ASSOCIATION OF C - REACTIVE PROTEIN WITH PSYCHOTIC FEATURES IN POSTPARTUM DEPRESSION: A CROSS-SECTIONAL STUDY FROM PAKISTAN
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Keywords
Postpartum depression; psychotic features; C-reactive protein; inflammation; biomarker
Abstract
Background: Postpartum depression (PPD) is one of the commonest psychiatric disorders following childbirth. PPD may be complicated by psychotic features, substantially increasing maternal morbidity and mortality. Increasing evidence suggests that inflammatory processes contribute to affective and psychotic symptoms. C-reactive protein (CRP), a widely available inflammatory marker, has been implicated in the etiology of depressive disorders, yet data linking CRP with psychotic features in PPD remain limited, particularly from low- and middle-income countries like Pakistan.
Objectives: To study the correlation between serum C-reactive protein levels and psychotic symptoms among women with postpartum depression.
Methods: This cross-sectional study was carried out at a tertiary care hospital in Hyderabad, Pakistan, over six months. A total of 236 postpartum women were enrolled using non-probability consecutive sampling. Postpartum depression was evaluated using the Urdu version of the Edinburgh Postnatal Depression Scale (EPDS), while psychotic symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS). Serum CRP levels were measured and categorized as normal (<5 mg/dL) or raised (≥5 mg/dL). Pearson correlation and logistic regression analyses were performed.
Results: The mean age of participants was 26.57 ± 5.87 years. Elevated CRP levels were observed in 47% of women. A significant positive correlation was found between CRP levels and psychotic symptom severity (r = 0.63, p < 0.05). Women with raised CRP had significantly higher odds of PPD with psychotic features (OR = 18.75; 95% CI: 9.68–36.30; p = 0.0005). After adjustment for sociodemographic and clinical variables, raised CRP remained an independent predictor (adjusted OR = 25.45; 95% CI: 11.76–55.06).
Conclusions: Elevated CRP levels are strongly associated with psychotic features in postpartum depression. These findings support the role of inflammation in the pathophysiology of severe postpartum mood disorders and highlight CRP as a potential biomarker for early identification of women at risk.
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Dr Jamil Junejo
Associate Professor of Psychiatry, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
Dr Warda Ishtiaque
Consultant Psychiatrist, Sir Cowasjee Jehangir institute of Psychiatry and Behavioral Sciences Hyderabad, Pakistan
Dr Ghulam Shabir Shaikh
Assistant Professor of Psychiatry, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
Dr summaira Channa
Senior Registrar, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
Dr Amber u Nissa
Assistant Professor Gynaecology and Obs, Shaikh Zyed Women Hospital Shaheed Mohtama Benazir Bhutto Medical University Larkana, Pakistan
Dr Inayatullah Awan
Associate Professor Psychiatry, Ghulam Muhammad Mahar Medical College Sukkur, Pakistan
