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PND rates are highest among women with persistent mental health problems before pregnancy, and antenatal healthcare provides ideal opportunity to intervene. We examined antenatal perceived social support as a potential intervention target in preventing PND symptoms among women with prior mental health problems. A total of 398 Australian women (600 pregnancies) were assessed repeatedly for mental health problems before pregnancy (ages 14\u201329 years, 1992\u20132006), and again during pregnancy, two months postpartum and one year postpartum (2006\u20132014). Causal mediation analysis found that intervention on perceived antenatal social support has the potential to reduce rates of PND symptoms by up to 3% (from 15 to 12%) in women with persistent preconception symptoms. Supplementary analyses found that the role of low antenatal social support was independent of concurrent antenatal depressive symptoms. Combined, these two factors mediated up to more than half of the association between preconception mental health problems and PND symptoms. Trialling dual interventions on antenatal depressive symptoms and perceived social support represents one promising strategy to prevent PND in women with persistent preconception symptoms. Interventions promoting mental health before pregnancy may yield an even greater reduction in PND symptoms by disrupting a developmental cascade of risks via these and other pathways.<\/jats:p>\n                  <jats:p>This article is part of the theme issue \u2018Multidisciplinary perspectives on social support and maternal\u2013child health\u2019.<\/jats:p>","DOI":"10.1098\/rstb.2020.0028","type":"journal-article","created":{"date-parts":[[2021,5,3]],"date-time":"2021-05-03T01:32:27Z","timestamp":1620005547000},"update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":29,"title":["Preventing postnatal depression: a causal mediation analysis of a 20-year preconception cohort"],"prefix":"10.1098","volume":"376","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2837-3514","authenticated-orcid":true,"given":"Elizabeth A.","family":"Spry","sequence":"first","affiliation":[{"name":"1 Centre for Social and Early Emotional Development, 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M.","family":"Howard","sequence":"additional","affiliation":[{"name":"4 Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK"},{"name":"5 South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie J.","family":"Brown","sequence":"additional","affiliation":[{"name":"2 Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria 3052, Australia"},{"name":"3 University of Melbourne, Melbourne, Victoria 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Molyneaux","sequence":"additional","affiliation":[{"name":"4 Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Greenwood","sequence":"additional","affiliation":[{"name":"1 Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia"},{"name":"2 Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Primrose","family":"Letcher","sequence":"additional","affiliation":[{"name":"2 Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria 3052, Australia"},{"name":"3 University of Melbourne, Melbourne, Victoria 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9451-2709","authenticated-orcid":true,"given":"Jacqui A.","family":"Macdonald","sequence":"additional","affiliation":[{"name":"1 Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia"},{"name":"2 Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria 3052, Australia"},{"name":"3 University of Melbourne, Melbourne, Victoria 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly C.","family":"Thomson","sequence":"additional","affiliation":[{"name":"1 Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia"},{"name":"3 University of Melbourne, Melbourne, Victoria 3052, Australia"},{"name":"6 Human Early Learning Partnership, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada V6T 1Z3"},{"name":"7 Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada V6Z 1Y6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ebony J.","family":"Biden","sequence":"additional","affiliation":[{"name":"1 Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia"},{"name":"2 Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5927-2014","authenticated-orcid":true,"given":"Craig A.","family":"Olsson","sequence":"additional","affiliation":[{"name":"1 Centre for Social and Early Emotional Development, School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia"},{"name":"2 Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria 3052, Australia"},{"name":"3 University of Melbourne, Melbourne, Victoria 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George 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