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Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings
Open accessAbstract
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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“substantial rates of comorbidity [20] and overlap in diagnostic criteria and symptoms [21, 22].”
From Trajectories of Maternal and Paternal Internalizing Symptoms from Pregnancy to 2 Years Postpartum: Identifying Modifiable Risk and Protective Factors (2024) · cites this paper as [20]
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“In a large-scale postpartum screening study with follow-up diagnostic evaluations [20], 66% of women with major depression in the postpartum period had comorbid anxiety disorders.”
From Perinatal mental illness: Definition, description and aetiology (2014) · cites this paper as [20]
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Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Medicine › Pediatrics, Perinatology and Child Health › 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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