Department of Economics and Business Economics

Adverse life events increase risk for postpartum psychiatric episodes: A population-based epidemiologic study

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • S Meltzer-Brody, University of North Carolina (UNC) HIV Cure Center, UNC Chapel Hill, Chapel Hill, North Carolina, USA.
  • ,
  • J T Larsen
  • L Petersen
  • J Guintivano, University of North Carolina (UNC) HIV Cure Center, UNC Chapel Hill, Chapel Hill, North Carolina, USA.
  • ,
  • A Di Florio, Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, United Kingdom; Neuroscience and Mental Health Research Institute, Cardiff University, United Kingdom.
  • ,
  • W C Miller, Department of Epidemiology,The Ohio State University,Columbus,OH,USA.
  • ,
  • P F Sullivan, Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
  • ,
  • T Munk-Olsen

BACKGROUND: Trauma histories may increase risk of perinatal psychiatric episodes. We designed an epidemiological population-based cohort study to explore if adverse childhood experiences (ACE) in girls increases risk of later postpartum psychiatric episodes.

METHODS: Using Danish registers, we identified women born in Denmark between January 1980 and December 1998 (129,439 childbirths). Exposure variables were ACE between ages 0 and 15 including: (1) family disruption, (2) parental somatic illness, (3) parental labor market exclusion, (4) parental criminality, (5) parental death, (6) placement in out-of-home care, (7) parental psychopathology excluding substance use, and (8) parental substance use disorder. Primary outcome was first occurrence of in- or outpatient contact 0-6 months postpartum at a psychiatric treatment facility with any psychiatric diagnoses, ICD-10, F00-F99 (N = 651). We conducted survival analyses using Cox proportional hazard regressions of postpartum psychiatric episodes.

RESULTS: Approximately 52% of the sample experienced ACE, significantly increasing risk of any postpartum psychiatric diagnosis. Highest risks were observed among women who experienced out-of-home placement, hazard ratio (HR) 2.57 (95% CI: 1.90-3.48). Women experiencing two adverse life events had higher risks of postpartum psychiatric diagnosis HR: 1.88 (95% CI: 1.51-2.36), compared to those with one ACE, HR: 1.24 (95% CI: 1.03-49) and no ACE, HR: 1.00 (reference group).

CONCLUSIONS: ACE primarily due to parental psychopathology and disability contributes to increased risk of postpartum psychiatric episodes; and greater numbers of ACE increases risk for postpartum psychiatric illness with an observed dose-response effect. Future work should explore genetic and environmental factors that increase risk and/or confer resilience.

Original languageEnglish
JournalDepression and Anxiety
Pages (from-to)160–167
Number of pages8
Publication statusPublished - 2018

    Research areas

  • Adult, Adult Survivors of Child Adverse Events/statistics & numerical data, Cohort Studies, Denmark/epidemiology, Depression, Postpartum/epidemiology, Female, Humans, Pregnancy, Psychotic Disorders/epidemiology, Puerperal Disorders/epidemiology, Registries/statistics & numerical data, Risk, Stress Disorders, Traumatic, Acute/epidemiology, Young Adult

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