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Hutchens BF, Kearney J, Kennedy HP. Survivors of Child Maltreatment and Postpartum Depression: An Integrative Review. J Midwifery Womens Health 2017; 62:706-722. [DOI: 10.1111/jmwh.12680] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 08/08/2017] [Accepted: 08/15/2017] [Indexed: 01/29/2023]
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Hauff NJ, Fry-McComish J, Chiodo LM. Cumulative trauma and partner conflict predict post-traumatic stress disorder in postpartum African-American women. J Clin Nurs 2017; 26:2372-2383. [PMID: 27271531 DOI: 10.1111/jocn.13421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2016] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE To describe relationships between cumulative trauma, partner conflict and post-traumatic stress in African-American postpartum women. BACKGROUND Cumulative trauma exposure estimates for women in the USA range from 51-69%. During pregnancy, most trauma research has focused on physical injury to the mother. Post-traumatic stress disorder (PTSD) is associated with trauma and more prevalent in African-American women than women of other groups. Knowledge about both the rate and impact of cumulative trauma on pregnancy may contribute to our understanding of women seeking prenatal care, and disparities in infant morbidity and mortality. DESIGN This retrospective, correlational, cross-sectional study took place on postpartum units of two Detroit hospitals. Participants were 150 African-American women aged between 18-45 who had given birth. METHODS Mothers completed the Cumulative Trauma Scale, Conflict Tactics Scale, Clinician Administered Post-traumatic Stress Scale, Edinburgh Postnatal Depression Scale and a Demographic Data form. Descriptive statistics, correlations and multiple regressions were used for data analysis. RESULTS All participants reported at least one traumatic event in their lifetime. Cumulative trauma and partner conflict predicted PTSD, with the trauma of a life-threatening event for a loved one reported by 60% of the sample. Nearly, one-fourth of the women screened were at risk for PTSD. Increased cumulative trauma, increased partner conflict and lower level of education were related to higher rates of PTSD symptoms. CONCLUSION Both cumulative trauma and partner conflict in the past year predict PTSD. Reasoning was used most often for partner conflict resolution. RELEVANCE TO CLINICAL PRACTICE The results of this study offer additional knowledge regarding relationships between cumulative trauma, partner conflict and PTSD in African-American women. Healthcare providers need to be sensitive to patient life-threatening events, personal failures, abuse and other types of trauma. Current evidence supports the need to assess for post-traumatic stress symptoms during pregnancy.
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Affiliation(s)
- Nancy J Hauff
- Family, Community, and Mental Health, College of Nursing, Wayne State University, Detroit, MI, USA
| | - Judith Fry-McComish
- Family, Community, and Mental Health, College of Nursing, Wayne State University, Detroit, MI, USA
| | - Lisa M Chiodo
- College of Nursing, University of Massachusetts, Amherst, MA, USA
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Vu H, Shaya FT. Predicting Factors of Depression, Antidepressant Use and Positive Response to Antidepressants in Perinatal and Postpartum Women. Clin Pract Epidemiol Ment Health 2017; 13:49-60. [PMID: 28761500 PMCID: PMC5510557 DOI: 10.2174/1745017901713010049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/30/2017] [Accepted: 05/15/2017] [Indexed: 11/22/2022]
Abstract
Background: In the United States, there is a disparity in knowledge of nationwide depression prevalence, the antidepressant use and the antidepressant responses during perinatal/postpartum periods. Objective: This study investigated the predicting factors of depression, antidepressant use and positive antidepressant response during the perinatal/postpartum periods. Method: The 2007-2012 National Health and Nutrition Examination Surveys (NHANES) were combined to identify adult pregnant women, those within the 18-month postpartum period (n=492) and their depression statuses via demographics, health care accessibility, antidepressant use and illicit drug use information. The characteristics of different study groups were compared (depression versus no-depression groups, antidepressant users versus non-antidepressant users, and antidepressant responders versus antidepressant non-responders). Multivariable logistic regression analysis was used to predict factors of perinatal depression (PND)/ postpartum depression (PPD), antidepressant use and antidepressant positive response in PND/PPD. Results: PND/PPD individuals had higher rates of mental health visits. No predicting factor for developing PND/PPD was shown. Antidepressant users were significantly older with insurance and recent health checkups/ mental visits. Being below the poverty level and having some health care accessibility are predictors for being on antidepressants. Recent non-illicit drug use is a predictor for PND/PPD symptom improvement while on antidepressants. Conclusion: The group of those with social-economic disadvantages was more likely to be on antidepressants for PND/PPD. Illicit drug users were less likely to show improvement with antidepressants. The safety and efficacy of antidepressant use during this period is controversial. More studies need to focus on the barriers involving antidepressant treatments, the safety and outcomes of antidepressants for PND/PPD management.
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Affiliation(s)
- Huyen Vu
- University of Maryland School of Pharmacy, Department of Pharmacy Practice and Science, Baltimore, MD, USA
| | - Fadia T Shaya
- University of Maryland School of Pharmacy, Department of Pharmaceutical Health Services Research Baltimore, MD, USA
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Meltzer-Brody S, Maegbaek ML, Medland SE, Miller WC, Sullivan P, Munk-Olsen T. Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women. Psychol Med 2017; 47:1427-1441. [PMID: 28112056 PMCID: PMC5429203 DOI: 10.1017/s0033291716003020] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Childbirth is a potent trigger for the onset of psychiatric illness in women including postpartum depression (PPD) and postpartum psychosis (PP). Medical complications occurring during pregnancy and/or childbirth have been linked to postpartum psychiatric illness and sociodemographic factors. We evaluated if pregnancy and obstetrical predictors have similar effects on different types of postpartum psychiatric disorders. METHOD A population-based cohort study using Danish registers was conducted in 392 458 primiparous women with a singleton delivery between 1995 and 2012 and no previous psychiatric history. The main outcome was first-onset postpartum psychiatric episodes. Incidence rate ratios (IRRs) were calculated for any psychiatric contact in four quarters for the first year postpartum. RESULTS PPD and postpartum acute stress reactions were associated with pregnancy and obstetrical complications. For PPD, hyperemesis gravidarum [IRR 2.69, 95% confidence interval (CI) 1.93-3.73], gestational hypertension (IRR 1.84, 95% CI 1.33-2.55), pre-eclampsia (IRR 1.45, 95% CI 1.14-1.84) and Cesarean section (C-section) (IRR 1.32, 95% CI 1.13-1.53) were associated with increased risk. For postpartum acute stress, hyperemesis gravidarum (IRR 1.93, 95% CI 1.38-2.71), preterm birth (IRR 1.51, 95% CI 1.30-1.75), gestational diabetes (IRR 1.42, 95% CI 1.03-1.97) and C-section (IRR 1.36, 95% CI 1.20-1.55) were associated with increased risk. In contrast, risk of PP was not associated with pregnancy or obstetrical complications. CONCLUSIONS Pregnancy and obstetrical complications can increase the risk for PPD and acute stress reactions but not PP. Identification of postpartum women requiring secondary care is needed to develop targeted approaches for screening and treatment. Future work should focus on understanding the contributions of psychological stressors and underlying biology on the development of postpartum psychiatric illness.
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Affiliation(s)
- S. Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. L. Maegbaek
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - S. E. Medland
- Quantitative Genetics, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - W. C. Miller
- Department of Epidemiology, The Ohio State University, Columbus, OH, USA
| | - P. Sullivan
- Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - T. Munk-Olsen
- National Center for Register-based Research, Aarhus University, Aarhus, Denmark
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55
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Di Florio A, Putnam K, Altemus M, Apter G, Bergink V, Bilszta J, Brock R, Buist A, Deligiannidis KM, Devouche E, Epperson CN, Guille C, Kim D, Lichtenstein P, Magnusson PKE, Martinez P, Munk-Olsen T, Newport J, Payne J, Penninx BW, O’Hara M, Robertson-Blackmore E, Roza SJ, Sharkey KM, Stuart S, Tiemeier H, Viktorin A, Schmidt PJ, Sullivan PF, Stowe ZN, Wisner KL, Jones I, Rubinow DR, Meltzer-Brody S. The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale. Psychol Med 2017; 47:787-799. [PMID: 27866476 PMCID: PMC5369767 DOI: 10.1017/s0033291716002087] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset. METHOD Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA. RESULTS Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01). CONCLUSIONS Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
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Affiliation(s)
- A. Di Florio
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
| | - K. Putnam
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Altemus
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - G. Apter
- Erasme Hospital, Paris Diderot University, Paris, France
| | - V. Bergink
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
- Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - J. Bilszta
- Women’s Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - R. Brock
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - A. Buist
- Women’s Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - K. M. Deligiannidis
- Departments of Psychiatry and Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Glen Oaks, NY, USA
| | - E. Devouche
- Erasme Hospital, Paris Descartes University, Paris, France
| | - C. N. Epperson
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - C. Guille
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA
| | - D. Kim
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - P. Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. K. E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. Martinez
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
| | - T. Munk-Olsen
- Department of Economics and Business, National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - J. Newport
- Department of Psychiatry, University of Miami, Miami, FL, USA
| | - J. Payne
- Department of Psychiatry, The Johns Hopkins University, Baltimore, MD, USA
| | - B. W. Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - M. O’Hara
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | | | - S. J. Roza
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - K. M. Sharkey
- Department of Psychiatry, Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
| | - S. Stuart
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - H. Tiemeier
- Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - A. Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - P. J. Schmidt
- Behavioral Endocrinology Branch, National Institute of Mental Health, National Institutes of Health, Health and Human Services, Bethesda, MD, USA
| | - P. F. Sullivan
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Z. N. Stowe
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - K. L. Wisner
- Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - I. Jones
- Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University School of Medicine, Cardiff, UK
| | - D. R. Rubinow
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S. Meltzer-Brody
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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56
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Matthey S, Agostini F. Using the Edinburgh Postnatal Depression Scale for women and men-some cautionary thoughts. Arch Womens Ment Health 2017; 20:345-354. [PMID: 28078472 DOI: 10.1007/s00737-016-0710-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/22/2016] [Indexed: 12/16/2022]
Abstract
The objective of the study was to critically consider some of the possible limitations in the Edinburgh Depression Scale (EDS), given that great emphasis is put on the results of this measure within both clinical and research fields. Using findings and discussion points from other studies, as well as from a critical analysis of issues by the authors based upon their clinical and research experience, possible limitations with the scale in nine areas are discussed. Possible limitations include the following: (1) ambiguous items, (2) exclusion of certain types of distress, (3) scoring difficulties, (4) low positive predictive value, (5) frequent use of incorrect cut-off scores, (6) a vast array of validated cut-off scores, (7) validation against a questionable gold-standard, (8) limited anxiety detection and of depressive symptoms in men, and (9) many screen positive women only have transient distress. While the EDS has unquestionably been an extremely valuable instrument in aiding in the recognition of the importance of perinatal mental health, users of the scale should be aware that it, like other measures, has limitations. We discuss possible strategies to overcome these limitations and describe a recent scale that has been developed to surmount these shortcomings more effectively.
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Affiliation(s)
- Stephen Matthey
- South Western Sydney Local Health District, University of Sydney and UNSW, Sydney, Australia.
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57
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Pharmacologically Induced Sex Hormone Fluctuation Effects on Resting-State Functional Connectivity in a Risk Model for Depression: A Randomized Trial. Neuropsychopharmacology 2017; 42:446-453. [PMID: 27649641 PMCID: PMC5399242 DOI: 10.1038/npp.2016.208] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/26/2016] [Accepted: 09/11/2016] [Indexed: 02/07/2023]
Abstract
Women are at relatively greater lifetime risk for depression than men. This elevated risk in women is partly due to heightened risk during time periods characterized by marked fluctuations in sex hormones, including postpartum and perimenopausal periods. How sex hormone fluctuations contribute to heightened risk is not fully understood but may involve intrinsic functional connectivity. We induced a biphasic ovarian sex hormone fluctuation using the gonadotropin-releasing hormone agonist (GnRHa) goserelin to determine, with a randomized placebo-controlled design, intervention effects on or GnRHa-provoked depressive symptoms associations with change in resting-state functional connectivity (rs-FC) in 58 healthy women for six seeds (amygdala, hippocampus, anterior cingulate cortex, dorsal raphe, median raphe, and posterior cingulate cortex). GnRHa intervention did not significantly affect rs-FC in any seeds. Considering the GnRHa group only, the emergence of depressive symptoms following intervention was positively associated with amygdala-right temporal cortex and negatively associated with hippocampus-cingulate rs-FC. A test for mediation suggested that rs-FC changes in these networks marginally mediated the association between decrease in estradiol and increase in depressive symptoms in the GnRHa group (p=0.07). Our findings provide novel evidence-linking changes in rs-FC networks, the emergence of depressive symptoms and sex hormone fluctuations. Notably, we observed evidence that changes in rs-FC may represent a key neurobiological intermediary between molecular changes induced by hormone fluctuations and the emergence of depressive symptoms. Taken together, our findings indicate that sex hormone fluctuations may contribute to heightened risk for developing depressive symptoms by affecting intrinsic functional connectivity of key limbic brain structures.
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Choi KW, Sikkema KJ. Childhood Maltreatment and Perinatal Mood and Anxiety Disorders: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2016; 17:427-453. [PMID: 25985988 DOI: 10.1177/1524838015584369] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Perinatal mood and anxiety disorders (PMADs) compromise maternal and child well-being and may be influenced by traumatic experiences across the life course. A potent and common form of trauma is childhood maltreatment, but its specific impact on PMADs is not well understood. A systematic review was undertaken to synthesize empirical literature on the relationship between maternal histories of childhood maltreatment and PMADs. Of the 876 citations retrieved, 35 reports from a total of 26,239 participants met inclusion criteria, documenting substantial rates of childhood maltreatment and PMADs. Robust trends of association were observed between childhood maltreatment and perinatal depression, as well as post-traumatic stress disorder, but findings for anxiety were less consistent. Examining multivariate results suggested that childhood maltreatment predicts PMADs above and beyond sociodemographic, psychiatric, perinatal, and psychosocial factors, but may also be partially mediated by variables such as later victimization and moderated by protective early relationships. Future research should test mediating and moderating pathways using prospective cohorts, expanding to cross-cultural settings and other disorder outcomes. Treatment and prevention of childhood maltreatment and its sequelae may help mitigate risk for perinatal psychopathology and its impact on maternal and child outcomes.
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Affiliation(s)
- Karmel W Choi
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
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59
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McDonnell CG, Valentino K. Intergenerational Effects of Childhood Trauma: Evaluating Pathways Among Maternal ACEs, Perinatal Depressive Symptoms, and Infant Outcomes. CHILD MALTREATMENT 2016; 21:317-326. [PMID: 27457410 DOI: 10.1177/1077559516659556] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Maternal adverse childhood experiences (ACEs) have been associated with negative physical and mental health outcomes in adulthood. Less is known regarding how maternal ACEs relate to perinatal depressive symptoms or the intergenerational effect of maternal childhood trauma history on birth outcomes and infant functioning. To address this gap, an at-risk sample of 398 pregnant women was recruited from Women, Infants, and Children health clinics. Participants completed a prenatal ( M = 4.84 months before due date) and postnatal ( M = 6.76 months after birth) assessment and provided birth outcome data. At the prenatal assessment, mothers completed an ACEs measure which assessed experiences of childhood maltreatment and household dysfunction. Self-report measures of maternal depressive symptoms were obtained at both time points. Mothers reported on infant socioemotional functioning at 6 months. Maternal ACEs predicted higher levels of prenatal depressive symptoms. Childhood maltreatment experiences, in particular, predicted higher postnatal depressive symptoms and a smaller reduction in depressive symptoms across the perinatal period. Regarding intergenerational associations, maternal childhood maltreatment directly predicted higher levels of maladaptive infant socioemotional symptoms, whereas maternal household dysfunction indirectly related to infant socioemotional symptoms through maternal age at first pregnancy and infant birth weight. Limitations and future directions are discussed.
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60
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Pope CJ, Mazmanian D, Bédard M, Sharma V. Breastfeeding and postpartum depression: Assessing the influence of breastfeeding intention and other risk factors. J Affect Disord 2016; 200:45-50. [PMID: 27126139 DOI: 10.1016/j.jad.2016.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/11/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Risk and protective factors for postpartum depression have been extensively studied, and in recent studies an association between breastfeeding and maternal mood has been reported. The present retrospective, cross-sectional study was conducted to evaluate the association between breastfeeding-related variables and postpartum depression (based on Edinburgh Postnatal Depression Scale threshold criteria) within the context of other known risk factors. METHOD Breastfeeding information, demographic information, and scores on the Edinburgh Postnatal Depression Scale were examined from the Canadian Maternity Experience Survey. This survey contains data collected from 6421 Canadian mothers between October 2006 and January 2007, and 2848 women between five and seven months postpartum were included in the current analyses. RESULTS In contrast to previous research, logistic regression analyses revealed that when considered within the context of other risk factors, breastfeeding attempt and duration were not associated with postpartum depression at five to seven months postpartum. Although a relationship between the prenatal intention to combination feed and postpartum depression was observed, these variables were no longer related once other potential risk factors were controlled for. Factors that were associated with postpartum depression included lower income, higher perceived stress, lower perceived social support, no history of depression, or no recent history of abuse. LIMITATIONS A clinical diagnostic instrument was not used and variable selection was restricted to data collected as part of this survey. CONCLUSION These findings suggest that the association between breastfeeding and postpartum depression reported by previous researchers may in fact be due to alternative risk factors.
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Affiliation(s)
- Carley J Pope
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada.
| | - Dwight Mazmanian
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Michel Bédard
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Verinder Sharma
- Mood & Anxiety Program, Regional Mental Health Care, London, Ontario, Canada; Psychiatry and Obstetrics & Gynecology, Western University, London, Ontario, Canada
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Do changes in subjective sleep and biological rhythms predict worsening in postpartum depressive symptoms? A prospective study across the perinatal period. Arch Womens Ment Health 2016; 19:591-8. [PMID: 26920913 DOI: 10.1007/s00737-016-0612-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/15/2016] [Indexed: 02/04/2023]
Abstract
Abnormalities of sleep and biological rhythms have been widely implicated in the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD). However, less is known about the influence of biological rhythm disruptions across the perinatal period on postpartum depression (PPD). The objective of this study was to prospectively evaluate the relationship between subjective changes in both sleep and biological rhythms and worsening of depressive symptoms from pregnancy to the postpartum period in women with and without mood disorders. Eighty-three participants (38 euthymic women with a history of a mood disorder and 45 healthy controls) were studied. Participants completed subjective assessments of sleep (Pittsburgh Sleep Quality Index), biological rhythm disturbances (Biological Rhythms Interview of Assessment in Neuropsychiatry), and depressive symptoms (Edinburgh Postnatal Depression Scale) prospectively at two time points: third trimester of pregnancy and at 6-12 weeks postpartum. Multivariate regression analyses showed that changes in biological rhythms across the perinatal period predicted worsening of depressive symptoms in both groups. Moreover, women with a history of a mood disorder showed higher levels of sleep and biological rhythm disruption during both pregnancy and the postpartum period. These findings suggest that disruptions in biological rhythms during the perinatal period increase the risk for postpartum mood worsening in healthy pregnant as well as in pregnant women with a history of mood disorders.
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62
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Deligiannidis KM, Kroll-Desrosiers AR, Mo S, Nguyen HP, Svenson A, Jaitly N, Hall JE, Barton BA, Rothschild AJ, Shaffer SA. Peripartum neuroactive steroid and γ-aminobutyric acid profiles in women at-risk for postpartum depression. Psychoneuroendocrinology 2016; 70:98-107. [PMID: 27209438 PMCID: PMC4907817 DOI: 10.1016/j.psyneuen.2016.05.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/12/2016] [Accepted: 05/07/2016] [Indexed: 01/21/2023]
Abstract
Neuroactive steroids (NAS) are allosteric modulators of the γ-aminobutyric acid (GABA) system. NAS and GABA are implicated in depression. The peripartum period involves physiologic changes in NAS which may be associated with peripartum depression and anxiety. We measured peripartum plasma NAS and GABA in healthy comparison subjects (HCS) and those at-risk for postpartum depression (AR-PPD) due to current mild depressive or anxiety symptoms or a history of depression. We evaluated 56 peripartum medication-free subjects. We measured symptoms with the Hamilton Depression Rating Scale (HAM-D17), Hamilton Anxiety Rating Scale (HAM-A) and Spielberger State-Trait Anxiety Inventory-State (STAI-S). Plasma NAS and GABA were quantified by liquid chromatography-mass spectrometry. We examined the associations between longitudinal changes in NAS, GABA and depressive and anxiety symptoms using generalized estimating equation methods. Peripartum GABA concentration was 1.9±0.7ng/mL (p=0.004) lower and progesterone and pregnanolone were 15.8±7.5 (p=0.04) and 1.5±0.7ng/mL (p=0.03) higher in AR-PPD versus HCS, respectively. HAM-D17 was negatively associated with GABA (β=-0.14±0.05, p=0.01) and positively associated with pregnanolone (β=0.16±0.06, p=0.01). STAI-S was positively associated with pregnanolone (β=0.11±0.04, p=0.004), allopregnanolone (β=0.13±0.05, p=0.006) and pregnenolone (β=0.02±0.01, p=0.04). HAM-A was negatively associated with GABA (β=-0.12±0.04, p=0.004) and positively associated with pregnanolone (β=0.11±0.05, p=0.05). Altered peripartum NAS and GABA profiles in AR-PPD women suggest that their interaction may play an important role in the pathophysiology of peripartum depression and anxiety.
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Affiliation(s)
- Kristina M. Deligiannidis
- Center for Psychopharmacologic Research & Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, U.S.A.,Women’s Mental Health Program, Departments of Psychiatry and Obstetrics & Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA 01655, U.S.A.,Corresponding Author: Kristina M. Deligiannidis, M.D. Associate Professor of Psychiatry and Obstetrics & Gynecology Director, Depression Specialty Clinic Reproductive Psychiatrist, Women’s Mental Health Program, University of Massachusetts Medical School/UMass Memorial Medical Center, Center for Psychopharmacologic Research and Treatment, 55 Lake Avenue, North, Worcester, MA 01655, U.S.A. Tel.: (+1) 774.455.4134; Fax: (+1) 508.856.4854
| | - Aimee R. Kroll-Desrosiers
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, U.S.A
| | - Shunyan Mo
- Proteomics and Mass Spectrometry Facility and Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - Hien P. Nguyen
- Proteomics and Mass Spectrometry Facility and Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA 01655, U.S.A
| | - Abby Svenson
- Center for Psychopharmacologic Research & Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - Nina Jaitly
- Center for Psychopharmacologic Research & Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655, USA; National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709-2233, USA.
| | - Janet E. Hall
- National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC 27709-2233, U.S.A
| | - Bruce A. Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, U.S.A
| | - Anthony J. Rothschild
- Center for Psychopharmacologic Research & Treatment, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, U.S.A
| | - Scott A. Shaffer
- Proteomics and Mass Spectrometry Facility and Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA 01655, U.S.A
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Weng SC, Huang JP, Huang YL, Lee TSH, Chen YH. Effects of tobacco exposure on perinatal suicidal ideation, depression, and anxiety. BMC Public Health 2016; 16:623. [PMID: 27448804 PMCID: PMC4957348 DOI: 10.1186/s12889-016-3254-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/30/2016] [Indexed: 12/16/2022] Open
Abstract
Background Previous studies have stressed the importance of tobacco exposure for the mood disorders of depression and anxiety. Although a few studies have focused on perinatal women, none have specifically considered the effects of smoking and secondhand smoke exposure on perinatal suicidal ideation. Thus, this study aimed to investigate the relationships of smoking/secondhand smoke exposure status with suicidal ideation, depression, and anxiety from the first trimester to the first month post partum. Methods This cross-sectional study based on self-reported data was conducted at five hospitals in Taipei, Taiwan from July 2011 to June 2014. The questionnaire inquired about women’s pregnancy history, sociodemographic information, and pre-pregnancy smoking and secondhand smoke exposure status, and assessed their suicidal ideation, depression, and anxiety symptoms. Logistic regression models were used for analysis. Results In the 3867 women in the study, secondhand smoke exposure was positively associated with perinatal depression and suicidal ideation. Compared with women without perinatal secondhand smoke exposure, women exposed to secondhand smoke independently exhibited higher risks for suicidal ideation during the second trimester (odds ratio (OR) = 7.63; 95 % confidence interval (CI) = 3.25–17.93) and third trimester (OR = 4.03; 95 % CI = 1.76–9.23). Women exposed to secondhand smoke had an increased risk of depression, especially those aged 26–35 years (OR = 1.71; 95 % CI = 1.27–2.29). Conclusions Secondhand smoke exposure also considerably contributes to adverse mental health for women in perinatal periods, especially for the severe outcome of suicidal ideation. Our results strongly support the importance of propagating smoke-free environments to protect the health of perinatal women. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3254-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shu-Chuan Weng
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Jian-Pei Huang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.,Mackay Memorial Hospital, New Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Ya-Li Huang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Promotion and Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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Meltzer-Brody S, Jones I. Optimizing the treatment of mood disorders in the perinatal period. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246794 PMCID: PMC4518703 DOI: 10.31887/dcns.2015.17.2/smeltzerbrody] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response.
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Affiliation(s)
- Samantha Meltzer-Brody
- UNC Center for Women's Mood Disorder, Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ian Jones
- National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
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Drury SS, Scaramella L, Zeanah CH. The neurobiological impact of postpartum maternal depression: prevention and intervention approaches. Child Adolesc Psychiatr Clin N Am 2016; 25:179-200. [PMID: 26980123 PMCID: PMC4794751 DOI: 10.1016/j.chc.2015.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The lasting negative impact of postpartum depression (PPD) on offspring is well established. PPD seems to have an impact on neurobiological pathways linked to socioemotional regulation, cognitive and executive function, and physiologic stress response systems. This review focus on examining the current state of research defining the effect of universal, selected, and indicated interventions for PPD on infant neurodevelopment. Given the established lasting, and potentially intergenerational, negative implications of maternal depression, enhanced efforts targeting increased identification and early intervention approaches for PPD that have an impact on health outcomes in both infants and mothers represent a critical public health concern.
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Affiliation(s)
- Stacy S. Drury
- Department of Psychiatry and Behavioral Sciences, Tulane University
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De Venter M, Smets J, Raes F, Wouters K, Franck E, Hanssens M, Jacquemyn Y, Sabbe BGC, Van Den Eede F. Impact of childhood trauma on postpartum depression: a prospective study. Arch Womens Ment Health 2016; 19:337-42. [PMID: 26189446 DOI: 10.1007/s00737-015-0550-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 07/08/2015] [Indexed: 12/15/2022]
Abstract
Studies on the impact of childhood trauma on postpartum depression show inconsistencies and methodological limitations. The present study examines the effect of childhood trauma on depression 12 and 24 weeks after childbirth, while controlling for history of depression, depression symptoms during pregnancy and type D personality. During the third trimester of pregnancy, 210 women completed self-report questionnaires assessing depression (current and/or past episodes), childhood trauma and type D personality, of whom 187 participated in the postpartum follow-up, with depression symptoms being reassessed at 12 and 24 weeks after delivery with three depression outcome measures. Eventually, 183 participants were retained for analysis. Results indicated no predictive value of childhood trauma on postpartum depression in the univariate analyses, nor after controlling for previous depression, depression symptoms during pregnancy and type D personality. However, past depression and depression symptoms during pregnancy did independently and convincingly predict postpartum depression, especially at 12 weeks and to a lesser extent at 24 weeks following childbirth. Overall, we found no significant association between childhood trauma and postpartum depression. Past depression and depression symptoms during pregnancy are more relevant factors to assess before childbirth.
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MESH Headings
- Adolescent
- Adult
- Adult Survivors of Child Abuse/psychology
- Depression, Postpartum/complications
- Depression, Postpartum/diagnosis
- Depression, Postpartum/psychology
- Depressive Disorder, Major/complications
- Depressive Disorder, Major/diagnosis
- Depressive Disorder, Major/psychology
- Female
- Follow-Up Studies
- Humans
- Mothers/psychology
- Postpartum Period/psychology
- Pregnancy
- Prospective Studies
- Resilience, Psychological
- Self Report
- Stress Disorders, Post-Traumatic/complications
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/psychology
- Surveys and Questionnaires
- Type D Personality
- Young Adult
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Affiliation(s)
- Maud De Venter
- University Department of Psychiatry, Campus University Hospital Antwerp (UZA), Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium.
| | - Jorien Smets
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Department of Applied Psychology, Thomas More University College, Antwerp, Belgium
| | - Filip Raes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Kristien Wouters
- Department of Scientific Coordination and Biostatistics, University Hospital Antwerp (UZA), Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Erik Franck
- Department of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
- Department of Health Care, Karel de Grote University College, Antwerp, Belgium
| | - Myriam Hanssens
- Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Leuven, Belgium
- Department of Development and Regeneration, Faculty of Medicine, University of Leuven, Leuven, Belgium
| | - Yves Jacquemyn
- Department of Gynaecology, Obstetrics and Fertility, University Hospital Antwerp (UZA), Antwerp, Belgium
- Department of Obstetrics and Gynaecology, University of Antwerp (UA), Antwerp, Belgium
| | - Bernard G C Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
- University Department of Psychiatry, Campus Psychiatric Hospital Duffel, Duffel, Belgium
| | - Filip Van Den Eede
- University Department of Psychiatry, Campus University Hospital Antwerp (UZA), Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
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Myers S, Burger O, Johns SE. Postnatal depression and reproductive success in modern, low-fertility contexts. EVOLUTION MEDICINE AND PUBLIC HEALTH 2016; 2016:71-84. [PMID: 26976787 PMCID: PMC4790780 DOI: 10.1093/emph/eow003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/12/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Postnatal depression (PND) presents a puzzling phenomenon to evolutionary anthropologists as it is highly prevalent and yet detrimental to child development and maternal health. Adaptive explanations have been proposed, but have not been tested with data that directly link PND to female fertility. METHODOLOGY A survey was designed to gather complete reproductive histories and retrospective measures of PND to measure the effects of PND on fitness. Respondents were born between 1930 and 1967, with the majority based in the UK during their childrearing years. The hypothesis that PND is detrimental to fitness is assessed using Mann-Whitney U tests on completed fertility. Binary logistic regression modelling is used to test the hypothesis that PND reduces the likelihood of parity progression. RESULTS Women experiencing PND at their first or second birth have lower completed fertility, with PND at the first birth leading to lowered fertility. Logistic regression analyses show that this is the result of reductions in the likelihood of parity progression to a third birth when PND is experienced at the first birth or when repeat bouts occur. CONCLUSIONS AND IMPLICATIONS Our results call into question adaptationist arguments, contribute to the growing understanding of the importance of emotional wellbeing to fertility decision making, and given the economic consequences of markedly below replacement fertility, highlight a potential new source of financial incentive to invest in screening and preventative measures to ensure good maternal mental health.
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Affiliation(s)
- Sarah Myers
- School of Anthropology and Conservation, Marlowe Building, University of Kent, Canterbury, Kent CT2 7NR, UK
| | - Oskar Burger
- School of Anthropology and Conservation, Marlowe Building, University of Kent, Canterbury, Kent CT2 7NR, UK
| | - Sarah E Johns
- School of Anthropology and Conservation, Marlowe Building, University of Kent, Canterbury, Kent CT2 7NR, UK
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Enatescu VR, Bernad E, Gluhovschi A, Papava I, Romosan R, Palicsak A, Munteanu R, Craina M, Enatescu I. Perinatal characteristics and mother's personality profile associated with increased likelihood of postpartum depression occurrence in a Romanian outpatient sample. J Ment Health 2016; 26:212-219. [PMID: 26925764 DOI: 10.3109/09638237.2016.1149802] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Postpartum depression represents an increasingly recognized psychiatric condition in new mothers, and even more so in recent years as its detection has improved. AIMS This study aimed to reveal those maternal and perinatal parameters that are significantly associated with increased likelihood of postpartum depression in delivering mothers from our region. METHODS A cross-sectional survey was conducted in 163 women between 6 and 8 weeks after delivery. Postnatal depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS) using a cut-off of >12. RESULTS Postnatal depression was detected in 39 (23.93%) new mothers. The preterm delivery [odds ratio (OR) 7.233; 95% confidence interval (CI) 1.631-32.078; p = 0.009], presence of complications during pregnancy (OR 4.579; 95% CI 1.314-15.953; p = 0.017) and being primiparous (OR 3.388; 95% CI 1.430-8.025; p = 0.006) have been associated with an increased likelihood of subsequent postpartum depression. Anxiety traits of personality were the most represented in depressive mothers. CONCLUSIONS Postpartum depression is a frequent psychiatric condition in new mothers from our region. These results outline the critical role of mother's profile of personality which in a particular context of perinatal events could result in an increased likelihood of postpartum depression requiring a multidisciplinary approach.
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Affiliation(s)
| | - Elena Bernad
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | - Adrian Gluhovschi
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | | | | | | | - Rosana Munteanu
- c Eduard Pamfil Psychiatric Clinic, Timisoara County Emergency Clinical Hospital , Timisoara , Romania
| | - Marius Craina
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
| | - Ileana Enatescu
- b Department of Obstetrics, Gynecology and Neonatology , Victor Babes University of Medicine and Pharmacy , Timisoara , Romania , and
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Abstract
This article is part of a Special Issue "Parental Care". The postpartum period involves some truly transformational changes in females' socioemotional behaviors. For most female laboratory rodents and women, these changes include an improvement in their affective state, which has positive consequences for their ability to sensitively care for their offspring. There is heterogeneity among females in the likelihood of this positive affective change, though, and some women experience elevated anxiety or depression (or in rodents anxiety- or depression-related behaviors) after giving birth. We aim to contribute to the understanding of this heterogeneity in maternal affectivity by reviewing selected components of the scientific literatures on laboratory rodents and humans examining how mothers' physical contact with her infants, genetics, history of anxiety and depression and early-life and recent-life experiences contribute to individual differences in postpartum affective states. These studies together indicate that multiple biological and environmental factors beyond female maternal state shape affective responses during the postpartum period, and probably do so in an interactive manner. Furthermore, the similar capacity of some of these factors to modulate anxiety and depression in human and rodent mothers suggests cross-species conservation of mechanisms regulating postpartum affectivity.
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Affiliation(s)
- Daniella Agrati
- Department of Physiology and Nutrition, Facultad de Ciencias, Universidad de la Republica, Montevideo, Uruguay.
| | - Joseph S Lonstein
- Neuroscience Program & Department of Psychology, Michigan State University, East Lansing, MI 48824, USA
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Capron LE, Glover V, Pearson RM, Evans J, O’Connor TG, Stein A, Murphy SE, Ramchandani PG. Associations of maternal and paternal antenatal mood with offspring anxiety disorder at age 18 years. J Affect Disord 2015; 187:20-6. [PMID: 26301478 PMCID: PMC4595479 DOI: 10.1016/j.jad.2015.08.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Maternal antenatal depression and anxiety are associated with increased risk of childhood behavioural and emotional problems in offspring; it remains unclear to what extent this is due to a maternal biological impact on foetal development. Here, we compare associations between maternal and paternal antenatal depression and anxiety with offspring anxiety disorders, thus controlling for some genetic and shared environmental factors. METHODS We used data from the ALSPAC population cohort including measures of antenatal parental depression and anxiety. At 18 years, offspring completed the CIS-R interview, yielding diagnoses for anxiety disorders. Results were adjusted for confounding variables including parental postnatal depression and anxiety. RESULTS Children of women with antenatal depression (18 weeks gestation), had an increased risk of anxiety disorders at 18 years of age (11.1% vs. 6.2%; adj. OR 1.75 (1.19, 2.58); p=0.01). Children of women with antenatal anxiety had increased risk of co-morbid anxiety and depression (adj. OR 1.39 (1.06, 1.82); p=0.02). No such associations were found with paternal antenatal depression or anxiety. LIMITATIONS There was a high attrition rate from the original cohort to the CIS-R completion at 18 years postpartum. Parental mood was only assessed together at one time point during the antenatal period. CONCLUSIONS The differences in the association between maternal and paternal mood during pregnancy and child outcomes supports the hypothesis that foetal programming may account, at least in part, for this association. We highlight the potential opportunity for preventative intervention by optimising antenatal mental health.
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Affiliation(s)
| | | | | | - Jonathan Evans
- Academic Unit of Psychiatry, University of Bristol, Bristol, UK
| | - Thomas G. O’Connor
- Wynne Center for Family Research and Department of Psychiatry, University of Rochester Medical Center, New York, NY, USA
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Paul G. Ramchandani
- Centre of Mental Health, Imperial College London, London, UK,Correspondence to: The Centre for Mental Health, Imperial College London, 7th Floor Commonwealth Building, Hammersmith Hospital Campus, London W12 0NN, UK. Fax: +44 208 383 4160.The Centre for Mental Health, Imperial College London7th Floor Commonwealth Building, Hammersmith Hospital CampusLondonW12 0NNUK
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Patton GC, Romaniuk H, Spry E, Coffey C, Olsson C, Doyle LW, Oats J, Hearps S, Carlin JB, Brown S. Prediction of perinatal depression from adolescence and before conception (VIHCS): 20-year prospective cohort study. Lancet 2015; 386:875-83. [PMID: 26072108 DOI: 10.1016/s0140-6736(14)62248-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Perinatal depression is a neglected global health priority, affecting 10-15% of women in high-income countries and a greater proportion in low-income countries. Outcomes for children include cognitive, behavioural, and emotional difficulties and, in low-income settings, perinatal depression is associated with stunting and physical illness. In the Victorian Intergenerational Health Cohort Study (VIHCS), we aimed to assess the extent to which women with perinatal depressive symptoms had a history of mental health problems before conception. METHODS VIHCS is a follow-up study of participants in the Victorian Adolescent Health Cohort Study (VAHCS), which was initiated in August, 1992, in the state of Victoria, Australia. In VAHCS, participants were assessed for health outcomes at nine timepoints (waves) from age 14 years to age 29 years. Depressive symptoms were measured with the Revised Clinical Interview Schedule and the General Health Questionnaire. Enrolment to VIHCS began in September, 2006, during the ninth wave of VAHCS; depressive symptoms at this timepoint were measured with the Composite International Diagnostic Interview. We contacted women every 6 months (from age 29 years to age 35 years) to identify any pregnancies. We assessed perinatal depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) by computer-assisted telephone interview at 32 weeks of gestation, 8 weeks after birth, and 12 months after birth. We defined perinatal depression as an EPDS score of 10 or more. FINDINGS From a stratified random sample of 1000 female participants in VAHCS, we enrolled 384 women with 564 pregnancies. 253 (66%) of these women had a previous history of mental health problems at some point in adolescence or young adulthood. 117 women with a history of mental health problems in both adolescence and young adulthood had 168 pregnancies, and perinatal depressive symptoms were reported for 57 (34%) of these pregnancies, compared with 16 (8%) of 201 pregnancies in 131 women with no preconception history of mental health problems (adjusted odds ratio 8·36, 95% CI 3·34-20·87). Perinatal depressive symptoms were reported at one or more assessment points in 109 pregnancies; a preconception history of mental health problems was reported in 93 (85%) of these pregnancies. INTERPRETATION Perinatal depressive symptoms are mostly preceded by mental health problems that begin before pregnancy, in adolescence or young adulthood. Women with a history of persisting common mental disorders before pregnancy are an identifiable high-risk group, deserving of clinical support throughout the childbearing years. Furthermore, the window for considering preventive intervention for perinatal depression should extend to the time before conception. FUNDING National Health and Medical Research Council (Australia), Victorian Health Promotion Foundation, Colonial Foundation, Australian Rotary Health Research and Perpetual Trustees.
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Affiliation(s)
- George C Patton
- Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, VIC, Australia.
| | - Helena Romaniuk
- Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, VIC, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Elizabeth Spry
- Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Carolyn Coffey
- Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Craig Olsson
- Psychological Sciences and Paediatrics, Murdoch Childrens Research Institute, University of Melbourne, Parkville, VIC, Australia; Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Lex W Doyle
- Royal Women's Hospital and Murdoch Childrens Research Institute, University of Melbourne, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy Oats
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephen Hearps
- Centre for Adolescent Health, Murdoch Childrens Research Institute, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, and General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, VIC, Australia
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Heterogeneity of postpartum depression: a latent class analysis. Lancet Psychiatry 2015; 2:59-67. [PMID: 26359613 PMCID: PMC4800818 DOI: 10.1016/s2215-0366(14)00055-8] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/31/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Maternal depression in the postpartum period confers substantial morbidity and mortality, but the definition of postpartum depression remains controversial. We investigated the heterogeneity of symptoms with the aim of identifying clinical subtypes of postpartum depression. METHODS Data were aggregated from the international perinatal psychiatry consortium Postpartum Depression: Action Towards Causes and Treatment, which represents 19 institutions in seven countries. 17,912 unique subject records with phenotypic data were submitted. We applied latent class analyses in a two-tiered approach to assess the validity of empirically defined subtypes of postpartum depression. Tier one assessed heterogeneity in women with complete data on the Edinburgh postnatal depression scale (EPDS) and tier two in those with postpartum depression case status. FINDINGS 6556 individuals were assessed in tier one and 4245 in tier two. A final model with three latent classes was optimum for both tiers. The most striking characteristics associated with postpartum depression were severity, timing of onset, comorbid anxiety, and suicidal ideation. Women in class 1 had the least severe symptoms (mean EPDS score 10·5), followed by those in class 2 (mean EPDS score 14·8) and those in class 3 (mean EPDS score 20·1). The most severe symptoms of postpartum depression were significantly associated with poor mood (mean EPDS score 20·1), increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptom onset within 4 weeks postpartum and had more pregnancy complications than in other two classes (69% vs 67% in class 1 and 29% in class 3). INTERPRETATION PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations. FUNDING Sources of funding are listed at the end of the article.
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Byrne EM, Carrillo-Roa T, Penninx BWJH, Sallis HM, Viktorin A, Chapman B, Henders AK, Pergadia ML, Heath AC, Madden PAF, Sullivan PF, Boschloo L, van Grootheest G, McMahon G, Lawlor DA, Landén M, Lichtenstein P, Magnusson PKE, Evans DM, Montgomery GW, Boomsma DI, Martin NG, Meltzer-Brody S, Wray NR. Applying polygenic risk scores to postpartum depression. Arch Womens Ment Health 2014; 17:519-28. [PMID: 25037970 PMCID: PMC4341990 DOI: 10.1007/s00737-014-0428-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/07/2014] [Indexed: 12/14/2022]
Abstract
The etiology of major depressive disorder (MDD) is likely to be heterogeneous, but postpartum depression (PPD) is hypothesized to represent a more homogenous subset of MDD. We use genome-wide SNP data to explore this hypothesis. We assembled a total cohort of 1,420 self-report cases of PPD and 9,473 controls with genome-wide genotypes from Australia, The Netherlands, Sweden and the UK. We estimated the total variance attributable to genotyped variants. We used association results from the Psychiatric Genomics Consortia (PGC) of bipolar disorder (BPD) and MDD to create polygenic scores in PPD and related MDD data sets to estimate the genetic overlap between the disorders. We estimated that the percentage of variance on the liability scale explained by common genetic variants to be 0.22 with a standard error of 0.12, p = 0.02. The proportion of variance (R (2)) from a logistic regression of PPD case/control status in all four cohorts on a SNP profile score weighted by PGC-BPD association results was small (0.1 %) but significant (p = 0.004) indicating a genetic overlap between BPD and PPD. The results were highly significant in the Australian and Dutch cohorts (R (2) > 1.1 %, p < 0.008), where the majority of cases met criteria for MDD. The genetic overlap between BPD and MDD was not significant in larger Australian and Dutch MDD case/control cohorts after excluding PPD cases (R (2) = 0.06 %, p = 0.08), despite the larger MDD group affording more power. Our results suggest an empirical genetic evidence for a more important shared genetic etiology between BPD and PPD than between BPD and MDD.
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Affiliation(s)
- Enda M Byrne
- Queensland Brain Institute, The University of Queensland, Upland Road, St. Lucia, Brisbane, QLD, 4072, Australia,
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Krause D, Jobst A, Kirchberg F, Kieper S, Härtl K, Kästner R, Myint AM, Müller N, Schwarz MJ. Prenatal immunologic predictors of postpartum depressive symptoms: a prospective study for potential diagnostic markers. Eur Arch Psychiatry Clin Neurosci 2014; 264:615-24. [PMID: 24595743 DOI: 10.1007/s00406-014-0494-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 02/20/2014] [Indexed: 11/27/2022]
Abstract
In postpartum depression (PPD), immunologic changes have been proposed to be involved in the disease pathology. The study evaluates the regulation of the innate and adaptive immune response over the course of late pregnancy and postpartum period and their association with the development of postpartum depressive symptoms. Furthermore, prenatal immunologic markers for a PPD were investigated. Hundred pregnant women were included. At 34th and 38th week of pregnancy as well as 2 days, 7 weeks and 6 months postpartum, immune parameters (neopterin, regulatory T cells, CXCR1, CCR2, MNP1 and CD11a) were measured by flow cytometry/ELISA, and the psychopathology was evaluated. We found that regulatory T cells were significantly increased prenatal (p=0.011) and postnatal (p=0.01) in mothers with postnatal depressive symptoms. The decrease in CXCR 1 after delivery was significantly higher in mother with postnatal depressive symptoms (p=0.032). Mothers with postnatal depressive symptoms showed already prenatal significantly elevated neopterin levels (p=0.049). Finally, regulatory T cells in pregnancy strongly predict postnatal depressive symptoms (p=0.004). The present study revealed that prenatal and postnatal immunologic parameters are associated with postpartum depressive symptoms in mothers. In addition, we found immune markers that could eventually be the base for a biomarker set that predicts postnatal depressive symptoms already during pregnancy.
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Affiliation(s)
- Daniela Krause
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstrasse 7, 80336, Munich, Germany,
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Effect of abuse during pregnancy on maternal and child safety and functioning for 24 months after delivery. Obstet Gynecol 2014; 123:839-47. [PMID: 24785613 DOI: 10.1097/aog.0000000000000183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To evaluate the long-term safety and functioning outcomes for abused women reporting abuse during pregnancy and their children's behavior compared with abused women who do not report abuse during pregnancy. METHODS Forty-six abused women seeking assistance for partner abuse and reporting being pregnant during the preceding 4 months were evaluated every 4 months for 24 months to compare levels of abuse, danger for murder, anxiety, depression, somatization, and posttraumatic stress disorder (PTSD) for abused women who report abuse during pregnancy (n=24) compared with abused women reporting abuse only outside of pregnancy (n=22). Internalizing and externalizing behavior scores were evaluated for the children. RESULTS At entry into the study, abused women reporting abuse during pregnancy reported significantly greater (P<.05) threats of abuse, sexual abuse, physical abuse, danger for murder, and PTSD compared with abused women not reporting abuse during pregnancy. Effect sizes were large. When evaluated over the course of 24 months after delivery, risk for murder remained higher for women reporting abuse during pregnancy for 8 months after delivery, depression was higher at 4, 8, 16, and 20 months after delivery, and PTSD was appreciably higher for 24 months. Children living with mothers abused during pregnancy displayed more behavioral problems for the entire 24-month period, especially problems of depression and anxiety. CONCLUSION The study documents the negative safety and function effects of abuse in pregnant women that remain for at least 24 months after delivery. This warrants incorporating abuse screening during the antenatal and postdelivery periods and a protocol of care during the antenatal period and beyond.
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Clinical Needs of In-treatment Pregnant Women with Co-occurring Disorders: Implications for Primary Care. Matern Child Health J 2014; 19:180-7. [DOI: 10.1007/s10995-014-1508-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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