TY - JOUR
T1 - Prospective longitudinal study of predictors of postpartum-onset depression in women with a history of major depressive disorder
AU - Suri, Rita
AU - Stowe, Zachary N.
AU - Cohen, Lee S.
AU - Newport, D. Jeffrey
AU - Burt, Vivien K.
AU - Aquino-Elias, Ana R.
AU - Knight, Bettina T.
AU - Mintz, Jim
AU - Altshuler, Lori L.
N1 - Funding Information:
Submitted: September 30, 2015; accepted June 14, 2016. Online first: March 14, 2017. Potential conflicts of interest: Dr Cohen has received research support from the National Pregnancy Registry for Atypical Antipsychotics, AstraZeneca, Bristol-Myers Squibb/Otsuka, Ortho-McNeil Janssen, Pfizer, and Sunovion; has received other research support from Bayer HealthCare, Cephalon, Forest, GlaxoSmithKline, National Institute on Aging, National Institutes of Health (NIH), National Institute of Mental Health (NIMH), and Takeda/Lundbeck; and has received advisory/ consulting fees from Noven, PamLab, and JDS Therapeutics. Dr Newport has received research support from the National Alliance for Research on Schizophrenia and Depression (NARSAD) and NIH, and neither he nor family members have received research support, speakers’ honoraria, served as a consultant or on advisory boards, or held equity positions in any biomedical or pharmaceutical corporations. Dr Burt is a consultant, advisor and speaker for Sunovion, Takeda, and Lundbeck and is a consultant and advisor to Otsuka. Dr Mintz has received advisory/consulting fees from Bracket Global. Dr Altshuler was on an advisory board for Takeda and H. Lundbeck A/S (Health and Wellness Partners) in November 2012 and attended an editorial board meeting sponsored by Sunovion (Health and Wellness Partners) in February 2013; received honorarium as part of the 2014 Award for Research in Mood Disorders given by the American College of Psychiatrists in March 2014; performed a medical records review for the law offices of Hughes-Sokol-Piers-Resnick DYM, Ltd in January and March 2015; and had been principal investigator and co-investigator on research studies sponsored by the NIMH in the 36 months prior to the submission of this manuscript. Over the course of his academic career, Dr Stowe has received research support from NIH, Pfizer, Wyeth, and GlaxoSmithKline; has participated in the Speakers’ Bureau for Eli Lilly, Forest, GlaxoSmithKline, Pfizer, and Wyeth and served on advisory boards at Pfizer,
Funding Information:
GlaxoSmithKline, and Bristol-Myers Squibb; and has participated in a variety of clinical trials sponsored by pharmaceutical companies that were operated in a clinical setting. He is currently a study clinician in clinical trials sponsored by Janssen and Sage and has, in the preceding 36 months, received research support from NIH and the Centers for Disease Control and Prevention. Dr Suri and Mss Aquino-Elias and Knight have no conflicts of interest relevant to this article to disclose. Funding/support: Funding for this study was provided by a collaborative R01 grant from the NIMH, Bethesda, MD, USA: 5R01MH063844 (Dr Altshuler), 5R01MH063989 (Dr Cohen), 5R01MH063979 (Dr Stowe). Role of the sponsor: The funder (NIMH) provided initial peer review and comments of the study protocol prior to funding but had no direct role in either the conduct of the protocol once it was funded or in the publication of study results. Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Objective: Risk factors for postpartum depression in euthymic pregnant women with histories of major depressive disorder (MDD) were evaluated. Methods: From April 2003 to March 2009, 343 pregnant women with a history of Structured Clinical Interview for DSM-IV (SCID)-diagnosed major depressive disorder were prospectively assessed from the third trimester into the postpartum period using the SCID mood module and 17-item Hamilton Depression Rating Scale (HDRS). Data from 300 subjects who completed at least 2 mood module assessments (1 within 60 days before and the other within 60 days after delivery) were analyzed for predictive associations between variables assessed in the third trimester and the development of a postpartum depression. Results: The majority of women were euthymic in pregnancy by SCID criteria. Women with third trimester SCID-diagnosed depression (n = 45) versus euthymia (n = 255) had a significantly higher risk for having depression after delivery (24% vs 11%, P =.013). For pregnant euthymic women, third trimester total HDRS scores significantly predicted postpartum depression (P <.0001); specifically, scores on 3 HDRS items alone - work activities, early insomnia, and suicidality - significantly predicted postpartum depression. Antidepressant use in the third trimester in euthymic women did not confer protection against the onset of postpartum depression. Conclusions: Among women with a history of MDD who are euthymic in the third trimester, 3 HDRS items - work activities, early insomnia, and suicidality - may be useful as screening items for clinicians working with pregnant women with histories of MDD to identify a group at risk for developing postpartum depression. Additionally, in euthymic women with a history of MDD, antidepressant use in the third trimester may not reduce the risk of developing postpartum depression.
AB - Objective: Risk factors for postpartum depression in euthymic pregnant women with histories of major depressive disorder (MDD) were evaluated. Methods: From April 2003 to March 2009, 343 pregnant women with a history of Structured Clinical Interview for DSM-IV (SCID)-diagnosed major depressive disorder were prospectively assessed from the third trimester into the postpartum period using the SCID mood module and 17-item Hamilton Depression Rating Scale (HDRS). Data from 300 subjects who completed at least 2 mood module assessments (1 within 60 days before and the other within 60 days after delivery) were analyzed for predictive associations between variables assessed in the third trimester and the development of a postpartum depression. Results: The majority of women were euthymic in pregnancy by SCID criteria. Women with third trimester SCID-diagnosed depression (n = 45) versus euthymia (n = 255) had a significantly higher risk for having depression after delivery (24% vs 11%, P =.013). For pregnant euthymic women, third trimester total HDRS scores significantly predicted postpartum depression (P <.0001); specifically, scores on 3 HDRS items alone - work activities, early insomnia, and suicidality - significantly predicted postpartum depression. Antidepressant use in the third trimester in euthymic women did not confer protection against the onset of postpartum depression. Conclusions: Among women with a history of MDD who are euthymic in the third trimester, 3 HDRS items - work activities, early insomnia, and suicidality - may be useful as screening items for clinicians working with pregnant women with histories of MDD to identify a group at risk for developing postpartum depression. Additionally, in euthymic women with a history of MDD, antidepressant use in the third trimester may not reduce the risk of developing postpartum depression.
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U2 - 10.4088/JCP.15m10427
DO - 10.4088/JCP.15m10427
M3 - Article
C2 - 28297589
AN - SCOPUS:85032634782
VL - 78
SP - 1110
EP - 1116
JO - The Journal of clinical psychiatry
JF - The Journal of clinical psychiatry
SN - 0160-6689
IS - 8
ER -