Course of major depressive disorder after pregnancy and the postpartum period
Course of major depressive disorder after pregnancy and the postpartum period
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DOI：
10.1002/da.22836
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发表时间：
2018-12-01
影响因子：
7.4
通讯作者：
Cohen, Lee S.
中科院分区：
文献类型：
--
作者：
Freeman, Marlene P.;Claypoole, Lauren D.;Cohen, Lee S.
背景母亲重度抑郁障碍（MDD）对儿童发育有不良影响，并增加儿童精神病理的风险。最重要的是要了解母亲在童年时期的抑郁过程，特别是在怀孕前，怀孕期间和怀孕后。目的探讨有抑郁史的女性在妊娠期的重度抑郁症病程。方法研究对象为有重度抑郁症病史且在怀孕期间参加过前瞻性观察性研究的女性。在随访中，参与者完成了一个结构化的访谈，内容包括(1)自第一次怀孕以来的重度抑郁症病程，(2)新的精神病学诊断，以及(3)随后怀孕期间的重度抑郁症病程和治疗。结果在129名符合条件的妇女中，48.8% （N = 63）参与了先前妊娠研究，平均/平均时间为12.9年（SD = 1.9, 8.8-16.7）。虽然大约有三分之一的人报告自怀孕以来重度抑郁症持续缓解，但在其余三分之二报告随后抑郁发作的妇女中，几乎有五分之一（相当于总样本的12%）在第一次怀孕后超过50%的时间里承认抑郁。在之前确诊为重度抑郁症的女性中，总共有6.3%的人报告了新的双相情感障碍诊断。在之前的研究中，妇女报告了在怀孕期间使用抗抑郁药的类似治疗选择。结论MDD女性在育龄期抑郁复发率较高。这是临床护理和研究的一个关键变量。
Background Maternal major depressive disorder (MDD) has an adverse effect on child development and increases risk for child psychopathology. It is paramount to understand the course of maternal depression during the childhood years particularly before, during, and after pregnancy. Objective To follow the course of MDD in women with prior histories of depression followed during an index pregnancy. Methods Subjects were women with histories of MDD who had participated in prior prospective, observational studies during pregnancy. In the follow-up, participants completed a structured interview that addressed (1) the course of MDD since their index pregnancy, (2) new psychiatric diagnoses, and (3) the course of MDD and treatment across subsequent pregnancies. Results Out of 129 eligible women, 48.8% participated (N = 63) with an average/mean time of 12.9 years (SD = 1.9, 8.8-16.7) elapsed since participation in the prior pregnancy studies. Although approximately one third reported sustained remission from MDD since the pregnancy during which they had been originally followed, of the remaining two thirds of women who reported subsequent depressive episodes, almost one fifth (similar to 12% of the total sample) endorsed depression more than 50% of the time following their index pregnancy. A total of 6.3% of the women with previous validated diagnoses of MDD reported new diagnoses of bipolar disorder. Women reported similar treatment choices regarding the use of antidepressants during pregnancies subsequent to the one followed in the previous study. Conclusion Women with MDD experienced high rates of recurrent depression across the childbearing years. This represents a critical variable for clinical care and research.