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Clinical features of and risk factors for major depression with history of postpartum episodes in Han Chinese women: A retrospective study.

Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, No. 600 South Wanping Road, Shanghai, People's Republic of China. Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA. Chinese Traditional Hospital of Zhejiang, No. 54 Youdian Road, Hangzhou, Zhejiang, People's Republic of China. No. 4 Hospital of Jiangsu University, No. 246 Nanmen Street, Zhenjiang, Jiangsu, People's Republic of China. Xinhua Hospital of Zhejiang Province, No. 318 Chaowang Road, Hangzhou, Zhejiang, People's Republic of China. The First Hospital of China Medical University, No. 155 North Nanjing Street, Heping District, Shenyang, Liaoning, People's Republic of China. No. 1 Hospital of Zhengzhou University, No. 1 East Jianshe Road, Zhengzhou, Henan, People's Republic of China. Beijing Anding Hospital of Capital University of Medical Sciences, No. 5 Ankang Hutong, Deshengmen wai, Xicheng District, Beijing, People's Republic of China. Xian Mental Health Center, No. 15 Yanyin Road, New Qujiang District, Xian, Shaanxi, People's Republic of China. No. 1 Hospital of Medical College of Xian Jiaotong University, No. 277 West Yanta Road, Xian, Shaanxi, People's Republic of China. No.1 Hospital of Shanxi Medical University, No. 85 South Jiefang Road, Taiyuan, Shanxi, People's Republic of China. Mental Hospital of Jiangxi Province, No. 43 Shangfang Road, Nanchang, Jiangxi, People's Republic of China. ShengJing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, Liaoning, People's Republic of China. Shandong Mental Health Center, No. 49 East Wenhua Road, Jinan, Shandong, People's Republic of China. Nanjing Brain Hospital, No. 264 Guangzhou Road, Nanjing, Jiangsu, People's Republic of China. Hebei Mental Health Center, No. 572 Dongfeng Road, Baoding, Hebei, People's Republic of China. Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, No. 600 South Wanping Road, Shanghai, People's Republic of China; Huashan Hospital of Fudan University, No. 12 Middle Wulumuqi Road, Shanghai, People's Republic of China. No. 3 Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Tianhe District, Guangzhou, Guangdong, People's Republic of China. Tongji University Hospital, No. 389 Xincun Road, Shanghai, People's Republic of China. First Hospital of Hebei Medical University, No. 89 Donggang Road, Shijiazhuang, Hebei, People's Republic of China. Tianjin Anding Hospital, No. 13 Liulin Road, Hexi District, Tianjin, People's Republic of China. Shenzhen Kang Ning Hospital, No. 1080, Cuizhu Street, Luohu District, Shenzhen, Guangdong, People's Republic of China. Weihai Mental Health Center, Qilu Avenue, ETDZ, Weihai, Shandong, People's Republic of China. Psychiatric Hospital of Henan Province, No. 388 Middle Jianshe Road, Xinxiang, Henan, People's Republic of China. Mental Health Center of West China Hospital of Sichuan University, No. 28 South Dianxin Street, Wuhou District, Chengdu, Sichuan, People's Republic of China. No. 1 Hospital of Jinan University, No. 613 West Huangpu Avenue, Guangzhou, Guangdong, People's Republic of China. Jilin Brain Hospital, No. 98 West Zhongyang Road, Siping, Jilin, People's Republic of China. Harbin Medical University, No. 23 Youzheng street, Nangang District, Haerbin, Heilongjiang, People's Republic of China. Chongqing Mental Health Center, No. 102 Jinzishan, Jiangbei District, Chongqing, People's Republic of China. No.1 Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, People's Republic of China. Guangzhou Brain Hospital (Guangzhou Psychiatric Hospital), No. 36 Mingxin Road, Fangcun Avenue, Liwan District, Guangzhou, Guangdong, People's Republic of China. Dalian No. 7 Hospital, No. 179 Lingshui Road, Ganjingzi District, Dalian, Liaoning, People's Republic of China. No. 3 Hospital of Heilongjiang Province, No. 135 Jiaotong Road, Beian, Heilongjiang, People's Republic of China. Sichuan Mental Health Center, No. 190, East Jiannan Road, Mianyang, Sichuan, People's Republic of China. No. 2 Hospital of Lanzhou University, No. 82, Cuiyingmen, Lanzhou, Gansu, People's Republic of China. Xijing Hospital of No. 4 Military Medical University, No. 17 West Changle Road, Xian, Shaanxi, People's Republic of China. Liaocheng No. 4 Hospital, No. 47 North Huayuan Road, Liaocheng, Shandong, People's Republic of China. Ningbo Kang Ning Hospital, No. 1 Zhuangyu Road, Zhenhai District, Ningbo, Zhejiang, People's Republic of China. Fuzhou Psychiatric Hospital, No. 451 South Erhuan Road, Cangshan District, Fuzhou, Fujian, People's Republic of China. Suzhou Guangji Hospital, No. 286, Guangji Road, Suzhou, Jiangsu, People's Republic of China. Mental Health Center of Shantou University, No. 243 Daxue Road, Shantou, Guangdong, People's Republic of China. Jining Psychiatric Hospital, North Dai Zhuang, Rencheng District, Jining, Shandong, People's Republic of China. No. 2 Xiangya Hospital of Zhongnan University, No. 139 Middle Renmin Road, Furong District, Changsha, Hunan, People's Republic of China. Harbin No. 1 Special Hospital, No. 217 Hongwei Road, Haerbin, Heilongjiang, People's Republic of China. Anhui Mental Health Center, No. 316 Huangshan Road, Hefei, Anhui, People's Republic of China. Changchun Mental Hospital, No. 4596 Beihuan Road, Changchun, Jilin, People's Republic of China. Huaian No. 3 Hospital, No. 272 West Huaihai Road, Huaian, Jiangsu, People's Republic of China. Huzhou No. 3 Hospital, No. 255 Gongyuan Road, Huzhou, Zhejiang, People's Republic of China. Mudanjiang Psychiatric Hospital of Heilongjiang Province, Xinglong, Mudanjiang, Heilongjiang, People's Republic of China. Qingdao Mental Health Center, No. 299 Nanjing Road, Shibei District, Qingdao, Shandong, People's Republic of China. Tangshan No. 5 Hospital, No. 57 West Nanxin Road, Lunan District, Tangshan, Hebei, People's Republic of China. Daqing No. 3 Hospital of Heilongjiang Province, No. 54 Xitai Road, Ranghulu district, Daqing, Heilongjiang, People's Republic of China. Renmin Hospital of Wuhan University, No. 238 Jiefang Road, Wuchang District, Wuhan, Hubei, People's Republic of China. Guangxi Longquanshan Hospital, No. 1 Jila Road, Yufeng District, Liuzhou, People's Republic of China. Tianjin First Center Hospital, No. 55 Xuetang Street, Xinkai Road, Hedong District, Tianjin, People's Republic of China. Wuhan Mental Health Center, No. 70, Youyi Road, Wuhan, Hubei, People's Republic of China. Anshan Psychiatric Rehabilitation Hospital, No. 127 Shuangshan Road, Lishan District, Anshan, Liaoning, People's Republic of China. Hainan Anning Hospital, No. 10 East Nanhai Avenue, Haikou, Hainan, People's Republic of China. Mental Health Institute of Jining Medical College, Dai Zhuang, Bei Jiao, Jining, Shandong, People's Republic of China. Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom. Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA. Electronic address: kendler@vcu.edu.

Journal of affective disorders. 2015;:339-46
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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). 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.