Educational differences in prenatal anxiety and depressive symptoms and the role of childhood circumstances

Sanni Kotimäki; Juho Härkönen; Linnea Karlsson; Hasse Karlsson; Noora M Scheinin

doi:10.1016/j.ssmph.2020.100690

Educational differences in prenatal anxiety and depressive symptoms and the role of childhood circumstances

SSM Popul Health. 2020 Nov 10:12:100690. doi: 10.1016/j.ssmph.2020.100690. eCollection 2020 Dec.

Authors

Sanni Kotimäki¹, Juho Härkönen^{2

3}, Linnea Karlsson^{4

5

6}, Hasse Karlsson^{4

6

7}, Noora M Scheinin^{4

7}

Affiliations

¹ Department of Social Sciences, University of Turku, 20014, Turku, Finland.
² Department of Political and Social Sciences, European University Institute, 50014, San Domenico di Fiesole, Italy.
³ Department of Sociology, Stockholm University, 10691, Stockholm, Sweden.
⁴ FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, 20014, Turku, Finland.
⁵ Department of Child Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.
⁶ Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.
⁷ Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.

Abstract

Despite interest in unequal maternal and child health, previous research has not focused on educational differences in anxiety and depressive symptoms during pregnancy, although they threaten maternal and child wellbeing. Using the prospective FinnBrain Cohort Study data on 2763 pregnant women over the three pregnancy trimesters and Finnish register data, we estimated multilevel regressions to describe educational differences in prenatal anxiety and depressive symptoms and to analyze whether they can be explained by socioeconomic background, parental mental disorders and adverse experiences during childhood. Prenatal anxiety was measured by the Symptom Checklist (SCL-90-anxiety subscale) and depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). The results showed less anxiety and depressive symptoms among more educated pregnant women. In accounting for the educational differences, we found support for both the social selection and the social causation perspectives. Adverse childhood experiences partly explained the educational differences, highlighting the role of an undisturbed childhood environment in prenatal mental health disparities. Results from the regression models as well as sensitivity analyses also suggested that education is likely to buffer against prenatal distress.

Keywords: Anxiety; Childhood adversity; Depression; Education; Multilevel modeling; Pregnancy.