Lluïsa Garcia-Esteve

An association between plasma ferritin concentrations measured 48 h after delivery and postpartum depression

CONTEXT Iron deficiency is the most common nutritional problem experienced by childbearing women, and postpartum depression (PPD) is the most common psychiatric disorder seen during the first year after delivery. The possible link between iron deficiency and PPD is not clear. OBJECTIVE To evaluate whether iron status 48 h after delivery was associated with PPD. Our hypothesis was that iron deficiency would be associated with PPD. DESIGN This was a prospective cohort study of depression-free women studied in the postpartum period. SETTING Women who give birth at obstetric units in several general hospitals in Spain. PARTICIPANTS A subsample of 729 women was included in the present study after exclusion of women with high C-reactive protein (CRP) and other diseases known to interfere with iron metabolism. MAIN OUTCOME MEASURES We evaluated depressive symptoms at 48 h, 8 weeks and 32 weeks postpartum and used a diagnostic interview to confirm the diagnosis of major depression. A blood sample obtained 48 h after delivery was used to measure the following iron storage parameters: ferritin, transferrin (Tf), free iron and transferrin saturation (TfS) and the inflammatory marker CCRP. RESULTS Overall, the women in the study had low iron concentrations (8.8 ± 6.9 μmol/L) and low TfS (12.6 ± 9.6%) but normal ferritin and Tf concentrations. A total of 65 women (9%) developed PPD during the 32 week postpartum period; these women also had a lower ferritin concentration (15.4 ± 12.7 μg/L vs. 21.6 ± 13.5 μg/L, P = 0.002). A strong association between ferritin and PPD was observed (odds ratio = 3.73, 95% CI: 1.84-7.56; P = 0.0001 for ferritin cutoff value of 7.26 μg/L). In our study, ferritin concentrations have a high specificity but low sensitivity in predicting PPD. CONCLUSIONS These findings support the role of iron in the etiology of PPD and the use of ferritin as a marker of iron deficiency in the postpartum period. We believe that this topic deserves further investigation.

Thyroid function 48 h after delivery as a marker for subsequent postpartum depression

Physiological changes during gestation and after delivery are associated with postpartum thyroid dysfunction, which is due to thyroid autoimmunity in some cases. Postpartum thyroid dysfunction, in turn, has been associated with postpartum depression (PPD). The aim of the present study was to evaluate whether thyroid function immediately after delivery can predict postpartum depression at 8 weeks and 32 weeks after delivery. This study examined 1053 postpartum Spanish women without a previous history of depression. We evaluated depressive symptoms at 48h, 8 weeks and 32 weeks postpartum and used a diagnostic interview to confirm major depression for all probable cases. Free thyroxin (fT4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibodies (TPOAb) and C-reactive protein (CRP) were assayed at 48h postpartum. Binary and multivariate logistic regression analyses were performed to determine independent risk factors for PPD. Although 152 women (14.4%) had high TPOAb (>27IU/mL) and slightly elevated TSH concentrations with normal fT4, we did not find any association between thyroid function and PPD. This thyroid dysfunction was not associated with CRP concentrations that were outside of the normal range (>3mg/L). We conclude that thyroid function at 48h after delivery does not predict PPD susceptibility.

Perfectionism dimensions in major postpartum depression

BACKGROUND Although perfectionism from a multidimensional perspective has generally been associated with depressive illness, there are not many studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism dimensions using the Frost Multidimensional Perfectionism Scale (FMPS) and major postpartum depression. METHODS One-hundred-twenty-two women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women were evaluated using the FMPS, an instrument for the assessment of six perfectionism dimensions: concern over mistakes, personal standards, parental expectations, parental criticism, doubt about actions and organisation. Other variables were also considered: neuroticism, psychiatric history, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms). RESULTS The prevalence of high-perfectionism was higher in major postpartum depression group than in control group (34% vs. 11%; p<0.001). Multivariate models confirmed high-perfectionism as an independent factor associated with major postpartum depression. Specifically, the high-concern over mistakes dimension increased over four-fold the odds of major depression in postpartum period. (OR=4.14; 95% CI=1.24-13.81) Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors. CONCLUSIONS High-perfectionism, and particularly high-concern over mistakes is a personality dimension associated with major postpartum depression. The inclusion of perfectionism assessment, together with others factors, may be considered in order to improve the detection of women at risk of postpartum depression, in whom early intervention may be of benefit.

Childhood physical abuse as a common risk factor for depression and thyroid dysfunction in the earlier postpartum

Childhood abuse is a powerful risk factor for developing postpartum depression in adulthood, and recently it has been associated to thyroid dysfunction in postpartum depressive women. The purpose of this study was to investigated the effects of childhood abuse on thyroid status and depressive symptomatology in two hundred and thirty-six (n=236) postpartum women 24-48h after delivery. The Early-Trauma-Inventory Self-Report was used to assess the presence of childhood abuse and the Edinburgh Postpartum Depression Scale (EPDS) to evaluate depressive symptomatology (EPDS≥11). Free thyroxin (fT4) and thyroid-stimulating hormone (TSH) were measured. Thyroid dysfunction (TD) was defined as altered TSH or TSH and fT4. Socio-demographic, reproductive, and psychopathological variables were also collected. Multivariate analysis shows that childhood physical abuse increases by four times the risk for TD (OR: 3.95, 95% CI: 1.23-12.71) and five times the risk for depressive symptomatology (OR: 5.45, 95% CI: 2.17-13.66) in the earlier postpartum. Our findings suggest that women with history of childhood physical abuse are particularly at-risk for thyroid dysfunction and depressive symptomatology 24-48h after delivery. The assessment of childhood abuse in the perinatal period is important to identify women at-risk for physical and mental health problems in this period.

Childhood sexual abuse and hypothalamus-pituitary-thyroid axis in postpartum major depression

OBJECTIVE The aim of this study was to investigate the association between early life events in women with postpartum major depression and concomitant hypothalamus-pituitary-thyroid axis disturbances (HPTD), thyroid dysfunction or presence of thyroid antibodies. METHODS Serum total tri-iodothyronine (TT3), free thyroxin (FT4), Thyroid-stimulating hormone (TSH), Thyroperoxidasa (TPOAb) and Thyroglobulin (TGAb) autoantibodies was measured in 103 major postpartum depressive women. HPTD was defined as TSH and/or T4 abnormal, presence of thyroid autoantibodies and alterations of TT3. All women were assessed with a psychiatry structured interview for DSM-IV. Early Trauma Inventory Self Report, sociodemographic, reproductive, psychosocial and psychopathological variables were also assessed. RESULTS Sixty three percent of women had suffered childhood trauma, which was childhood sexual abuse in 27.2%. Childhood sexual abuse in postpartum major depression women increased the risk for thyroid dysfunction (OR=5.018, 95%CI=1.128-22.327), presence of thyroid autoantibodies (OR=2.528; 95%CI=1.00-6.39) and HPTD (OR=2.955; 95%CI=1.191-7.32). Moreover, age over 34 (OR=12.394; 95%CI=1.424-107.910) and previous postpartum depression (OR=8.470; 95%CI=1.20-59.43) increased the risk for thyroid dysfunction in postpartum depression. LIMITATIONS The study design does not allow us to know the direction of the association and there is a lack of previous assessment of current posttraumatic stress disorder. CONCLUSIONS According to the present findings, childhood sexual abuse may represent an important risk factor for the presence of thyroid autoantibodies and HPTD in women with postpartum depression.

Family caregiver role and premenstrual syndrome as associated factors for postnatal depression

The goal of this study was to identify sociodemographic, psychopathological, and obstetric risk factors associated with postnatal depression (PND) and their relative weight. A cross-sectional two-stage design was used. All consecutive women receiving a routine check-up 6 weeks postpartum at Obstetric Services during a 1-year period were included. In the first stage, women completed the Edinburgh Post-natal Depression Scale (EPDS). In the second stage, mothers with EPDS scores ≥9 and a randomized sample of 16% with EPDS <9 were explored through a structured clinical interview to diagnose DSM-IV PND (major and minor depression). Variables were entered into stepwise regression models. A total of 1,201 women were recruited and did the EPDS; 261 women with EPDS scores ≥9 and 151 with EPDS scores <9 were selected. Three hundred and thirty-four women agreed to be interviewed and 100 were diagnosed with PND. Family caregiver role (defined as women who have to take care of handicapped or ill relatives) was associated with a 4.4-fold increase in risk for major PND (OR: 4.39, 95%CI: 1.10-17.38). Premenstrual syndrome was identified as an independent risk factor for major and minor PND (OR: 1.81, 95%CI: 1.03-3.18). Moreover, previous depression, poor partner relationship, and lower social support were also confirmed as risk factors for PND. Both family caregiver role and premenstrual syndrome should be considered for inclusion in the rating scales of pregnant women at risk for PND.

Examining the Factor Structure and Discriminant Validity of the 12-Item General Health Questionnaire (GHQ-12) Among Spanish Postpartum Women.

In this study, the authors tested alternative factor models of the 12-item General Health Questionnaire (GHQ-12) in a sample of Spanish postpartum women, using confirmatory factor analysis. The authors report the results of modeling three different methods for scoring the GHQ-12 using estimation methods recommended for categorical and binary data. A discriminant function analysis was also performed to test the utility of a multiple factor model. A two-phase cross-sectional study was designed: (a) 1,453 women visiting at 6 weeks postpartum completed the GHQ-12 and the Edinburgh Postnatal Depression Scale questionnaire and (b) based on the Edinburgh Postnatal Depression Scale outcomes, participants were stratified and randomly selected within each stratum for clinical evaluation. Using the Likert-type scoring approach, Hankins’s one-factor model with “method effects” obtained the best fit. In addition, Graetz’s three-factor model provided little discrimination between diagnostic groups, the factors being highly correlated. These results support the presence of only one latent factor in the GHQ-12.

Mothers with Depression, School-Age Children with Depression? A Systematic Review

PURPOSE To carry out a systematic review of the association between maternal and school-age children depression and covariate factors. DESIGN AND METHODS The key words maternal depression, depressed children, and school-age key words were searched in Medline, Lilacs, Scielo, IndexPsi, and PsycInfo (2004-2010). Clinical and community cross-sectional and longitudinal studies were included. A qualitative checklist was used. FINDINGS Thirty studies were included (21.926 dyads). The results supported the association, showing several modulators: family environment, marital adjustment, social support, depression symptoms, and children-related variables. Limitations were nonrandom samples, single informants, and nondepression diagnosis. PRACTICE IMPLICATIONS   Identifying mothers with depression may be useful for prevention and early detection of school-age childrens depression.

Validation and test-retest reliability of Early Trauma Inventory in Spanish postpartum women.

The aims were to study the validity and test-retest reliability of the Early Trauma Inventory—Self Report (ETI-SR) and its short-form (ETI-SF), which retrospectively assess different childhood trauma, in a sample of Spanish postpartum women. A total of 227 healthy postpartum women completed the ETI-SR and ETI-SF. The longitudinal, expert, all data procedure was used as the external criterion for the assessment of childhood trauma. The ETI-SR and ETI-SF were also administered to a sample of 102 postpartum depressive women (DSM-IV) and the results were compared with those of the healthy postpartum sample. The area under the curve values of the ETI-SR and ETI-SF were 0.77 (95% confidence interval [CI], 0.71–0.84) and 0.78 (95% CI, 0.72–0.85), the internal consistencies of the 2 scales were 0.79 and 0.72, and the intraclass correlation coefficients were 0.92 (95% CI, 0.80–0.97) and 0.91 (95% CI, 0.78–0.96), all respectively. The ETI-SR and ETI-SF had higher test-retest reliability on all subscales. The ETI-SR and ETI-SF are shown to be valid and reliable instruments for assessing childhood trauma in postpartum women.

Psychological impact of first‐trimester prevention for preeclampsia on anxiety

This study aims to examine whether a first‐trimester strategy of secondary prevention for preeclampsia increases anxiety in pregnant women.