Postpartum Major Depression Research Articles

P02-499 - Perfectionism and other risk factors in postpartum depression: a case-control study

IntroductionAlthough perfectionism has generally been associated with depressive illness in general, there are no studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism and major postpartum depression.MethodsIn this case-control study, we compared the differences in perfectionism dimensions between 122 women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women. The Frost Multidimensional Perfectionism Scale (FMPS) was used to assess perfectionism. Other variables were also considered: Socio-demographic and obstetric data, psychiatric history, other personality traits, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms).ResultsMultivariate models confirmed perfectionism as an independent factor associated with major postpartum depression. The FMPS dimension concern over mistakes was associated with a 4-fold increase in risk for major postpartum depression (OR = 4.14; 95%CI: 1.24–13.81). Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors.ConclusionsPerfectionism, and particularly the concern over mistakes perfectionism dimension, is associated with major postpartum depression. These results highlight the importance of assessing personality traits together with other risk factors to identify women at risk of depression after childbirth.

Abnormally Reduced Dorsomedial Prefrontal Cortical Activity and Effective Connectivity With Amygdala in Response to Negative Emotional Faces in Postpartum Depression

Postpartum major depression is a significant public health problem that strikes 15% of new mothers and confers adverse consequences for mothers, children, and families. The neural mechanisms involved in postpartum depression remain unknown, but brain processing of affective stimuli appears to be involved in other affective disorders. The authors examined activity in response to negative emotional faces in the dorsomedial pre-frontal cortex and amygdala, key emotion regulatory neural regions of importance to both mothering and depression. Postpartum healthy mothers (N=16) and unmedicated depressed mothers (N=14) underwent functional magnetic resonance imaging blood-oxygen-level-dependent acquisition during a block-designed face versus shape matching task. A two-way analysis of variance was performed examining main effects of condition and group and group-by-condition interaction on activity in bilateral dorsomedial prefrontal cortical and amygdala regions of interest. Depressed mothers relative to healthy mothers had significantly reduced left dorsomedial prefrontal cortical face-related activity. In depressed mothers, there was also a significant negative correlation between left amygdala activity and postpartum depression severity and a significant positive correlation between right amygdala activity and absence of infant-related hostility. There was reliable top-down connectivity from the left dorsomedial prefrontal cortex to the left amygdala in healthy, but not depressed, mothers. Significantly diminished dorsomedial prefrontal cortex activity and dorsomedial prefrontal cortical-amygdala effective connectivity in response to negative emotional faces may represent an important neural mechanism, or effect, of postpartum depression. Reduced amygdala activity in response to negative emotional faces is associated with greater postpartum depression severity and more impaired maternal attachment processes in postpartum depressed mothers.

Changes in sleep quality, but not hormones predict time to postpartum depression recurrence

BackgroundPoor sleep quality, dysregulation of hormones and increased inflammatory cytokines are all associated with the risk for postpartum major depression (PPMD). We evaluated change over time in sleep quality and hormones during the first 17 weeks postpartum, as well as a single cytokine measure, and their association with PPMD recurrence. MethodsParticipants were pregnant women (N=56), with past histories of MDD/PPMD but not depressed in their current pregnancy. The Pittsburgh Sleep Quality Index (PSQI) and blood samples were collected 8 times during the first 17weeks postpartum. Estradiol, prolactin and cortisol, and a single measure of IL-6 were assayed. Recurrence was determined by two consecutive 21-item Hamilton Rating Scale for Depression (HRSD) scores≥15 and clinician interview. ResultsIn the analyses of time to PPMD recurrence, poor sleep quality, but none of the hormones, was associated with PPMD recurrence (p<.05) after controlling for medication assignment. With every one point increase in PSQI scores across time, a woman's risk for recurrence increased by approximately 25% There was no significant association between PSQI scores and IL-6 concentrations in early postpartum (χ2=0.98, p=.32). ConclusionsPoor sleep quality across the first 17weeks post-delivery increases the risk for recurrent PPMD among women with a history of MDD. Changes in the hormonal milieu were not associated with recurrence. Further exploration of the degree to which poor sleep contributes to hormonal and cytokine dysregulation and how they are involved in the pathophysiology of PPMD is warranted.

Changes in sleep quality, but not hormones predict time to postpartum depression recurrence

Abstract Background Poor sleep quality, dysregulation of hormones and increased inflammatory cytokines are all associated with the risk for postpartum major depression (PPMD). We evaluated change over time in sleep quality and hormones during the first 17 weeks postpartum, as well as a single cytokine measure, and their association with PPMD recurrence. Methods Participants were pregnant women (N = 56), with past histories of MDD/PPMD but not depressed in their current pregnancy. The Pittsburgh Sleep Quality Index (PSQI) and blood samples were collected 8 times during the first 17 weeks postpartum. Estradiol, prolactin and cortisol, and a single measure of IL-6 were assayed. Recurrence was determined by two consecutive 21-item Hamilton Rating Scale for Depression (HRSD) scores ≥ 15 and clinician interview. Results In the analyses of time to PPMD recurrence, poor sleep quality, but none of the hormones, was associated with PPMD recurrence (p 2 = 0.98, p = .32). Conclusions Poor sleep quality across the first 17 weeks post-delivery increases the risk for recurrent PPMD among women with a history of MDD. Changes in the hormonal milieu were not associated with recurrence. Further exploration of the degree to which poor sleep contributes to hormonal and cytokine dysregulation and how they are involved in the pathophysiology of PPMD is warranted.

Omega-3 Polyunsaturated Fatty Acids and Depression: A Review of the Evidence

Brain lipids contain a high proportion of polyunsaturated fatty acids (PUFA), which are a main component of cell membranes. Omega-3 (omega-3) PUFA eicosapentaeoic acid (EPA) and docosahexaenoic acid (DHA) are the most common PUFA in the brain. The physiological roles of omega-3 PUFA in the brain include regulation of cell membrane fluidity, dopaminergic and serotoninergic transmission, membrane-bound enzymes and cellular signal transduction. They are also thought to play a role in brain glucose metabolism, eicosanoid synthesis, gene expression, cell growth and protection from apoptosis. Increasing evidence from animal and human research shows omega-3 PUFA depletion may play an etiological role in several inflammatory, autoimmune and neuropsychiatric disorders. In particular, an association between omega-3 PUFA and depression was repeatedly suggested in observational and experimental studies on populations affected by major depression, depressed mood or post-partum depression. Consistently, the potential therapeutic role of omega-3 PUFA dietary supplementation was tested in clinical trials on depression. The current review identifies and evaluates available epidemiological evidence of a negative relationship between omega-3 PUFA and depression and examines its biological plausibility. Although current evidence increasingly supports an inverse association between omega-3 PUFA and depression, the validity of findings from observational and experimental research is limited by several methodological issues. Further studies with larger sample sizes and more sophisticated design are required to provide convincing evidence of a causal relationship between omega-3 PUFA and depression.

Événements de vie et sévérité de la dépression aux différents âges de la vie

Major depression is a common, severe, chronic, and often life-threatening illness. There is a growing body of evidence that, far from being a disease with purely psychological manifestations, major depression is a systemic disease with deleterious effects on multiple organ systems. Stressful life events have a substantial causal association with depression, and there is now compelling evidence that even early life stress constitutes a major risk factor for the subsequent development of depression. This review will focus on the association between severity of depression and diachronic vulnerability across the life-span, in terms of events of life, stress, and hormonal modulation, with a special focus on depression in young adults, women during postpartum and in depression in ederly people. Given the high prevalence of depressive disorders, the significant burden and the severity of disease in adolescents and young adults experiencing their first episode, they represent a group at high risk of relapse, recurrence, comorbidity and suicide to whom early intervention and prevention efforts should be targeted. Females exhibit different stress sensitivities than males which might contribute to their increased vulnerability for depression and the disease exhibit a prevalence among women which is 2-3x higher than in men. The postpartum period is considered the time of greatest risk for women to develop major depression and postpartum depression affects approximately 15% of women. In old age, depression mainly affects those with chronic medical illness, severe disability or mental decline. Depression in elderly worsens the outcomes of many medical illness and increases mortality. Environmental factors, such as isolation, caregiving and bereavement, contribute to further increase susceptibility to depression or triggering depression in already vulnerable elderly people. Suitable treatment of depression in elderly reduces the symptoms, prevents suicidal ideation, improves cognitive and functional status in order to improve the recovery of a good quality of life, as well as the mortality risk.

Childhood sexual abuse and hypothalamus-pituitary-thyroid axis in postpartum major depression

Objective The aim of this study was to investigate the association between early life events in women with postpartum major depression and concomitant hypothalamus-pituitary-thyroid axis disturbances (HPTD), thyroid dysfunction or presence of thyroid antibodies. Methods Serum total tri-iodothyronine (TT3), free thyroxin (FT4), Thyroid-stimulating hormone (TSH), Thyroperoxidasa (TPOAb) and Thyroglobulin (TGAb) autoantibodies was measured in 103 major postpartum depressive women. HPTD was defined as TSH and/or T4 abnormal, presence of thyroid autoantibodies and alterations of TT3. All women were assessed with a psychiatry structured interview for DSM-IV. Early Trauma Inventory Self Report, sociodemographic, reproductive, psychosocial and psychopathological variables were also assessed. Results Sixty three percent of women had suffered childhood trauma, which was childhood sexual abuse in 27.2%. Childhood sexual abuse in postpartum major depression women increased the risk for thyroid dysfunction (OR = 5.018, 95%CI = 1.128–22.327), presence of thyroid autoantibodies (OR = 2.528; 95%CI = 1.00–6.39) and HPTD (OR = 2.955; 95%CI = 1.191–7.32). Moreover, age over 34 (OR = 12.394; 95%CI = 1.424–107.910) and previous postpartum depression (OR = 8.470; 95%CI = 1.20–59.43) increased the risk for thyroid dysfunction in postpartum depression. Limitations The study design does not allow us to know the direction of the association and there is a lack of previous assessment of current posttraumatic stress disorder. Conclusions According to the present findings, childhood sexual abuse may represent an important risk factor for the presence of thyroid autoantibodies and HPTD in women with postpartum depression.

Postpartum Psychosis: Detection of Risk and Management

Mrs. A, a 34-year-old married mother who lived with her husband and their 5year-old daughter, strangled her infant son to death 3 weeks after birth. She had a planned, healthy pregnancy with some depression at 28 weeks’ gestation. She had a normal spontaneous vaginal delivery, giving birth to a healthy boy, “B.” She began breastfeeding immediately. From postpartum days 2 through 11, her depression worsened. She was unable to sleep but could not get out of bed or attend to her hygiene. She was suspicious that her husband would harm B. On postpartum day 2, she began having obsessional, ego-dystonic images of throwing B out the window. She believed, despite the pediatrician’s reassurances, that she was harming B with her breast milk and that he was losing weight. She was unable to give him a bath, believing that he had “gas” or “something bad” inside and could not be moved.

Sleep Complaints in Late Pregnancy and the Recurrence of Postpartum Depression

This study evaluated the relationship between sleep quality in late pregnancy and recurrence of postpartum major depression (PPMD) through 28 weeks postpartum. The Pittsburgh Sleep Quality Index (PSQI) at 36 weeks gestation was assessed in 51 non-depressed women with a history of PPMD; recurrence was determined by the 21-item Hamilton Rating Scale for Depression and the Schedule for Affective Disorders and Schizophrenia. Sleep quality in late pregnancy was not related to recurrence per se, but it was related to timing of recurrence (Kruskal–Wallace = 9.78, p = .008). Rapid recurrence (within 4 weeks post delivery) was preceded by fewer sleep complaints (mean PSQI for early recurrers = 4.8 vs. 7.3 for non-recurrers, p = .09). Recurrence after 4 weeks postpartum was preceded by more sleep complaints in late pregnancy (mean PSQI for late recurrers = 9.9 vs. 7.3 for non-recurrers, p = .02). Sleep quality in late pregnancy may help in identifying women at risk for a PPMD recurrence.

S46-03 Substance use during pregnancy, postpartum depression and child outcomes: A longitudinal study

Introduction:Although it is well know that the substance use during pregnancy has a negative impact on mother and child health, there are few data on pregnancy - related substance use as a risk factor for postpartum depression and child outcomes.Aims: To determine maternal and child outcomes at 8 and 32 weeks postpartum of women who reported substance use during pregnancy.Method:This is a cohort study of 1804 Caucasian women in postpartum. Exclusion criteria: psychiatric disorders during pregnancy. Women were evaluated at 2-3 days, 8 and 32 weeks postpartum. Socio-demographic, obstetric, personal and family psychiatric history and substance use during pregnancy; the Edimburgh Postpartum Depression Scale (EPDS) were assessed. All women with EPDS&gt;9 at 8 and 32 weeks were evaluated by a structured interview (DIGS) for DSM-III major depression.Results:The mean (SD) age was 31.7 (4.6). Forty-six percent of them were primiparous. Thirty-one percent has a family and 16% a psychiatry history. Fifty percent of women reported substance use during pregnancy: 42% caffeine, 21.6% nicotine, 8% alcohol and 0.6% cannabis. Incidence of major postpartum depression was: 12.7%. Incidence of: Apgar scores &lt; 7 at 5 min after birth:0.4%, gestational age at delivery &lt; 37 weeks:7.3%, birth weigt &lt; 2.5 Kg:7.3%, and congenital malformations:1.4%.Conclusions:In the presentation, the maternal and child perinatal outcomes of women exposed to licit and ilicit drugs will be summarize and will include a discussion of the future clinical and research implications. This work has been done in part with Grants: GO3/184;FIS:PI04178;PI041635,PI041783,PI041779,PI041758,PI041761,PI041791,PI041766,PI041782,RD06/0001/1009; CIBER-SAM.

Women’s health—what’s new world wide

Women’s health—what’s new world wide

Prenatal Depression in Latinas in the U.S. and Mexico

The study aimed to investigate the prevalence of depressive symptoms and their associated risk factors during pregnancy in Latinas in the United States (U.S.) and Mexico. The sample included 108 women in the U.S. whose data were obtained from medical chart reviews in a community clinic in Washington, D.C., and 117 women in Mexico who participated in face-to-face interviews in the waiting rooms of primary care community centers in Mexico City. Variables, chosen to match in both countries for comparisons, were: socio-demographics, pregnancy gestation and order, social support, depressive symptoms, personal history of depression, family psychiatric history, and suicidal thoughts. Depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale (CES-D). The prevalence of depressive symptoms was 32.4% for pregnant Latinas and 36.8% for Mexicans (CES-D > or = 16), and 15.7% and 23.9% (CES-D > or = 24), respectively, with no differences between groups. Separate multiple logistic regression analyses showed that for U.S. Latinas: (1) being more educated predicted depressive symptoms (CES-D > or = 16), and (2) second trimester, as compared to first, also predicted symptoms (CES-D > or /= 24). (3) History of suicidal thoughts predicted symptoms in Latinas in the U.S. (CES-D > or = 24) and in Mexico (using both definitions of high symptoms), and (4) living with a partner but not formally married and multi-parous condition predicted symptoms (CES-D > or /= 24) among pregnant Mexicans. A high prevalence of depressive symptoms and significant risk factors during pregnancy were found in Latinas in U.S. and Mexico, suggesting increased risk for postpartum major depression. Implications for screening and interventions are discussed.

A Cross-Sectional Evaluation of Perimenopausal Depression

Overall, the clinical spectrum of depression during the perimenopause is not well characterized. This cross-sectional study examined the following: (1) clinical characteristics of women who presented to the National Institute of Mental Health midlife mood disorders clinic (between March 1990 and January 2004) with peri-menopausal major and minor depressions and (2) the impact on these characteristics of either a prior episode of depression or the presence of hot flushes. Historical variables, reproductive status, symptom ratings, and plasma hormone measures were examined in 116 women between the ages of 40 and 55 years who met research criteria for perimenopause-related depression (a current episode of major or minor depression according to the Structured Clinical Interview for DSM-IV or Primary Care Evaluation of Mental Disorders supplemented with a past history form). Clinical characteristics did not differ in those women with first-onset (39%) versus recurrent depressions or in those with (57%) and without hot flushes. Depressive episodes clustered in the later stages of the menopause transition and the first year postmenopause. Seven women (6%) reported a past postpartum major depression, and 55% of women reported a history of premenstrual dysphoria (PMD). We found no evidence that either hot flushes or a previous episode of depression conveys a distinct clinical profile in these women. The clustering of onsets of depression suggests the hormone events that characterize the late menopause transition may be relevant to the onset of this form of depression. Finally, although we observed a high rate of PMD, neither postpartum depression nor PMD are consistent accompaniments of perimenopausal depression.

Omega-3 fatty acids and supportive psychotherapy for perinatal depression: A randomized placebo-controlled study

Background Perinatal major depressive disorder (MDD), including antenatal and postpartum depression, is common and has serious consequences. This study was designed to investigate the feasibility, safety, and efficacy of omega-3 fatty acids for perinatal depression in addition to supportive psychotherapy. Methods Perinatal women with MDD were randomized to eicosapentaenoic (EPA) and docosahexaenoic acids (DHA), 1.9g/day, or placebo for 8weeks. A manualized supportive psychotherapy was provided to all subjects. Symptoms were assessed with the Hamilton Rating Scale for Depression (HAM-D) and Edinburgh Postnatal Depression Scale (EPDS) biweekly. Results Fifty-nine women enrolled; N = 51 had two data collection points that allowed for evaluation of efficacy. Omega-3 fatty acids were well tolerated. Participants in both groups experienced significant decreases in EPDS and HAM-D scores ( p < .0001) from baseline. We did not find a benefit of omega-3 fatty acids over placebo. Dietary omega-3 fatty acid intake was low among participants. Limitations The ability to detect an effect of omega-3 fatty acids may have been limited by sample size, study length, or dose. The benefits of supportive psychotherapy may have limited the ability to detect an effect of omega-3 fatty acids. Conclusions There was no significant difference between omega-3 fatty acids and placebo in this study in which all participants received supportive psychotherapy. The manualized supportive psychotherapy warrants further study. The low intake of dietary omega-3 fatty acids among participants is of concern, in consideration of the widely established health advantages in utero and in infants.

Using the Internet to Screen for Postpartum Depression

To examine the feasibility of using the Internet to screen for postpartum depressive symptoms. A total of 142 participants completed the Postpartum Depression Screening Scale (PDSS) and the Edinburgh Postnatal Depression Scale on the Internet, and these findings were compared with those administered in-person by the authors of the PDSS (Beck and Gable) in recruitment sources, demographic characteristics, psychometric properties, and prevalence of significant postpartum depressive symptoms. Participants were more likely to be recruited through Internet websites than mailing sources in the Internet study, and participants in the in-person study were recruited through prenatal childbirth classes. A higher proportion of Hispanic and Asian women participated on the Internet compared to the in-person study. The PDSS had excellent internal consistencies and construct validity across Internet and in-person studies. The Internet sample also reported more risk for major postpartum depression (PPD) compared to the community sample (23% vs. 12%). The Internet is a viable and feasible tool to screen for PPD. Implications for preventing and treating PPD on the Internet are discussed.

Risk Factors for Sub-Clinical and Major Postpartum Depression Among a Community Cohort of Canadian Women

To identify prenatal and perinatal factors that predict women at risk of sub-clinical and major postpartum depression among a cohort of low medical risk pregnant women in Canada. Data from 1,403 women who completed a randomized controlled trial of supplementary support during pregnancy was analyzed to identify risk factors for sub-clinical and major postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS), completed at eight weeks postpartum, was used to classify each woman's depression symptom severity. Demographic, obstetric, behavioral risk, mental health and psychosocial factors were considered. Multiple logistic regression analyses were used to identify risk factors most predictive of sub-clinical and major postpartum depression. After adjustment for other covariates, variables that increased the risk of sub-clinical postpartum depression included a history of depression (OR = 2.27, CI = 1.42-3.63), anxiety symptoms during pregnancy (OR = 2.12, CI = 1.09-4.11), being born outside Canada (OR = 1.87, CI = 1.17-3.00), and low parenting self-efficacy (OR = 1.65, CI = 1.06-2.55). Variables that increased the risk of major postpartum depression included a history of depression (OR = 2.78, CI = 1.56-4.97), being born outside Canada (OR = 2.97, CI = 1.70-5.17), depressive symptoms during pregnancy (OR = 2.83, CI = 1.29-6.19) and not breastfeeding at eight weeks postpartum (OR = 2.12, CI = 1.21-3.70). A history of depression and being born outside Canada predicted women who were at an increased risk of sub-clinical and major postpartum depression. The remaining risk factors specific to sub-clinical and major postpartum depression suggest some differences between women vulnerable to sub-clinical compared to major depressive symptoms in the postpartum period, which may have implications for targeted screening and intervention strategies.

Use of the Postpartum Depression Screening Scale in a Collaborative Obstetric Practice

Postpartum depression is a clinical depressive episode that occurs in 13% to 20% of women after birth or miscarriage. This illness has potentially devastating consequences for both mother and infant, and is thought to be highly underreported and under-diagnosed. Our study examined the use of the Postpartum Depression Screening Scale (PDSS) in a high-volume collaborative obstetric and midwifery practice. The prevalence of women with a positive screen for major postpartum depression in our study was 16%, which is consistent with other studies. An additional 20% of the participants had symptoms that indicated a potential postpartum depression. Obstetric clinicians were willing to use the PDSS, and 15 of 20 clinicians actively participated in the study. Women who had a positive screen at 6 weeks after birth were more likely to have not completed a high school education, be unpartnered, be exclusively bottle feeding, and have a history of depression. Two variables were statistically significant predictors of screening positively with the PDSS following logistic regression: history of depression (risk ratio, 4.8; 95% confidence interval, 4.4-5.2) and exclusive bottle feeding (risk ratio, 2.0; 95% confidence interval, 1.6-2.4).

Clinical applications of anxiety, social support, stressors, and self‐esteem measured during pregnancy and postpartum for screening postpartum depression in Thai women

To assess the clinical applications of anxiety, social support, stressors and self-esteem as well as the Postpartum Depression Risk Scale (PDRS), measured during pregnancy and postpartum, for screening postpartum depression. A questionnaire regarding anxiety, social support, stressors and self-esteem was administered to 400 women during 36-40 weeks of gestation and 6-8 weeks postpartum prospectively, using factor analysis. The enrolled women were interviewed 6-8 weeks postpartum by psychiatrists using a diagnostic system of the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), for diagnosis of postpartum depression. Multiple logistic regression was used to identify the significant predictors for postpartum depression and then developed to be the PDRS and tested for clinical benefit. Of 400 enrolled women, 40 (10%) were diagnosed with minor or major postpartum depression. After factor analysis, 10 items of anxiety, 10 items of social support, four items of stressors and five items of self-esteem were identified, with a standardized reliability coefficient of 0.85, 0.82, 0.81 and 0.82 during pregnancy and of 0.84, 0.82, 0.85 and 0.84 during the postpartum period, respectively. During pregnancy, a significant predictor was anxiety about postpartum depression, but postpartum significant predictors were anxiety and social support, which were generated to be PDRS. The clinical benefit of PDRS as a measure was better postpartum than during pregnancy. Anxiety and social support were identified as the predictors of postpartum depression. The development of the PDRS is clinically beneficial and useful during pregnancy and postpartum for the screening of postpartum depression in Thai women.

Postpartum major depression at six weeks in primary health care: prevalence and associated factors.

Major depression is a common and disabling complication of the postpartum period in women. It is thought to occur three times more commonly in the developing than in developed countries. The objectives of this study were to determine the prevalence of and factors associated with major depression among women attending a peri-urban primary health care unit in Kampala, Uganda, at six weeks postpartum. Five hundred and fourty four women attending a peri-urban health centre were investigated in a cross-sectional study. These women were screened using the twenty five-item Self Reporting Questionnaire (SRQ-25), while major depression was confirmed using the Mini International Neuro-psychiatric Interview (MINI). Associations were sought between major depression and the respondents' demographics and various psychological, social and obstetric factors. The point prevalence of major depression at six weeks postpartum was 6.1%. Psychiatric disorder was significantly associated with young age, being single, negative life events, unplanned pregnancy, unwanted sex of baby and current physical illness in both mother and newborn. There is indication for routine screening of at risk women in the peri-natal period to avoid, recognize and manage postpartum psychiatric morbidity and its consequence on mothers and their developing children.

Are Stress-Induced Cortisol Changes During Pregnancy Associated With Postpartum Depressive Symptoms?

The purpose of this study was to examine the association between psychobiological stress reactivity during healthy pregnancy and depressive symptoms in the early puerperium. A sample of healthy nulliparous pregnant women (N = 57) between the ages of 21 and 35 years underwent a standardized psychosocial stress test during pregnancy. Within an average of 13 days after delivery, postpartum depressive symptoms were assessed using the German version of the Edinburgh postnatal depression scale (EPDS). The sample was divided into a group with probable cases (EPDS score >9, N = 16) and a group with probable noncases (EPDS score < or =9, N = 41). The probable case group showed significantly higher cortisol responses to the stress test compared with the probable noncase group, whereas baseline levels did not differ. Additionally, women in the probable case group showed significantly higher state anxiety and lower mood state throughout the experiment. Furthermore, the probable case group showed higher stress susceptibility, higher trait anxiety, and higher levels in the Symptom Checklist. No differences were found for prior episodes of psychiatric disorders, obstetrical complications, birth weight, or mode of delivery. Our data provide evidence that healthy pregnant women developing postpartum depressive symptoms might already be identified during pregnancy by means of their higher cortisol reactivity and their higher psychological reactivity in response to psychosocial stress. Further investigations are required to explore whether higher psychobiological stress responses not only precede depressive symptoms within 2 weeks after birth, but might also predict postpartum major depression.