Lifetime substance use and postpartum mental health

background: Approximately 10-20% of women experience postpartum mood disorders (PPMD) (CDC, 2008). Unfortunately, only about 25% of women receive treatment, in part due to underdetection (Goodman & Tyer-Viola, 2010). Lifetime substance use has received limited attention in screening for PPMD, despite being a robust predictor of mood disorders in other populations (Regier, et al., 1990). The present study examined the contributions of lifetime substance use to the prediction of PPMD.

method: One hundred women participated in semi-structured interviews within 3 months postpartum. In addition to reporting on their sociodemographic characteristics and history of mental health problems, women completed instruments assessing their overall postpartum mood and symptoms of anxiety, stress, posttraumatic stress disorder (PTSD), depression, obsessive-compulsive disorder (OCD), and lifetime alcohol and drug use.

results: Hierarchical regression models showed that consideration of lifetime substance use improved the prediction of postpartum mood overall (p=.036), anxiety (p=.074), stress (p=.054), and PTSD (p=.008)—but not depression (p=.329) or OCD (p=.242) —above and beyond sociodemographic characteristics and mental health history. Lifetime drug use was a unique predictor of overall postpartum mood (p=.022), symptoms of anxiety (p=.044), and stress (p=.020). Lifetime drug use was not a unique predictor of PTSD (p=.093). Lifetime alcohol use was not a unique predictor of any PPMD symptoms (ps>.955).

conclusions: This study provides the first evidence that screening for lifetime drug use during antenatal and postpartum care may improve identification of women at risk for PPMD. Findings will be discussed with respect to the development of early intervention and prevention strategies.