Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
Perinatal Parent-Infant Mental Health Service, Goodmayes Hospital, North East London Foundation Trust, London IG3 8XD, UK.
Psychoneuroendocrinology. 2021 Jun;128:105218. doi: 10.1016/j.psyneuen.2021.105218. Epub 2021 Apr 3.
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.
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).
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.
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.
产后精神病是与分娩相关的最严重精神障碍，对于有双相情感障碍、分裂情感障碍病史或曾患有产后精神病的女性，风险尤其高。虽然有大量证据表明压力与与分娩无关的精神病有关，但压力在产后精神病发病中的作用尚未得到充分研究。
对 112 名孕妇进行前瞻性纵向研究，其中 51 名孕妇有产后精神病风险，因为她们符合 DSM-IV 诊断的双相情感障碍（n=41）、分裂情感障碍（n=6）或之前的产后精神病（n=4），61 名健康孕妇无过去或当前的 DSM-IV 诊断，也没有产后精神病家族史。从妊娠第三个三个月开始对女性进行随访，直到产后 4 周。在产后 4 周内有精神病复发的风险女性（AR-患病）（n=22）与仍保持健康的风险女性（AR-健康）（n=29）进行比较，评估社会心理压力（严重童年虐待和生活压力事件）和生物压力（皮质醇和炎症生物标志物）。
逻辑回归分析显示，严重的童年虐待（OR=4.9，95%CI 0.5-49.2）和妊娠第三个三个月的皮质醇水平较高（OR=3.7，95%CI 1.2-11.6），在调整了临床和社会人口统计学协变量后，预测了产后精神病风险女性在产后 4 周内的精神病复发。
本研究为社会心理压力和生物压力系统在产后精神病风险女性产后复发风险中的作用提供了证据。
