TY - JOUR
T1 - Risk factors for postpartum relapse in women at risk of postpartum psychosis
T2 - The role of psychosocial stress and the biological stress system
AU - Hazelgrove, Katie
AU - Biaggi, Alessandra
AU - Waites, Freddie
AU - Fuste, Montserrat
AU - Osborne, Sarah
AU - Conroy, Susan
AU - Howard, Louise M.
AU - Mehta, Mitul A.
AU - Miele, Maddalena
AU - Nikkheslat, Naghmeh
AU - Seneviratne, Gertrude
AU - Zunszain, Patricia A.
AU - Pawlby, Susan
AU - Pariante, Carmine M.
AU - Dazzan, Paola
N1 - Funding Information:
This work was supported by the UK Medical Research Foundation [grant number C0439 ]. The research was also in part supported by the UK Medical Research Council [grant number MR/S003444/1 , e-BRAIN Study] and the UK National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. CMP is a NIHR Senior Investigator. The funding sources played no role in the study design, collection, analysis or interpretation of the data, in writing the report or in the decision to submit the article for publication.
Funding Information:
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: PD has received speaker's fees from Lundbeck and Janssen. CMP has received research funding from Johnson & Johnson for research on depression and inflammation and is funded by the Wellcome Trust strategy award to the Neuroimmunology of Mood Disorders and Alzheimer’s Disease (NIMA) Consortium [104025], which is also funded by Janssen, GlaxoSmithKline, Lundbeck and Pfizer. LMH has received funding from the NIHR and the Nuffield Foundation for Research Programmes on maternal mental disorders. MAM has received research funding from Takeda Pharmaceuticals, Lundbeck, Johnson & Johnson and support in kind from AstraZeneca and has acted as a consultant for Lundbeck and Takeda. However, this paper is independent from this funding; there are no further declarations of interest.
Funding Information:
This work was supported by the UK Medical Research Foundation [grant number C0439]. The research was also in part supported by the UK Medical Research Council [grant number MR/S003444/1, e-BRAIN Study] and the UK National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. CMP is a NIHR Senior Investigator. The funding sources played no role in the study design, collection, analysis or interpretation of the data, in writing the report or in the decision to submit the article for publication.
Publisher Copyright:
© 2021 Elsevier Ltd
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/6
Y1 - 2021/6
N2 - Background: Postpartum psychosis is the most severe psychiatric disorder associated with childbirth, and the risk is particularly high for women with a history of bipolar disorder, schizoaffective disorder or those who have suffered a previous episode of postpartum psychosis. Whilst there is a lot of evidence linking stress to psychosis unrelated to childbirth, the role of stress in the onset of postpartum psychosis has not been fully investigated. Methods: A prospective longitudinal study of 112 pregnant women, 51 at risk of postpartum psychosis because of a DSM-IV diagnosis of bipolar disorder (n = 41), schizoaffective disorder (n = 6) or a previous postpartum psychosis (n = 4) and 61 healthy women with no past or current DSM-IV diagnosis and no family history of postpartum psychosis. Women were followed up from the third trimester of pregnancy to 4 weeks’ post partum. Women at risk who had a psychiatric relapse in the first 4 weeks’ post partum (AR-unwell) (n = 22), were compared with those at risk who remained well (AR-well) (n = 29) on measures of psychosocial stress (severe childhood maltreatment and stressful life events) and biological stress (cortisol and inflammatory biomarkers). Results: Logistic regression analyses revealed that severe childhood maltreatment (OR = 4.9, 95% CI 0.5–49.2) and higher daily cortisol in the third trimester of pregnancy (OR=3.7, 95% CI 1.2–11.6) predicted psychiatric relapse in the first 4 weeks’ post partum in women at risk of postpartum psychosis after adjusting for clinical and sociodemographic covariates. Conclusion: The current study provides evidence for the role of psychosocial stress and the biological stress system in the risk of postpartum relapse in women at risk of postpartum psychosis.
AB - Background: Postpartum psychosis is the most severe psychiatric disorder associated with childbirth, and the risk is particularly high for women with a history of bipolar disorder, schizoaffective disorder or those who have suffered a previous episode of postpartum psychosis. Whilst there is a lot of evidence linking stress to psychosis unrelated to childbirth, the role of stress in the onset of postpartum psychosis has not been fully investigated. Methods: A prospective longitudinal study of 112 pregnant women, 51 at risk of postpartum psychosis because of a DSM-IV diagnosis of bipolar disorder (n = 41), schizoaffective disorder (n = 6) or a previous postpartum psychosis (n = 4) and 61 healthy women with no past or current DSM-IV diagnosis and no family history of postpartum psychosis. Women were followed up from the third trimester of pregnancy to 4 weeks’ post partum. Women at risk who had a psychiatric relapse in the first 4 weeks’ post partum (AR-unwell) (n = 22), were compared with those at risk who remained well (AR-well) (n = 29) on measures of psychosocial stress (severe childhood maltreatment and stressful life events) and biological stress (cortisol and inflammatory biomarkers). Results: Logistic regression analyses revealed that severe childhood maltreatment (OR = 4.9, 95% CI 0.5–49.2) and higher daily cortisol in the third trimester of pregnancy (OR=3.7, 95% CI 1.2–11.6) predicted psychiatric relapse in the first 4 weeks’ post partum in women at risk of postpartum psychosis after adjusting for clinical and sociodemographic covariates. Conclusion: The current study provides evidence for the role of psychosocial stress and the biological stress system in the risk of postpartum relapse in women at risk of postpartum psychosis.
KW - Childhood maltreatment
KW - Cortisol
KW - Inflammatory markers
KW - Perinatal
KW - Postpartum psychosis
KW - Stressful life events
UR - http://www.scopus.com/inward/record.url?scp=85104292894&partnerID=8YFLogxK
U2 - 10.1016/j.psyneuen.2021.105218
DO - 10.1016/j.psyneuen.2021.105218
M3 - Article
AN - SCOPUS:85104292894
SN - 0306-4530
VL - 128
JO - Psychoneuroendocrinology
JF - Psychoneuroendocrinology
M1 - 105218
ER -