Depression within the first year after giving birth (postpartum depression) is a serious mood disorder that affects daily life. A better understanding of depression among women with a recent pregnancy in the UK is important to help families, clinicians, and policy leaders. The overall aim of this study is to examine the frequency of depression diagnosis among women in the first year after giving birth in the UK. In addition, the study will compare mothers who get diagnosed with postpartum depression to mothers who do not get diagnosed, to examine differences in characteristics such as age, depression screenings, medications, other health problems, death, and health problems with the infant. In addition, the study will examine how often women with postpartum depression have health care visits, including hospitalizations, general practitioner visits, and six-week infant checks.
We aim to examine the 12-month cumulative incidence of diagnosed postpartum depression (PPD) and patient characteristics of pregnancy episodes with and without a diagnosis of PPD.
Eligible participants between 12-55 years will be drawn from the CPRD Pregnancy Register with an end date of pregnancy January 2017 to December 2021, excluding those with prior history of manic/bipolar episodes. Pregnancy Register data will be used to identify pregnancy episodes and the mother-baby-link used to follow health outcomes for mother and infant.
In a cohort study, participants are followed 12-months for incident PPD. PPD will be defined in two methods; one using a more restricted definition (only PPD codes) and one a broader definition (PPD and depression codes).
In a case-control design, we will use descriptive statistics in the year before and after index to compare patient characteristics including demographics, medications, and comorbidities between pregnancy episode cases with PPD to matched controls without PPD during the study period.
Using linked data from HES Admitted Patient Care, we will examine in-patient spells comparing PPD cases and controls. We will examine mean number of spells, duration, reasons for hospitalization and healthcare utilization.
HES Outpatient data will be linked to examine outpatient visits in mothers and infants; and HES Accident and Injury to examine emergency visits, maternal self-harm episodes, and maternal suicide attempts.
ONS death registration data will be used to examine mortality in mothers and infants.
Cox models and KM survival curves will be used to understand time to PPD diagnosis, screening, psychotropic medication initiation/discontinuation, and time to self-harm and suicide attempts in mothers; and time to first spell, first accident/emergency visit, and death in mothers and linked infants.
Findings from this work will be submitted to conferences to increase knowledge of PPD characteristics in the UK and will aid PPD drug development efforts.
Primary outcome: Postpartum depression diagnosis cumulative incidence
Secondary outcomes: prescription medications; comorbidities; infant six-week check; all-cause hospitalization; GP visits; postnatal depression screening; mortality; failure to thrive in infants; mental health referrals
Cai Gillis - Chief Investigator - Biogen
Cai Gillis - Corresponding Applicant - Biogen
Catherine Mak - Collaborator - Biogen Inc.
Ellen Tworkoski - Collaborator - Biogen
Li Li - Collaborator - Biogen
Manja Koch - Collaborator - Biogen Inc.
Nancy Maserejian - Collaborator - Biogen
Shih-Yin Chen - Collaborator - Biogen
Susan Eaton - Collaborator - Biogen
HES Accident and Emergency;HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;CPRD Aurum Mother-Baby Link;CPRD Aurum Pregnancy Register;CPRD GOLD Mother-Baby Link;CPRD GOLD Pregnancy Register