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.

[1]  L. Altshuler,et al.  Prospective Longitudinal Study of Predictors of Postpartum-Onset Depression in Women With a History of Major Depressive Disorder. , 2017, The Journal of clinical psychiatry.

[2]  Tone Breines Simonsen,et al.  The Impact of Perinatal Depression on Children’s Social-Emotional Development: A Longitudinal Study , 2017, Maternal and Child Health Journal.

[3]  L. Christian,et al.  Serum brain-derived neurotrophic factor (BDNF) across pregnancy and postpartum: Associations with race, depressive symptoms, and low birth weight , 2016, Psychoneuroendocrinology.

[4]  Sabine J. Roza,et al.  The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale , 2016, Psychological Medicine.

[5]  Jing Wang,et al.  Serum BDNF concentration after delivery is associated with development of postpartum depression: A 3-month follow up study. , 2016, Journal of affective disorders.

[6]  M. Beckmann,et al.  Oxytocin receptor DNA methylation in postpartum depression , 2016, Psychoneuroendocrinology.

[7]  Lei Zhang,et al.  The Effect of Stressful Life Events on Postpartum Depression: Findings from the 2009–2011 Mississippi Pregnancy Risk Assessment Monitoring System , 2016, Maternal and Child Health Journal.

[8]  D. Rubinow,et al.  Reproductive Steroid Regulation of Mood and Behavior. , 2016, Comprehensive Physiology.

[9]  M. Phipps,et al.  Screening for Depression in Adults: US Preventive Services Task Force Recommendation Statement. , 2016, JAMA.

[10]  S. Assari,et al.  Stressful Life Events and Risk of Depression 25 Years Later: Race and Gender Differences , 2016, Front. Public Health.

[11]  P. Sullivan,et al.  Heritability of Perinatal Depression and Genetic Overlap With Nonperinatal Depression. , 2015, The American journal of psychiatry.

[12]  S. Curtin,et al.  Births: Final Data for 2014. , 2015, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[13]  Jodie B. Ullman,et al.  Cumulative burden of lifetime adversities: Trauma and mental health in low-SES African Americans and Latino/as. , 2015, Psychological trauma : theory, research, practice and policy.

[14]  D. Rubinow,et al.  Oxytocin and HPA stress axis reactivity in postpartum women , 2015, Psychoneuroendocrinology.

[15]  M. Daly,et al.  An Atlas of Genetic Correlations across Human Diseases and Traits , 2015, Nature Genetics.

[16]  Wma Wan Emilin,et al.  Magnitude and risk factors for postpartum symptoms: a literature review. , 2015, Journal of affective disorders.

[17]  Nestor L. Lopez-Duran,et al.  Differential associations between childhood trauma subtypes and adolescent HPA-axis functioning , 2015, Psychoneuroendocrinology.

[18]  Jacquelyn C. Campbell,et al.  Intimate Partner Violence and Its Health Impact on Ethnic Minority Women , 2015 .

[19]  Sabine J. Roza,et al.  Heterogeneity of postpartum depression: a latent class analysis. , 2015, The lancet. Psychiatry.

[20]  Benjamin M. Neale,et al.  Genetic Consortium for Anorexia Nervosa of the Wellcome Trust Case Control Consortium , 2015 .

[21]  Tesfaye B Mersha,et al.  Self-reported race/ethnicity in the age of genomic research: its potential impact on understanding health disparities , 2015, Human Genomics.

[22]  Jacquelyn C. Campbell,et al.  Intimate Partner Violence and its Health Impact on Ethnic Minority Women [corrected]. , 2014, Journal of women's health.

[23]  C. Pariante,et al.  Effects of perinatal mental disorders on the fetus and child , 2014, The Lancet.

[24]  A. Stein,et al.  Non-psychotic mental disorders in the perinatal period , 2014, The Lancet.

[25]  J. Bjørngaard,et al.  Adult physical, sexual, and emotional abuse and postpartum depression, a population based, prospective study of 53,065 women in the Norwegian Mother and Child Cohort Study , 2014, BMC Pregnancy and Childbirth.

[26]  T. Gould,et al.  Antenatal prediction of postpartum depression with blood DNA methylation biomarkers , 2014, Molecular Psychiatry.

[27]  M. Stephens,et al.  fastSTRUCTURE: Variational Inference of Population Structure in Large SNP Data Sets , 2014, Genetics.

[28]  C. Dubertret,et al.  Predictors of postpartum depression: Prospective study of 264 women followed during pregnancy and postpartum , 2014, Psychiatry Research.

[29]  Shankaracharya,et al.  Relationship Estimation from Whole-Genome Sequence Data , 2014, PLoS genetics.

[30]  Jianxin Shi,et al.  Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs , 2013, Nature Genetics.

[31]  E. Tronick,et al.  Prevalence and predictors of maternal postpartum depressed mood and anhedonia by race and ethnicity , 2013, Epidemiology and Psychiatric Sciences.

[32]  Karen Grewen,et al.  Association between maternal mood and oxytocin response to breastfeeding. , 2013, Journal of women's health.

[33]  M. O’Hara,et al.  Postpartum depression: current status and future directions. , 2013, Annual review of clinical psychology.

[34]  E. Tronick,et al.  Rates and Predictors of Postpartum Depression by Race and Ethnicity: Results from the 2004 to 2007 New York City PRAMS Survey (Pregnancy Risk Assessment Monitoring System) , 2013, Maternal and Child Health Journal.

[35]  L. Callister,et al.  Prevalence of postpartum depression among Hispanic immigrant women , 2012, Journal of the American Academy of Nurse Practitioners.

[36]  G. Zimet,et al.  Influence of race and socioeconomic status on the diagnosis of child abuse: a randomized study. , 2012, The Journal of pediatrics.

[37]  J. Studd.  A guide to the treatment of depression in women by estrogens , 2011, Climacteric : the journal of the International Menopause Society.

[38]  Beppie van den Bogaerde,et al.  Clinical practice , 2011, European Journal of Pediatrics.

[39]  S. Wisniewski,et al.  Changes in sleep quality, but not hormones predict time to postpartum depression recurrence. , 2011, Journal of affective disorders.

[40]  J. H. Fujimura,et al.  Different differences: The use of ‘genetic ancestry’ versus race in biomedical human genetic research , 2011, Social studies of science.

[41]  Pranee Liamputtong,et al.  Detection of Postnatal Depression , 2011 .

[42]  Kesheng Wang,et al.  A genome-wide meta-analysis identifies novel loci associated with schizophrenia and bipolar disorder , 2010, Schizophrenia Research.

[43]  Patrick F Sullivan,et al.  The Psychiatric GWAS Consortium: Big Science Comes to Psychiatry , 2010, Neuron.

[44]  E. Lange,et al.  Comparison of Genome Wide Variation between Malawians and African Ancestry HapMap Populations , 2010, Journal of Human Genetics.

[45]  S. Gilman,et al.  Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States , 2010, Psychological Medicine.

[46]  K. Wisner,et al.  Postpartum depression: a disorder in search of a definition , 2010, Archives of Women's Mental Health.

[47]  P. Visscher,et al.  Common polygenic variation contributes to risk of schizophrenia and bipolar disorder , 2009, Nature.

[48]  J. Price,et al.  A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women , 2009, Acta psychiatrica Scandinavica.

[49]  Xiao-Li Meng,et al.  Disparity in depression treatment among racial and ethnic minority populations in the United States. , 2008, Psychiatric services.

[50]  V. Shavers.  Measurement of socioeconomic status in health disparities research. , 2007, Journal of the National Medical Association.

[51]  J. Britton.  Postpartum anxiety and breast feeding. , 2007, The Journal of reproductive medicine.

[52]  S. Meltzer-Brody,et al.  Trauma and Posttraumatic Stress Disorder in Women With Chronic Pelvic Pain , 2007, Obstetrics and gynecology.

[53]  M. Jafarpour,et al.  The Effect of Stressful Life Events on Postpartum Depression , 2007 .

[54]  D. Reich,et al.  Population Structure and Eigenanalysis , 2006, PLoS genetics.

[55]  D. Reich,et al.  Principal components analysis corrects for stratification in genome-wide association studies , 2006, Nature Genetics.

[56]  I. Brockington,et al.  The Postpartum Bonding Questionnaire: a validation , 2006, Archives of Women's Mental Health.

[57]  John Bound,et al.  "Weathering" and age patterns of allostatic load scores among blacks and whites in the United States. , 2006, American journal of public health.

[58]  Abraham Weizman,et al.  The relevance of neurosteroids to clinical psychiatry: From the laboratory to the bedside , 2006, European Neuropsychopharmacology.

[59]  J. Leserman.  Sexual Abuse History: Prevalence, Health Effects, Mediators, and Psychological Treatment , 2005, Psychosomatic medicine.

[60]  Gerald Gartlehner,et al.  Perinatal Depression: A Systematic Review of Prevalence and Incidence , 2005, Obstetrics and gynecology.

[61]  Masaru Mimura,et al.  Reliability and validity of Japanese version of the Mini‐International Neuropsychiatric Interview , 2005, Psychiatry and clinical neurosciences.

[62]  Olga V. Demler,et al.  Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. , 2005, Archives of general psychiatry.

[63]  J. Pearson,et al.  Prevalence of suicidality during pregnancy and the postpartum , 2005, Archives of Women’s Mental Health.

[64]  N Gavin,et al.  Perinatal Depression : Prevalence , Screening Accuracy , and Screening Outcomes Summary , 2005 .

[65]  M. Olivier.  A haplotype map of the human genome. , 2003, Nature.

[66]  M. Olivier.  A haplotype map of the human genome , 2003, Nature.

[67]  E. Fuentes-Afflick,et al.  Depressive Symptoms in the Immediate Postpartum Period Among Hispanic Women in Three U.S. Cities , 2004, Journal of Immigrant Health.

[68]  W. Iacono,et al.  Psychiatric disorders among offspring of depressed mothers: associations with paternal psychopathology. , 2004, The American journal of psychiatry.

[69]  H. Flynn,et al.  Rates of maternal depression in pediatric emergency department and relationship to child service utilization. , 2004, General hospital psychiatry.

[70]  Jean Golding,et al.  The course of anxiety and depression through pregnancy and the postpartum in a community sample. , 2004, Journal of affective disorders.

[71]  M. McKee,et al.  Prenatal and Postpartum Depression among Low-Income Dominican and Puerto Rican Women , 2003 .

[72]  Olga V. Demler,et al.  The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). , 2003, JAMA.

[73]  L. Rubenstein,et al.  The Acceptability of Treatment for Depression Among African-American, Hispanic, and White Primary Care Patients , 2003, Medical care.

[74]  K. Matthews,et al.  The influence of socioeconomic status and ethnicity on adolescents' exposure to stressful life events. , 2002, Journal of pediatric psychology.

[75]  K. Wisner,et al.  Clinical practice. Postpartum depression. , 2002, The New England journal of medicine.

[76]  M. McKee,et al.  Depression and negative life events among pregnant African-American and Hispanic women. , 2002, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[77]  A. Rush,et al.  Onset and persistence of postpartum depression in an inner-city maternal health clinic system. , 2001, The American journal of psychiatry.

[78]  N. Martin,et al.  Genetic influences on post-natal depressive symptoms: findings from an Australian twin sample , 1999, Psychological Medicine.

[79]  G. Spalletta,et al.  Concentrations of 3α-reduced neuroactive steroids and their precursors in plasma of patients with major depression and after clinical recovery , 1999, Biological Psychiatry.

[80]  R. Conley,et al.  Effects of antidepressant treatment on neuroactive steroids in major depression. , 1998, The American journal of psychiatry.

[81]  A. Guidotti,et al.  Increase in the cerebrospinal fluid content of neurosteroids in patients with unipolar major depression who are receiving fluoxetine or fluvoxamine. , 1998, Proceedings of the National Academy of Sciences of the United States of America.

[82]  D. Sheehan,et al.  The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. , 1998, The Journal of clinical psychiatry.

[83]  M. Rayens,et al.  Self-esteem as a mediator of the effects of stressors and social resources on depressive symptoms in postpartum mothers. , 1996, Nursing research.

[84]  M. O’Hara,et al.  Rates and risk of postpartum depression—a meta-analysis , 1996 .

[85]  D. Drossman,et al.  Sexual and Physical Abuse History in Gastroenterology Practice: How Types of Abuse Impact Health Status , 1996, Psychosomatic medicine.

[86]  D. Drossman,et al.  The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders. , 1995, Behavioral medicine.