Postpartum Depression Risk Heightened With Familial History of Psychiatric Disorders

Mette-Marie Zacher Kjeldsen, MSc

When the mothers family has a history of psychiatric disorders there is an increased risk of developing postpartum depression within a year post-partum.

A team, led by Mette-Marie Zacher Kjeldsen, MSc, National Centre for Register-based Research, Aarhus University, investigated the link between family history of psychiatric disorders and the risk of developing postpartum depression within 12 months of giving birth.

Uncertain Evidence

The evidence showing the link between family history of psychiatric disorders and postpartum depression is inconsistent, which some studies showing familial risk of postpartum depression and other systematic reviews and umbrella reviews compiling all risk factors for postpartum depression not showing this link.

In the study, the investigators searched various databases for peer-reviewed cohort and case-control studies reporting odds ratios or sufficient data to calculate 1 of the associations between family history of any psychiatric disorder and postpartum depression.

The investigators performing reporting using the MOOSE checklist and a pair of independent reviewers extracted predefined information and assessed included studies for risk of bias using the Newcastle-Ottawa Scale.

They used a random-effects model to pool the data in the meta-analysis and investigated heterogeneity with meta-regression, subgroup, and sensitivity analyses.

Finally, they investigators publication bias using a funnel plot and GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to evaluate the overall certainty of the findings.

The investigators sought primary outcomes of the pooled associations between family history of psychiatric disorders and postpartum depression.

The Studies

The team identified 26 studies involving 100,877 women. The meta-analysis showed an increased odds ratio of developing postpartum depression when the maternal family had a history of psychiatric disorders (OR, 2.08; 95% CI, 1.67-2.59; I² = 57.14%) corresponding to a risk ratio of 1.79 (95% CI, 1.52-2.09), assuming a 15% postpartum depression prevalence in the general population.

The subgroup, sensitivity, and meta-regression analyses were similar to what was found in the primary analysis. They deemed the overall certainty of evidence deemed as moderate, according to GRADE.

“In this study, there was moderate certainty of evidence for an almost 2-fold higher risk of developing postpartum depression among mothers who have a family history of any psychiatric disorder compared with mothers without,” the authors wrote.

Postpartum Depression and COVID-19

Last year, investigators found physician visits for individuals with postpartum mental illnesses were significantly higher than what was expected during the
COVID-19 pandemic based on prepandemic data.

A team, led by Simone N. Vigod, MD, MSc, Women’s College Research Institute, compared physician visit rates for postpartum mental illness in Ontario during the pandemic with rates that were expected based on prepandemic patterns.

It is not yet known whether or not the clinical burden of postpartum mental illness has increased during the course of the COVID-19 pandemic, but there have been reports throughout the pandemic on concerns about postpartum infections and difficulty accessing the extended postpartum social support networks and key community programs such as home visits from public health nurses, breastfeeding clinics, and support groups.

The visit rate was 43.6 per 1000 individuals in March 2020, with a rate different of 3.11 per 1000 (95% CI, 1.25-4.89) and an incidence rate ratio (IRR) of 1.08 (95% CI, 1.03-1.13) compared to the expected rate.

For April, the rate difference was 10.9 per 1000 patients (95% CI, 9.14-12.6), while the IRR was 1.30 (95% CI, 1.24-1.36).

The higher levels were generally sustained throughout the duration of the pandemic study period.

The study, “Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression,” was published online in JAMA Psychiatry.