Abstract
Postnatal depression is a common disorder occurring in 13% to 15% pregnant women and is associated with deleterious health outcomes for mother, infant and families. There is a subset of women with increased susceptibility to estrogen fluctuations which may represent an underlying risk factor for postnatal depression. Given the crosstalk between different endocrine systems, we interrogated whether hormonal sensitivity might influence other hormonal phases in women such as post-sex distress or postcoital dysphoria. We assessed 1,801 women using questionnaires. Data analyses were carried out using SPSS Version 17.0. Women with postnatal depression had significantly higher rates of postcoital dysphoria (P-value=0.009, 99% CI of 0.007-0.012), this remained significant even after corrections for multiple testing. Women with postnatal depression reported higher rates of anxiety (P-value=2 × 10-6), depression (P-value=2.9 × 10-11), childhood sexual abuse (P-value=0.022), childhood physical abuse (P-value=0.001), childhood emotional abuse (P-value=0.000103), adult sexual abuse (p-value=0.001), physical abuse (P-value=0.000313) and emotional abuse (P-value=0.002). Women with postnatal depression tended to have increased rates of postcoital dysphoria, implying a likely common vulnerability mechanism for the disorders. These findings have implications for preventive diagnosis and treatment.
Highlights
Women are twice as likely as men to suffer from depression
Our findings suggested that there was a subset of women who were more susceptible to rapid estrogen fluctuations and this estrogen sensitivity was an underlying risk factor for Postnatal depression (PND)
Education - Completed secondary school Education - >5 years post-secondary school Relationship Status Single In a relationship Living with partner Married Separated Relationship satisfaction Sexual satisfaction Anxiety disorder diagnosis Depression diagnosis Childhood sexual abuse Childhood physical abuse Childhood emotional abuse Adult sexual abuse Adult physical abuse Adult emotional abuse Postcoital dysphoria lifetime Postcoital dysphoria current Postnatal Depression
Summary
Women are twice as likely as men to suffer from depression. Windows of increased vulnerability during hormonal fluctuation phases prime women for higher risk of depression [1,2]. We and others have investigated genome-wide gene expression in postnatal depression and identified a subset of genes whose expression in the third trimester of pregnancy predicted with high accuracy which women went to develop PND [3]. Our findings suggested that there was a subset of women who were more susceptible to rapid estrogen fluctuations and this estrogen sensitivity was an underlying risk factor for PND. This was in line with other evidence that a subset of women is more likely to develop depressive symptoms in periods with physiological changes in sex steroid hormones and that this is mediated by a differential sensitivity rather than abnormal levels of steroid hormones [4,5,6]
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