Psychological Medicine, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK.
Institute of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK.
J Affect Disord. 2020 Feb 15;263:661-666. doi: 10.1016/j.jad.2019.11.042. Epub 2019 Nov 11.
Women are particularly vulnerable to recurrence of bipolar disorder (BD) following childbirth. Risk of postpartum psychosis (PP) is especially high, but postpartum depression (PPD) is also common. Adverse childhood experiences (ACEs) have not been associated with PP, but have been associated with PPD in non-bipolar samples. The relationship between ACEs and PPD within BD remains to be investigated. Here, we examined this association in a large, well-defined sample of women with BD.
Participants were 575 parous women with DSM-IV BD. Lifetime psychopathology, including perinatal, was assessed via semi-structured interview and case-notes. ACEs, assessed via self-report and case-notes, were compared between women with lifetime PPD (n = 368) and those without a lifetime history of perinatal mood episodes (n = 207).
In univariate analysis exposure to 3 or more ACEs, and to childhood abuse specifically, was significantly associated with PPD (p = 0.026 and 0.041 respectively), but this did not remain significant after adjusting for lifetime number of episodes of depression and parity. Post-hoc analysis revealed more frequent episodes of depression to be associated with both a history of 3 or more ACEs and of childhood abuse.
Limited range of ACEs assessed and potential recall bias.
Increased frequency of ACEs and particularly childhood abuse was associated with more frequent lifetime episodes of depression, but not specifically episodes with postpartum onset. Understanding factors that mediate the pathway between ACEs and PPD in BD has implications for risk prediction of PPD.
女性在产后特别容易复发双相情感障碍（BD）。产后精神病（PP）的风险尤其高，但产后抑郁症（PPD）也很常见。不良的童年经历（ACEs）与 PP 无关，但与非双相样本中的 PPD 有关。ACEs 与 BD 内的 PPD 之间的关系仍有待研究。在这里，我们在一个大型的、明确界定的 BD 女性样本中研究了这种关联。
参与者为 575 名患有 DSM-IV BD 的经产妇。通过半结构化访谈和病历记录评估了包括围产期在内的终生精神病理学。通过自我报告和病历记录评估 ACEs，并将其与有或无围产期情绪发作史的女性（n=368 名）进行比较。
在单变量分析中，暴露于 3 个或更多 ACEs 以及童年虐待与 PPD 显著相关（p=0.026 和 0.041），但在调整了终生抑郁发作次数和产次后，这一结果不再显著。事后分析显示，更频繁的抑郁发作与 3 个或更多 ACEs 以及童年虐待的历史有关。
评估的 ACEs 范围有限，可能存在回忆偏差。
ACEs 的发生频率增加，特别是童年虐待与更频繁的终生抑郁发作有关，而不是与产后发作的发作有关。了解 ACEs 与 BD 中的 PPD 之间的中介因素对 PPD 的风险预测具有重要意义。
