title: Is maternal disclosure of HIV serostatus associated with a reduced risk of postpartum depression?
abstract: Patients with chronic diseases that include HIV infection are at increased risk of experiencing postpartum depression. In addition, social isolation has been associated with depression among women with HIV. Yet, it is unclear whether disclosure of HIV serostatus before the birth is associated with the risk of postpartum depression.
  
  
  
  The purpose of this study was to determine whether maternal disclosure of her positive HIV serostatus before the delivery is associated with the risk of early postpartum depression.
  
  
  
  In this retrospective cohort study, women who received obstetric care in a specialty perinatal HIV clinic (2007-2014) were stratified by whether, before the delivery, they had disclosed their HIV serostatus to (1) their sexual partner(s) or (2) at least 1 family member aside from sexual partner(s). Postpartum depression was identified initially by a positive result on a validated depression screening tool (Patient Health Questionnaire-9 or Edinburgh Postnatal Depression Scale) at the 6-week postpartum visit and then confirmed by evaluation with a mental health professional. Postpartum depression rates were compared by disclosure status. Multivariable logistic regression was performed to identify whether disclosure to either sexual partner(s) or family members remained associated independently with postpartum depression after we controlled for potential confounders that included antenatal mental health disorders.
  
  
  
  Of the 215 women who received perinatal HIV care in this center and who had a documented disclosure status, 149 women (71.3%) had disclosed to their sexual partner(s), and 78 women (42.9%) had disclosed to at least 1 family member who was not a sexual partner. Although disclosure to sexual partner(s) was associated with a reduction in the proportion of women with postpartum depression (15.6% vs 25.5%), this difference did not reach statistical significance (P = .126) and remained statistically insignificant after we controlled for potential confounders (adjusted odds ratio, 0.47; 95% confidence interval, 0.15-1.41). In contrast, disclosure to family member(s) was associated with a decreased prevalence of postpartum depression (11.4% vs 24.7%; P = .03), and this difference persisted in multivariable regression (adjusted odds ratio, 0.35; 95% confidence interval, 0.13-0.95).
  
  
  
  In this cohort, maternal disclosure of HIV serostatus to family members (other than sexual partner[s]) was associated independently with a reduction in postpartum depression by more than one-half. Disclosure of HIV serostatus to a family member may be a marker for psychosocial well-being and enhanced support that affords protection against postpartum depression.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: emily-miller-1@northwestern.edu.
authors.forename: Emily S
authors.initials: ES
authors.lastname: Miller
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Yee
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Robin M
authors.initials: RM
authors.lastname: Dorman
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Donna V
authors.initials: DV
authors.lastname: McGregor
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Sutton
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Garcia
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Wisner
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology*; D005190:Family; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology*; D006679:HIV Seropositivity; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000523:psychology*; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D012747:Sexual Partners; D012944:Social Support; D014342:Truth Disclosure
keywords: HIV; disclosure; perinatal depression; postpartum depression; social support