PND Recurrence — MRCPsych Paper B MCQ

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ModeratePerinatal PsychiatryPND RecurrenceMRCPsych Paper B

A 32-year-old woman is 20 weeks pregnant. She experienced a major depressive episode beginning 4 weeks after the birth of her first child. She made a full recovery and is currently euthymic, with no history of mania or psychosis. Which range best represents the approximate risk that she will experience another postnatal depressive episode following this pregnancy?

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Correct answer: E — 25–50%

The correct answer is E. A previous episode of postnatal depression substantially increases the risk of recurrence after a later birth. NICE’s supporting evidence describes an approximate 40% risk of subsequent postnatal or non-postnatal relapse, while a prospective cohort specifically following women after another birth found a 41% recurrence rate. Therefore, 25–50% is the best available range. A risk below 10% is closer to the background frequency of postnatal depression among women without a previous episode and underestimates this patient’s risk. Estimates above 50%, particularly those approaching 90–100%, imply near-inevitable recurrence and are not supported for a single previous postnatal depressive episode. Individual risk is modified by illness severity, other depressive episodes, psychosocial adversity and preventive treatment, so the figure is an approximate group-level estimate.

Reference: National Institute for Health and Care Excellence. Antenatal and postnatal mental health: clinical management and service guidance, CG192, full guideline section 2.3.1, page 24; published 2014, guideline last updated 2020. https://www.nice.org.uk/guidance/cg192/evidence/full-guideline-pdf-4840896925