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1 Supplementary Online Content Di Florio A, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N, Jones I. Perinatal episodes across the mood disorder spectrum. Arch Gen Psychiatry. Published online December 17, doi: /jamapsychiatry etable. Studies Reporting the Rates of Perinatal Episodes in Mood Disorders ereferences. This supplementary material has been provided by the authors to give readers additional information about their work.

2 etable 1: Studies reporting the rates of perinatal episodes in mood disorders. First Author Year Country Sampling Sample characteristics Time window Outcome Outcome N % Kendell UK E Pregnancies in women with a history of manic depressive illness manic or circular 90 days post Incidence Psychiatric admissions Blehar US G Parous women with a history of BD-I Severe emotional disturbance ~50% Viguera US, Italy C Pregnant women with a history of BD-I, BD- Jones UK G Pregnancies in women with BD-I, or schizoaffective disorder, bipolar type Pregnancy Incidence Mania, or hypomania, or MD 24 weeks post weeks post Incidence Mania or psychosis Parous women with a history of BD-I or schizoaffective disorder, bipolar type Freeman US C Parous women with a history of BD-I or BD- Pregnancy 6 weeks post Post Any DSM-IV affective episode Mania or psychosis 38.2 MDE or anxiety disorders Any DSM-IV mood episode Eberhard Norway E Pregnancies in women with a history of Gran 6 depression Pregnancy-12 months post Incidence EPDS > Cohen US C Pregnant women with a history of MDD Pregnancy Incidence MDE Payne US G Parous women with a history of BD-I 1 month post Mood symptoms a Parous women with a history BD Parous women with a history MDD Harlow Sweden E 1 st time pregnant women with a history of 90 days post Incidence Hospitalization BD-I For BD Pregnancy 1.4 Viguera US C Pregnant women with a history of BD-I or Pregnancy Incidence MDE

3 Munk Denmark E Olsen 11 BD- 1 st time pregnant women with a history of BD 90 days post 1 st time pregnant women with a history of 1 year post MDD Colom Spain C Parous women with a history of BD-I or BD- 4 weeks post Cumulative incidence Hypomania 16.9 Mania 6.7 Re-admission to a 22 psychiatric hospital ~5% MDE Mania or mixed episode 16.7 Viguera US, Italy C Parous women with a history of BD-I Parous women with a history of BD- Parous women with a history of RMD Search methods and selection criteria of papers available on request. DSM-I/IV Mania or 7.9 Mixed DSM-I/IV MDE 19.2 Psychosis 1.9 DSM-IV hypomania 2.3 DSM-I/IV MDE a By asking Have you ever had any severe emotional problems within a month of childbirth? Abbreviations: BD: bipolar disorder: BD-I bipolar disorder, type I: BD-: bipolar disorder, type, C: Clinical, DSM: Diagnostic and Statistical Manual of Mental Disorders, E: epidemiological, EPDS: Edinburgh Postnatal Depression Scale, G: genetic family study; MDD: major depressive disorder, MDE: major depressive episode.

4 ereferences 1. Kendell RE, Chalmers JC, Platz C. Epidemiology of puerperal psychoses. Br J Psychiatry. 1987;150: Blehar MC, DePaulo JR Jr, Gershon ES, Reich T, Simpson SG, Nurnberger JI Jr. Women with bipolar disorder: findings from the NIMH Genetics Initiative sample. Psychopharmacol Bull. 1998;34(3): Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ. Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatry. 2000;157(2): Jones I, Craddock N. Familiality of the puerperal trigger in bipolar disorder: results of a family study. Am J Psychiatry. 2001;158(6): Freeman MP, Smith KW, Freeman SA, McElroy SL, Kmetz GE, Wright R, Keck PE Jr. The impact of reproductive events on the course of bipolar disorder in women. J Clin Psychiatry. 2002;63(4): Eberhard-Gran M, Tambs K, Opjordsmoen S, Skrondal A, Eskild A. Depression during pregnancy and after delivery: a repeated measurement study. J Psychosom Obstet Gynaecol. 2004;25(1): Cohen LS, Altshuler LL, Harlow BL, Nonacs R, Newport DJ, Viguera AC, Suri R, Burt VK, Hendrick V, Reminick AM, Loughead A, Vitonis AF, Stowe ZN. Relapse of major depression during pregnancy in women who maintain or discontinue antidepressant treatment. JAMA. 2006;295(5): Payne JL, Roy PS, Murphy-Eberenz K, Weismann MM, Swartz KL, McInnis MG, Nwulia E, Mondimore FM, MacKinnon DF, Miller EB, Nurnberger JI, Levinson DF, DePaulo JR Jr, Potash JB. Reproductive cycle-associated mood symptoms in women with major depression and bipolar disorder. J Affect Disord. 2007;99(1-3): Harlow BL, Vitonis AF, Sparen P, Cnattingius S, Joffe H, Hultman CM. Incidence of hospitalization for post psychotic and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations. Arch. Gen. Psychiatry. 2007;64(1): Viguera AC, Whitfield T, Baldessarini RJ, Tondo L, Murray A, Baldessarini RJ. Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation. Am J Psychiatry. 2007;164(12): ; quiz 1923.

5 11. Munk-Olsen T, Laursen TM, Mendelson T, Pedersen CB, Mors O, Mortensen PB. Risks and predictors of readmission for a mental disorder during the post period. Arch. Gen. Psychiatry. 2009;66(2): Colom F, Cruz N, Pacchiarotti I, Mazzarini L, Goikolea JM, Popova E, Torrent C, Vieta E. Post bipolar episodes are not distinct from spontaneous episodes: implications for DSM-V. J Affect Disord. 2010;126(1-2): Viguera AC, Tondo L, Koukopoulos AE, Reginaldi D, Lepri B, Baldessarini RJ. Episodes of mood disorders in 2,252 pregnancies and post periods. Am J Psychiatry Accessed September 24, 2011.

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