Association between premenstrual syndrome and postnatal depression in women with recurrent major depressive disorder

Postnatal depression (PND) represents a major mental health concern with significant implications for mothers and children. Premenstrual syndrome (PMS) has been suggested as a potential risk factor for PND, although its role among women with recurrent major depressive disorder (MDD) remains unclear. Using data from the Korean Mood Disorder Genetic Study-Depression (KOMOGEN-D), an analysis of 2309 women with recurrent major depressive disorder and at least one childbirth experience was conducted to investigate the association between PMS and PND.PMS was defined by self-reported premenstrual emotional symptoms, and PND was defined as a depressive episode within 6 months postpartum. Logistic regression analysis was performed. Women with PMS demonstrated significantly higher rates of PND than those without PMS (45.5% vs. 22.5%, p < 0.001). Younger age (odd ratio [OR]: 0.93, 95% confidence interval [CI]: 0.93–0.94, p < 0.001), younger age at menarche (OR: 0.84, 95% CI: 0.8–0.87, p < 0.001), PMS (OR: 2.87, 95% CI: 2.4–3.45, p < 0.001), childhood sexual abuse (OR: 1.65, 95% CI: 1.33–2.04, p < 0.001), and a family history of MDD (OR: 1.76, 95% CI: 1.48–2.1, p < 0.001) were associated with PND. A positive association was observed between PMS symptom burden and PND incidence. Women with PND also exhibited earlier onset of depression, longer illness duration, and higher trauma exposure. These findings identify PMS as a marker of a clinically meaningful vulnerability profile within recurrent MDD, underscoring the need for tailored screening and intervention strategies across the reproductive life cycle.