New AJP Research Explores Postpartum Depression and Psychosis Risks

To recognize Maternal Mental Health Awareness month, The American Journal of Psychiatry published two studies yesterday on postpartum mental health and hosted a special press conference related to the research at the Annual Meeting.

The first study focused on postpartum depression (PPD), a common condition that affects about one in 10 new mothers. While clinicians recognize the issue and regularly screen for PPD at prenatal and postpartum visits, the current approach is imperfect, according to Mark Clapp, M.D., M.P.H., an assistant professor of obstetrics and gynecology at Harvard Medical School.

Clapp noted that while clinicians see women 10 to 12 times during the prenatal period, there is usually just one postpartum visit—and about 40% of women don’t show up for that. As many women may not show depression risk before childbirth, this gap is problematic.

Clapp and his colleagues developed an AI-based tool that calculated PPD risk scores for women about to give birth based on health record information available before discharge, such as medications used, prenatal depression scores, and pregnancy characteristics (e.g., premature birth or cesarean delivery). They limited the assessment to women without a prior history of mental illness, as these women traditionally get more attention.

While the model was not perfect, Clapp said it had about 75% accuracy in identifying future PPD, which is considered very good given the heterogeneity of depression and the nearly 30,000 women analyzed. Overall, about 30% of women classified as being at high risk for depression eventually were diagnosed with the disorder.

Clapp said that in real-world practice, this AI tool could be useful in identifying new mothers who might benefit from a follow-up phone call from a nurse or doctor. “Sometimes, a simple call asking, ‘How are you doing?’ can help mothers be aware about their feelings,” Clapp said.

The second study explored the risk of postpartum psychosis, a potentially severe medical condition in which symptoms such as mania, agitation, hallucinations, and/or paranoia emerge quickly. The condition is also extremely rare, which has made elucidating genetic and environmental risk factors difficult, said Veerle Bergink, M.D., Ph.D., director of the Women’s Health Center and professor of psychiatry at Icahn School of Medicine at Mount Sinai.

Making use of Swedish national health records for more than 1.6 million new mothers, Bergink and colleagues found that women who had a sister who experienced postpartum psychosis had more than 10 times the risk of postpartum psychosis themselves compared with women without an affected sibling. To put that in perspective, Bergink noted that this is a higher familial risk than observed for both schizophrenia and bipolar disorder.

The analysis also revealed that women with a sister who had bipolar disorder had more than twice the risk of postpartum psychosis as those without an affected sibling, supporting the idea that postpartum psychosis shares traits with schizophrenia and bipolar disorder.

Bergink stressed that even among the high-risk mothers, the absolute incidence of postpartum psychosis was just 1.6%. She said mothers at risk don’t need to panic or start medications like lithium after childbirth, but rather just stay aware of their symptoms and get plenty of sleep, as insomnia is another important risk factor. ■