Advertisement

Is depression more likely following childbirth? A population-based study

  • Michael E. Silverman
  • Abraham Reichenberg
  • Paul Lichtenstein
  • Sven Sandin
Original Article
  • 194 Downloads

Abstract

Postpartum depression (PPD) is characterized as a depressive episode conditional on childbirth. We examined whether the risk of depression is higher following childbirth than that at a randomly generated time unrelated to childbirth. In a prospective cohort of all women with live singleton births in Sweden, 1997–2008, we first calculated the relative risk (RR) of PPD for mothers with a history of depression compared to mothers without such a history. Next, we repeated the calculations, but now for depression following a computer-generated arbitrary “phantom delivery” date, unrelated to the true date of delivery. For this phantom delivery date, we used the average expected date of delivery for all women of the same age. For the analyses of each group, women were followed for a full calendar year. We fitted Poisson regression and calculated RR and two-sided 95% confidence intervals (CI). Among a total of 707,701 deliveries, there were 4397 PPD cases and 4687 control depression cases. The RR of PPD was 21.0 (CI 19.7–22.4). The RR of depression in the control group was 26.2 (CI 24.7–27.9). We provide evidence that the risk for PPD is no greater following childbirth than following a random date unrelated to childbirth. This finding suggests that the postpartum period may not necessarily represent a time of heightened vulnerability for clinically significant depression and that the well-established observation of depression covarying with childbirth does not necessarily equate to causation, but rather may be a secondary effect of postpartum women representing a medically captured population.

Keywords

Epidemiology Depression Postpartum depression (PPD) Diagnosis 

Notes

Funding/support

This study was supported by a grant to Michael E. Silverman from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; Grant number: R21HD073010.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

References

  1. Altemus M, Neeb CC, Davis A, Occhiogrosso M, Nguyen T, Bleiberg KL (2012) Phenotypic differences between pregnancy-onset and postpartum-onset major depressive disorder. J Clin Psychiatry 73(12):e1485–e1491CrossRefPubMedGoogle Scholar
  2. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. APA Press, ArlingtonCrossRefGoogle Scholar
  3. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103(4):698–709CrossRefPubMedGoogle Scholar
  4. Bergink V, Rasgon N, Wisner KL (2016) Postpartum psychosis: madness, mania, and melancholia in motherhood. Am J Psychiatry 173(12):1179–1188CrossRefPubMedGoogle Scholar
  5. Borrell-Carrio F, Epstein RM (2004) Preventing errors in clinical practice: a call for self-awareness. Ann Fam Med 2(4):310–316CrossRefPubMedPubMedCentralGoogle Scholar
  6. Cooper PJ, Murray L (1995) Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. Br J Psychiatry 166(2):191–195CrossRefPubMedGoogle Scholar
  7. Cooper PJ, Campbell EA, Day A, Kennerley H, Bond A (1988) Non-psychotic psychiatric disorder after childbirth. A prospective study of prevalence, incidence, course and nature. Br J Psychiatry 152:799–806CrossRefPubMedGoogle Scholar
  8. Corwin EJ, Kohen R, Jarrett M, Stafford B (2010) The heritability of postpartum depression. Biol Res Nurs 12(1):73–83CrossRefPubMedPubMedCentralGoogle Scholar
  9. Cox J (2017) Use and misuse of the Edinburgh Postnatal Depression Scale (EPDS): a ten point ‘survival analysis’. Arch Womens Ment Health 20(6):789–790CrossRefPubMedGoogle Scholar
  10. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786CrossRefPubMedGoogle Scholar
  11. Di Florio A, Meltzer-Brody S (2015) Is postpartum depression a distinct disorder? Curr Psychiatry Rep 17(10):76–82CrossRefPubMedGoogle Scholar
  12. Fisher J, de Mello MC, Patel V, Rahman A, Tran T, Holton S, Holmes W (2012) Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 90:139–149CrossRefGoogle Scholar
  13. Forty L, Jones L, Macgregor S, Caesar S, Cooper C, Hough A, Dean L, Dave S, Farmer A, McGuffin P, Brewster S, Craddock N, Jones I (2006) Familiality of postpartum depression in unipolar disorder: results of a family study. Am J Psychiatry 163(9):1549–1553CrossRefPubMedGoogle Scholar
  14. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083CrossRefPubMedGoogle Scholar
  15. Gaynes BN, Gavin N, Meltzer-Brody S, Lohr KN, Swinson T, Gartlehner G, Brody S, Miller WC (2005). Perinatal depression: prevalence, screening accuracy, and screening outcomes. Evidence Report/Technology Assessment No. 119. (Prepared by the RTI-University of North Carolina Evidence-based Practice Center, under Contract No. 290–02-0016.) AHRQ Publication No. 05-E006–2. Rockville, MD: Agency for Healthcare Research and QualityGoogle Scholar
  16. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R (2009) A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand 119(5):350–364CrossRefPubMedGoogle Scholar
  17. Gjerdingen DK, Yawn BP (2007) Postpartum depression screening: importance, methods, barriers, and recommendations for practice. J Am Board Fam Med 20(3):280–288CrossRefPubMedGoogle Scholar
  18. Guardino CM, Schetter CD (2014) Coping during pregnancy: a systematic review and recommendations. Health Psychol Rev 8(1):70–94CrossRefPubMedGoogle Scholar
  19. Healey C, Morriss R, Henshaw C, Wadoo O, Sajjad A, Scholefield H, Kinderman P (2013) Self-harm in postpartum depression and referrals to a perinatal mental health team: an audit study. Arch Womens Ment Health 16(3):237–245CrossRefPubMedPubMedCentralGoogle Scholar
  20. Hoertel N, López S, Peyre H, Wall MM, González-Pinto A, Limosin F, Blanco C (2015) Are symptom features of depression during pregnancy, the postpartum period and outside the peripartum period distinct? Results from a nationally representative sample using item response theory (IRT). Depress Anxiety 32(2):129–140CrossRefPubMedGoogle Scholar
  21. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J (2014) Non-psychotic mental disorders in the perinatal period. Lancet 384(9956):1775–1788CrossRefPubMedGoogle Scholar
  22. Kessler RC (2003) Epidemiology of women and depression. J Affect Disord 74(1):5–13CrossRefPubMedGoogle Scholar
  23. Klein JG (2005) Five pitfalls in decisions about diagnosis and prescribing. BMJ 330(7494):781–783CrossRefPubMedPubMedCentralGoogle Scholar
  24. Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J, Schneider LS, Kales HC (2015) Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry 72(5):438–445CrossRefPubMedPubMedCentralGoogle Scholar
  25. Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB (2006) New parents and mental disorders: a population-based register study. JAMA 296(21):2582–2589CrossRefPubMedGoogle Scholar
  26. Myers ER, Aubuchon-Endsley N, Bastian LA, Gierisch JM, Kemper AR, Swamy GK et al (2013) Efficacy and safety of screening for postpartum depression. Comparative Effectiveness Review 106. AHRQ Publication No. 13-EHC064-EF. Agency for Healthcare Research and Quality, RockvilleGoogle Scholar
  27. Navarro P, García-Esteve L, Ascaso C, Aguado J, Gelabert E, Martín-Santos R (2008 Jul) Non-psychotic psychiatric disorders after childbirth: prevalence and comorbidity in a community sample. J Affect Disord 109(1–2):171–176CrossRefPubMedGoogle Scholar
  28. O’Hara MW, McCabe JE (2013) Postpartum depression: current status and future directions. Annu Rev Clin Psychol 9:379–407CrossRefPubMedGoogle Scholar
  29. O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression: a meta-analysis. Int Rev Psychiatry 8:37–54CrossRefGoogle Scholar
  30. O’Hara MW, Wisner KL (2014) Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol 28(1):3–12CrossRefPubMedGoogle Scholar
  31. O’Hara MW, Zekoski EM, Philipps LH, Wright EJ (1990) Controlled prospective study of postpartum mood disorders: comparison of childbearing and nonchildbearing women. J Abnorm Psychol 99:3–15CrossRefPubMedGoogle Scholar
  32. Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium (2015) Heterogeneity of postpartum depression: a latent class analysis. Lancet Psychiatry 2(1):59–67CrossRefGoogle Scholar
  33. Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S (2014) Risk factors for and perinatal outcomes of major depression during pregnancy: a population-based analysis during 2002-2010 in Finland. BMJ Open 4(11):e004883CrossRefPubMedPubMedCentralGoogle Scholar
  34. Rasmussen MH, Strøm M, Wohlfahrt J, Videbech P, Melbye M (2017 Sep 26) Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: a population-based cohort study. PLoS Med 14(9):e1002392CrossRefPubMedPubMedCentralGoogle Scholar
  35. Savitz D, Stein C, Yee F, Kellerman L, Silverman ME (2011) The epidemiology of hospitalized postpartum depression in New York State, 1995–2004. Ann Epidemiol 21(6):399–406CrossRefPubMedPubMedCentralGoogle Scholar
  36. Silverman ME, Loudon H, Liu X, Mauro C, Leiter G, Goldstein MA (2011) The neural processing of negative emotion postpartum: a preliminary study of amygdala function in postpartum depression. Arch Womens Ment Health 14(4):355–359CrossRefPubMedGoogle Scholar
  37. Silverman ME, Reichenberg A, Savitz DA, Cnattingius S, Lichtenstein P, Hultman CM, Larsson H, Sandin S (2017) The risk factors for postpartum depression: a population-based study. Depress Anxiety 34(2):178–187CrossRefPubMedPubMedCentralGoogle Scholar
  38. Surkan PJ, Ettinger AK, Ahmed S, Minkovitz CS, Strobino D (2012) Impact of maternal depressive symptoms on growth of preschool- and school-aged children. Pediatrics 130(4):847–855CrossRefGoogle Scholar
  39. Thombs BD, Kwakkenbos L, Levis AW, Benedetti A (2018) Addressing overestimation of the prevalence of depression based on self-report screening questionnaires. CMAJ 190(2):E44–E49CrossRefPubMedGoogle Scholar
  40. Viktorin A, Meltzer-Brody S, Kuja-Halkola R, Sullivan PF, Landén M, Lichtenstein P, Magnusson PK (2015) Heritability of perinatal depression and genetic overlap with nonperinatal depression. Am J Psychiatry 173(2):158–165CrossRefPubMedGoogle Scholar
  41. Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V (2016) Risk of postpartum relapse in bipolar disorder and postpartum psychosis: a systematic review and meta-analysis. Am J Psychiatry 173(2):117–127CrossRefPubMedGoogle Scholar
  42. Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, Eng HF, Luther JF, Wisniewski SR, Costantino ML, Confer AL, Moses-Kolko EL, Famy CS, Hanusa BH (2013) Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 70(5):490–498CrossRefPubMedPubMedCentralGoogle Scholar
  43. World Health Organization (1992) International statistical classification of diseases and related health problems, 10th revision (ICD-10). WHO, GenevaGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Michael E. Silverman
    • 1
  • Abraham Reichenberg
    • 1
    • 2
    • 3
  • Paul Lichtenstein
    • 4
  • Sven Sandin
    • 1
    • 3
    • 4
  1. 1.Department of PsychiatryIcahn Medical School at Mount SinaiNew YorkUSA
  2. 2.Department of Preventive Medicine, Friedman Brain Institute and The Mindich Child Health and Development InstituteIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkUSA
  4. 4.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden

Personalised recommendations