Mothers with Family History of Psychiatric Disorders Have Almost 2-Fold Risk of Developing Postpartum Depression

Mothers who have a family history of any psychiatric disorder have an almost 2-fold higher risk of developing postpartum depression (PPD) compared to mothers without, according to a study published in JAMA Psychiatry. This finding, established with moderate certainty of evidence, suggests that screening for family history of psychiatric disorders may help identify mothers at high risk of developing PPD, the study authors noted.

PPD is among the most common complications related to childbirth, ranging from mild to severe episodes. As PPD is preventable and treatable, identification of risk factors is important for preventing or mitigating the consequences of PPD. Previous research on the association between family history of psychiatric disorders and PPD is inconsistent and contradictory.

Researchers conducted a systematic review and meta-analysis of current literature to investigate the association between family history of psychiatric disorders and risk of developing PPD within 12 months postpartum. They conducted literature searches in PubMed, Embase, and PsycINFO to determine the pooled association between family history of psychiatric disorders and PPD.

The analysis included 26 studies from 18 countries, containing information on 100,877 women. Family history of psychiatric disorders was assessed with self-report in the majority (23) of these studies.

A meta-analysis revealed an increased odds ratio (OR) of developing PPD when mothers had a family 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% PPD prevalence in the general population. All subgroup, sensitivity, and meta-regression analyses were found to be in line with the primary analysis.

This finding contrasts other systematic and umbrella reviews; however, the authors assert that their findings are supported through studies of heritability of psychiatric disorders within and outside the postpartum period.

The authors note that it is outside of the scope of this review to investigate why family history of psychiatric disorders is a risk factor for PPD. However, they suggest that genetic and environmental factors during upbringing and later in life may contribute to this risk, as suggested for psychiatric disorders outside the postpartum period.

The findings indicate that family history of psychiatric disorders is a strong risk factor for PPD, indicating potential benefits of using self-reported questions on family history of psychiatric disorders in routine perinatal care when trying to identify high-risk women.

“Family history of psychiatric disorders is a strong risk factor for PPD, which ideally can be identified through self-report already during pregnancy and enable timely and targeted preventive initiatives,” they wrote.

Although the authors note that it is beyond the reach of the review to suggest actionable clinical implications, they hope their findings could inform selective prevention efforts targeting women at risk of PPD in a way that would allow for the appropriate allocation of scarce resources.

The study has some limitations. Phrasing of the self-reported question used to measure family history of psychiatric disorders was inconsistent among studies, which prevented researchers from investigating how the type of specific diagnosis or family members affect the risk of developing PPD.

Researchers were unable to make conclusions about the specificity of the question. Additionally, they note that self-report of psychiatric disorders often leads to underreporting due to risk of stigma and social desirability bias.

However, the authors highlighted strengths of their review, including alignment with the originally published protocol, stringent search string, and screening, extraction, and assessment of included studies done independently by 2 reviewers. They assert that these methods reduce reporting bias and increase validity, supporting their findings.

Reference

Zacher Kjeldsen MM, Bricca A, Liu X, Frokjaer VG, Madsen KB, Munk-Olsen T. Family history of psychiatric disorders as a risk factor for maternal postpartum depression: A systematic review and meta-analysis. [published online August 17, 2022]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2022.2400