Researchers recently investigated the relative recurrence risk of postpartum depression among women who experienced depression after their first births.
Postpartum depression is a temporary, non-psychotic state of depression following the delivery of a child. Postpartum depression may affect between 5% and 15% of all mothers, making it one of the most common postnatal complications of childbearing. For many women, postpartum depression is their first psychiatric disorder. Prompt and effective treatment is essential, as both the mother and child may experience potential long-term effects. Postpartum affective disorder (AD) is a broader, umbrella term that includes postpartum depression as well as other postpartum conditions such as postpartum psychosis.
A team of Danish researchers recently conducted a study to describe the risk of postpartum affective disorder among women with no prior psychiatric episodes, the duration of treatment, and the recurrence risk with subsequent pregnancies. They linked data from several national registries to include a cohort of 457,317 first-time mothers and their subsequent births between 1996 and 2013. All participants had no previous psychiatric hospital contacts and no prior use of antidepressants.
High Recurrence Risk of Postpartum Depression
The results, recently published PLoS Medicine, demonstrated that, although the relative risk of postpartum depression was low, the recurrence risk was high. Postpartum depression was observed after 4,550 births or 0.6%. After the first year, postpartum, 27.9% of these women were still in treatment, however after four years that number had dropped to only 5.4% of the women.
The recurrence risk was striking. The recurrence risk of postpartum affective disorder was 15% for women prescribed antidepressants after their first birth and 21% for women who were hospitalized for an affective disorder after their first birth. In fact, compared to women who did not experience postpartum depression, the risk of postpartum depression after a second birth was 46.6 times higher in women who had been hospitalized for depression after their first. Women who were prescribed antidepressant medication after their first birth experienced postpartum depression 26.9 times more often after their second birth than women who had never experienced postpartum depression.
Preventive Measures Needed
This important study has some serious implications for healthcare providers treating women with postpartum depression. It identifies women who experienced postpartum depression as their first psychiatric episode as particularly vulnerable to subsequent episodes of postpartum depression, and therefore as a population requiring identification and extra care. This study highlights the seriousness of the first initial episode of postpartum depression and the necessity of preventive measures aimed at this group of women.
Written by Lisa Borsellino, B. Sc.
Citation: Rasmussen M-LH, StrømM, Wohlfahrt J, Videbech P, Melbye M (2017) 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): e1002392. https://doi.org/10.1371/journal.pmed.1002392