Eating Disorders and Trauma History in Women with Perinatal Depression

Abstract

Objective: Although the prevalence of perinatal depression (depression occurring during pregnancy and postpartum) is 10%, little is known about psychiatric comorbidity in these women. We examined the prevalence of comorbid eating disorders (ED) and trauma history in women with perinatal depression. Methods: A research questionnaire was administered to 158 consecutive patients seen in a perinatal psychiatry clinic during pregnancy (n = 99) or postpartum (n = 59). Measures included Structured Clinical Interview for DSM (SCID) IV-based questions for lifetime eating psychopathology and assessments of comorbid psychiatric illness including the State/Trait Anxiety Inventory (STAI), Patient Health Questionnaire (PHQ-9), Edinburgh Postnatal Depression Scale (EPDS), and Trauma Inventory. Results: In this cohort, 37.1% reported a putative lifetime ED history; 10.1% reported anorexia nervosa (AN), 10.1% reported bulimia nervosa (BN), 10.1% reported ED not otherwise specified-purging subtype (EDNOS-P), and 7.0% reported binge eating disorder (BED). Women with BN reported more severe depression (EPDS score, 19.1, standard deviation [SD 4.3], p = 0.02; PHQ-severity 14.5, SD 7.4, p = 0.02) than the referent group of women with perinatal depression and no ED history (EPDS 13.3, SD = 6.1; PHQ 9.0, SD = 6.2). Women with AN were more likely to report sexual trauma history than the referent group (62.5% vs. 29.3%, p < 0.05), and those with BN were more likely report physical (50.0%, p < 0.05) and sexual (66.7%, p < 0.05) trauma histories. Conclusions: ED histories were present in over one third of admissions to a perinatal psychiatry clinic. Women with BN reported more severe depression and histories of physical and sexual trauma. Screening for histories of eating psychopathology is important in women with perinatal depression.

Now What? Effects of On-Site Assessment on Treatment Entry After Perinatal Depression Screening

“…27 The PHQ-9 is being used increasingly in research studies with pregnant women. [28][29][30] Because its items are derived from DSM-IV diagnostic criteria, it facilitates rapid diagnostic assessment and was, therefore, well suited to the current study.…”

Reproductive issues in anorexia nervosa

“…Furthermore, women with a history of anorexia nervosa were over-represented in a clinical sample of women seeking treatment for postpartum depression. Approximately 10% of women seeking treatment for postpartum depression in a tertiary care clinic had a previous history of anorexia nervosa [64]. Women with anorexia nervosa may have an equal or greater risk of developing perinatal and postpartum depression compared with women with a history of major depressive disorder and no eating disorder [60,65].…”

“…Trauma and abuse histories also independently increase the risk of perinatal and postpartum depression and other psychiatric comorbidity [77–81]. Women with comorbid perinatal depression and lifetime anorexia nervosa are significantly more likely to report a history of sexual trauma abuse in comparison to women with perinatal depression and no eating disorder history (62.5 vs 29.3%; p < 0.05) [64]. Traumatic life events are independently associated with pregnancy complications including miscarriages, high-risk pregnancy, hyperemesis, preterm contractions [82] and delivery complications [83–88].…”

Comportamento alimentar e percepção da imagem corporal de gestantes atendidas em um ambulatório de alto risco

“…As mudanças no peso, forma e no tamanho corporal próprias da gestação podem gerar sentimentos negativos acerca da percepção corporal, influenciando o comportamento alimentar de tal forma, que os achados de TA em gestantes têm sido considerados cada vez mais comuns (2,11,13,14) . Em função da existência de poucos estudos envolvendo compulsão alimentar e percepção da imagem corporal em gestantes, objetivou-se investigar o comportamento alimentar e a percepção da imagem corporal em gestantes atendidas em um ambulatório de alto risco.…”