Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, No. 600 South Wanping Road, Shanghai, People's Republic of China.
Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
J Affect Disord. 2015 Sep 1;183:339-46. doi: 10.1016/j.jad.2015.05.033. Epub 2015 May 23.
We sought to investigate the clinical features of and risk factors for recurrent major depression (MD) with history of postpartum episodes (PPD) in Han Chinese women and the differences between first-onset postpartum MD (MD that has its first lifetime depressive episode in the postpartum period) and first-onset non-postpartum MD (MD with history of PPD and has its first lifetime depressive episode in a period other than postpartum).
Data were derived from the China, Oxford and Virginia Commonwealth University Experimental Research on Genetic Epidemiology (CONVERGE) study (N=6017 cases) and analyzed in two steps. We first examined the clinical features of and risk factors for MD patients with (N=981) or without (N=4410) a history of PPD. We then compared the differences between first-onset postpartum MD (N=583) and first-onset non-postpartum MD (N=398) in those with a history of PPD. Linear, logistic and multinomial logistic models were employed to measure the associations.
A history of PPD was associated with more guilt feelings, greater psychiatric comorbidity, higher neuroticism, earlier onset and more chronicity (OR 0.2-2.8). Severe premenstrual symptoms (PMS) and more childbirths increased the risk of PPD, as did a family history of MD, childhood sexual abuse, stressful life events and lack of social support (OR 1.1-1.3). In the MD with history of PPD subsample, first-onset postpartum MD was associated with fewer recurrent major depressive episodes, less psychiatric comorbidity, lower neuroticism, less severe PMS and fewer disagreements with their husbands (OR 0.5-0.8), but more childbirths (OR 1.2).
Data were obtained retrospectively through interview and recall bias may have affected the results.
MD with history of PPD in Han Chinese women is typically chronic and severe, with particular risk factors including severe PMS and more childbirths. First-onset postpartum MD and first-onset non-postpartum MD can be partly differentiated by their clinical features and risk factors, but are not clearly distinctive.
我们旨在研究有产后发作史的汉族女性复发性重度抑郁症（MD）的临床特征和危险因素，以及首发产后 MD（首次产后期间发生的 MD）与首发非产后 MD（有产后发作史且首次发病期不在产后的 MD）之间的差异。
数据来自中国、牛津和弗吉尼亚联邦大学基因流行病学实验研究（CONVERGE）（N=6017 例），并分两步进行分析。我们首先检查了有（N=981）或无（N=4410）产后发作史的 MD 患者的临床特征和危险因素。然后，我们比较了有产后发作史的患者中首发产后 MD（N=583）与首发非产后 MD（N=398）之间的差异。采用线性、逻辑和多项逻辑回归模型来衡量关联。
有产后发作史与更多的内疚感、更高的精神共病率、更高的神经质、更早的发病年龄和更长的病程有关（OR 0.2-2.8）。严重经前综合征（PMS）和更多的分娩次数增加了产后发作的风险，MD 家族史、儿童期性虐待、生活压力事件和缺乏社会支持也是如此（OR 1.1-1.3）。在有产后发作史的 MD 亚组中，首发产后 MD 与更少的复发性重度抑郁发作、更少的精神共病、更低的神经质、更轻的 PMS 和与丈夫的更少分歧有关（OR 0.5-0.8），但更多的分娩次数（OR 1.2）。
数据是通过访谈获得的回顾性数据，可能会受到回忆偏倚的影响。
有产后发作史的汉族女性 MD 通常为慢性和严重的，其特定的危险因素包括严重的 PMS 和更多的分娩次数。首发产后 MD 和首发非产后 MD 可以通过其临床特征和危险因素进行部分区分，但并不完全明显。
