Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression
JAMA Psychiatry: August, 2022
The postpartum period is critical
for mothers, children, and families, and approximately 10% to 15% of new
mothers experience postpartum depression (PPD), one of the most common
complications related to childbirth.
PPD ranges from mild to severe
episodes and includes similar symptoms as major depression outside the
postpartum period. PPD is preventable and treatable, and therefore, early
identification of women at high risk is important to prevent or mitigate the
detrimental consequences observed in relation to PPD.
Several risk factors for PPD have
been identified and summarized in systematic reviews; however, having a
relative with a psychiatric disorder is often not listed as a risk factor in
reviews summarizing all identified risk factors.
The primary objective of this
systematic review and meta-analysis was to summarize the current literature on
the association between family history of psychiatric disorders and PPD with an
onset of 0 to 12 months post-partum.
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The
evidence showed, with moderate certainty, that mothers who had a family history
of any psychiatric disorder had an increased risk of postpartum depression.
There is an
approximately twofold risk of postpartum depression in mothers with a family
history of psychiatric disorders.
Prenatal
care providers should prioritize prenatal screening and postpartum monitoring
for postpartum depression in this population of patients.
Conclusions
Based on 26 studies from 18
countries representing 5 continents, this systematic review and meta-analysis
highlights mothers with a family history of any psychiatric disorder have an
almost doubled risk of developing PPD compared with mothers without.
Information on family history of psychiatric disorders is easy to identify through simple self-reported question(s), potentially as part of routine perinatal care, and early identification makes timely and targeted intervention possible to prevent PPD or mitigate the consequences thereof.
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Importance: Current
evidence on the association between family history of psychiatric disorders and
postpartum depression is inconsistent; family studies have identified familial
risk of postpartum 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.
Data sources: Literature
searches were conducted in PubMed, Embase, and PsycINFO in September 2021 and
updated in March 2022, accompanied by citation and reference search.
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 2 independent reviewers: title and
abstract screening followed by full-text screening.
Data extraction and
synthesis: Reporting was performed using the MOOSE checklist. Two
reviewers independently extracted predefined information and assessed included
studies for risk of bias using the Newcastle-Ottawa Scale. Data were pooled in a
meta-analysis using a random-effects model. Heterogeneity was investigated with
meta-regression, subgroup, and sensitivity analyses. Publication bias was
investigated using a funnel plot, and GRADE (Grading of Recommendations
Assessment, Development, and Evaluation) was used to evaluate the overall
certainty of the findings.
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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