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All-Cause Mortality in Women With Severe Postpartum Psychiatric Disorders.

https://arctichealth.org/en/permalink/ahliterature282342
Source
Am J Psychiatry. 2016 Jun 01;173(6):635-42
Publication Type
Article
Date
Jun-01-2016
Author
Benedicte Marie Winther Johannsen
Janne Tidselbak Larsen
Thomas Munk Laursen
Veerle Bergink
Samantha Meltzer-Brody
Trine Munk-Olsen
Source
Am J Psychiatry. 2016 Jun 01;173(6):635-42
Date
Jun-01-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Case-Control Studies
Cause of Death
Denmark - epidemiology
Female
Humans
Mental Disorders - mortality
Postpartum Period - psychology
Puerperal Disorders - mortality - psychology
Registries
Suicide - statistics & numerical data
Survival Analysis
Young Adult
Abstract
The postpartum period is associated with a high risk of psychiatric episodes. The authors studied mortality in women with first-onset severe psychiatric disorders following childbirth and compared their mortality rates with those in women from the background population including other female psychiatric patients (mothers and childless women).
In a register-based cohort study with linked information from Danish population registers, the authors identified women with first psychiatric inpatient or outpatient contacts 0-3 months postpartum. The main outcome measure was mortality rate ratios (MRRs): deaths from natural causes (diseases and medical conditions) or unnatural causes (suicides, accidents, and homicides). The cohort included 1,545,857 women representing 68,473,423 person-years at risk.
In total, 2,699 women had first-onset psychiatric disorders 0-3 months postpartum, and 96 of these died during follow-up. Women with postpartum psychiatric disorders had a higher MRR (3.74; 95% CI=3.06-4.57) than non-postpartum-onset mothers (MRR=2.73; 95% CI=2.67-2.79) when compared with mothers with no psychiatric history. However, childless women with psychiatric diagnoses had the highest MRR (6.15; 95% CI=5.94-6.38). Unnatural cause of death represented 40.6% of fatalities among women with postpartum psychiatric disorders, and within the first year after diagnosis, suicide risk was drastically increased (MRR=289.42; 95% CI=144.02-581.62) when compared with mothers with no psychiatric history.
Women with severe postpartum psychiatric disorders had increased MRRs compared with mothers without psychiatric diagnoses, and the first year after diagnosis represents a time of particularly high relative risk for suicide in this vulnerable group.
Notes
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PubMed ID
26940804 View in PubMed
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Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study.

https://arctichealth.org/en/permalink/ahliterature285816
Source
BMJ. 2017 Sep 06;358:j3668
Publication Type
Article
Date
Sep-06-2017
Author
Xiaoqin Liu
Esben Agerbo
Katja G Ingstrup
Katherine Musliner
Samantha Meltzer-Brody
Veerle Bergink
Trine Munk-Olsen
Source
BMJ. 2017 Sep 06;358:j3668
Date
Sep-06-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Antidepressive Agents - therapeutic use
Child
Child, Preschool
Cohort Studies
Denmark - epidemiology
Disease Susceptibility
Female
Humans
Infant
Infant, Newborn
Mental Disorders - diagnosis - epidemiology
Pregnancy
Pregnancy Complications - drug therapy
Prenatal Exposure Delayed Effects
Registries
Risk factors
Withholding Treatment
Abstract
Objective To investigate the association between in utero exposure to antidepressants and risk of psychiatric disorders.Design Population based cohort study.Setting Danish national registers.Participants 905?383 liveborn singletons born during 1998-2012 in Denmark and followed from birth until July 2014, death, emigration, or date of first psychiatric diagnosis, whichever came first. The children were followed for a maximum of 16.5 years and contributed 8.1×10(6) person years at risk.Exposures for observational studies Children were categorised into four groups according to maternal antidepressant use within two years before and during pregnancy: unexposed, antidepressant discontinuation (use before but not during pregnancy), antidepressant continuation (use both before and during pregnancy), and new user (use only during pregnancy).Main outcome measure First psychiatric diagnosis in children, defined as first day of inpatient or outpatient treatment for psychiatric disorders. Hazard ratios of psychiatric disorders were estimated using Cox regression models.Results Overall, psychiatric disorders were diagnosed in 32?400 children. The adjusted 15 year cumulative incidence of psychiatric disorders was 8.0% (95% confidence interval 7.9% to 8.2%) in the unexposed group, 11.5% (10.3% to 12.9%) in the antidepressant discontinuation group, 13.6% (11.3% to 16.3%) in the continuation group, and 14.5% (10.5% to 19.8%) in the new user group. The antidepressant continuation group had an increased risk of psychiatric disorders (hazard ratio 1.27, 1.17 to 1.38), compared with the discontinuation group.Conclusions In utero exposure to antidepressants was associated with increased risk of psychiatric disorders. The association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero. The findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive.
Notes
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PubMed ID
28877907 View in PubMed
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Depression and anxiety in the postpartum period and risk of bipolar disorder: A Danish nationwide register-based cohort study.

https://arctichealth.org/en/permalink/ahliterature283428
Source
J Clin Psychiatry. 2017 May;78(5):e469-e476
Publication Type
Article
Date
May-2017
Author
Xiaoqin Liu
Esben Agerbo
Jiong Li
Samantha Meltzer-Brody
Veerle Bergink
Trine Munk-Olsen
Source
J Clin Psychiatry. 2017 May;78(5):e469-e476
Date
May-2017
Language
English
Publication Type
Article
Keywords
Adult
Anxiety Disorders - diagnosis - epidemiology - genetics - psychology
Bipolar Disorder - diagnosis - epidemiology - genetics - psychology
Cohort Studies
Denmark
Depression, Postpartum - diagnosis - epidemiology - genetics - psychology
Female
Genetic Predisposition to Disease - genetics
Humans
Proportional Hazards Models
Puerperal Disorders - diagnosis - epidemiology - genetics - psychology
Registries
Risk factors
Abstract
The first-onset affective episode requiring inpatient treatment in the postpartum period can be a marker of bipolar disorder, but it is unknown whether milder postpartum affective episodes are also indicators of underlying bipolarity. Therefore, we aimed to study whether women with a nonpsychotic postpartum affective episode treated with antidepressants have an increased risk of bipolar disorder.
A register-based cohort study was conducted in Denmark of 122,622 parous women without psychiatric history who received a first-time antidepressant prescription during 1997-2012. We compared women with a first-time antidepressant prescription, which was our indicator of a first-onset affective disorder, within 1 year postpartum to women with a first-time antidepressant prescription outside the postpartum period. Our outcome was psychiatric contact for bipolar disorder (ICD-10 criteria) during follow-up, and we estimated hazard ratios using Cox regressions.
The risk of bipolar disorder among women with a postpartum affective episode was higher than that in women with an affective episode outside the postpartum period. The risk of bipolar disorder was 1.66 (95% CI, 1.12-2.48) for postpartum antidepressant monotherapy and 10.15 (95% CI, 7.13-14.46) for postpartum antidepressant therapy plus a subsequent prescription for anxiolytics when these therapies were compared to antidepressant monotherapy outside the postpartum period.
First-onset nonpsychotic postpartum affective disorder can be a marker of underlying bipolarity. Women who fill an antidepressant prescription following childbirth should be asked about hypomanic or manic symptoms and monitored long term. Clinically, when antidepressant monotherapy is ineffective or the individual woman experiences persistent and concerning symptoms, health professionals should consider a possible bipolar spectrum disorder.
PubMed ID
28570797 View in PubMed
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Heritability of Perinatal Depression and Genetic Overlap With Nonperinatal Depression.

https://arctichealth.org/en/permalink/ahliterature274100
Source
Am J Psychiatry. 2016 Feb 1;173(2):158-65
Publication Type
Article
Date
Feb-1-2016
Author
Alexander Viktorin
Samantha Meltzer-Brody
Ralf Kuja-Halkola
Patrick F Sullivan
Mikael Landén
Paul Lichtenstein
Patrik K E Magnusson
Source
Am J Psychiatry. 2016 Feb 1;173(2):158-65
Date
Feb-1-2016
Language
English
Publication Type
Article
Keywords
Adult
Depression, Postpartum - genetics - psychology
Depressive Disorder - genetics - psychology
Female
Humans
Pregnancy
Pregnancy Complications - genetics - psychology
Siblings
Sweden
Twins, Dizygotic - genetics - psychology
Twins, Monozygotic - genetics - psychology
Abstract
The authors investigated the relative importance of genetic and environmental influences on perinatal depression, and the genetic overlap between perinatal depression and nonperinatal depression.
Analyses were conducted using structural equation modeling for 1) the lifetime version of the Edinburgh Postnatal Depression Scale in 3,427 Swedish female twins and 2) clinical diagnoses of depression separated into perinatal depression and nonperinatal depression in a Swedish population-based cohort of 580,006 sisters.
In the twin study, the heritability of perinatal depression was estimated at 54% (95% CI=35%-70%), with the remaining variance attributable to nonshared environment (46%; 95% CI=31%-65%). In the sibling design, the heritability of perinatal depression was estimated at 44% (95% CI=35%-52%) and the heritability of nonperinatal depression at 32% (95% CI=24%-41%). Bivariate analysis showed that 14% of the total variance (or 33% of the genetic variance) in perinatal depression was unique for perinatal depression.
The heritability of perinatal depression was estimated at 54% and 44%, respectively, in separate samples, and the heritability of nonperinatal depression at 32%. One-third of the genetic contribution was unique to perinatal depression and not shared with nonperinatal depression, suggesting only partially overlapping genetic etiologies for perinatal depression and nonperinatal depression. The authors suggest that perinatal depression constitutes a subset of depression that could be prioritized for genomic discovery efforts. The study findings have direct translational impact that can assist clinicians in the counseling of their patients regarding risk and prognosis of perinatal depression.
PubMed ID
26337037 View in PubMed
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Psychiatric disorders with postpartum onset: possible early manifestations of bipolar affective disorders.

https://arctichealth.org/en/permalink/ahliterature129044
Source
Arch Gen Psychiatry. 2012 Apr;69(4):428-34
Publication Type
Article
Date
Apr-2012
Author
Trine Munk-Olsen
Thomas Munk Laursen
Samantha Meltzer-Brody
Preben Bo Mortensen
Ian Jones
Author Affiliation
National Centre for Register-Based Research, Aarhus University, Denmark. tmo@ncrr.dk
Source
Arch Gen Psychiatry. 2012 Apr;69(4):428-34
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Bipolar Disorder - complications - diagnosis - epidemiology - psychology
Denmark - epidemiology
Early Diagnosis
Female
Humans
Incidence
International Classification of Diseases - statistics & numerical data
Mental Disorders - diagnosis - psychology
Pregnancy
Pregnancy Complications - diagnosis - epidemiology - psychology
Registries - statistics & numerical data
Risk factors
Time Factors
Abstract
Childbirth has an important influence on the onset and course of bipolar affective disorder, and it is well established that there may be a delay of many years before receiving a diagnosis of bipolar disorder following an initial episode of psychiatric illness.
To study to what extent psychiatric disorders with postpartum onset are early manifestations of an underlying bipolar affective disorder.
Survival analyses were performed in a register-based cohort study linking information from the Danish Civil Registration System and the Danish Psychiatric Central Register.
Denmark.
A total of 120,378 women with a first-time psychiatric inpatient or outpatient contact with any type of mental disorder excluding bipolar affective disorder.
Each woman was followed up individually from the day of discharge, with the outcome of interest being an inpatient or outpatient contact during the follow-up period with a first-time diagnosis of bipolar affective disorder.
A total of 3062 women were readmitted or had an outpatient contact with bipolar affective disorder diagnoses. A postpartum onset of symptoms within 0 to 14 days after delivery predicted subsequent conversion to bipolar disorder (relative risk = 4.26; 95% CI =3.11-5.85). Approximately 14% of women with first-time psychiatric contacts during the first postpartum month converted to a bipolar diagnosis within the 15-year follow-up period compared with 4% of women with a first psychiatric contact not related to childbirth. Postpartum inpatient admissions were also associated with higher conversion rates to bipolar disorder than outpatient contacts (relative risk = 2.16; 95% CI = 1.27-3.66).
A psychiatric episode in the immediate postpartum period significantly predicted conversion to bipolar affective disorder during the follow-up period. Results indicate that the presentation of mental illness in the early postpartum period is a marker of possible underlying bipolarity.
PubMed ID
22147807 View in PubMed
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