AbstractBackground: Despite the severity of postpartum psychosis and fact it occurs in relation to childbirth, little is known about the biopsychosocial risk factors for the disorder, or the possible effects on early infant outcome. Literature suggests that experience of childhood maltreatment, stressful life events and Hypothalamic Pituitary Adrenal (HPA) axis function play a role in the onset of affective and non-affective psychoses unrelated to gestation and other postpartum psychopathology, as well as having an impact on early infant outcome. The aim of this thesis was to investigate experience of maternal childhood maltreatment, antenatal and delivery related stressful life events and HPA axis function in women at risk of postpartum psychosis who subsequently become unwell in the postpartum compared to women at risk who remained well and healthy controls. Furthermore, the thesis aimed to examine the behaviour and stress response in the infants of these women.
Methodology: A prospective longitudinal study of 93 pregnant women, 42 at risk of postpartum psychosis because of a DSM-IV diagnosis of bipolar disorder (n=34), schizoaffective disorder (n=6) or a previous postpartum psychosis (n=2) and 51 healthy women, were followed up from the third trimester of pregnancy, with their infant, to 4 weeks post partum. Women at risk who became unwell with clinically meaningful symptoms in the first 4 weeks post partum (AR-PS) (n=16), were compared to those at risk who remained well (AR-NPS) (n=26) and healthy women (HC) on measures of severe childhood maltreatment, antenatal and delivery related stressful life events and antenatal HPA axis function. Furthermore, the infants of the three participant groups were compared on their behaviour and stress response at birth.
Results: Compared to the HC and AR-NPS groups, women in the AR-PS group were more likely to have experienced both sexual abuse and antipathy, to perceive antenatal stressful life events as more distressing, to have elevated antenatal daily cortisol and to have more major delivery related events. Furthermore, compared to the infants born to the HC and AR-NPS groups, infants of the AR-PS group had lower basal cortisol levels prior to the Neonatal Behavioral Assessment Scale (NBAS) assessment, as well as an increased cortisol response to the assessment.
Conclusion: The current findings provide preliminary evidence of several potential biopsychosocial risk factors for the development of clinically significant postpartum symptomatology in women at increased risk of postpartum psychosis. Furthermore, they show, for the first time, the effect of postpartum symptomatology on infant outcome in infants born to women at risk of postpartum psychosis. As well as adding to the literature on postpartum psychosis, these findings have important clinical implications for these women and their infants.
|Date of Award||1 Jul 2018|
|Supervisor||Paola Dazzan (Supervisor) & Susan Pawlby (Supervisor)|