Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings
By K. Wisner, D. Sit, Mary C McShea, D. Rizzo, Rebecca Zoretich, Carolyn Hughes, H. Eng, J. Luther, S. Wisniewski, Michelle Costantino and 4 more. JAMA psychiatry, 2013
1,005 citations recorded by the source corpus.
Importance The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. Objectives To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. Design Sequential case series of women who recently gave birth. Setting Urban academic women’s hospital. Participants During the maternity hospitalization, women were offered screening at 4 to 6 weeks post parturn by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. Main Outcomes and Measures A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: “The thought of harming myself has occurred to me” (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. Results Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had co-morbid anxiety disorders. A striking 22.6% had bipolar disorders. Conclusions and Relevance The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed. Trial Registration clinicaltrials.gov Identifier: NCT00282776
Subfields: Clinical Psychology, Public Health, Environmental and Occupational Health, Social Psychology
View Paper: https://www.semanticscholar.org/paper/01147e5d0ba6d1ce4f370856b321845142e32a7a
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Citations in the corpus
- Sex differences in anxiety and depression clinical perspectives (2014, background): “Of women who have major depression postpartum, approximately one quarter have chronic depression, one third have depression that onset during pregnancy and only a little more than one third have actual postpartum onset of depression (Wisner et al., 2013).”
- Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods (2015, background): “Estrogen treatment seems to increase BDNF expression in several brain regions including hippocampus, amygdala and cortex (Zhou et al., 2005), and has been shown to decrease the risk for neurodegenerative diseases such as Parkinson’s disease and Alzheimer’s disease (Sohrabji and Lewis, 2006).”