Skip to main content

Advertisement

Log in

Examination of premenstrual symptoms as a risk factor for depression in postpartum women

  • Original Article
  • Published:
Archives of Women's Mental Health Aims and scope Submit manuscript

Abstract

Postpartum depression (PPD) is a significant public health concern with prevalence of major and minor depressions reaching 20 % in the first three postpartum months. Sociodemographic and psychopathology correlates of PPD are well established; however, information on the relationship between premenstrual disorders and the development of PPD is less well established. Thus, the aim of this study was to examine the role of premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD) as a risk factor for PPD. Premenstrual symptoms were assessed retrospectively using the premenstrual symptoms screening tool (PSST) and depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and assessed using the Hamilton Depression Rating Scale (HDRS). A two-stage screening procedure was applied. In the first stage, the Patient Health Questionnaire (PHQ-9) was employed. In the second stage, women endorsing ≥5 symptoms on the PHQ-9 were administered the Structured Clinical Interview for DSM-IV, HDRS, and PSST. Hierarchical linear regression showed that history of depression and PMS/PMDD contributed an additional 2 % of the variance (p < 0.001), beyond that of sociodemographic factor effects. The full model accounted for 13 % of the variance in postpartum depressive symptoms. Using logistic regression, a significant association also emerged between PMS/PMDD and PPD (OR = 1.97). The findings of this study suggest that PMS/PMDD is an important risk factor for PPD. Women endorsing a history of PMS/PMDD should be monitored during the perinatal period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The low education variable is defined as having at most a high school diploma.

  2. Non-Hispanic was not significantly correlated with each of the response variables thus was not included in the analyses, which may be a function of the low prevalence rate of Hispanics evidenced in the sample.

References

  • American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders Fourth Edition—Text Revision (DSM-IV-TR). American Psychiatric Press, Washington, DC

    Book  Google Scholar 

  • Angst J, Sellaro R, Merikangas KR, Endicott J (2001) The epidemiology of perimenstrualpsychological symptoms. Acta Psychiatr Scand 104:110–116

    Article  PubMed  CAS  Google Scholar 

  • Beck CT (2001) Predictors of postpartum depression: an update. Nurs Res 50:275–285

    Article  PubMed  CAS  Google Scholar 

  • Bloch M, Schmidt PJ, Danaceau M, Murphy J, Nieman L, Rubinow DR (2000) The role of gonadal steroid in postpartum depression. Amer J Psychiatr 157(6):924–930

    Article  CAS  Google Scholar 

  • Bloch M, Daly RC, Rubinow DR (2003) Endocrine factors in the etiology of postpartum depression. Compr Psychiatr 44:234–246

    Article  Google Scholar 

  • Bloch M, Rotenberg N, Koren D, Klein E (2005) Risk factors associated with the development of postpartum mood disorders. J Affect Disord 88:9–18

    Article  PubMed  Google Scholar 

  • Bloch M, Rotenberg N, Koren D, Klein E (2006) Risk factors for early postpartum depressive symptoms. Psychiatr Prim Care 28:3–8

    Google Scholar 

  • Borenstein JE, Dean BB, Endicott J, Wong J, Brown C, Dicerkson V (2003) Health and economic impact of the premenstrual syndrome. J Reprod Med 48:515–524

    PubMed  Google Scholar 

  • Cohen LS, Miner C, Brown EW, Freeman E, Halbreich U, Sundell K, McCray S (2002) Premenstrual daily fluoxetine for premenstrual dysphoric disorder: a placebo-controlled, clinical trial using computerized diaries. Obstet Gynecol 100:435–444

    Article  PubMed  CAS  Google Scholar 

  • DaCosta D, Dritsa M, Rippen N, Lowensteyn I, Khalife S (2006) Health-related quality of life in postpartum depressed women. Arch Wom Ment Health 9:95–102

    Article  CAS  Google Scholar 

  • Epperson CN, Steiner M, Hartlage SA, Eriksson E, Schmidt PJ, Jones I, Yonkers KA (2012) Premenstrual dysphoric disorder: evidence for a new category for DSM-5. Am J Psychiatry 169:465–475

    Google Scholar 

  • First MB, Spitzer RL, Gibbon M, Williams JBW (1995) Structured clinical interview for DSM-IV axis I disorders, patient edition (SCID-I/P), version 2.0. New York Biometrics Research Department, New York State Psychiatric Institute

  • Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T (2005) Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 106:1071–1083

    Article  PubMed  Google Scholar 

  • Halbreich U, Borenstein J, Pearlstein T, Kahn L (2003) The prevalence, impairment, impact, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology 28(Suppl 3):1–23

    CAS  Google Scholar 

  • Hamilton M (1967) Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 6:278–296

    Article  PubMed  CAS  Google Scholar 

  • Huang FY, Chung H, Kroenke K, Delucchi KL, Spitzer RL (2006) Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med 21:547–552

    Article  PubMed  CAS  Google Scholar 

  • Johnson SR, McChesney C, Bean JA (1988) Epidemiology of premenstrual symptoms in a nonclinical sample. J Reprod Med 33:340–346

    PubMed  CAS  Google Scholar 

  • Jovanovic H, Cerin A, Karlsson P, Lundberg J, Halldin C, Nordström A (2006) PET study of 5-HT1A receptors at different phases of the menstrual cycle in women with premenstrual dysphoria. Psychiatr Res 148:185–193

    Article  CAS  Google Scholar 

  • Kroenke K, Spitzer RL (2002) The PHQ-9: a new depression and diagnostic severity measure. Psych Ann 32:509–521

    Google Scholar 

  • Lokuge S, Frey BN, Foster JA, Soares CN, Steiner M (2011) Depression in women: windows of vulnerability and new insights into the link between estrogen and serotonin. J Clin Psychiatr 72(11):1563–1569

    Article  Google Scholar 

  • Löwe B, Kroenke K, Herzog W, Gräfe R (2004) Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 81:61–66

    Article  PubMed  Google Scholar 

  • McCoy SJB, Beal M, Shipman SBM, Payton ME, Watson GH (2006) Risk factors for postpartum depression: a retrospective investigation at 4-weeks postnatal and a review of the literature. J Am Osteopath Assoc 106(4):193–198

    PubMed  Google Scholar 

  • Meaden PM, Hartlage SA, Cook-Karr J (2005) Timing and severity of symptoms associated with the menstrual cycle in a community-based sample in the Midwestern United States. Psychiatr Res 134(1):27–36

    Article  Google Scholar 

  • Moses-Kolko EL, Wisner KL, Price JC, Berga SL, Drevets WC, Hanusa BH et al (2008) Serotonin 1A receptor reductions in postpartum depression: a positron emission tomography study. Fertil Steril 89(3):685–692

    Article  PubMed  CAS  Google Scholar 

  • Murray L, Cooper PJ (1997) Postpartum depression and child development. Psychol Med 27:253–260

    Article  PubMed  CAS  Google Scholar 

  • Murray L, Cooper PJ, Wilson A, Romaniuk H (2003) Controlled trial of the short-and long-term effect of psychological treatment of post-partum depression. 2. Impact on the mother child relationship and child outcome. Br J Psychiatry 182:420–427

    Article  PubMed  Google Scholar 

  • O’Hara MW, Stuart S, Gorman LL, Wenzel A (2000) Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry 57:1039–1045

    Article  PubMed  Google Scholar 

  • Pearlstein T, Steiner M (2008) Premenstrual dysphoric disorder: burden of illness and treatment update. J Psychiatr Neurosci 33(4):291–301

    Google Scholar 

  • Pearlstein TB, Halbreich U, Batzar ED, Brown CS, Endicott J, Frank E, Freeman E, HarrisonWM HRF, Stout AL, Yonkers KA (2000) Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo. J Clin Psychiatr 61:101–109

    Article  CAS  Google Scholar 

  • Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA (2005) Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. J Affect Disord 85:275–282

    Article  PubMed  Google Scholar 

  • Robertson E, Grace S, Wallington T, Stewart DE (2004) Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatr 26:289–295

    Article  Google Scholar 

  • Ross LE, Gilbert Evans SE, Sellers EM, Romach MK (2003) Measurement issues in postpartum depression part 1: anxiety as a feature of postpartum depression. Arch Wom Ment Health 6:51–57

    Article  CAS  Google Scholar 

  • Sacher J, Wilson AA, Houle S, Rusjan P, Hassan S, Bloomfield PM, Stewart DE, Meyer JH (2010) Elevated brain monoamine oxidase a binding in the early postpartum period. Arch Gen Psychiatry 67:468–474

    Article  PubMed  Google Scholar 

  • Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR (1998) Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 338:209–216

    Article  PubMed  CAS  Google Scholar 

  • Smith MJ, Schmidt PJ, Rubinow DR (2003) Operationalizing DSM-IV criteria for PMDD: selecting symptomatic and asymptomatic cycles for research. J Psychiatr Res 37:75–83

    Article  PubMed  Google Scholar 

  • SPSS for Windows (2010) Rel. 19.0.0.1. Chicago: SPSS Inc

  • Steiner M, Macdougall M, Brown E (2003) The premenstrual symptoms screening tool (PSST) for clinicians. Arch Wom Ment Health 6:203–209

    Article  CAS  Google Scholar 

  • Sternfeld B, Swindle R, Chawla A, Long S, Kennedy S (2002) Severity of premenstrual symptoms in a health maintenance organization population. Obstet Gynecol 99:1014–1024

    Article  PubMed  Google Scholar 

  • Weissman MM, Jensen P (2002) What research suggests for depressed women with children. J Clin Psychiatry 63:641–647

    Article  PubMed  Google Scholar 

  • Whiffen VE, Gotlib IH (1989) Infants of postpartum depressed mothers: temperament and cognitive status. J Abn Psychol 98:274–279

    Article  CAS  Google Scholar 

  • Wittchen HU, Becker E, Lieb R, Krause P (2002) Prevalence, incidence and stability of premenstrual dysphoric disorder in the community. Psychol Med 32:119–132

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by grant MH 074636 from the National Institute of Mental Health, Bethesda, MD (Drs. Stuart and Zlotnick).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Melissa M. Buttner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buttner, M.M., Mott, S.L., Pearlstein, T. et al. Examination of premenstrual symptoms as a risk factor for depression in postpartum women. Arch Womens Ment Health 16, 219–225 (2013). https://doi.org/10.1007/s00737-012-0323-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00737-012-0323-x

Keywords

Navigation