title: Postpartum GAD is a risk factor for postpartum MDD: the course and longitudinal relationships of postpartum GAD and MDD.
abstract: BACKGROUND
  The objective was to examine the course and longitudinal associations of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in mothers over the postpartum 2 years.
  
  
  METHODS
  Using a prospective naturalistic design, 296 mothers recruited from a large community pool were assessed for GAD and MDD at 3, 6, 10, 14, and 24 months postpartum. Structured clinical interviews were used for diagnoses, and symptoms were assessed using self-report questionnaires. Logistic regression analyses were used to examine diagnostic stability and longitudinal relations, and latent variable modeling was employed to examine change in symptoms.
  
  
  RESULTS
  MDD without co-occurring GAD, GAD without co-occurring MDD, and co-occurring GAD and MDD, displayed significant stability during the postpartum period. Whereas MDD did not predict subsequent GAD, GAD predicted subsequent MDD (in the form of GAD + MDD). Those with GAD + MDD at 3 months postpartum were significantly less likely to be diagnosis free during the follow-up period than those in other diagnostic categories. At the symptom level, symptoms of GAD were more trait-like than those of depression.
  
  
  CONCLUSIONS
  Postpartum GAD and MDD are relatively stable conditions, and GAD is a risk factor for MDD but not vice versa. Given the tendency of MDD and GAD to be persistent, especially when comorbid, and the increased risk for MDD in mothers with GAD, as well as the potential negative effects of cumulative exposure to maternal depression and anxiety on child development, the present findings clearly highlight the need for screening and treatment of GAD in addition to MDD during the postpartum period.
authors.affiliation: Department of Psychology, Loyola University Maryland, Baltimore, Maryland 21210, USA. jmprenoveau@loyola.edu
authors.forename: Jason
authors.initials: J
authors.lastname: Prenoveau
authors.forename: Michelle
authors.initials: M
authors.lastname: Craske
authors.forename: Nicholas
authors.initials: N
authors.lastname: Counsell
authors.forename: Valerie
authors.initials: V
authors.lastname: West
authors.forename: Beverley
authors.initials: B
authors.lastname: Davies
authors.forename: Peter
authors.initials: P
authors.lastname: Cooper
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rapa
authors.forename: Alan
authors.initials: A
authors.lastname: Stein
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000453:epidemiology; D015897:Comorbidity; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D049590:Postpartum Period; D011446:Prospective Studies; D012307:Risk Factors