Kępińska Adrianna P, Robakis Thalia K, Humphreys Keith, Liu Xiaoqin, Kahn René S, Munk-Olsen Trine, Bergink Veerle, Mahjani Behrang
Seaver Autism Center for Research and Treatment (Kępińska, Mahjani), Department of Psychiatry (Kępińska, Robakis, Kahn, Bergink, Mahjani), Department of Genetics and Genomic Sciences (Kępińska, Mahjani), Mindich Child Health and Development Institute (Mahjani), and Department of Artificial Intelligence and Human Health (Mahjani), Icahn School of Medicine at Mount Sinai, New York; Department of Medical Epidemiology and Biostatistics (Humphreys, Mahjani) and Department of Molecular Medicine and Surgery (Mahjani), Karolinska Institutet, Stockholm; Department of Clinical Research, Research Unit Children and Adolescent Psychiatry, University of Southern Denmark, Odense (Liu, Munk-Olsen); Department of Psychiatry, Erasmus Medical Center, Rotterdam, the Netherlands (Bergink).
Am J Psychiatry. 2025 Jun 1;182(6):542-550. doi: 10.1176/appi.ajp.20230576. Epub 2025 May 19.
Postpartum psychosis is one of the most severe psychiatric conditions, with high risks of suicide and infanticide if untreated. Although genetic factors contribute to the risk of postpartum psychosis, the extent of familial risk remains to be determined. The authors compared relative recurrence risk across different family relationship types, hypothesizing that relative recurrence risk for postpartum psychosis varies by degree of genetic relatedness and is higher in female full siblings than in cousins.
This cohort study consisted of 1,648,759 women from the Swedish nationwide registers, of whom 2,514 (0.15%) experienced postpartum psychosis within 3 months of their first-ever childbirth. The authors estimated the relative recurrence risk of postpartum psychosis for female full siblings and cousins as a measure of familial risk.
The relative recurrence risk of postpartum psychosis in full siblings was 10.69 (95% CI=6.60, 16.26) when adjusted for year of and age at childbirth. Although cousins showed an elevated relative recurrence risk, these results did not reach statistical significance (1.78, 95% CI=0.70, 3.62). Despite the higher familial risk of postpartum psychosis among full siblings, the absolute risk for women with an affected sibling was relatively low, estimated at 1.60% within the entire population.
The observed increased risk of postpartum psychosis in full siblings suggests both genetic and shared environmental influences. However, the lack of significant results in cousins hampers a more accurate distinction between these factors. Furthermore, despite increased relative recurrence risk in siblings, their overall likelihood of developing postpartum psychosis remains low. This study underscores the need for further research to better understand the intricate interplay of genetics and shared environment in the development of postpartum psychosis.
产后精神病是最严重的精神疾病之一，若不治疗，有很高的自杀和杀婴风险。虽然遗传因素会增加产后精神病的风险，但家族风险的程度仍有待确定。作者比较了不同家庭关系类型中的相对复发风险，假设产后精神病的相对复发风险因遗传相关性程度而异，在女性同胞中比在堂亲中更高。
这项队列研究包括来自瑞典全国登记册的1,648,759名女性，其中2,514名（0.15%）在首次分娩后的3个月内经历了产后精神病。作者估计了女性同胞和堂亲产后精神病的相对复发风险，作为家族风险的一种衡量指标。
在调整分娩年份和年龄后，同胞中产后精神病的相对复发风险为10.69（95%置信区间=6.60, 16.26）。虽然堂亲显示出相对复发风险升高，但这些结果未达到统计学显著性（1.78, 95%置信区间=0.70, 3.62）。尽管同胞中产后精神病的家族风险更高，但有患病同胞的女性的绝对风险相对较低，在整个人口中估计为1.60%。
观察到的同胞中产后精神病风险增加表明存在遗传和共同环境影响。然而，堂亲中缺乏显著结果妨碍了对这些因素进行更准确的区分。此外，尽管同胞中的相对复发风险增加，但他们患产后精神病的总体可能性仍然较低。这项研究强调需要进一步研究，以更好地理解遗传和共同环境在产后精神病发展中的复杂相互作用。
