Depressive Severity Associated with Cesarean Section in Young Depressed Individuals
Major depressive disorder (MDD) is a significant contributor to youth suicide, making it a critical area of study. Cesarean section (C-section), a common method of childbirth, has been shown to impact not only mothers but also their children. This impact includes effects on cognitive and brain development, as well as other physical health issues. The absence of vaginal microorganisms and the lack of the squeezing pressure experienced during vaginal birth are believed to be key factors in these outcomes. Despite the known associations between C-section and various health issues in children, there has been limited research on the connection between depressive severity and C-section delivery in young individuals with MDD. This study aims to explore this relationship, focusing on young patients diagnosed with MDD.
The study recruited 347 patients (178 males and 169 females) aged between 19 and 30 years, all diagnosed with MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. These patients underwent in-person interviews, the Mini International Neuropsychiatric Interview, and physical examinations conducted by experienced psychiatrists at the Division of Neuropsychiatry, Department of Neurology, Xuanwu Hospital of Capital Medical University in Beijing, China. The recruitment period spanned from August 20, 2015, to December 28, 2018. Patients with conditions such as anemia, thyroid dysfunction, mental retardation, neurological conditions, bipolar disorders, schizophrenia, and other mental disorders were excluded from the study.
Depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HAMD-17), administered by three experienced psychological testing technicians who were blinded to the participants’ birth delivery types. The study adhered to the Declaration of Helsinki and received approval from the Ethics Committee of Xuanwu Hospital. As a retrospective study, it was exempt from obtaining informed consent from patients, given that data analysis was performed anonymously.
The HAMD-17 total score and its five domains—anxiety, weight, cognitive dysfunction, retardation, and sleep disturbance—were evaluated. Information on whether participants were born full-term via vaginal delivery or C-section was provided by the patients and/or their parents. Additional data collected included age of onset, gender, marital status, educational level, occupation, and disease course, which referred to the time from the onset of the disease to the first MDD diagnosis. Educational level was dichotomized based on whether participants had a high school diploma or not, corresponding to nine years of education.
Participants were divided into two groups based on their HAMD-17 scores: moderate depression (scores of 17 to 23) and severe depression (scores of 24 or higher). Non-parametric tests and Chi-square tests were used to assess differences in continuous and categorical variables between the two groups, respectively. Multivariate logistic regression was employed to investigate the associations between depressive severity and delivery type, adjusting for age of onset, gender, marital status, educational level, occupation, and disease course.
The analysis revealed significant associations between depressive severity and age of onset, occupation, disease course, marital status, and delivery type (all P < 0.01). Multivariate logistic regression further indicated that individuals born via C-section were more likely to experience severe depression (odds ratio 3.50, 95% confidence interval 1.72–7.14; P < 0.01).
The study participants had an average age of 25.7 years, with 58% born via C-section. Those born via C-section exhibited greater depressive severity compared to those born via vaginal delivery. The severe depression group had an older age of onset, a higher proportion of C-section births, a shorter disease course, and a higher divorce rate compared to the moderate depression group.
These findings build on previous research that identified risk factors for increased depressive severity, such as mental or physical comorbidities, low education level or social status, and high living pressure. This study adds to the literature by demonstrating that depressive severity in young MDD patients is correlated with age of onset, marital status, occupation, disease course, and delivery type. Importantly, it highlights that C-section significantly increases the risk of severe depression in young individuals with MDD.
The route of delivery has been shown to influence an individual’s physical and cognitive development. C-section impacts the composition of vaginal and intestinal microflora, which can synthesize and transport neuroactive substances involved in the gut-brain axis, potentially increasing the risk of MDD. This study suggests that C-section may be an important factor contributing to depressive severity in young patients with MDD.
However, due to the cross-sectional design of the study, further research is needed to elucidate the mechanisms and pathogenesis underlying the relationship between depressive severity and C-section delivery. Future investigations should aim to explore these relationships in greater depth, providing a more comprehensive understanding of the factors contributing to depression in young individuals.
The authors acknowledge the contributions of several researchers and express gratitude to their research team and participants for their professionalism and efforts in conducting this study. The study was supported by grants from the Beijing Municipal Science and Technology Project, the National Natural Science Foundation of China, the Beijing Natural Science Foundation, the Beijing Municipal Hospital Research and Development Plan, and the Beijing Hundred, Thousand, and Ten Thousand Talents Project.
doi.org/10.1097/CM9.0000000000000326
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