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Association of Pain Catastrophizing with Postnatal Depressive States in Nulliparous Parturients: A Prospective Study

Authors Zeng Y, Tan CW, Sultana R, Chua TE, Chen HY, Sia ATH, Sng BL

Received 1 April 2020

Accepted for publication 13 July 2020

Published 30 July 2020 Volume 2020:16 Pages 1853—1862


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Yuping Ning

Yanzhi Zeng,1 Chin Wen Tan,1,2 Rehena Sultana,3 Tze-Ern Chua,4,5 Helen Yu Chen,4,5 Alex Tiong Heng Sia,1,2 Ban Leong Sng1,2

1Department of Women’s Anaesthesia, KK Women’s and Children’s Hospital, Singapore; 2Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; 3Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; 4Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore; 5Paediatrics Academic Clinical Program, Duke-NUS Medical School, Singapore

Correspondence: Ban Leong Sng Tel +65 6394 1081
Fax +65 62912661

Purpose: Postnatal depression (PND) is associated with maternal morbidity and socioeconomic burden. Recent studies have shown an association between pain catastrophizing, increased labor pain, and subsequent adverse postnatal adjustment; however, little is known on its role in PND development. We aimed to investigate the association between pain catastrophizing and probable PND.
Methods: Parturients planning to undergo epidural labor analgesia were recruited. Predelivery questionnaires, including the Pain Catastrophizing Scale (PCS) and Edinburgh Postnatal Depression Scale (EPDS), were administered during early labor. A phone survey at 5– 9 weeks postdelivery was conducted to determine postdelivery EPDS and Spielberger’s State–Trait–Anxiety Inventory scores. The primary outcome was a binary variable of postdelivery EPDS with cutoff of ≥ 10, whereas the secondary outcome was a continuous variable on increases in EPDS score.
Results: Probable PND (EPDS ≥ 10) occurred in 10.5% (95% CI 8.0%– 13.5%, 55 of 525) of women who underwent epidural labor analgesia. We found that high pain catastrophizing (PCS ≥ 25) was associated with increased postdelivery EPDS scores (adjusted β estimate 0.36, 95% CI 0.15– 0.57; p=0.0008), but did not meet significance for increased risk of probable PND (p=0.1770). Additionally, presence of breakthrough pain during epidural analgesia (adjusted β estimate 0.24, 95% CI 0.02– 0.46; p=0.0306) and lower BMI at term (adjusted β estimate − 0.04, 95% CI − 0.07 to − 0.01; p=0.0055) were associated with increased postdelivery EPDS scores.
Conclusion: No significant association was found between high pain catastrophizing and probable PND; however, high predelivery pain catastrophizing, presence of breakthrough pain during epidural analgesia, and lower BMI at term were associated with increased postdelivery EPDS scores. Further research will be needed to validate this association in the context of the risk of PND development.

Keywords: pain catastrophizing, breakthrough pain, epidural analgesia, postnatal depressive states

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