Childhood physical abuse as a common risk factor for depression and thyroid dysfunction in the earlier postpartum
Introduction
Childhood abuse is a powerful risk factor for developing depression (Widom et al., 2007, Heim et al., 2008, Heim and Binder, 2012), and it is suggested as a risk factor for postpartum depression (Buist and Barnett, 1995, Kendall-Tackett, 2007).
Many studies have focused on the relationship between lifetime abuse and antenatal or postpartum depression (Girdler et al., 2004, Mezey et al., 2005, Records and Rice, 2005, Seng et al., 2008, Dayan et al., 2010, Silverman and Loudon, 2010, LaCoursiere et al., 2012). Several studies have reported the presence of childhood abuse as a risk factor for prenatal depression (Romano et al., 2006, Chung et al., 2008, Leigh and Milgrom, 2008, Yampolsky et al., 2010, Rich-Edwards et al., 2011) and for post-traumatic stress disorder (PTSD) (Seng et al., 2008; 2009). Both prenatal depression and PTSD have been identified as mediators between childhood abuse and postpartum depression (Leigh and Milgrom, 2008, Onoye et al., 2009).
Incomplete results exist to establish a more direct relationship between childhood abuse and postpartum depression. Table 1 summarizes five studies that have reported results concerning this relationship. Three of these studies were conducted with a non-clinical sample (Lang et al., 2006; Dennis and Ross, 2006, Garabedian et al., 2011), and two were conducted with a sample of postpartum depressive women (Buist, 1998, Grote et al., 2012). Only two of these studies (Lang et al., 2006; Grote et al., 2012) used specific-validated instruments to measure both childhood abuse and the presence of postpartum depression, but with reduced samples. Of these five studies, four presented positive evidence for a relationship, and one presented negative evidence.
Childhood sexual abuse has also been associated with hypothalamus-pituitary-thyroid (HPT) axis disturbances in adolescent girls (Haviland et al., 2006) and in women with PTSD (Friedman et al., 2005). Lifetime sexual abuse has been associated with premenstrual dysphoric disorder (PMDD) (Girdler et al., 2004). In a recent study, our group (Plaza et al., 2010) reported that the presence of childhood sexual abuse increases by five times the risk of TD in postpartum depressive women, indicating a difficulty in the recovery capability of the HPT axis in women with depression and a history of childhood sexual abuse.
Given the few and sometimes contradictory findings on childhood abuse as a risk factor for depression in the postpartum period, as well as the absence of studies on childhood abuse and the HPT axis in the postpartum period using a non-clinical sample of women, the aim of this study is to investigate the effects of childhood physical, emotional, and sexual abuse on depressive symptomatology and thyroid status in a non-clinical sample of women, 24–48 h after delivery.
Based on the study of Dennis and Ross (2006), we hypothesized that women who had experienced childhood abuse would show greater risk of depression 24–48 h after delivery than women who had not. Given the results of our previous study (Plaza et al., 2010), which showed a relationship between childhood abuse and TD in women with postpartum depression, as well as the results of Albacar et al. (2010), who presented negative evidence for the relationship between postpartum depressive symptomatology and thyroid hormone dysregulation, it was also hypothesized that women who had suffered childhood abuse would show greater risk of TD in the immediate postpartum period than those who had not.
Section snippets
Participants
This study sample consisted of 303 Caucasian Spanish postpartum women, over 18 years of age, who gave birth in the same Obstetrics Unit, and were able to understand and answer clinical questionnaires. This sample was selected to participate in a larger prospective multi-center study on postpartum depression that took place between December 2004 and July 2005 in Spain (Sanjuan et al., 2008). For the present study, exclusion criteria included being under psychopharmacological or psychological
Characteristics of the sample (n=236)
The mean age was 32.6 years old (SD 4.56) (range 19–46). Almost all participants were married (98%), and a majority had secondary (59%) and/or university (40%) education level. A majority had a sufficient income level (65%), as defined by self-assessment. Sixty-six percent were primiparous, 16.5% had a history of abortion, and 8.7% needed cesarean section. Thirty percent reported PMS. None of the women who had children prior to the study reported postpartum depression. Six percent had a
Discussion
The main findings of this study were that a history of childhood physical abuse increases by four times the risk of TD, and by five times the risk of depressive symptomatology 24–48 h after delivery. Furthermore, the presence of PMS increased by four times the risk of depressive symptomatology in the same period.
Acknowledgments
The authors thank David Wolland for editorial assistance and Beatriz Gonzalez for her help in the questionnaire administration.
Grant support: Funding for this study was provided by grant FIS: P1041783 and grant SGR2009/1435. These institutions had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.
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