Pregnancy-Related Depression Raises Suicide Risk, Even Years Later
[ad_1]
Women who develop depression during pregnancy or the period after giving birth, known as perinatal and postpartum depression, face an increased risk of death in the months and years afterwards, according to a study published January 10 in the BMJ. Most deaths are due to suicide, the researchers discovered.
“Our study found that a diagnosis of perinatal depression — that is, depression occurring during pregnancy or in the year after delivery — was associated with an increased risk of death, independent of preexisting psychiatric illness, compared with women without this diagnosis,” says lead author Qing Shen, PhD, a researcher at the school of medicine at Tongji University in Shanghai, China. The increased risk was highest during the first year after diagnosis, and remained elevated up to 18 years later, says Dr. Shen.
Given these findings, women diagnosed with or at risk of perinatal depression, their families, and health professionals should work together to improve early detection and treatment, says Shen. “It is important to use available tools, such as the postpartum questionnaire, to screen the symptoms of postpartum depression, if available,” she adds.
Perinatal Depression Affects Up to 1 in 5 U.S. Women
Depression affects 10 to 20 percent of women in the United States during pregnancy, the postpartum period, or both, according to a review published in 2020 in the Cleveland Clinic Journal of Medicine. Women with perinatal depression can feel intense sadness and anxiety which can make it hard to bond with or breastfeed a baby. In severe perinatal depression, women may think about or actually harm themselves or their baby.
Perinatal depression should not be confused with the “postpartum blues,” which is a commonly experienced state of fluctuating mood, fatigue, tearfulness, irritability, and feelings of anxiety that generally gets better within two weeks following delivery, per research.
Women With Perinatal Depression 3 Times More Likely to Die During Study Compared With Women Without
Researchers used data from a Swedish national registry from 2001 through 2018 to identify over 86,000 women with a first-ever diagnosis of perinatal depression. They matched these women with 865,510 unaffected women (meaning there were 10 “control” subjects for every 1 woman with perinatal depression) according to age and calendar year at delivery.
Women who experienced perinatal depression were 31 years old on average. Those with the condition were less likely to live with the father of the child, and more likely to have a lower education and household income, to be overweight or obese, to smoke tobacco, and to have a preexisting psychiatric disorder compared with women without perinatal depression.
To try to zero in on the impact of perinatal depression, researchers controlled for many known risk factors for both depression and premature death, including income, education, and preexisting psychiatric disorders.
During the 18-year study follow-up period, there were 522 deaths (0.82 per 1,000 person-years) in women with perinatal depression and 1,568 deaths (0.26 per 1,000 person-years) among women who were never diagnosed with perinatal depression — meaning that women with perinatal depression were more than 3 times more likely to die than the matched women who did not have perinatal depression.
After controlling for pregnancy characteristics, women with perinatal depression were still more than twice as likely to die as women without the condition.
Although suicide was rare (0.23 per 1,000 person-years), it still accounted for more than 1 in 4 deaths in the women with perinatal depression. In fact, those women were more than 6 times as likely to die from suicide, and 3 times as likely to die from an accident, compared with women who did not have perinatal depression.
The increased risk was highest during the first year after diagnosis, and although it gradually reduced over time, it remained higher throughout the 18 years of study follow-up.
Study Included Sisters to Control for Some Genetic and Environmental Factors
Investigators included data from more than 20,000 women who had perinatal depression that they compared with the womens’ biological full sisters who did not have perinatal depression and delivered at least one baby during the same time frame.
The risk of suicidal behavior for the women with perinatal depression was close to 3 times that of their sisters, leading researchers to conclude that depression plays a greater role in these outcomes than genetics or childhood environment.
Depression Can Increase the Risk of Death for Reasons Besides Suicide
Unfortunately, the increased risk of death found in women with perinatal depression isn’t particularly surprising, as it’s expected that depression is associated with suicide, says Emily Harville, PhD, a perinatal epidemiologist at Tulane University’s School of Public Health and Tropical Medicine in New Orleans.
Several other causes of death are probably associated with depression as well, adds Dr. Harville, who was not involved with the study. “People with health problems are more likely to be depressed. Those who are depressed may be less likely to manage health conditions well. Those with depression may be more likely to injure themselves accidentally, through not having full attention during driving, for instance. And some social factors, like partner violence, would also be associated with depression,” says Harville.
Study Has Strengths as Well as Limitations
The advantages to this study are both the very large sample size and, because of how the registries are organized, follow-up is very complete and exposure is measured consistently across the population.
“That said, [the researchers] are limited to what is recorded routinely — many cases of [perinatal] depression are probably not diagnosed or medicated — and the Swedish population and social context is quite different from many other countries, including the United States,” says Harville. “This study probably captures the most severe cases of depression, as well as those who are regularly seeking healthcare, so those with chronic diseases may be particularly likely to have depression diagnosed,” says Harville. It’s likely the associations found here would not be as strong, and maybe wouldn’t exist at all, for those with mild depression, she adds.
“It is interesting that they find this relationship even in a country with a strong social safety net, where lack of access to healthcare, for instance, would presumably not be a major factor,” says Harville.
The authors acknowledged a few limitations to the study. Because it was observational, the findings only show that perinatal depression was associated with an increased risk of death — it doesn’t prove that perinatal depression directly caused the increased risk.
The study also only included women who sought specialist care for their depression, and it’s possible that some suicides were misclassified as accidents. Finally, while researchers controlled for a range of factors, including those shared within families, they can’t rule out the possibility that some other unknown or unmeasured factors may have influenced their results.
Hopefully these findings provide more awareness and a push to get depressed women the care they need, says Harville. “Mental health should be viewed as part of a picture of the overall circumstances of a woman’s life, including her physical health and life circumstances. Mental health can affect physical health, and vice versa,” she says.
Perinatal Depression Is Highly Treatable
The good news: Postpartum depression is a highly treatable illness, says Adele Viguera, MD, who serves as the associate director of the perinatal and reproductive psychiatry program at Cleveland Clinic in Ohio and was not involved in the study.
The first step typically involves obtaining a diagnosis of postpartum mood disturbances via a screening, followed by referral to an expert in this area, says Dr. Viguera. “Treatment typically involves a combination of medications, talk therapy, support from family members, and community support services,” she says.
Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed to help manage symptoms and regulate mood, says Viguera.
“An exciting development in the treatment of postpartum depression is the recent release of the first-ever [U.S. Food and Drug Administration] FDA-approved antidepressant indicated for postpartum depression called Zurzuvae (zuranolone),” says Viguera. Compared with current standard antidepressants that can take weeks to work and need chronic use, zuranolone is the first rapid-acting oral short-course treatment specifically for moderate to severe postpartum depression taking effect as early as day 3 in clinical trials, she says.
“Psychotherapy can also be very helpful. For example, cognitive behavioral therapy helps identify and change negative thought patterns or interpersonal therapy focuses on improving communication and relationships. Also, group therapy connects women facing similar struggles,” says Viguera.
Lifestyle can make a difference as well, she says. “Getting adequate sleep, eating healthy foods, exercising, and joining support groups are very important components to recovery, as is having a strong support system. Partners, family, and friends can provide emotional support and practical help to alleviate stress,” says Viguera.
There Are Helplines and Other Free Resources for Anyone Struggling With Suicidal Thoughts
People with perinatal depression (or any type of depression) who are having thoughts of suicide can call or text the Suicide and Crisis Lifeline at 988 for free access to a trained crisis counselor who can provide you with support and connect you with additional help and resources. If you’re deaf or hard of hearing, use your preferred relay service or dial 711 then 988.
Additional resources include the National Maternal Mental Health Hotline at 833-TLC-MAMA (833-852-6262) for 24/7 free access to professional counselors. If you’re deaf or hard of hearing, use your preferred relay service or dial 711 then 833-852-6262.
Call or text “Help” to the Postpartum Support International helpline at 800-944-4773 for PPD information, resources, and support groups for women, partners, and supporters.
[ad_2]
