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Cited by 1,091Maternal Mental Health During Pregnancy and PostpartumMaternal and Neonatal HealthcarePersonality Disorders and Psychopathology

Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings

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Wisner, Katherine L., Sit, Dorothy K. Y., McShea, Mary C., Rizzo, David M., Zoretich, Rebecca A., Hughes, Carolyn L., Eng, Heather F., Luther, James F. +6 more·2013·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2013.87PMC PMC4440326
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Abstract

IMPORTANCE: The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. OBJECTIVES: To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. DESIGN: Sequential case series of women who recently gave birth. SETTING: Urban academic women's hospital. PARTICIPANTS: During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. MAIN OUTCOMES AND MEASURES: A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. RESULTS: Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders. CONCLUSIONS AND RELEVANCE: The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00282776.

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  1. [26]First MB Spitzer Rt Gibbon M Williams JBW Structured Clinical Interview for DSM-IV Axis I Disorders—Patient Edition New York New York State Psychiatric Institute 1996
  2. [31]National Center for Health Statistics, Centers for Disease Control and Prevention Vital Statistics of the United States: 1999: Natality Atlanta, GA Centers for Disease Control and Prevention 2002 1 25077730
  3. [45]Wisner K Sit D Reynolds S Psychiatric disorders Gabbe S Niebyl J Simpson J Obstetrics: Normal and Problem Pregnancies 5 Philadelphia, PA Elsevier 2007 1249 1288

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Authors
Wisner, K. L., Sit, D. K. Y., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., Eng, H. F., Luther, J. F., Wisniewski, S. R., Costantino, M. L., Confer, A. L., Moses-Kolko, E. L., Famy, C. S., & Hanusa, B. H.
Affiliations
Northwestern University (US)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2013-05-01
Volume
70
Issue
5
Pages
490
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2013.87
PMC
PMC4440326
OpenAlex
W2102941960
Cited by
1,091
References
59
Citations by year
2026: 81 · 2025: 85 · 2024: 102 · 2023: 120 · 2022: 106 · 2021: 105 · 2020: 100 · 2019: 74 · 2018: 83 · 2017: 55 · 2016: 58 · 2015: 70 · 2014: 35 · 2013: 15
FWCI
60.67
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Mental Health (R01MH071825)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD067185)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
postpartum depression, depression screening, Edinburgh Postnatal Depression Scale, self-harm ideation, bipolar disorder, major depressive disorder, generalized anxiety disorder, comorbidities, postpartum women, psychiatric diagnosis
MeSH terms
Adult, Anxiety Disorders, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Pregnancy, Time Factors, Comorbidity, Prevalence, Self-Injurious Behavior, Depression, Postpartum, Young Adult

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