Affiliation:
1. Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry University of Zurich Zurich Switzerland
2. Department of Psychiatry The Zucker Hillside Hospital, Northwell Health Glen Oaks New York USA
3. Department of Psychiatry Zucker School of Medicine at Northwell/Hofstra Hempstead New York USA
4. WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry University of Verona Verona Italy
5. Institute of Social and Preventive Medicine University of Bern Bern Switzerland
6. Department of Obstetrics University Hospital of Zurich Zurich Switzerland
7. University of Zürich Zürich Switzerland
Abstract
AbstractObjectiveTo assess the postpartum depression (PPD) risk in women with postpartum hemorrhage (PPH) and moderators.MethodsWe identified observational studies of PPD rates in women with versus without PPH in Embase/Medline/PsychInfo/Cinhail in 09/2022. Study quality was evaluated using the Newcastle‐Ottawa‐Scale. Our primary outcome was the odds ratio (OR, 95% confidence intervals [95%CI]) of PPD in women with versus without PPH. Meta‐regression analyses included the effects of age, body mass index, marital status, education, history of depression/anxiety, preeclampsia, antenatal anemia and C‐section; subgroup analyses were based on PPH and PPD assessment methods, samples with versus without history of depression/anxiety, from low‐/middle‐ versus high‐income countries. We performed sensitivity analyses after excluding poor‐quality studies, cross‐sectional studies and sequentially each study.ResultsOne, five and three studies were rated as good‐, fair‐ and poor‐quality respectively. In nine studies (k = 10 cohorts, n = 934,432), women with PPH were at increased PPD risk compared to women without PPH (OR = 1.28, 95% CI = 1.13 to 1.44, p < 0.001), with substantial heterogeneity (I2 = 98.9%). Higher PPH‐related PPD ORs were estimated in samples with versus without history of depression/anxiety or antidepressant exposure (OR = 1.37, 95%CI = 1.18 to 1.60, k = 6, n = 55,212, versus 1.06, 95%CI = 1.04 to 1.09, k = 3, n = 879,220, p < 0.001) and in cohorts from low‐/middle‐ versus high‐income countries (OR = 1.49, 95%CI = 1.37 to 1.61, k = 4, n = 9197, versus 1.13, 95%CI = 1.04 to 1.23, k = 6, n = 925,235, p < 0.001). After excluding low‐quality studies the PPD OR dropped (1.14, 95%CI = 1.02 to 1.29, k = 6, n = 929,671, p = 0.02).ConclusionsWomen with PPH had increased PPD risk amplified by history of depression/anxiety, whereas more data from low‐/middle‐income countries are required.
Subject
Psychiatry and Mental health