Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: A population-based cohort study.
Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: A population-based cohort study.
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DOI：
10.1371/journal.pmed.1002392
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发表时间：
2017-09
期刊：
影响因子：
15.8
通讯作者：
Melbye M
中科院分区：
文献类型：
--
作者：
Rasmussen MH;Strøm M;Wohlfahrt J;Videbech P;Melbye M
大约5%-15%的女性患有产后抑郁症（PPD），这对许多人来说是她们的第一个精神疾病。本研究的目的是在全国范围内无精神病史的女性队列中估计产后情感性障碍（AD）的发生率、治疗持续时间以及随后的产后AD和其他情感性发作的发生率。我们将几个丹麦国家登记册的信息联系起来，构建了一个队列，从1996年1月1日至2013年12月31日（共789,068例分娩），457,317名首次分娩（及后续分娩）的初产母亲，之前没有精神病医院联系和/或使用抗抑郁药。从1996年1月1日至2014年12月31日对这些妇女进行了随访。产后AD被定义为在产后6个月内使用抗抑郁药和/或因产后抑郁症到医院就诊。主要观察指标为产后AD风险、治疗持续时间和复发风险。我们观察到4550例（0.6%）产后AD发作。治疗持续时间分析显示，在首次发作开始治疗1年后，27.9%的妇女仍在治疗；4年后，5.4%。产后产后阿尔茨海默病的复发风险为55.4 / 100人年；对于第一次分娩后服用产后抗抑郁药物的妇女，每100人年的死亡率为35.0。无产后阿尔茨海默病史的妇女生育二胎后患产后阿尔茨海默病的比率为1.2 / 100人年。在调整出生年份和母亲年龄后，产后产后联系医院就诊的产后抑郁症妇女与没有产后AD病史的妇女相比，产后产后复发的发生率高46.4倍（95% CI 31.5-68.4），产后服用抗抑郁药物的妇女产后复发的发生率高26.9倍（95% CI 21.9-33.2）。局限性包括使用登记数据来识别病例和有限的混杂因素控制。在这项研究中，在没有精神病史的产妇中，产后AD发作率为0.6%。观察到的发作的特点是治疗时间相对较短，但这些妇女的后期AD和产后AD复发率明显较高。产后产后联系医院的产后AD复发风险明显高于产后服用抗抑郁药物的产后AD复发风险。我们的研究结果强调了针对特定弱势群体采取措施的必要性，比如首次出现产后抑郁症的女性。在一项以人群为基础的研究中，Marie-Louise Rasmussen及其同事在丹麦对无精神病史的妇女进行了产后情感障碍的风险和复发检查。产后抑郁症（PPD）是一种发生在分娩后的非精神病性抑郁发作。根据纳入标准，它影响了分娩后所有妇女的5%-15%，这使其成为最常见的分娩后并发症之一。如果不及时治疗，这种疾病可能对母亲和孩子都产生长期影响，包括损害儿童的发育，增加母亲长期抑郁的风险。我们的目的是描述之前没有精神疾病发作的女性产后情感障碍（AD）（一个更广泛的类别，包括产后抑郁症）的风险，以及复发风险和治疗持续时间。我们将丹麦国家登记处的数据联系起来，并构建了一个队列，从1996年1月1日至2013年12月31日（共789,068例分娩），457,317例首次分娩（及后续分娩）的初产母亲，之前没有精神病医院联系和/或使用抗抑郁药。在这项研究中，在没有精神病史的产妇中，产后AD发作率为0.6%。观察到的发作的特点是治疗时间相对较短，但这些妇女的后期AD和产后AD复发率明显较高。产后AD复发的风险在产后产后联系医院的产后抑郁症患者中明显高于产后使用抗抑郁药物的产后AD复发风险。这些基于人群的数据为医生治疗女性产后抑郁症提供了有价值的指导。该研究记录了一组患者的存在，他们在最初的PPD发作后经历了随后的抑郁和PPD的高发病率。它强调了单一的初次发作的严重性，并强调了初级和二级预防措施的必要性。局限性包括使用登记数据来确定病例，因为这可能导致一组妇女可能处于PPD谱系的较严重一端；因此，这项研究不一定能解释较轻的病例。
Some 5%–15% of all women experience postpartum depression (PPD), which for many is their first psychiatric disorder. The purpose of this study was to estimate the incidence of postpartum affective disorder (AD), duration of treatment, and rate of subsequent postpartum AD and other affective episodes in a nationwide cohort of women with no prior psychiatric history. Linking information from several Danish national registers, we constructed a cohort of 457,317 primiparous mothers with first birth (and subsequent births) from 1 January 1996 to 31 December 2013 (a total of 789,068 births) and no prior psychiatric hospital contacts and/or use of antidepressants. These women were followed from 1 January 1996 to 31 December 2014. Postpartum AD was defined as use of antidepressants and/or hospital contact for PPD within 6 months after childbirth. The main outcome measures were risk of postpartum AD, duration of treatment, and recurrence risk. We observed 4,550 (0.6%) postpartum episodes of AD. The analyses of treatment duration showed that 1 year after the initiation of treatment for their first episode, 27.9% of women were still in treatment; after 4 years, 5.4%. The recurrence risk of postpartum AD for women with a PPD hospital contact after first birth was 55.4 per 100 person-years; for women with postpartum antidepressant medication after first birth, it was 35.0 per 100 person-years. The rate of postpartum AD after second birth for women with no history of postpartum AD was 1.2 per 100 person-years. After adjusting for year of birth and mother’s age, women with PPD hospital contact after first birth had a 46.4 times higher rate (95% CI 31.5–68.4) and women with postpartum antidepressant medication after their first birth had a 26.9 times higher rate (95% CI 21.9–33.2) of a recurrent postpartum episode after their second birth compared to women with no postpartum AD history. Limitations include the use of registry data to identify cases and limited confounder control. In this study, an episode of postpartum AD was observed for 0.6% of childbirths among women with no prior psychiatric history. The observed episodes were characterized by a relatively short treatment duration, yet the women had a notably high rate of later AD and recurrent episodes of postpartum AD. The recurrence risk of postpartum AD was markedly higher among women with PPD hospital contact after first birth compared to women with postpartum antidepressant medication after first birth. Our results underline the necessity of measures targeted at specific vulnerable groups, such as women who experience PPD as a first psychiatric episode. In a population-based study, Marie-Louise Rasmussen and colleagues examine risk and recurrence of postpartum affective disorder in women with no prior psychiatric history in Denmark. Postpartum depression (PPD) is a non-psychotic depressive episode occurring in the period following delivery of a child. Depending on the inclusion criteria, it affects 5%–15% of all women after childbirth, which makes it one of the most common postnatal complications of childbearing. Left untreated, the disorder can have long-term implications for both mother and child, including impairment of the child’s development and increased risk of long-term maternal depression. Our aim was to describe the risk of postpartum affective disorder (AD) (a broader category that includes PPD) among women with no prior psychiatric episodes, as well as the recurrence risk and the duration of treatment. We linked data from the Danish national registries and constructed a cohort of 457,317 primiparous mothers with first birth (and subsequent births) from 1 January 1996 to 31 December 2013 (a total of 789,068 births) and no prior psychiatric hospital contacts and/or use of antidepressants. In this study, an episode of postpartum AD was observed for 0.6% of childbirths among women with no prior psychiatric history. The observed episodes were characterized by a relatively short treatment duration, yet the women had a notably high rate of later AD and recurrent episodes of postpartum AD. The recurrence risk of postpartum AD was markedly higher among women with a PPD hospital contact after first birth than among women with postpartum antidepressant medication use after first birth. These population-based figures provide valuable guidance to physicians treating women with PPD. The study documents the existence of a group of patients who experience elevated rates of subsequent depression and PPD following an initial PPD episode. It underlines the seriousness of single initial episodes and highlights the necessity of both primary and secondary preventive measures. Limitations include the use of registry data to identify cases, as this may result in a group of women likely to be at the more severe end of the PPD spectrum; thus, this study does not necessarily account for the milder cases.
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