Risk factors and stress variables that differentiate depressed from nondepressed pregnant women

Eight hundred ten pregnant women (N=340 depressed and N=470 nondepressed) were recruited at prenatal clinics at around 20 weeks gestational age. The women were diagnosed as depressed based on the Center for Epidemiological Studies Depression scale (CES-D) and the Structured Clinical Interview for Depression (SCID). They were interviewed on several demographic variables, risk factors and stress questionnaires. On average, the depressed pregnant women were younger, had lower education levels and socioeconomic status and were less often married. Fewer of the depressed women and their partners were happy when they were told they were pregnant, a greater number of the depressed women experienced a stressful situation during pregnancy, more of the depressed women were prescribed antibiotics during pregnancy, the depressed women had less optimal obstetric complications scores, and a greater percentage of them delivered prematurely. Finally, the scores of the depressed pregnant women on the stress questionnaires suggested greater depression (CES-D), anxiety (STAI), anger (STAXI), pregnancy anxieties (PAAS) and daily hassles.

Happy faces are habituated more slowly by infants of depressed mothers

Three-month-old infants of depressed (n=16) and non-depressed mothers (n=16) were habituated to video clips of a female model reciting phrases while posing happy or sad facial/vocal expressions and dishabituated to the alternate expressions. Overall, infants of depressed mothers took longer to habituate the video clips compared to infants of non-depressed mothers, and those assigned to habituate the sad video clips displayed a novelty response or dishabituated to the happy expressions. These findings suggest that 3-month-old infants of depressed mothers discriminate sad from happy expressions, however, they do not appear to perceive sad expressions as novel.

Newborns of depressed mothers who received moderate versus light pressure massage during pregnancy

Sixty-four neonates (M age=6.8 days) of depressed mothers who received moderate pressure massage versus light pressure massage therapy during pregnancy (month 5 through month 8) were compared on their behaviors during 15-min observations and on their performance on the Brazelton Neonatal Behavior Assessment Scale. The group of neonates whose mothers received moderate pressure massage spent a greater percent of the observation time smiling and vocalizing, and they received better scores on the orientation, motor, excitability, and depression clusters of the Brazelton scale.

Cortisol decreases and serotonin and dopamine increase following massage therapy

In this article the positive effects of massage therapy on biochemistry are reviewed including decreased levels of cortisol and increased levels of serotonin and dopamine. The research reviewed includes studies on depression (including sex abuse and eating disorder studies), pain syndrome studies, research on auto-immune conditions (including asthma and chronic fatigue), immune studies (including HIV and breast cancer), and studies on the reduction of stress on the job, the stress of aging, and pregnancy stress. In studies in which cortisol was assayed either in saliva or in urine, significant decreases were noted in cortisol levels (averaging decreases 31%). In studies in which the activating neurotransmitters (serotonin and dopamine) were assayed in urine, an average increase of 28% was noted for serotonin and an average increase of 31% was noted for dopamine. These studies combined suggest the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions and stressful experiences.

Prenatal maternal cortisol, fetal activity and growth

Pregnant women (N = 131) were recruited at a prenatal ultrasound clinic between 20 and 28 weeks (M = 24 weeks) gestation. The women were given the CES-D for depression and the State-Trait Anxiety Inventory and were asked to provide a urine sample to be assayed for cortisol, norepinephrine, epinephrine, dopamine, and serotonin. Ultrasound sessions were conducted and coded for fetal activity and estimated fetal weight. Regression analyses were then conducted with fetal activity and fetal weight as outcome variables. Gestational age entered both analyses as the first variable followed by: (1) prenatal cortisol as a significant predictor of fetal activity; and (2) prenatal cortisol as a significant predictor of estimated fetal weight.

Breast cancer patients have improved immune and neuroendocrine functions following massage therapy

OBJECTIVES

Women with breast cancer are at risk for elevated depression, anxiety, and decreased natural killer (NK) cell number. Stress has been linked to increased tumor development by decreasing NK cell activity. The objectives of this study included examining massage therapy for women with breast cancer for (1) improving mood and biological measures associated with mood enhancement (serotonin, dopamine), (2) reducing stress and stress hormone levels, and (3) boosting immune measures.

METHODS

Thirty-four women (M age=53) diagnosed with Stage 1 or 2 breast cancer were randomly assigned postsurgery to a massage therapy group (to receive 30-min massages three times per week for 5 weeks) or a control group. The massage consisted of stroking, squeezing, and stretching techniques to the head, arms, legs/feet, and back. On the first and last day of the study, the women were assessed on (1) immediate effects measures of anxiety, depressed mood, and vigor and (2) longer term effects on depression, anxiety and hostility, functioning, body image, and avoidant versus intrusive coping style, in addition to urinary catecholamines (norepinephrine, epinephrine, and dopamine) and serotonin levels. A subset of 27 women (n=15 massage) had blood drawn to assay immune measures.

RESULTS

The immediate massage therapy effects included reduced anxiety, depressed mood, and anger. The longer term massage effects included reduced depression and hostility and increased urinary dopamine, serotonin values, NK cell number, and lymphocytes.

CONCLUSIONS

Women with Stage 1 and 2 breast cancer may benefit from thrice-weekly massage therapy for reducing depressed mood, anxiety, and anger and for enhancing dopamine, serotonin, and NK cell number and lymphocytes.

Pregnancy anxiety and comorbid depression and anger: effects on the fetus and neonate

One hundred sixty-six women were classified as experiencing high or low anxiety during the second trimester of pregnancy. The high anxiety women also had high scores on depression and anger scales. In a follow-up across pregnancy, the fetuses of the high anxiety women were noted to be more active and to experience growth delays. The high anxiety mothers' high prenatal norepinephrine and low dopamine levels were followed by their neonates having low dopamine and serotonin levels. The high anxiety mothers' newborns also had greater relative right frontal EEG activation and lower vagal tone. Finally, the newborns of high anxiety mothers spent more time in deep sleep and less time in quiet and active alert states and showed more state changes and less optimal performance on the Brazelton Neonatal Behavior Assessment Scale (motor maturity, autonomic stability and withdrawal). These data highlight the need for prenatal intervention for elevated anxiety symptoms during pregnancy.

Sucrose attenuates a negative electroencephalographic response to an aversive stimulus for newborns

Reports that sweet taste calms crying in newborns and is analgesic against the pain caused by a heel lance served as the basis for this study. Electroencephalographic (EEG) activity, heart rate activity, and infants' facial behaviors were recorded before and after a noninvasive, but noxious, heelstroke (procedure from the Brazelton Neonatal Behavior Assessment Scale). In a randomized and controlled trial, 34 newborns were administered 2 mL of water or sucrose solution before the heelstroke. Frontal EEG asymmetry scores were computed, and power in the 3 to 6 Hz frequency band was analyzed. Infants who received water showed increased relative right frontal EEG activation from baseline to the post-heelstroke phase, a pattern that typifies negative affect. The EEG of infants in the sucrose group did not change. Heart rate increased rapidly in both groups during the heelstroke phase. However, after the heelstroke, the heart rate of infants who received sucrose returned to baseline, whereas the heart rate of infants who tasted water remained elevated. During the heelstroke, the infants in the water group cried and grimaced twice as long as the infants in the sucrose group. These findings add to the growing literature showing that sucrose attenuates newborns' negative response to aversive or noxious stimuli.

Music effects on EEG in intrusive and withdrawn mothers with depressive symptoms

The EEG patterns of 48 intrusive and withdrawn mothers with depressive symptoms were assessed following a 20-minute music session to determine if the music had mood-altering effects. Half the mothers listened to classical music while half listened to rock music. Intrusive mothers were expected to have more positive responses and more symmetrical EEG following the calming classical music, while withdrawn mothers were expected to have a more positive response and symmetrical EEG following the energizing rock music. Although more positive EEGs were noted for rock music in both groups, only the withdrawn mothers showed a significant change in EEG toward symmetry following rock music, and only the intrusive mothers showed a decrease in cortisol levels following the rock music. Their State Anxiety Inventory (STAI) anxiety levels also decreased, while the Profile of Mood States (POMS) depressed mood levels decreased significantly for all four groups following music.

Adolescents' parent and peer relationships

High school seniors (N = 89) from a suburban private high school were administered a comprehensive questionnaire to determine differences between adolescents who rated the quality of their parent and peer relationships as high or low. Adolescents with high parent and high peer relationship scores had more friends, greater family togetherness, lower levels of depression and drug use, and a higher grade point average.

EEG asymmetry responses to lavender and rosemary aromas in adults and infants

Frontal EEG asymmetry shifting from baseline was examined in adults and infants exposed to lavender and rosemary by reanalyzing previously published data, using techniques different from those utilized in the original two studies. Results from Study 1 on 39 adults revealed significant EEG shifting in the lavender group, with greater relative left frontal EEG activation (associated with greater approach behavior and less depressed affect). The participants in the two aroma groups were further grouped by those with greater baseline, relative to left frontal EEG activation, versus those with a greater baseline, relative to right frontal activation. Collapsing across aroma groups, those with greater baseline, relative to right frontal activation, shifted left during the aroma. Those with greater baseline relative to left frontal activation did not change. In the rosemary group, those with greater baseline relative to right frontal EEG activation shifted left during the aroma, while those with greater baselines relative to left frontal EEG activation shifted right. In the lavender group, those with greater baselines relative to right frontal baseline EEG activation shifted left, but those with greater baselines relative to left baseline did not shift. Study 2 on 27 full-term newborns revealed no significant shifts in asymmetry in either aroma group. However, when the aroma groups were collapsed, the right frontal EEG group exhibited significant shifting relative to left frontal EEG activation. This finding was similar to the adult findings, suggesting that either lavender or rosemary may induce left frontal EEG shifting in adults and infants who show greater baselines relative to right frontal EEG activation.

Relative right versus left frontal EEG in neonates

Although infants have been noted to have greater relative right or left frontal EEG as early as the neonatal period, other ways in which these newborns differ have not been reported. In this study, 48 newborns were divided on the basis of greater relative right versus greater relative left frontal EEG to determine whether these groups differed in other ways at the neonatal period including behavior, physiology, and biochemistry. We also were interested in whether these EEG patterns were related to any prenatal maternal variables including mood states (depression, anxiety, anger) and biochemistry as well as fetal activity. The greater relative right frontal EEG newborns had mothers with lower prenatal and postnatal serotonin and higher postnatal cortisol levels. The mothers of the greater relative right frontal EEG newborns also had greater relative right frontal EEG activation and lower vagal tone. The greater relative right frontal EEG newborns themselves had elevated cortisol levels, showed a greater number of state changes during sleep/wake behavior observations, and performed less optimally on the Brazelton Neonatal Behavior Assessment (T. B. Brazelton, 1973) including the habituation, motor, range of state, excitability, and depressive symptoms scales. These data suggest that greater relative right frontal EEG newborns may be at greater risk for developmental problems than those with greater relative left frontal EEG activation. In addition, a discriminant function analysis correctly classified 67% of the newborns' EEGs by prenatal maternal variables, suggesting that these might be used to target pregnant women for prenatal intervention.

Adolescent depression and risk factors

Seventy-nine high school seniors were administered the Center for Epidemiological Studies Depression Scale (CES-D), as well as a questionnaire on parent relationships, peer relationships, positive and negative feelings including suicidal thoughts, and lifestyle variables including academic performance, exercise, and drug use. The group of adolescents who scored above the clinical cutoff for depression on the CES-D (n = 29) had poorer relations with parents. Further, the incidence of paternal depression in that group was greater. The depressed adolescents also had less optimal peer relationships, fewer friends, and were less popular. They experienced less happiness and more frequent suicidal thoughts. They spent less time doing homework, had a lower grade point average, and spent less time exercising. The depressed group also reported more use of marijuana and cocaine. A stepwise regression indicated that physical affection with parents, homework, well-being, exercise, happiness, and parent relations explained 55% of the variance.

Prenatal anger effects on the fetus and neonate

One hundred and sixty-six women were classified as experiencing high or low anger during the second trimester of pregnancy. The high-anger women also had high scores on depression and anxiety scales. In a follow-up across pregnancy, the fetuses of the high-anger women were noted to be more active and to experience growth delays. The high-anger mothers' high prenatal cortisol and adrenaline and low dopamine and serotonin levels were mimicked by their neonates' high cortisol and low dopamine levels. The high-anger mothers and infants were also similar on their relative right frontal EEG activation and their low vagal tone. Finally, the newborns of high-anger mothers had disorganised sleep patterns (greater indeterminate sleep and more state changes) and less optimal performance on the Brazelton Neonatal Behavior Assessment Scale (orientation, motor maturity and depression). These data highlight the need for prenatal intervention for elevated angry mood during pregnancy.