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The phenomenology of postpartum psychosis: preliminary findings from the Massachusetts General Hospital Postpartum Psychosis Project

Molecular Psychiatry volume 30, pages 2537–2544 (2025)Cite this article

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Abstract

Postpartum psychosis (PP) is a severe psychiatric disorder–with limited data or consensus on diagnostic criteria and clinical presentation–that affects thousands of people each year. The Massachusetts General Hospital Postpartum Psychosis Project (MGHP3) was established to: 1) describe the phenomenology of PP, and 2) identify genomic and clinical predictors in a large cohort. Results thus far point to a richer understanding of the heterogeneity and complexity of this often-misunderstood illness and its nature over time. Data are collected from those who experienced PP within 6 months of delivery and within the 10 years prior to the MGHP3 interview. Participants provide information via the Mini International Neuropsychiatric Interview for Psychotic Disorders Studies (MINI-PDS), MGHP3© Questionnaire (including assessment of episode onset, duration, symptoms, and treatment received), and other relevant history. This retrospective study uses validated diagnostic tools to evaluate psychiatric history across participants’ lifetimes. Descriptive statistics (e.g., median values, frequencies) were conducted to describe the phenomenology of PP. As of November 3, 2022, 248 participants with histories of at least one episode of PP completed the MGHP3 interview. Most participants met criteria for Bipolar I Disorder with psychotic features (71.8%). During PP episode(s), participants reported odd beliefs or delusions (87.6%), persecutory delusions (75.2%), ideas of reference (55.8%), and visual (52.3%) and/or auditory (48.1%) hallucinations. The median time between delivery and symptom onset was 10 days (SD = 43.72). Most participants reported receiving medication (93.0%) and/or psychotherapy (65.9%). This report describes findings regarding the phenomenology of postpartum psychosis among the MGHP3 cohort, the largest cohort with validated PP studied to date. This ongoing effort to refine the phenotype of PP and to delineate underlying genetic determinants of the disorder will contribute to an enhanced understanding of this serious illness. It also underscores areas for further rigorous assessment using other research methods and sets the stage for translational reproductive neuroscience – including ongoing analyses of neuroimaging and genetic data from the MGHP3 cohort.

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Fig. 1: Time to psychotic symptom onset following delivery.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Notes

  1. Several protocol deviations were made to include participants who had their episode more than 10 years before the interview date but were confident in strong recollection of their episodes.

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Acknowledgements

This study was supported by the Jeanne and Gerhard Andlinger Research Fund for Innovative Science at Massachusetts General Hospital and The Rosalie Katz Family Foundation.

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Author notes

  1. These authors contributed equally: Rachel Vanderkruik, Marlene P. Freeman.

Authors and Affiliations

  1. Ammon-Pinizzotto Center for Women’s Mental Health, Massachusetts General Hospital, Boston, MA, USA

    Lee S. Cohen, Miranda Arakelian, Taylor R. Church, Madison M. Dunk, Margaret L. Gaw, Hannah E. Yoon, Lauren A. Kobylski, Rachel Vanderkruik & Marlene P. Freeman

  2. Department of Psychological & Brain Sciences, George Washington University, Washington, DC, USA

    Lauren A. Kobylski

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Contributions

Conceptualization: Lee S. Cohen, Marlene P. Freeman. Funding acquisition: Lee S. Cohen, Marlene P. Freeman. Methodology: Lee S. Cohen, Marlene P. Freeman. Data collection: Miranda Arakelian, Taylor R. Church, Madison M. Dunk, Margaret L. Gaw, Lauren A. Kobylski. Writing – original draft: Lee S. Cohen, Miranda Arakelian, Taylor R. Church, Lauren A. Kobylski, Rachel Vanderkruik, Marlene P. Freeman. Writing – review & editing: Lee S. Cohen, Miranda Arakelian, Taylor R. Church, Madison M. Dunk, Margaret L. Gaw, Hannah E. Yoon, Lauren A. Kobylski, Rachel Vanderkruik, Marlene P. Freeman.

Corresponding author

Correspondence to Lee S. Cohen.

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Competing interests

Lee S. Cohen, MD – 12-month disclosures as of 11/12/2024. Research Support: Dr. Cohen is an employee of Massachusetts General Hospital and works with the MGH National Pregnancy Registry. MGH National Pregnancy Registry: Current Sponsors: Alkermes, Inc. (2016–Present); Dr. Reddy’s Laboratories, Inc. (2023-Present); Eisai Inc. (2022 – Present); Otsuka America Pharmaceutical, Inc. (2008-Present); Sage Therapeutics (2019–2023 & 2024–Present); Supernus Pharmaceuticals (2021–Present); Teva Pharmaceutical Industries Ltd. (2018-Present). Past Sponsors: Forest/Actavis/Allergan (2016-2018, declined to sponsor: 2018-Present); Aurobindo Pharma (2020–2022, declined to sponsor: 2022–Present); AstraZeneca Pharmaceuticals (2009–2014, declined to sponsor: 2014-Present); AuroMedics Pharma LLC (2021–2022, declined to sponsor: 2022-Present); Johnson & Johnson/Janssen Pharmaceuticals, Inc (2019–2023, declined to sponsor: 2024-Present); Ortho-McNeil-Janssen Pharmaceuticals, Inc (2009–2014, declined to sponsor: 2015-Present); Pfizer, Inc. (2009–2011, declined to sponsor: 2012-Present); Sunovion Pharmaceuticals, Inc. (2011–2023, declined to sponsor: 2024-Present). Updated sponsors can be found at: https://womensmentalhealth.org/research/pregnancyregistry/. As an employee of MGH, Dr. Cohen works with the MGH CTNI and MGH Center for Women’s Mental Health, which has had research funding from multiple pharmaceutical companies and NIMH. Other research support: National Institutes of Health, Sage Therapeutics. Advisory/Consulting: None. Speaking/Honoraria: None. Marlene P. Freeman, MD – 36-month disclosures as of 11/12/2024. Research Support: Dr. Freeman is an employee of Massachusetts General Hospital and works with the MGH National Pregnancy Registry. MGH National Pregnancy Registry: Current Sponsors: Alkermes, Inc. (2016–Present); Dr. Reddy’s Laboratories, Inc. (2023-Present); Eisai Inc. (2022 – Present); Otsuka America Pharmaceutical, Inc. (2008–Present); Sage Therapeutics (2019–2023 & 2024-Present); Supernus Pharmaceuticals (2021-Present); Teva Pharmaceutical Industries Ltd. (2018-Present). Past Sponsors: Forest/Actavis/Allergan (2016–2018, declined to sponsor: 2018-Present); Aurobindo Pharma (2020–2022, declined to sponsor: 2022–Present); AstraZeneca Pharmaceuticals (2009–2014, declined to sponsor: 2014–Present); AuroMedics Pharma LLC (2021–2022, declined to sponsor: 2022–Present); Johnson & Johnson/Janssen Pharmaceuticals, Inc (2019–2023, declined to sponsor: 2024–Present) ; Ortho-McNeil-Janssen Pharmaceuticals, Inc (2009-2014, declined to sponsor: 2015–Present); Pfizer, Inc. (2009–2011, declined to sponsor: 2012-Present); Sunovion Pharmaceuticals, Inc. (2011–2023, declined to sponsor: 2024-Present). Updated sponsors can be found at: https://womensmentalhealth.org/research/pregnancyregistry/. As an employee of MGH, Dr. Freeman works with the MGH CTNI and MGH Center for Women’s Mental Health, which has had research funding from multiple pharmaceutical companies and NIMH. Other Research Support: Sage Therapeutics, National Institute of Aging (NIA), National Institute of Mental Health (NIMH), consulting through CTNI. Advisory/Consulting, Data Safety Committees/Independent Data Safety and Monitoring Committees: Janssen (Johnson& Johnson), Novartis, Neurocrine; Eliem, Sage; Brainify; Everly Health; Tibi Health; Relmada; Beckley Psytech; Brii Biotech; Reunion. Speaking/Honoraria: MGH Psych Academy, WebMD, Medscape, Pri-Med, Postpartum Support International, PRIME, HMP Global, CME Institute. Miranda Arakelian, BA, Taylor R. Church, BS, Madison M. Dunk, BA, Margaret L. Gaw, BA, Hannah E. Yoon, BA, Lauren A. Kobylski, MPH, Rachel Vanderkruik, PhD MSc have no conflicts of interest to disclose.

Ethical approval

All study procedures were performed in accordance with The Massachusetts General Hospital Institutional Review Board’s relevant guidelines and regulations (IRB Protocol #: 2018P000886). Informed consent was obtained from all participants.

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Cohen, L.S., Arakelian, M., Church, T.R. et al. The phenomenology of postpartum psychosis: preliminary findings from the Massachusetts General Hospital Postpartum Psychosis Project. Mol Psychiatry 30, 2537–2544 (2025). https://doi.org/10.1038/s41380-024-02856-3

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