Zarchev Milan, Wei Dang, Valdimarsdottir Unnur A, László Krisztina D, Grootendorst-van Mil Nina H, Mulder Cornelis L, Bränn Emma, Fang Fang, Kamperman Astrid M, Lu Donghao
Department of Psychiatry, Erasmus MC, Rotterdam, the Netherlands.
Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Eur J Psychotraumatol. 2025 Dec;16(1):2545661. doi: 10.1080/20008066.2025.2545661. Epub 2025 Sep 3.
Perinatal mental disorders are common, yet few robust risk factors are known. Stressful life events such as loss of a close family member due to death could serve as potential clinical predictors for which mothers develop perinatal mental disorders. This study investigated the association between bereavement and the risk of first-onset perinatal mental disorders. This nationwide register-based study included 1,986,490 pregnancies in Sweden (1,097,126 mothers). The exposure was death of a family member (sibling, parent, partner or child) occurring any time before pregnancy and during the perinatal period, treated as a time-varying variable (number exposed = 276,252). The outcome consisted of first-onset mental disorders diagnosed during the pregnancy and the year after birth were identified from registers. Hazard ratios (HRs) for any mental disorder and specific disorders were estimated using Cox proportional hazards regression. Loss of a family member at any time before or during the perinatal period was associated with an increased risk of any perinatal mental disorder (hazard ratio [95% confidence interval]: 1.44 [1.41, 1.48]), particularly if the loss occurred during the perinatal period (5.86 [5.62, 6.12]). The strongest associations were observed for postpartum mental disorders in relation to stillbirth (25.97 [24.60, 27.42]) or multiple losses during the perinatal period (16.92 [13.72, 20.86]). Family loss during the perinatal period was most strongly associated with stress-related disorders (16.90 [16.10, 17.75]), but also with depressive, anxiety, and psychotic disorders. Loss of a family member was associated with increased risks of first-onset perinatal mental disorders, particularly if the loss occurred during the perinatal period. Bereaved women may benefit from enhanced monitoring and screening for mental disorders during the perinatal period.
围产期精神障碍很常见，但已知的有力风险因素却很少。诸如因死亡而失去亲密家庭成员等生活应激事件可能是母亲患围产期精神障碍的潜在临床预测因素。本研究调查了丧亲之痛与首次发作的围产期精神障碍风险之间的关联。这项基于全国登记数据的研究纳入了瑞典的1986490例妊娠（1097126名母亲）。暴露因素为在怀孕前及围产期任何时间发生的家庭成员（兄弟姐妹、父母、伴侣或子女）死亡，将其视为一个随时间变化的变量（暴露人数 = 276252）。结局包括在孕期及产后一年内诊断出的首次发作精神障碍，通过登记数据确定。使用Cox比例风险回归估计任何精神障碍和特定障碍的风险比（HRs）。在围产期之前或期间任何时间失去家庭成员与任何围产期精神障碍风险增加相关（风险比[95%置信区间]：1.44[1.41, 1.48]），特别是如果在围产期发生丧亲之痛（5.86[5.62, 6.12]）。观察到产后精神障碍与死产（25.97[24.60, 27.42]）或围产期多次丧亲之痛（16.92[13.72, 20.86]）的关联最强。围产期的家庭丧亲之痛与应激相关障碍关联最为密切（16.90[16.10, 17.75]），但也与抑郁、焦虑和精神障碍有关。失去家庭成员与首次发作的围产期精神障碍风险增加相关，特别是如果在围产期发生丧亲之痛。丧亲的女性可能会从围产期加强精神障碍监测和筛查中受益。
