One year follow-up of post-partum-onset depression: the role of depressive symptom severity and personality disorders.

OBJECTIVE: Long-term follow-up and risk factors of persistent post-partum depression (PPD) are fairly unknown compared with its prevalence in the developing countries. In this study, we did a follow-up measure of PPD and examined the factors, which were associated with PPD 1-year post-partum. METHOD: Our sample comprised of 34 women. Depressive symptoms were assessed by the Edinburgh post-natal depression scale (EPDS) 6 weeks post-partum, and women with scores >12 on this scale was categorised as depressed. Personality disorders were determined at the same occasion by means of the Structured Clinical Interview for DSM-III-R personality disorders (SCID-II). One year post-partum EPDS was completed. RESULTS: The rate of PPD 1-year post-partum was 32.4%, and it was unrelated to age at assessment, primiparity, number of children, employment status, economical status and educational level. Women depressed 1-year post-partum had significantly higher basal scores of EPDS and more often also a diagnosis of any axis II disorder; and specifically dependent and obsessive-compulsive personality disorders. In our sample, the predictors of 1-year post-partum PPD were having higher basal score of EPDS and the existence of a personality disorder. CONCLUSION: This study suggests that women with PPD, scoring high in the EPDS scale 6 weeks post-partum and having a personality disorder, run a higher risk for depression at 1-year follow-up.

Anti-tumor necrosis factor-alpha therapy is associated with less frequent mood and anxiety disorders in patients with rheumatoid arthritis.

AIMS: The purpose of the present study was to examine the current prevalence of mood and anxiety disorders, and factors related to mood and anxiety disorders in patients with rheumatoid arthritis (RA). METHOD: The study sample included 83 consecutive patients with RA who were admitted to a rheumatology outpatient clinic. Diagnoses of psychiatric disorders were determined using the Structured Clinical Interview for DSM-IV (SCID-I). To assess physical disability and disease activity, the Health Assessment Questionnaire and the Disease Activity Score, respectively, were used. RESULTS: The prevalence of any mood or any anxiety disorder was 43.4%. The two most common psychiatric diagnoses were major depression (21.7%) and generalized anxiety disorder (16.9%). Mood and anxiety disorders were unrelated to sociodemographic features, disease-related factors, and medications for RA except anti-tumor necrosis factor-alpha (TNF-alpha). These disorders, however, were identified less frequently in patients with RA receiving anti-TNF-alpha drugs compared to patients who did not receive such medications. CONCLUSION: Patients with RA frequently have mood and anxiety disorders, and anti-TNF-alpha drugs may be useful for the mental status of these patients.

Postpartum-onset major depression is associated with personality disorders.

OBJECTIVES: The objective of the study was to investigate the incidence rate of postpartum-onset major depression (PPMD) and to examine associated sociodemographic characteristics, obstetric factors, and personality disorders. METHOD: The study data were obtained from 302 women who delivered at a child and maternity hospital. We interviewed the new mothers on the first day of their childbirth and at 6 weeks postpartum. Major depression and axis II diagnoses were determined by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, Personality Disorders, respectively. RESULTS: Nineteen (6.3%) women had new-onset major depression during 6 weeks postpartum. Postpartum-onset major depression was unrelated to age, educational level, employment status, planned or unplanned pregnancy, history of abortion and gestational complications, term of delivery, type of delivery, sex of the baby, and mother's breast-feeding. Frequency of primiparity and of avoidant, dependent, and obsessive-compulsive personality disorders was higher in women with PPMD than that in women without PPMD. As a result of logistic regression analysis, the independent predictor of PPMD was the presence of avoidant, dependent, and obsessive-compulsive personality disorders. CONCLUSION: Our results suggest that childbearing women with avoidant, dependent, and obsessive-compulsive personality disorders have increased risk of new-onset major depression during the postpartum period.

Postpartum-onset obsessive-compulsive disorder: incidence, clinical features, and related factors.

OBJECTIVE: The aims of this study were to investigate the incidence rate and symptomatology of postpartum-onset obsessive-compulsive disorder (PPOCD), to investigate the factors associated with PPOCD, and to compare clinical characteristics of obsessive-compulsive disorder (OCD) with and without postpartum onset. METHOD: The study data were collected from 302 women who delivered at a child and maternity hospital in Turkey from August 2005 to November 2005 and a control group of 33 women who were admitted to the psychiatric outpatient clinic of a university hospital during the same time period and who met DSM-IV criteria for OCD. The 2 clinical interviews with women who delivered were performed face-to-face on the first day after childbirth and at 6 weeks postnatally. OCD and comorbid Axis II disorders were diagnosed by means of the Structured Clinical Interview for DSM-IV and the Structured Clinical Interview for DSM-III-R Personality Disorders, respectively. Obsessive-compulsive symptomatology was assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: The incidence of PPOCD was 4% at 6 weeks postnatally. The most common obsessions in women with PPOCD were contamination (75%), aggressive (33.3%), and symmetry/exactness (33.3%), and the most common compulsions were cleaning/ washing (66.7%) and checking (58.3%). The patients with PPOCD had significantly more frequent aggressive obsessions (p = .039) and less severe obsessive-compulsive symptoms (p = .013) than the OCD patients without postpartum onset. The predictors of PPOCD were avoidant (p = .000) and obsessive-compulsive (p = .004) personality disorders. CONCLUSIONS: This study suggests that the puerperium is a risk period in terms of new-onset OCD and that avoidant and obsessive-compulsive personality disorders predict PPOCD.