Factors associated with onset timing, symptoms, and severity of depression identified in the postpartum period

Sheehan D. Fisher*, Katherine L. Wisner, Crystal T. Clark, Dorothy K. Sit, James F. Luther, Stephen Wisniewski

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

28 Scopus citations


Background Unipolar and bipolar depression identified in the postpartum period have a heterogeneous etiology. The objectives of this study are to examine the risk factors that distinguish the timing of onset for unipolar and bipolar depression and the associations between depression onset by diagnosis, and general and atypical depressive symptoms. Methods Symptoms of depression were assessed at 4- to 6-weeks postpartum by the Structured Interview Guide for the Hamilton Depression Rating Scale-Atypical Depression Symptoms in an obstetrical sample of 727 women. Data were analyzed using ANOVA, Chi-square, and linear regression. Results Mothers with postpartum onset of depression were more likely to be older, Caucasian, educated, married/cohabitating, have one or no previous child, and have private insurance in contrast to mothers with pre-pregnancy and prenatal onset of depression. Mothers with bipolar depression were more likely to have a pre-pregnancy onset. Three general and two atypical depressive symptoms distinguished pre-pregnancy, during pregnancy, and postpartum depression onset, and the presence of agitation distinguished between unipolar and bipolar depression. Limitations The sample was urban, which may not be generalizable to other populations. The study was cross-sectional, which excludes potential late onset of depression (after 4-6 weeks) in the first postpartum year. Conclusions A collective set of factors predicted the onset of depression identified in the postpartum for mothers distinguished by episodes of unipolar versus bipolar depression, which can inform clinical interventions. Future research on the onset of major depressive episodes could inform prophylactic and early psychiatric interventions.

Original languageEnglish (US)
Pages (from-to)111-120
Number of pages10
JournalJournal of Affective Disorders
StatePublished - Oct 1 2016


  • Bipolar disorder
  • Onset
  • Postpartum depression

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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