Factors associated with onset timing, symptoms, and severity of depression identified in the postpartum period.
Unipolar and bipolar depression identified in the postpartum period have a heterogeneous etiology. The objectives of this study are to examine the risk factors that distinguish the timing of onset for unipolar and bipolar depression and the associations between depression onset by diagnosis, and general and atypical depressive symptoms.



Symptoms of depression were assessed at 4- to 6-weeks postpartum by the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms in an obstetrical sample of 727 women. Data were analyzed using ANOVA, Chi-square, and linear regression.



Mothers with postpartum onset of depression were more likely to be older, Caucasian, educated, married/cohabitating, have one or no previous child, and have private insurance in contrast to mothers with pre-pregnancy and prenatal onset of depression. Mothers with bipolar depression were more likely to have a pre-pregnancy onset. Three general and two atypical depressive symptoms distinguished pre-pregnancy, during pregnancy, and postpartum depression onset, and the presence of agitation distinguished between unipolar and bipolar depression.



The sample was urban, which may not be generalizable to other populations. The study was cross-sectional, which excludes potential late onset of depression (after 4-6 weeks) in the first postpartum year.



A collective set of factors predicted the onset of depression identified in the postpartum for mothers distinguished by episodes of unipolar versus bipolar depression, which can inform clinical interventions. Future research on the onset of major depressive episodes could inform prophylactic and early psychiatric interventions.
Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Science, 676 North St. Clair, Suite 1000, Chicago, IL 60611, United States. Electronic address: sheehan.fisher@northwestern.edu.
Sheehan D
SD
Fisher
Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Science and Obstetrics and Gynecology, United States.
Katherine L
KL
Wisner
Northwestern University, Feinberg School of Medicine, Department of Psychiatry and Behavioral Science, 676 North St. Clair, Suite 1000, Chicago, IL 60611, United States.
Crystal T
CT
Clark
University of Pittsburgh, Department of Psychiatry, United States.
Dorothy K
DK
Sit
University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, United States.
James F
JF
Luther
University of Pittsburgh, Department of Epidemiology, Graduate School of Public Health, United States.
Stephen
S
Wisniewski
D000328:Adult; D003430:Cross-Sectional Studies; D019052:Depression, Postpartum / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D009035:Mothers / Q000523:psychology*; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
Bipolar disorder; Onset; Postpartum depression