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. 2018 Feb;35(2):160-167.
doi: 10.1002/da.22697. Epub 2017 Nov 24.

Adverse life events increase risk for postpartum psychiatric episodes: A population-based epidemiologic study

S Meltzer-Brody  1 , J T Larsen  2 , L Petersen  2 , J Guintivano  1 , A Di Florio  1   3 , W C Miller  4 , P F Sullivan  1   5 , T Munk-Olsen  2
Affiliations

Adverse life events increase risk for postpartum psychiatric episodes: A population-based epidemiologic study

S Meltzer-Brody et al. Depress Anxiety. 2018 Feb.

Abstract

Background: Trauma histories may increase risk of perinatal psychiatric episodes. We designed an epidemiological population-based cohort study to explore if adverse childhood experiences (ACE) in girls increases risk of later postpartum psychiatric episodes.

Methods: Using Danish registers, we identified women born in Denmark between January 1980 and December 1998 (129,439 childbirths). Exposure variables were ACE between ages 0 and 15 including: (1) family disruption, (2) parental somatic illness, (3) parental labor market exclusion, (4) parental criminality, (5) parental death, (6) placement in out-of-home care, (7) parental psychopathology excluding substance use, and (8) parental substance use disorder. Primary outcome was first occurrence of in- or outpatient contact 0-6 months postpartum at a psychiatric treatment facility with any psychiatric diagnoses, ICD-10, F00-F99 (N = 651). We conducted survival analyses using Cox proportional hazard regressions of postpartum psychiatric episodes.

Results: Approximately 52% of the sample experienced ACE, significantly increasing risk of any postpartum psychiatric diagnosis. Highest risks were observed among women who experienced out-of-home placement, hazard ratio (HR) 2.57 (95% CI: 1.90-3.48). Women experiencing two adverse life events had higher risks of postpartum psychiatric diagnosis HR: 1.88 (95% CI: 1.51-2.36), compared to those with one ACE, HR: 1.24 (95% CI: 1.03-49) and no ACE, HR: 1.00 (reference group).

Conclusions: ACE primarily due to parental psychopathology and disability contributes to increased risk of postpartum psychiatric episodes; and greater numbers of ACE increases risk for postpartum psychiatric illness with an observed dose-response effect. Future work should explore genetic and environmental factors that increase risk and/or confer resilience.

Keywords: acute stress reaction; adverse life events; mood disorders; postpartum depression.

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Figures

FIGURE 1
FIGURE 1
Cumulative incidence of any postpartum psychiatric diagnosis by number of different adversities experienced at age 0–15 years
See this image and copyright information in PMC

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