Risk Factors for Postpartum Depression: Family History of Psychiatric Illness

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In the general population, about 15% of women will experience depression after the birth of a child.  Given the downstream effects of postpartum depression (PPD) on the child’s health and well-being,  it is essential that we be able to identify women at high risk for experiencing PPD.  Identifying risk factors before delivery — or even before pregnancy — would allow us to monitor high-risk women more closely and may also afford the opportunity to initiate preventative interventions that mitigate the risk of illness.

A systematic review and meta-analysis from Zacher Kjeldsen and colleagues examined the association between a family history of psychiatric illness and the risk for postpartum depression.  In their final analysis, 26 studies were included, containing information on 100,877 women.  The meta-analysis showed a twofold increased odds ratio (OR) of developing PPD when mothers had a family history of psychiatric illness (OR, 2.08; 95% CI, 1.67-2.59).

The meta-analysis from the current study indicates an almost twofold increase in the risk of PPD in mothers with a family history of psychiatric disorders compared with mothers without a family history.  In other words, women with a family history of psychiatric illness will have a 30% risk of experiencing PPD.  While this is a useful piece of information, this is most likely not a surprise to most.  We know that having a family history of psychiatric illness increases one’s risk for depression, and having a history of depression increases the risk for PPD.  (However, some studies have not shown an association between a family history of psychiatric illness and PPD.)

The current study did not look at specific psychiatric disorders.  In another study analyzing data from the Danish medical register, researchers observed that if a woman had a first-degree relative (mother, father, brother, sister, or child) with a history of any psychiatric disorder, her risk of having an episode of postpartum psychiatric illness was about 1.5-fold higher than in women with no family history.   However, if the woman had a first-degree relative with a history of bipolar disorder, her risk of having an episode of postpartum psychiatric illness increased nearly threefold.  (In contrast to the study from Zacher Kjeldsen and colleagues, the Danish study looked at risk only in women with no personal history of psychiatric illness prior to pregnancy.)

Both studies remind us to ask about family history on both sides of the family.  While having a mother or sister who has experienced postpartum psychiatric illness may increase a woman’s risk of PPD, having a brother or father with any type of psychiatric illness also confers significant risk.

What we do not yet know is how various risk factors — such as depressive symptoms during pregnancy or discontinuation of medications — interact with each other, nor do we know how protective factors (e.g., social supports) may modulate risk.  Our ultimate goal would be to generate some PPD risk calculator so that we could evaluate each woman and give a more personalized estimate of risk for perinatal psychiatric illness and to select appropriate preventative interventions.  This is maybe where big data can help us.

Ruta Nonacs, MD PhD

Zacher Kjeldsen MM, Bricca A, Liu X, Frokjaer VG, Madsen KB, Munk-Olsen T. Family History of Psychiatric Disorders as a Risk Factor for Maternal Postpartum Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022 Aug 17.

 

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9 Emotionally Devastating Mental Illness Graphic Memoirs – Book Riot

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One of my favorite combinations of format and topic is mental illness and graphic memoir. The best way to get inside someone’s head, to really see the world as they see it, is through their own artwork. Comics artists wield a special talent when it comes to writing graphic memoirs about mental illness, and I am so grateful to them.

The first books that turned me into a reader were about teens with mental illnesses — I’m looking at you, Beatrice Sparks — and it’s remained one of my go-to book topics when I need something to remind me why I love books. Sometimes they’re like looking inside my own brain, but more often than not, they’re offering a brand new perspective that I hadn’t known much about before opening the book.

Here are some of the best graphic memoirs about mental illness, covering depression, anxiety, addiction, obsessive-compulsive disorder, borderline personality disorder, eating disorders, postpartum depression, and grief. Please exercise your best self-care when reading any of these books; they go deep into dark topics.

Mental Illness Graphic Memoirs

The Way She Feels: My Life on the Borderline in Pictures + Pieces by Courtney Cook

The Way She Feels is a really moving memoir in comics, essays, and lists about a life with a borderline personality disorder. Courtney Cook writes about how no one writes about BPD (there are, like, four books out there on the topic), and her work makes the disorder a little less scary, taboo, and misunderstood. She writes candidly about her experiences with self-harm, dermatillomania (obsessive skin-picking), and numerous hospitalizations in an astounding way that feels like reading a friend’s diary. In fact, it often feels like she was one of my friends in high school. The book is raw, but also full of humor, heart, and oh so many bright colors.

My Solo Exchange Diary Vol. 2 by Kabi Nagata, Translated by Jocelyne Allen

Kabi Nagata’s diary-in-manga is so good. My Solo Exchange Diary Vol. 2 is the third book in the series, following the same themes as the previous — loneliness, depression, and finding her way in the world as a young person — but with an addition of alcohol addiction. Amid her darkest days of drinking and wetting the bed, Nagata is brought to a hospital to monitor her well-being. And in the end, she realizes that she was loved all along, just not in the ways she was expecting.

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Everything Is an Emergency: An OCD Story in Words Pictures by Jason Adam Katzenstein

Jason Adam Katzenstein’s art is stunning. Told in the present tense, starting when he was a young boy, we are taken on his journey through life with obsessive-compulsive disorder. Everything is an Emergency puts us inside Katzenstein’s brain and shows that OCD is much more than merely being tidy — it’s seemingly inane obsessions that disrupt daily life until the ritual is complete. This mental illness graphic memoir will give you a much deeper understanding of this disorder.

Feelings: A Story in Seasons by Manjit Thapp

I don’t have the words that can do this book justice. Majit Thapp is an incredible artist, and her illustrations speak volumes over the sparse words that connect the images throughout the book. Feelings is a year in Thapp’s life, told through the ebbs and flows of six seasons: the anxiety of monsoon, the exuberance of high summer, the desolation of winter. Each page is a marvel.

Solutions and Other Problems by Allie Brosh

Allie Brosh was on hiatus for many years between this book and her previous one, Hyperbole and a Half, and in that time she endured a lot of terrible experiences. Her sister died by suicide. She got divorced. Solutions and Other Problems is dark and poignant and somehow also hilarious, covering those devastating events alongside her weird childhood and dumb dogs.

Dear Scarlet- The Story of My Postpartum Depression by Teresa Wong

Dear Scarlet: The Story of My Postpartum Depression by Teresa Wong

In this arresting graphic memoir, Teresa Wong pens a letter to her daughter, chronicling the hours, days, weeks, and months after she was born. Dear Scarlet gets deep into the seemingly taboo topic of postpartum depression, showing just how devastating a beautiful moment can be when one’s body is ravaged by hormones.

Ink in Water: An Illustrated Memoir by Lacy J. Davis and Jim Kettner

I have not been able to stop thinking about this book. Amid a breakup, Lacy J. Davis has a passing thought: am I not small enough to be loved? Thus begins her derailment into the land of disordered eating and overexercising. Ink in Water is her journey back toward wellness with numerous setbacks and a riot grrrl attitude. Jim Kettner’s black-and-white illustrations are visceral.

Barely Functional Adult: It’ll All Make Sense Eventually by Meichi Ng

Meichi Ng’s webcomics probably need no introduction. She draws perfect, #relatable little scenes of life as a young adult trying to figure everything out. Barely Functional Adult is a series of stories from her life, covering heartbreak, therapy, and everything in between, illustrated with cartoons in her signature style. It’ll make you laugh and sigh and feel so seen.

Dancing at the Pity Party

Dancing at the Pity Party: A Dead Mom Graphic Memoir by Tyler Feder

While not directly a mental illness, grief is a major deal and can manifest as mental illnesses. Tyler Feder’s graphic memoir about losing her mom to cancer is just stunning. She writes openly about her grief but also the guilt that follows loss, like the relief of death after a terminal illness. The oldest of her sisters, Feder had the most time with their goofy mom and often felt like she’d hogged her for those years before her sisters were born and cognizant. Because grief makes your brain think weird things. Dancing at the Pity Party is so beautiful and sad and made me want to hug my mom and smell her wonderful mom smell for the rest of time.


For further reading in the world of mental illness graphic memoirs, be sure to check out these comics for people with anxiety, comics about depression, and comics about mental illness.

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