یک مطالعه آینده نگر درباره اختلال پانیک در دوران پس از زایمان
Abstract
1- Introduction
2- Material and methods
3- Results
4- Discussion
5- Conclusion
References
Abstract
Background: Panic disorders during pregnancy and after delivery may have detrimental effects for mother and child, but no firm conclusions regarding the course and outcomes peripartum panic disorders can be drawn from previous studies.
Methods: N=306 women were repeatedly interviewed with the Composite International Diagnostic Interview for Women. Social support and partnership quality, gestational outcomes, duration of breastfeeding, regulatory disorders, maternal bonding and parenting style were assessed via medical and maternal reports. Standardized observations of neuropsychological development, infant temperament and attachment were conducted 4 and 16 months after delivery.
Results: Women reported heterogenous courses of panic disorders, and panic disorders /panic attacks were commonly observed during the early stages of pregnancy. Women with peripartum PD presented with a worse psychosocial situation (e.g. lower social support). Clear behavioral differences (temperament, attachment) in infants of women with panic disorders as compared to women with no anxiety and depression could not be detected in this study, but differences concerning gestational outcomes, duration of breastfeeding, maternal parenting, and bonding as well as regulatory problems in infants were identified.
Limitations: This prospective-longitudinal multi-wave study is restricted by the relative small sizes of the particular groups that limit the power to detect differences between the respective groups.
Conclusions: Heterogenous courses and outcomes of perinatal panic disorders require intensive monitoring of affected mother-infant-dyads who may benefit from early targeted interventions to prevent an escalation of dyadic problems.
Introduction
Panic disorder (PD) is one of the most prevalent and disabling psychiatric disorders and prevalence estimates of PD are twice as high in women as in men (Jacobi et al., 2014; Jacobi et al., 2015). The age of onset of PD is typically before or during the reproductive years (according to the meta-analyis by de Lijster et al., 2017: mean age 30.3 years; 95% CI 26.1-34.6 years). Thus, the investigation of the course of PD during the peripartum period and the impact on child development is an important research aim. Prior studies have shown that the course of peripartum PD is variable and some studies found a decrease or rather low rates of PD, if women become pregnant (Bandelow et al., 2006; George et al., 1987; Hertzberg and Wahlbeck, 1999; Klein et al., 1994; Northcott and Stein, 1994; Villeponteaux et al., 1992). However, worsening or unchanged course patterns of PD during pregnancy have also been reported (Cohen et al., 1994; Cohen et al., 1996; Griez et al., 1995; Wisner et al., 1996). Further evidence suggests heterougeneous course patterns during the postpartum period with an increased risk for a new onset or an exacerbation of PD (Bandelow et al., 2006; Cohen et al., 1994; Cohen et al., 1996; Hertzberg and Wahlbeck, 1999; Sholomskas et al., 1993). Moreover, it has been hypothesized that breastfeeding also affects the course of PD, but studies were inconclusive (Bandelow et al., 2006). Noteworthy, approximately 50% of individuals with PD also suffer from comorbid Major Depression (MD) and prenatal anxiety disorders, such as PD, were specified as prominent risk factors for later depression (Marchesi et al., 2014; Martini et al., 2015; Sutter-Dallay et al., 2004). Therefore pre- and peripartum PD may be associated with significant depressive morbidity. Finally, evidence suggests that psychosocial factors (e.g. marital status, cohabitation with the partner, partnership quality, social support) may be associated with anxiety and depressive disorders during peripartum period (Asselmann et al., 2016b; Asselmann et al., 2016c), but thus far, their role in PD remains unclear.