Suicidal Ideation During the Postpartum Period.

OBJECTIVE: To examine the association between suicidal ideation (SI), 3 weeks, 3 months, and 6 months postpartum with demographic, psychosocial, clinical factors, and depressive/anxiety symptoms (measured 24-48 hours after delivery), among a cohort of postpartum women. METHODS: This study included 1,073 mothers who gave birth in a large tertiary New York City hospital (2009-2010). Later, self-report SI was assessed using the suicide measure from the Edinburgh Postnatal Depression Scale and from the Patient Health Questionnaire. RESULTS: Two percent of participants presented with SI during the first 6 months postpartum. In bivariate analyses, race/ethnicity, nativity, insurance, and language were significantly correlated with SI 3 weeks, 3 months, and 6 months postpartum. Screening positive for depression (p = 0.0245) and anxiety (0.0454), assessed 1-2 days postpartum, was significantly correlated with later SI in bivariate analyses, as were antepartum complications (p = 0.001), depressive history (0.001), and self-efficacy (0.045). In adjusted models, antepartum complications (OR = 4.681, 95% CI = 1.99-10.99) and depressive history (OR-3.780, 95% CI = 1.514-9.441) were significantly associated with later postpartum SI. Heightened self-efficacy reduced the odds of later SI (p = 0.050). CONCLUSION: Findings suggest that SI among a relatively healthy group of new mothers occurs with some frequency. Mothers with a history of depression and antepartum complications may be at increased risk.

Screening for bipolar disorder in women with polycystic ovary syndrome: a pilot study.

OBJECTIVE: Previous reports have attributed polycystic ovary syndrome (PCOS) to valproate treatment in women with bipolar disorder and with epilepsy. However, since high rates of mood disorders have been identified in women with PCOS, we sought to investigate the hypothesis that an intrinsic association may exist between PCOS and bipolar disorder, independent of pharmacotherapy. METHOD: Seventy-eight women identified with PCOS were screened for the presence of bipolar illness using the Mood Disorders Questionnaire (MDQ), a validated self-assessment screen for bipolar disorder. RESULTS: Twenty-eight percent of subjects had either a previous bipolar diagnosis or met MDQ threshold criteria for bipolar screen positivity. Ninety seven percent of previously diagnosed or MDQ screen-positive subjects had no valproate exposure before PCOS diagnosis. LIMITATIONS: Possible selection bias, lack of direct comparison with a control group, and lack of knowledge of specific diagnostic work up for PCOS, should all be considered in interpretation of these results. The MDQ as a self-report screen may be less sensitive to detect bipolar II or NOS than bipolar I disorder, and was not corroborated by a diagnostic interview. CONCLUSION: These preliminary findings suggest a higher rate of bipolar screen positivity among women with PCOS than is expected in the general population, independent of an association with valproate. This observed link between PCOS and bipolar screen-positivity is consistent with a possible shared hypothalamic-pituitary-gonadal axis abnormality.