Zhenmin Shen, Xiaoping Wang, Jicheng Dong, Kenneth S. Kendler, Yunchun Chen, Qiwen Zhang, Gongying Li, Min Cai, Guoping Huang, Yutang Zhang, Guodong Miao, Jianhua Shen, Wenyuan Wu, Yi Li, Xueyi Wang, Donglin Yang, Tiebang Liu, Danhua Gu, Yan Song, Youhui Li, Xiang Fang, Wei Zhang, Chunmei Hu, Jiyang Pan, Xumei Wang, Sun Jing, Kan Li, Runde Pan, Qiyi Mei, Hui Zhong, Tieqiao Liu, Yu Fengyu, Wei Liang, Hong Sang, Lanfen Liu, Bo Du, Shu Gao, Xiaojuan Liu, Jingfang Gao, Zhen Zhang, Charles O. Gardner, Fuzhong Yang, Zhengrong Liu, Gang Wang, Ming Tao, Jingbei Zhang, Lijun Yang, Kerang Zhang, Jonathan Flint, Hu Jian, Chengge Gao, Hong Deng, Jianguo Shi, Guibing Chen, Guoqin Jiang, Huaqing Meng, Tim B. Bigdeli, Xiaohong Hong, Shenxun Shi, Baowei Ha, and Liu Ying
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). Limitations 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.