Adverse life events, psychiatric history, and biological predictors of postpartum depression in an ethnically diverse sample of postpartum women

Abstract

Background: Race, psychiatric history, and adverse life events have all been independently associated with postpartum depression (PPD). However, the role these play together in Black and Latina women remains inadequately studied. Therefore, we performed a case-control study of PPD, including comprehensive assessments of symptoms and biomarkers, while examining the effects of genetic ancestry.

Methods: We recruited our sample (549 cases, 968 controls) at 6 weeks postpartum from obstetrical clinics in North Carolina. PPD status was determined using the MINI-plus. Psychiatric history was extracted from medical records. Participants were administered self-report instruments to assess depression (Edinburgh Postnatal Depression Scale) and adverse life events. Levels of estradiol, progesterone, brain-derived neurotrophic factor, oxytocin, and allopregnanalone were assayed. Principal components from genotype data were used to estimate genetic ancestry and logistic regression was used to identify predictors of PPD.

Results: This population was racially diverse (68% Black, 13% Latina, 18% European). Genetic ancestry was not a predictor of PPD. Case status was predicted by a history of major depression (p = 4.01E-14), lifetime anxiety disorder diagnosis (p = 1.25E-34), and adverse life events (p = 6.06E-06). There were no significant differences between groups in any hormones or neurosteroids.

Conclusions: Psychiatric history and multiple exposures to adverse life events were significant predictors of PPD in a population of minority and low-income women. Genetic ancestry and hormone levels were not predictive of case status. Increased genetic vulnerability in conjunction with risk factors may predict the onset of PPD, whereas genetic ancestry does not appear predictive.

Keywords: Adverse life events; genetic ancestry; postpartum depression; psychiatric history..

Figure 1.

Genetic Ancestry of Study Participants. A) Principal Component plot of cases (orange), controls (blue), and HapMap references (red). B) Principal Component plot of self-reported race: Black (green), Latina (purple), White (orange), and HapMap references (red). C) Ternary plot of fastStructure estimated percent ancestry for each participant. D) Average genetic ancestry composition for each self-reported racial group. Abbreviations: African ancestry in Southwest USA (ASW); Utah residents with Northern and Western European ancestry (CEU); Han Chinese in Beijing, China (CHB); Chinese in Metropolitan Denver, CO (CHD); Gujarati Indians in Houston, TX (GIH); Japanese in Tokyo, Japan (JPT); Luhya in Webuye, Kenya (LWK); Mexican ancestry in Los Angeles, CA (MEX); Toscani in Italia (TSI); Yoruba in Ibadan, Nigeria (YRI)

Figure 2.

Radar plot representing the cumulative amount of risk factors (lifetime psychiatric disorders and adverse life events) experienced by cases compared to controls.