Childhood physical abuse as a common risk factor for depression and thyroid dysfunction in the earlier postpartum

Abstract

Childhood abuse is a powerful risk factor for developing postpartum depression in adulthood, and recently it has been associated to thyroid dysfunction in postpartum depressive women. The purpose of this study was to investigated the effects of childhood abuse on thyroid status and depressive symptomatology in two hundred and thirty-six (n=236) postpartum women 24–48 h after delivery. The Early-Trauma-Inventory Self-Report was used to assess the presence of childhood abuse and the Edinburgh Postpartum Depression Scale (EPDS) to evaluate depressive symptomatology (EPDS≥11). Free thyroxin (fT4) and thyroid-stimulating hormone (TSH) were measured. Thyroid dysfunction (TD) was defined as altered TSH or TSH and fT4. Socio-demographic, reproductive, and psychopathological variables were also collected. Multivariate analysis shows that childhood physical abuse increases by four times the risk for TD (OR: 3.95, 95% CI: 1.23–12.71) and five times the risk for depressive symptomatology (OR: 5.45, 95% CI: 2.17–13.66) in the earlier postpartum. Our findings suggest that women with history of childhood physical abuse are particularly at-risk for thyroid dysfunction and depressive symptomatology 24–48 h after delivery. The assessment of childhood abuse in the perinatal period is important to identify women at-risk for physical and mental health problems in this period.

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.