR 1.63, 95% CI 1.38 to 1.93) at 4 months postpartum. Low total social support at 4 months was associated with an increased risk of anxiety symptoms (RR 1.65, 95% CI 1.31 to 2.09) at 1 year. Absolute risk differences were largest among women with previous mental health challenges resulting in a number needed to treat of 5 for some outcomes. Emotional/informational support was the most important type of support for postpartum anxiety.
Conclusion: Group prenatal care, prenatal education and peer support programmes have the potential to improve social support.
2024
Turgeon J, Racine R, McDonald S, Tough S, Madigan S. Maternal adverse childhood experiences, child resilience factors, and child mental health problems: A multi-wave study. Child Abuse & Neglect. 2024 Aug:154:106927. DOI: 10.1016/j.chiabu.2024.106927.
Zhu J, Racine N, McDonald S, Tough S, Madigan S. Examining the Association Between Maternal Adverse Childhood Experiences and Child Socio-Emotional and Behavioral Concerns at 8 Years of Age. Child Maltreatment. 28 August 2024. DOI: 10.1177/1077559524127936
Bergeron J, Avraam D, Calas L, Fraser W, Harris JR, Heude B, Mandhane P, Moraes TJ, Muckle G, Nader J, Séguin JR, Simons E, Subbarao P, Swertz MA, Tough S, Turvey SE, FortierI, Rod NH, Andersen AMN. Stress and anxiety during pregnancy and length of gestation: a federated study using data from five Canadian and European birth cohorts. European Journal of Epidemiology. 39, 773–783 (2024). doi.org/10.1007/s10654-024-01126-4
Roy A, Patten S, Thurston W, Beran T, Crowshoe L, Tough SC. Race as a determinant of prenatal depressive symptoms: Analysis of data from the ‘All Our Families’ study. Ethnicity & Health, 29, Jan 2024 Issue 3. 395-422 (February 2024). DOI: 10.1080/13557858.2024.2312420
2023
Racine N, Plamondon A, McArthur BA, Hetherington E*, McDonald S, Edwards S, Tough S, Madigan S. Changes and predictors of maternal depressive and anxiety symptoms during the COVID-19 pandemic. Archives of Women’s Mental Health. 26, June 2023. https://doi.org/10.1007/s00737-023-01339-8
2022
Dahal KA, Racine N, Hetherington E*, McDonald SW, Tough S. Women’s Mental Health up to 8 Years after Childbirth and Associated Risk Factors: Longitudinal Findings from the All Our Families Cohort in Canada. The Canadian Journal of Psychiatry. 22 Nov, 2022. doi.org/10.1177/0706743722114038
2021
Racine N*, McDonald S, Tough S, Madigan S. Mediating Mechanisms for Maternal Mental Health from pre- to during the COVID-19 Pandemic: Mediators of maternal mental illness during COVID-19. Journal of Affective Disorders. Dec 2021, Vol. 6, 100287. DOI: 10.1016/j.jadr.2021.100287
Scime N*, Metcalfe A, Nettel-Aguirre A, Tough SC, Chaput KH. Association of prenatal medical risk with breastfeeding outcomes up to 12 months in the All Our Families community-based birth cohort. International Breastfeeding Journal. September 2021, 16:69. DOI: 10.1186/s13006-021-00413-0
Letourneau N, McDonald S, MacKay L, Bell RC, Hetherington E*, Deane AJ*, Dewey D, Edwards S, Field CH, Giesbrecht G, Graham SA, Lebel C, Leung B, Madigan S, McArthur BA*, McMorris C, Racine N*, Ross K, Wu M*, Tough S. Cross-Sectional Study Protocol for the COVID-19 Impact Survey of Mothers and Their 7-11 Year Old Children in Alberta, Canada. Frontiers in Psychiatry. June 2021, 12: 902. DOI: 10.3389/fpsyt.2021.597759
Hentges RF*, Madigan S, Tough S, McDonald SW, Graham SA. Maternal depressive symptoms and language development: The moderating role of child temperament. Developmental Psychology. 2021 Jun;57(6):863-875. DOI: 10.1037/dev0001184
Plamondon A, Racine N*, Tough S, Madigan S. Disentangling adversity timing and type: Contrasting theories in the context of maternal postpartum physical and mental health using latent formative models. Development & Psychopathology. May 2021, 1-13, DOI: 10.1017/S0954579421000353.
Hentges RF*, Graham S, Plamondon A, Tough S, Madigan S. Bidirectional associations between maternal depression, hostile parenting, and early child emotional problems: Findings from the All Our Families Pregnancy Cohort. Journal of Affective Disorders. May 2021, 287: 397-404. DOI: 10.1016/j.jad.2021.03.056.
Racine N*, Hetherington E, McArthur BA*, McDonald S, Edwards S, Tough S, Madigan S. Maternal depressive and anxiety symptoms before and during COVID-19: Longitudinal findings from the All Our Families Cohort, Canada. Lancet Psychiatry. March 2021, 1-11. DOI: 10.1016/S2215-0366(21)00074-2.
Racine, N*, McDonald, S, Chaput, K, Tough, S, Madigan, S. Pathways from maternal adverse childhood experiences to substance use in pregnancy: Findings from the All Our Families Cohort. Journal of Women’s Health. February 2021. DOI: 10.1089/jwh.2020.8632.
Currie CL, Tough S. Adverse childhood experiences are associated with illicit drug use among pregnant women with middle to high socioeconomic status: Findings from the All Our Families Cohort. BMC Pregnancy and Childbirth. January 2021, 133:1-9. DOI: 10.21203/rs.3.rs-33576/v1.
2020
Racine N*, Plamondon A, McDonald S, Tough S, Madigan, S. The consistency of maternal abuse reporting in pregnancy and the postpartum period. Journal of Women’s Health. November 2019, 29(4):561-569. DOI: 10.1089/jwh.2019.7795.
Racine N*, Zumwalt KA, McDonald S, Madigan S, Tough S. Perinatal depression: The role of maternal adverse childhood experiences and social support. Journal of Affective Disorders. November 2019, 263:576-581. DOI: 10.1016/j.jad.2019.11.030.
Hentges R*, Graham S, Plamondon A, Tough S, Madigan S. A developmental cascade from prenatal stress to child internalizing and externalizing problems: Findings from a prospective pregnancy cohort. Journal of Pediatric Psychology. October 2019, 44(9): 1057-1067. DOI: 10.1093/jpepsy/jsz044.
Cooke J, Racine N*, Plamondon A, Tough S, Madigan S. Maternal adverse childhood experiences, attachment style, and mental health: Pathways of transmission to child behavior problems. Child Abuse & Neglect. July 2019, 93:27-37. DOI: 10.1016/j.chiabu.2019.04.011.
Premji S, McDonald S, Metcalfe A, Faris P, Quan H, Tough S, McNeil D. Examining postpartum depression screening effectiveness in well child clinics in Alberta, Canada: a study using the All Our Families cohort and administrative data. Preventive Medicine Reports. June 2019, 14: 100888. DOI: 10.1016/j.pmedr.2019.100888
Horsley KJ, Tomfohr-Madsen LM, Ditto B, Tough S. Hypertensive disorders of pregnancy and symptoms of depression and anxiety as related to gestational age at birth: Findings from the All Our Families Study. Psychosomatic Medicine. April 2019, 81(5): 458-463. DOI: 10.1097/PSY.0000000000000695.
Racine N*, Plamondon A, Hentges R*, Tough S, Madigan S. Dynamic and bidirectional associations between maternal stress, anxiety, and social support: The critical role of partner and family support. Journal of Affective Disorders. April 2019, 252: 19-24. DOI: 10.1016/j.jad.2019.03.083.
McDonald SW, Madigan S, Racine R*, Benzies K, Tomfohr L, Tough S. Maternal adverse childhood experiences, mental health, and child behaviour at age 3: The All Our Families community cohort study. Preventive Medicine. January 2019, 118: 286-294. DOI: 10.1016/j.ypmed.2018.11.013.
2018
Racine N*, Madigan S, Plamondon A, Hetherington E*, McDonald S, Tough S. Maternal adverse childhood experiences and antepartum risks: The moderating role of social support. Archives of Women’s Mental Health, December 2018, 21(6): 663-670. DOI: 10.1007/s00737-018-0826-1.
Racine N*, Madigan S, Plamondon A, Hetherington E*, McDonald S, Tough S. Maternal psychosocial risk profiles in pregnancy: Associations with postpartum maternal health and child outcomes. Clinical Psychological Science, August 2018, 6(6): 783-796. DOI: 10.1177/2167702618788863.
Hetherington E*, McDonald S, Wu M, Tough S. Risk and protective factors for mental health and community cohesion after the 2013 Calgary flood. Disaster Medicine and Public Health Preparedness. August 2018, 12(4): 470-477. DOI: 10.1017/dmp.2017.91.
Hetherington E*, McDonald S, Williamson T, Patten SB, Tough SC. Social support and maternal mental health at 4 months and 1 year postpartum: analysis from the All Our Families cohort. Journal of Epidemiology & Community Health. May 2018, 72(10): 933-939. DOI: 10.1136/jech-2017-210274.
Dewell S*, Slater D, Benzies K, McDonald S, Tough S. Relationship between psychosocial distress in pregnancy and two genes associated with human social interaction: A pilot study. SAGE Open Nursing. March 2018. 4: 1-8. DOI: 10.1177/2377960818765272.
Racine N*, Plamondon A, Madigan S, McDonald S, Tough S. Maternal adverse childhood experiences and infant development. Pediatrics. March 2018, 141(2): e20172495. DOI: 10.1542/peds.2017-2495.
Racine NM*, Madigan SL, Plamondon AR, McDonald SW, Tough SC. Differential associations of adverse childhood experience on maternal health. American Journal of Preventive Medicine. March 2018, 54(3): 368-375. DOI: 10.1016/j.amepre.2017.10.028.
Doktorchik C, Premji S, Slater D, Williamson T, Tough S, Patten S. Patterns of change in anxiety and depression during pregnancy predict preterm birth. Journal of Affective Disorders. February 2018, 227: 71-78. DOI: 10.1016/j.jad.2017.10.001.
2017
Tough SC, McDonald SW, Collisson BA, Graham SA, Kehler H, Kingston D, Benzies K. Cohort profile: the All Our Babies cohort (AOB). International Journal of Epidemiology. October 2017, 46(5): 1389-1390k. DOI: 10.1093/ije/dyw363.
2016
Robinson AM*, Benzies KM, Cairns SL, Fung T, Tough SC. Who is distressed? A comparison of psychosocial stress in pregnancy across seven ethnicities. BMC Pregnancy and Childbirth. August 2016, 16(215):1-11. DOI: 10.1186/s12884-016-1015-8.
Bayrampour H*, Tomfohr L, Tough S. Trajectories of perinatal depressive and anxiety symptoms in a community cohort. Journal of Clinical Psychiatry. November 2016, 77(11): e1467–e1473. DOI: 10.4088/JCP.15m10176.
Benediktsson I*, McDonald S, Tough S. Examining the psychometric properties of three standardized screening tools in a pregnant and parenting population. Maternal and Child Health Journal. July 2016, 21(2): 253-259. DOI: 10.1007/s10995-016-2128-4.
2015
Bayrampour H*, Salmon C*, Vinturache A*, Tough S. Effect of depressive and anxiety symptoms during pregnancy on risk of obstetric interventions. Journal of Obstetrics and Gynaecology Research. July 2015, 41(7): 1040-1048. DOI: 10.1111/jog.12683.
Vinturache A*, Stephenson N, McDonald SW, Wu M, Bayrampour H*, Tough S. Health-related quality of life in pregnancy and postpartum among women with assisted conception. Fertility and Sterility. July 2015, 104(1):188-195.e1. DOI: 10.1016/j.fertnstert.2015.04.012.
Bayrampour H*, McDonald S, Tough S. Risk factors of transient and persistent anxiety during pregnancy. Midwifery. June 2015, 31(6): 582–589. DOI: 10.1016/j.midw.2015.02.009.
2014
McDonald SW*, Kingston D, Bayrampour H*, Dolan SM, Tough SC. Cumulative psychosocial stress, coping resources, and preterm birth. Archives of Women’s Mental Health. December 2014, 17(6):559-568. DOI: 10.1007/s00737-014-0436-5.
Bayrampour H*, McDonald S*, Fung T, Tough S. Reliability and validity of three shortened versions of the State Anxiety Inventory scale during the perinatal period. Journal of Psychosomatic Obstetrics and Gynecology. September 2014, 35(3): 101–107. DOI: 10.3109/0167482X.2014.950218.
Benzies K*, Mychasiuk R, Tough S. What patterns of postpartum psychological distress are associated with maternal concerns about their children’s emotional and behavioral problems at age 3 years? Early Child Development and Care. March 31, 2014, 185(1):1-16. DOI: 10.1080/03004430.2014.899592.
Raguz N, McDonald SW*, Metcalfe A*, O'Quinn C, Tough SC. Mental health outcomes of mothers who conceived using fertility treatment. Reproductive Health. February 2014, 11(19): 1-7. DOI: 10.1186/1742-4755-11-19.
2013
McDonald SW*, Benzies KM, Gallant JE, McNeil DA, Dolan SM, Tough SC. A comparison between late preterm and term infants on breastfeeding and maternal mental health. Maternal and Child Health Journal. October 2013, 17(8):1468-1477. DOI: 10.1007/s10995-012-1153-1.
McDonald SW*, Lyon AW, Benzies KM, McNeil DA, Lye SJ, Dolan SJ, Pennell CE, Bocking AD, Tough SC. The All Our Babies pregnancy cohort: design, methods, and participant characteristics. BMC Pregnancy and Childbirth. January 2013, 13(Suppl 1):S2. DOI: 10.1186/1471-2393-13-S1-S2.
2012
Malta LA*, McDonald SW*, Hegadoren KM, Weller CA*, Tough SC. Influence of interpersonal violence on maternal anxiety, depression, stress and parenting morale in the early postpartum: a community based pregnancy cohort study. BMC Pregnancy and Childbirth. December 2012, 12(153): 1-9. DOI: 10.1186/1471-2393-12-153.
McDonald SW*, Wall J*, Forbes K, Kingston D, Kehler H, Vekved M, Tough S. Development of a prenatal psychosocial screening tool for post-partum depression and anxiety. Paediatric and Perinatal Epidemiology. May 2012, 26(4): 316-327. DOI: 10.1111/j.1365-3016.2012.01286.x.
2010
Gracie SK*, Lyon AW, Kehler HL, Pennell CE, Dolan SM, McNeil DA, Siever JE, McDonald SW, Bocking AD, Lye SJ, Hegadoren KM, Olson DM, Tough SC. All Our Babies Cohort Study: Recruitment of a cohort to predict women at risk of preterm birth through the examination of gene expression profiles and the environment. BMC Pregnancy and Childbirth. December 2010, 10(87). DOI: 10.1186/1471-2393-10-87.