شروع افسردگی اساسی پس از زایمان با اختلالات شخصیتی در ارتباط است

Abstract Objectives The objective of the study was to investigate the incidence rate of postpartum-onset major depression (PPMD) and to examine associated sociodemographic characteristics, obstetric factors, and personality disorders. Method The study data were obtained from 302 women who delivered at a child and maternity hospital. We interviewed the new mothers on the first day of their childbirth and at 6 weeks postpartum. Major depression and axis II diagnoses were determined by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, Personality Disorders, respectively. Results Nineteen (6.3%) women had new-onset major depression during 6 weeks postpartum. Postpartum-onset major depression was unrelated to age, educational level, employment status, planned or unplanned pregnancy, history of abortion and gestational complications, term of delivery, type of delivery, sex of the baby, and mother's breast-feeding. Frequency of primiparity and of avoidant, dependent, and obsessive-compulsive personality disorders was higher in women with PPMD than that in women without PPMD. As a result of logistic regression analysis, the independent predictor of PPMD was the presence of avoidant, dependent, and obsessive-compulsive personality disorders. Conclusion Our results suggest that childbearing women with avoidant, dependent, and obsessive-compulsive personality disorders have increased risk of new-onset major depression during the postpartum period.

Introduction Childbirth is one of the most important life events not only in the social context but also in the psychological and biological perspective. In puerperium, dramatic alterations occur [1] in gonadal steroids influencing central neurotransmitter functions associated with mood [2]. Moreover, during this time, the risk of higher frequency of depressive symptoms or recurrence of mood episodes increases [3] and [4]. Although the prevalence rate of depression at the postnatal period has been reported within a large range due probably to methodological and population differences in studies, this rate has been found to be 8% to 20% in most of studies [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14] and [15]. Some investigators have suggested that postpartum women have a higher prevalence of depression than nonpostpartum matched controls [4]. The incidence of postpartum depression has been less studied compared with its prevalence. Several studies reported the incidence rate of postpartum depression as 3.4% to 11% [14], [15], [16] and [17]. Furthermore, to the best of our knowledge, there is no study examining the incidence of postpartum depression based on a prospective design by means of a structural clinical interview in the Turkish population. Maternal depression has negative effects on mother-child relationship, and it is associated with more functional disorders and socioemotional difficulties in the infant [18] and [19]. Therefore, detection of women under risk of postpartum depression, early diagnosis of postpartum depression, and appropriate preventive measures and treatments are considerably important to decrease the risk of later psychological, behavioral, and personality disturbances in children. Various risk factors associated with postpartum depression have been widely explored. Depression and anxiety during pregnancy and history of depression seem to be the strongest predictors of postpartum depression. Recent stressful life events and perceived low levels of social support have been identified as other notable risk factors for postpartum depression [20]. Some authors reported that women with postpartum depression had higher vulnerability subscale score, which includes the items worrier, sensitive, timid, nervy, volatility, and obsessive, in the Vulnerable Personality Style Questionnaire compared with women without postpartum depression [13] and [21]. However, there are no adequate published data regarding whether premorbid axis II disorders are predictors for the development of depression after childbirth. The aims of this study were to investigate the incidence rate of postpartum-onset major depression (PPMD) and to examine associated sociodemographic characteristics, obstetric factors, and particularly personality disorders

Results Demographic features of the final sample are presented in Table 1. All of the participants were married. The frequency of primiparous women was 137 (45.4%). Others had 2 or more children. Seventy-six (25.2%) women had a history of abortion, and 62 (20.5%) women had a history of gestational complications during their last pregnancy. Sixty-three (20.9%) participants reported their pregnancy as unplanned. The type of delivery was surgical in 82 (27.2%) subjects. The childbirth was preterm in 28 (9.3%) women and postterm in 4 (1.3%) women. The percentage of breast-feeding mothers was 94.7%. Table 1. Demographic characteristics of the study sample Age (y), mean ± SD 25.25 ± 4.88 Education, n (%) Primary school 224 (74.2) Secondary school 69 (22.8) University 9 (3.0) Employment status, n (%) Employed 15 (5.0) Housewife 287 (95.0) Table options Of the 302 women, 39 (12.9%) had at least one axis II diagnosis. Avoidant personality disorder (6.0%) was the most common axis II diagnosis. Dependent (3.0%), obsessive-compulsive (3.3%), passive-aggressive (1.3%), histrionic (1.0%), and borderline (0.7%) personality disorders were less frequent. None of the women met the criteria for paranoid, schizotypal, schizoid, narcissistic, and antisocial personality disorders. The frequency of new-onset major depression according to SCID-I was 19 (6.3%) during the postnatal 6 weeks. We found no significant association of postpartum major depression with age (t = 0.571, P = .568), educational level (χ2 = 0.712, P = .701), employment status (Fisher exact test, P = .610), planned or unplanned pregnancy (Fisher exact test, P = .561), history of abortion (Fisher exact test, P = .000) and gestational complications (χ2 = 1.327, P = .857), term of delivery (χ2 = 2.470, P = .291), type of delivery (Fisher exact test, P = .605), sex of the baby (Fisher exact test, P = .344), and mother's breast-feeding (Fisher exact test, P = .266). The rate of primiparity was significantly higher in women with PPMD compared with that in nondepressed women (73.7% vs 43.8%, Fisher exact test, P = .016). The incidence rate of postpartum major depression was 10.2% among primiparous women and 3.1% among multiparous women. In addition, avoidant, dependent, and obsessive-compulsive personality disorders were more frequent in women with PPMD compared with those in women without PPMD ( Table 2). Table 2. Personality disorders in women with and without PPMD (n [%]) Women with PPMD (n = 19) Women without PPMD (n = 283) Fisher exact test Avoidant 5 (26.3) 13 (4.6) .003 Dependent 4 (21.1) 5 (1.8) .001 Obsessive-compulsive 6 (31.6) 4 (1.4) .000 Passive-aggressive – (–) 4 (1.4) 1.000 Paranoid – (–) – (–) – Schizotypal – (–) – (–) – Schizoid – (–) – (–) – Histrionic 1 (5.3) 2 (0.7) .178 Borderline – (–) 2 (0.7) 1.000 Narcissistic – (–) – (–) – Antisocial – (–) – (–) – Any axis II disorder 13 (68.4) 26 (9.2) .000 Table options The variables of primiparity and avoidant, dependent, and obsessive-compulsive personality disorders were entered in a logistic regression analysis to determine the predictors of PPMD. The presence of avoidant (B = 2.12, SE = 0.71, Wald χ2 = 8.85, df = 1, P = .003), dependent (B = 2.90, SE = 0.81, Wald χ2 = 12.78, df = 1, P = .000), and obsessive-compulsive (B = 3.78, SE = 0.76, df = 1, Wald χ2 = 24.24, P = .000) personality disorders was an independent predictor of PPMD, whereas predictive value of primiparity (B = −1.19, SE = 0.63, df = 1, Wald χ2 = 3.55, P = .60) was not significant.