Danish researchers have found women suffering post-partum depression (PPD), with a family history of a psychiatric disorder, have almost twice the risk of developing this condition than mothers without.
PPD ranges from mild to severe episodes and includes similar symptoms to major depression: the condition is preventable and treatable, and early identification of women at high risk is important to prevent or mitigate the detrimental consequences.
At least 10% to 15% of new mothers experience PPD, and the researchers said familial risk of mental disorders outside this consistently show high heritability of PPD. Several risk factors for the condition have been identified and summarised in systematic reviews; however, having a relative with a psychiatric disorder is often not listed as a risk factor in several reviews summarising all identified risk factors, according to their review and meta-analysis.
They said three recent comprehensive umbrella reviews, compiling evidence from several systematic reviews on risk factors for PPD, also did not identify family history of psychiatric disorders as a risk factor.
The few systematic reviews highlighting family history of psychiatric disorders as a risk factor have predominantly been based on a few primary studies, are often cross-sectional or with small effect sizes, and have inconsistent findings. In contrast, familiality of PPD has been found in observational family studies, where greater heritability of PPD than major depressive disorders has been reported.
This is directly in line with the research on familial risk of mental disorders outside the post-partum period consistently showing high heritability of psychiatric disorders.
It is “puzzling”, they said, why family history of psychiatric disorders is not identified as a risk factor in several reviews focused on all PPD risk factors, when evidence from research in psychiatry outside the post-partum strongly suggests so.
The study team, from Aarhus University and the University of Copenhagen, Denmark, said the aim of their systematic review (published in JAMA Psychiatry) was to summarise current literature on the association between family history of psychiatric disorders and PPD.
Study details
Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression: A Systematic Review and Meta-analysis
Mette-Marie Zacher Kjeldsen, MSc1,2; Alessio Bricca, PhD3,4; Xiaoqin Liu, PhD1; et al
Published online in JAMA Psychiatry on 17 August 2022.
Key Points
Question Is the risk of developing postpartum depression higher for mothers with a family history of psychiatric disorders than mothers without?
Findings In this systematic review and meta-analysis comprising 26 studies from 5 continents totalling 100,877 women, the risk of developing postpartum depression was almost twice as high among mothers who had a family history of psychiatric disorders compared with mothers without a family history.
Meaning Family history of psychiatric disorders is a strong risk factor for postpartum depression, which ideally can be identified through self-report already during pregnancy and enable timely and targeted preventive initiatives.
Abstract
Importance
Current evidence on the association between family history of psychiatric disorders and post-partum depression is inconsistent; family studies have identified familial risk of post-partum depression, whereas systematic reviews and umbrella reviews, compiling all risk factors for postpartum depression, often have not.
Objective
To investigate the association between family history of psychiatric disorders and risk of developing postpartum depression within 12 months post partum.
Study Selection
Studies eligible for inclusion comprised peer-reviewed cohort and case-control studies reporting an odds ratio (OR) or sufficient data to calculate one for the association between family history of any psychiatric disorder and postpartum depression. Study selection was made by two independent reviewers: title and abstract screening followed by full-text screening.
Main Outcomes and Measures
The primary outcome was the pooled association between family history of psychiatric disorders and postpartum depression.
Results
A total of 26 studies were included, containing information on 100,877 women. Meta-analysis showed an increased OR of developing postpartum depression when mothers had a family history of psychiatric disorders (OR, 2.08; 95% CI, 1.67-2.59; I2 = 57.14%) corresponding to a risk ratio of 1.79 (95% CI, 1.52-2.09), assuming a 15% postpartum depression prevalence in the general population. Subgroup, sensitivity, and meta-regression analyses were in line with the primary analysis. The overall certainty of evidence was deemed as moderate according to GRADE.
Conclusions and Relevance
In this study, there was moderate certainty of evidence for an almost 2-fold higher risk of developing postpartum depression among mothers who have a family history of any psychiatric disorder compared with mothers without.
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