本文由小咖机器人翻译整理

期刊来源：BMJ

原文链接：https://doi.org/10.1136/bmj-2023-075462

摘要内容如下：

客观

确定患有围产期抑郁症的女性与未患该疾病的女性相比，以及与亲姐妹相比，死亡风险是否增加。

设计

在全国范围内，基于注册的研究。

设置

瑞典国家登记册，2001年1月1日至2018年12月31日。

参与者

根据分娩时的年龄和日历年，对86551名通过专业护理和使用抗抑郁药首次诊断为围产期抑郁症的妇女和865510名未患围产期抑郁症的妇女进行了识别和匹配。为了解决家族混杂因素，在270586名亲姐妹（患有围产期抑郁症的妇女（n=24473）和未患有这种疾病的亲姐妹（n=246113））之间进行了比较，她们在研究期间至少有一次单胎分娩。

主要结果指标

主要转归是任何原因导致的死亡。次要结果是特定原因死亡（即非自然和自然原因）。考虑到几个混杂因素，使用多变量Cox回归来估计死亡率的风险比，将患有围产期抑郁症的妇女与未受影响的妇女和姐妹进行比较。还研究了围产期抑郁症的时间模式以及产前和产后发生围产期抑郁症的差异。

结果

在长达18年的随访中，在诊断为围产期抑郁症的妇女中报告了522例死亡（0.82/1000人年），中位年龄为31.0岁（四分位间距27.0至35.0）。与未患围生期抑郁症的妇女相比，患有围生期抑郁症的妇女死亡风险增加（校正风险比2.11（95%可信区间1.86至2.40））；据报道，在先前患有和未患有精神疾病的妇女中也存在类似的关联。产后抑郁症的死亡风险似乎高于产前抑郁症（风险比2.71（95%置信区间2.26至3.26）比1.62（1.34至1.94））。在同胞比较中，围产期抑郁症也有类似的关联（2.12（1.16至3.88））。这种关联在围产期抑郁症后的第一年内最为明显，但在随访开始后的18年内仍然存在。在患有围产期抑郁症的妇女中，非自然死亡和自然死亡的风险增加（4.28（3.44至5.32）比1.38（1.16至1.64）），与自杀的相关性最强（6.34（4.62至8.71）），尽管自杀很罕见（0.23/1000人年）。

结论

即使考虑到家庭因素，临床诊断为围产期抑郁症的妇女也与死亡风险增加相关，特别是在诊断后的第一年和自杀。受影响的妇女、其家人和卫生专业人员应了解围产期抑郁症后的这些严重健康危害。

英文原文如下：

Abstracts

OBJECTIVE  To determine whether women with perinatal depression are at an increased risk of death compared with women who did not develop the disorder, and compared with full sisters.

DESIGN  Nationwide, register based study.

SETTING  Swedish national registers, 1 January 2001 to 31 December 2018.

PARTICIPANTS  86 551 women with a first ever diagnosis of perinatal depression ascertained through specialised care and use of antidepressants, and 865 510 women who did not have perinatal depression were identified and matched based on age and calendar year at delivery. To address familial confounding factors, comparisons were made between 270 586 full sisters (women with perinatal depression (n=24 473) and full sisters who did not have this disorder (n=246 113)), who gave at least one singleton birth during the study period.

MAIN OUTCOME MEASURES  Primary outcome was death due to any cause. Secondary outcome was cause specific deaths (ie, unnatural and natural causes). Multivariable Cox regression was used to estimate hazard ratios of mortality comparing women with perinatal depression to unaffected women and sisters, taking into account several confounders. The temporal patterns of perinatal depression and differences between antepartum and postpartum onset of perinatal depression were also studied.

RESULTS  522 deaths (0.82 per 1000 person years) were reported among women with perinatal depression diagnosed at a median age of 31.0 years (interquartile range 27.0 to 35.0) over up to 18 years of follow-up. Compared with women who did not have perinatal depression, women with perinatal depression were associated with an increased risk of death (adjusted hazard ratio 2.11 (95% confidence interval 1.86 to 2.40)); similar associations were reported among women who had and did not have pre-existing psychiatric disorder. Risk of death seemed to be increased for postpartum than for antepartum depression (hazard ratio 2.71 (95% confidence interval 2.26 to 3.26) v 1.62 (1.34 to 1.94)). A similar association was noted for perinatal depression in the sibling comparison (2.12 (1.16 to 3.88)). The association was most pronounced within the first year after perinatal depression but remained up to 18 years after start of follow up. An increased risk was associated with both unnatural and natural causes of death among women with perinatal depression (4.28 (3.44 to 5.32) v (1.38 (1.16 to 1.64)), with the strongest association noted for suicide (6.34 (4.62 to 8.71)), although suicide was rare (0.23 per 1000 person years).

CONCLUSIONS  Even when accounting for familial factors, women with clinically diagnosed perinatal depression were associated with an increased risk of death, particularly during the first year after diagnosis and because of suicide. Women who are affected, their families, and health professionals should be aware of these severe health hazards after perinatal depression.

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