title: Clinical features of and risk factors for major depression with history of postpartum episodes in Han Chinese women: A retrospective study.
abstract: BACKGROUND
  We sought to investigate the clinical features of and risk factors for recurrent major depression (MD) with history of postpartum episodes (PPD) in Han Chinese women and the differences between first-onset postpartum MD (MD that has its first lifetime depressive episode in the postpartum period) and first-onset non-postpartum MD (MD with history of PPD and has its first lifetime depressive episode in a period other than postpartum).
  
  
  METHODS
  Data were derived from the China, Oxford and Virginia Commonwealth University Experimental Research on Genetic Epidemiology (CONVERGE) study (N=6017 cases) and analyzed in two steps. We first examined the clinical features of and risk factors for MD patients with (N=981) or without (N=4410) a history of PPD. We then compared the differences between first-onset postpartum MD (N=583) and first-onset non-postpartum MD (N=398) in those with a history of PPD. Linear, logistic and multinomial logistic models were employed to measure the associations.
  
  
  RESULTS
  A history of PPD was associated with more guilt feelings, greater psychiatric comorbidity, higher neuroticism, earlier onset and more chronicity (OR 0.2-2.8). Severe premenstrual symptoms (PMS) and more childbirths increased the risk of PPD, as did a family history of MD, childhood sexual abuse, stressful life events and lack of social support (OR 1.1-1.3). In the MD with history of PPD subsample, first-onset postpartum MD was associated with fewer recurrent major depressive episodes, less psychiatric comorbidity, lower neuroticism, less severe PMS and fewer disagreements with their husbands (OR 0.5-0.8), but more childbirths (OR 1.2).
  
  
  CONCLUSIONS
  Data were obtained retrospectively through interview and recall bias may have affected the results.
  
  
  CONCLUSIONS
  MD with history of PPD in Han Chinese women is typically chronic and severe, with particular risk factors including severe PMS and more childbirths. First-onset postpartum MD and first-onset non-postpartum MD can be partly differentiated by their clinical features and risk factors, but are not clearly distinctive.
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, No. 600 South Wanping Road, Shanghai, People's Republic of China.
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authors.affiliation: Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: kendler@vcu.edu.
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mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D049590:Postpartum Period / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012944:Social Support; D012959:Socioeconomic Factors; D016387:Women's Health / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Comorbidity; Major depression; Postpartum depression; Premenstrual symptoms