LAUSR

Postpartum depression (PPD) is a disabling psychiatric disorder that represents one of the most common complications of childbearing. PPD has a variable duration, from 4 weeks postpartum up to 12 months postpartum. The prevalence of PPD in the general population ranges from 6.5 to 12.9% [1]. PPD has been associated with a myriad of negative effects on child and maternal health (weight problems, worse quality of life [2], poor maternal care, and psychiatric and medical disorders in adolescence) [3]. Women with autoimmune rheumatic diseases (ARD) have a high frequency of depression [4]. Information regarding PPD in women with ARD is scarce. This study aimed to describe the frequency of PPD symptoms by the Edinburgh Postpartum Depression Scale (EPDS) in Mexican women with ARD. We conducted an observational, cross-sectional, and descriptive study. Fifty-two postpartum women (up to 1-year postpartum) were evaluated in the Pregnancy and Rheumatic Diseases Clinic of the University Hospital “Dr. Jose E. Gonzalez.” Sociodemographic data were collected from the electronic medical record. The EPDS questionnaire was applied. A score of 10 or higher was classified as positive for depressive symptoms [5]. The Kolmogorov–Smirnov test was employed to determine normality. Differences between groups were analyzedwith chi-square or Kruskal–Wallis tests. The protocol was approved by the institutional ethics and research committee (RE18-00008). The most common diagnosis was rheumatoid arthritis (RA) with 20 (38.5 %). Sociodemographic and biological factors for PPD are described in Table 1. From the total sample, 14 (26.9 %) reported a score of 10 or more. Patients with systemic lupus erythematosus (SLE) had the highest mean score compared to other ARD with 8.9 (SD 6.7) points. From the SLE group, 2 patients (20%) were positive to question 10 (“The thought of harming myself has occurred to me”). This item has been related to postpartum suicidality [6]. Of the 52 patients, 5 (9.6 %) were positive to this item (Table 1). A total of 43 (82.6%) patients were on treatment with diseasemodifying antirheumatic drugs (DMARDs). There was no significant difference in the positive EPDS between patients treated with DMARDs (n = 12) and those who were not (n = 2) (p = 0.727). The patients with positive EPDS (n = 14) were referred to the psychiatrist or psychologist, of whom 4 did not attend their appointments, 8 required supportive therapy, and 2 drug treatment. In Mexico, few studies have evaluated the prevalence of PPD symptoms using the EPDS scale in the general population ranging from 14 to 16% [7]. The frequency described in our study was almost twice than reported by Lara MA and colleagues [8] at 6 weeks postpartum using the Patient Health Questionnaire (PHQ-9) (26.9% vs 13.8%), and lower than the one reported by Pérez-García et al. [9] with a 46.7% frequency of depression symptoms also inMexicans but including women and men. Mercier RJ et al. [10] demonstrated that unplanned and unwanted pregnancies are associated with increased risk of PPD; similarly, in our study, there were differences in PPD positive scores among those who referred to planned pregnancy and those who did not (p = 0.012). Furthermore, Minaldi E et al. [11] reported that thyroid autoimmunity during pregnancy and in the weeks after childbirth is associated with an increased risk of developing PPD. Similarly, our study shows a difference among women with and without comorbidities (p = 0.041) (Table 2). Limitations of our study include the single-center, transversal design, the absence of a control group, information about * Lorena Perez-Barbosa [email protected]