1
|
Hofheimer JA, McGowan EC, Smith LM, Meltzer-Brody S, Carter BS, Dansereau LM, Pastyrnak S, Helderman JB, Neal CR, DellaGrotta SA, O'Shea TMD, Lester BM. Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge. Am J Perinatol 2024; 41:1396-1408. [PMID: 37072014 PMCID: PMC11223892 DOI: 10.1055/s-0043-1768132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/03/2023] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. STUDY DESIGN We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively. RESULTS Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. CONCLUSION Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward. KEY POINTS · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..
Collapse
Affiliation(s)
- Julie A. Hofheimer
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Elisabeth C. McGowan
- Department of Pediatrics, Women and Infant's Hospital/Brown University, Providence, Rhode Island
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Los Angeles, California
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian S. Carter
- Department of Pediatrics, Department of Medical Humanities and Bioethics, University of Missouri-Kansas City, School of Medicine, Kansas City, Missouri
| | - Lynne M. Dansereau
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Steven Pastyrnak
- Department of Pediatrics, Spectrum Health Helen DeVos Children's Hospital/Michigan State University, Grand Rapids, Michigan
| | - Jennifer B. Helderman
- Department of Pediatrics, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Charles R. Neal
- Division of Neonatology, Department of Pediatrics, Kapi'olani Medical Center for Women and Children and Hawaii Pacific Medical Group, University of Hawaii John A Burns School of Medicine, Honolulu, Hawaii
| | - Sheri A. DellaGrotta
- Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| | - Thomas Michael D. O'Shea
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Barry M. Lester
- Departments of Pediatrics, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown Center for the Study of Children at Risk, Brown Alpert Medical School and Women and Infants Hospital, Providence, Rhode Island
| |
Collapse
|
2
|
Miller ML, Jiang LJ, O'Hara MW. Experiential avoidance as a mediator of risk factors for higher order internalizing psychopathology in the perinatal period. J Clin Psychol 2024; 80:625-645. [PMID: 38265296 DOI: 10.1002/jclp.23644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/09/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance. METHOD Participants (N = 246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: distress (composed of depression, generalized anxiety, irritability, and panic symptoms); fear (social anxiety, agoraphobia, specific phobia, and obsessive-compulsive); and bipolar (mania and obsessive-compulsive). RESULTS During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed fear. CONCLUSION It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.
Collapse
Affiliation(s)
- Michelle L Miller
- University of Iowa, Iowa City, Iowa, USA
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Lily J Jiang
- Indiana University-Bloomington, Bloomington, Indiana, USA
| | | |
Collapse
|
3
|
Kiewa J, Meltzer-Brody S, Milgrom J, Guintivano J, Hickie IB, Whiteman DC, Olsen CM, Medland SE, Martin NG, Wray NR, Byrne EM. Comprehensive Sex-Stratified Genetic Analysis of 28 Blood Biomarkers and Depression Reveals a Significant Association between Depression and Low Levels of Total Protein in Females. Complex Psychiatry 2024; 10:19-34. [PMID: 38584764 PMCID: PMC10997320 DOI: 10.1159/000538058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Major depression (MD) is more common amongst women than men, and MD episodes have been associated with fluctuations in reproductive hormones amongst women. To investigate biological underpinnings of heterogeneity in MD, the associations between depression, stratified by sex and including perinatal depression (PND), and blood biomarkers, using UK Biobank (UKB) data, were evaluated, and extended to include the association of depression with biomarker polygenic scores (PGS), generated as proxy for each biomarker. Method Using female (N = 39,761) and male (N = 38,821) UKB participants, lifetime MD and PND were tested for association with 28 blood biomarkers. A GWAS was conducted for each biomarker and genetic correlations with depression subgroups were estimated. Using independent data from the Australian Genetics of Depression Study, PGS were constructed for each biomarker, and tested for association with depression status (n [female cases/controls] = 9,006/6,442; n [male cases/controls] = 3,106/6,222). Regions of significant local genetic correlation between depression subgroups and biomarkers highlighted by the PGS analysis were identified. Results Depression in females was significantly associated with levels of twelve biomarkers, including total protein (OR = 0.90, CI = [0.86, 0.94], p = 3.9 × 10-6) and vitamin D (OR = 0.94, CI = [0.90, 0.97], p = 2.6 × 10-4), and PND with five biomarker levels, also including total protein (OR = 0.88, CI = [0.81, 0.96], p = 4.7 × 10-3). Depression in males was significantly associated with levels of eleven biomarkers. In the independent Australian Genetics of Depression Study, PGS analysis found significant associations for female depression and PND with total protein (female depression: OR = 0.93, CI = [0.88, 0.98], p = 3.6 × 10-3; PND: OR = 0.91, CI = [0.86, 0.96], p = 1.1 × 10-3), as well as with vitamin D (female depression: OR = 0.93, CI = [0.89, 0.97], p = 2.0 × 10-3; PND: OR = 0.92, CI = [0.87, 0.97], p = 1.4 × 10-3). The male depression sample did not report any significant results, and the point estimate of total protein (OR = 0.98, CI = [0.92-1.04], p = 4.7 × 10-1) did not indicate any association. Local genetic correlation analysis highlighted significant genetic correlation between PND and total protein, located in 5q13.3 (rG = 0.68, CI = [0.33, 1.0], p = 3.6 × 10-4). Discussion and Conclusion Multiple lines of evidence from genetic analysis highlight an association between total serum protein levels and depression in females. Further research involving prospective measurement of total protein and depressive symptoms is warranted.
Collapse
Affiliation(s)
- Jacqueline Kiewa
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
| | | | - Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Ian B. Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Sarah E. Medland
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | | | - Naomi R. Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, QLD, Australia
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Enda M. Byrne
- Child Health Research Centre, University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
4
|
Guintivano J, Byrne EM, Kiewa J, Yao S, Bauer AE, Aberg KA, Adams MJ, Campbell A, Campbell ML, Choi KW, Corfield EC, Havdahl A, Hucks D, Koen N, Lu Y, Mægbæk ML, Mullaert J, Peterson RE, Raffield LM, Sallis HM, Sealock JM, Walker A, Watson HJ, Xiong Y, Yang JMK, Anney RJL, Gordon-Smith K, Hubbard L, Jones LA, Mihaescu R, Nyegaard M, Pardiñas AF, Perry A, Saquib N, Shadyab AH, Viktorin A, Andreassen OA, Bigdeli TB, Davis LK, Dennis CL, Di Florio A, Dubertret C, Feng YCA, Frey BN, Grigoriadis S, Gloaguen E, Jones I, Kennedy JL, Krohn H, Kallak TK, Li Y, Martin NG, McIntosh AM, Milgrom J, Trine Munk-Olsen, Oberlander T, Olsen CM, Ramoz N, Reichborn-Kjennerud T, Blackmore ER, Rubinow D, Skalkidou A, Smoller JW, Stein DJ, Stowe ZN, Taylor V, Tebeka S, Tesli M, Van Lieshout RJ, van den Oord EJCG, Vigod SN, Werge T, Westlye LT, Whiteman DC, Zar HJ, Wray N, Meltzer-Brody S, Sullivan P. Meta-Analyses of Genome-Wide Association Studies for Postpartum Depression. Am J Psychiatry 2023; 180:884-895. [PMID: 37849304 PMCID: PMC11163373 DOI: 10.1176/appi.ajp.20230053] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Postpartum depression (PPD) is a common subtype of major depressive disorder (MDD) that is more heritable, yet is understudied in psychiatric genetics. The authors conducted meta-analyses of genome-wide association studies (GWASs) to investigate the genetic architecture of PPD. METHOD Meta-analyses were conducted on 18 cohorts of European ancestry (17,339 PPD cases and 53,426 controls), one cohort of East Asian ancestry (975 cases and 3,780 controls), and one cohort of African ancestry (456 cases and 1,255 controls), totaling 18,770 PPD cases and 58,461 controls. Post-GWAS analyses included 1) single-nucleotide polymorphism (SNP)-based heritability ([Formula: see text]), 2) genetic correlations between PPD and other phenotypes, and 3) enrichment of the PPD GWAS findings in 27 human tissues and 265 cell types from the mouse central and peripheral nervous system. RESULTS No SNP achieved genome-wide significance in the European or the trans-ancestry meta-analyses. The [Formula: see text] of PPD was 0.14 (SE=0.02). Significant genetic correlations were estimated for PPD with MDD, bipolar disorder, anxiety disorders, posttraumatic stress disorder, insomnia, age at menarche, and polycystic ovary syndrome. Cell-type enrichment analyses implicate inhibitory neurons in the thalamus and cholinergic neurons within septal nuclei of the hypothalamus, a pattern that differs from MDD. CONCLUSIONS While more samples are needed to reach genome-wide levels of significance, the results presented confirm PPD as a polygenic and heritable phenotype. There is also evidence that despite a high correlation with MDD, PPD may have unique genetic components. Cell enrichment results suggest GABAergic neurons, which converge on a common mechanism with the only medication approved by the U.S. Food and Drug Administration for PPD (brexanolone).
Collapse
Affiliation(s)
- Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Enda M Byrne
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Jacqueline Kiewa
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Shuyang Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna E Bauer
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karolina A Aberg
- Center for Biomarker Research and Precision Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Mark J Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Megan L Campbell
- MRC Genomic and Precision Medicine Research Unit, Division of Human Genetics. Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Global Initiative for Neuropsychiatric Genetics Education in Research, Broad Institute, Cambridge, MA, USA
| | - Karmel W Choi
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Elizabeth C Corfield
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Center for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Psychology, PROMENTA Research Center, University of Oslo, Oslo, Norway
| | - Donald Hucks
- Department of Medicine, Division of Genetic Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nastassja Koen
- SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Merete L Mægbæk
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus University, BSS, Aarhus, Denmark
| | - Jimmy Mullaert
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP.Nord – Université Paris Cité, Paris, France
- UMR 1137 IAME, INSERM, Paris, France
| | - Roseann E Peterson
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Institute for Genomics in Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Laura M Raffield
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannah M Sallis
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Julia M Sealock
- Analytic & Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, USA
| | - Alicia Walker
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - Hunna J Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Discipline of Psychology, Curtin University, Perth, Western Australia, Australia
- Division of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Ying Xiong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jessica MK Yang
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Richard JL Anney
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | | | - Leon Hubbard
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Lisa A Jones
- Psychological Medicine, University of Worcester, Worcester, UK
| | - Raluca Mihaescu
- Department of Psychiatry, Catharina Hospital, Eindhoven, Netherlands
| | - Mette Nyegaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Nordjylland, Denmark
| | - Antonio F Pardiñas
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Amy Perry
- Psychological Medicine, University of Worcester, Worcester, UK
| | - Nazmus Saquib
- Department of Clinical Sciences, Sulaiman AlRajhi University, Bukairiyah, Saudi Arabia
| | - Aladdin H Shadyab
- Department of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Alexander Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ole A Andreassen
- NORMENT Centre, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- KG Jebsen Centre of Neurodevelopment Research, University of Oslo, Oslo, Norway
| | - Tim B Bigdeli
- Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
- Research Service, Department of Veterans Affairs New York Harbor Healthcare System, New York, NY, USA
| | - Lea K Davis
- Department of Medicine, Division of Genetic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cindy-Lee Dennis
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Arianna Di Florio
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Caroline Dubertret
- INSERM U1266, Université de Paris, Paris, France
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Yen-Chen A Feng
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, Sunnybrook Health Science Centre and Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Emilie Gloaguen
- Hôpital Bichat, Department of Epidemiology Biostatistics and Clinical Research, AP-HP, Paris, France
| | - Ian Jones
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - James L Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Molecular Brain Science Dept, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Holly Krohn
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Yun Li
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nick G Martin
- Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Heights, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Trine Munk-Olsen
- The National Center for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Clinical Research, Psychiatric Research Unit, University of Southern Denmark, Odense, Denmark
| | - Tim Oberlander
- BC Children’s Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine M Olsen
- The Frazer Institute, The University of Queensland, Brisbane, Queensland, Australia
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nicolas Ramoz
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR1266, Tean-Genetic vulnerability to addictive and psychiatric disorders, Paris, France
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, F-75014 Paris, France
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - David Rubinow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alkistis Skalkidou
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Jordan W Smoller
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Zachary N Stowe
- Department of Psychiatry, University of Wisconsin at Madison, Madison, WI, USA
| | - Valerie Taylor
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Tebeka
- Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
- INSERM U1266, Université Paris Cité, Paris, France
| | - Martin Tesli
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Research and Education in Forensic Psychiatry, Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Edwin JCG van den Oord
- Center for Biomarker Research and Precision Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Women’s College Hospital, Toronto, Ontario, Canada
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- LF Center for Geogenetics, Globe Institute, University of Copenhagen, Copenhagen, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen, Denmark
| | - Lars T Westlye
- Department of Psychology, University of Oslo, Oslo, Norway
- NORMENT, Division for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - David C Whiteman
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Heather J Zar
- Department of Paediatrics & Child Health, University of Cape Town, Cape Town, Western Cape, South Africa
- SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | | | - Naomi Wray
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Patrick Sullivan
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
5
|
Bränn E, Vaina A, Daníelsdóttir HB, Thordardottir EB, Yang Q, Jakobsdóttir J, Aspelund T, Hauksdóttir A, Valdimarsdóttir UA, Lu D. Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland. Arch Womens Ment Health 2023; 26:839-849. [PMID: 37726573 PMCID: PMC10632282 DOI: 10.1007/s00737-023-01369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
Emerging data suggest that certain adverse childhood experiences (ACEs) are associated with perinatal depression (PND). However, few studies have comprehensively assessed the cumulative number and types of ACEs and their association to PND. We conducted a cross-sectional analysis among 16,831 female participants from the Stress-And-Gene-Analysis (SAGA) cohort in Iceland, 2018. ACEs were surveyed with the World Health Organization ACE-International questionnaire, while PND symptoms were assessed using the Edinburgh Postnatal Depression Scale (lifetime version). We, while adjusting for confounding factors, estimated the prevalence ratio (PR) of PND in relation to total number of ACEs using the Poisson quasi-likelihood model and further performed analyses for type-specific ACEs. At a mean age of 44 years (SD ± 11.1), 6,201 (36.8%) participants had experienced probable PND. Total number of ACEs was positively associated with PND (PR 1.11 per ACE, 95% CI: 1.10-1.11), also among women without any psychiatric comorbidities (PR 1.13, 95% CI: 1.11-1.14). PRs increased in a dose-response manner with the number of ACEs (P for trend < 0.001); women that endorsed 5 or more ACEs were twice as likely to have experienced PND (PR 2.24, 95% CI: 2.09-2.41). All ACE types (n = 13) were associated with PND, with most pronounced association for emotional neglect by a guardian (PR 1.53, 95% CI: 1.47-1.59). Our findings suggest a positive association between number of ACEs and PND symptoms. If our results are confirmed with prospective data, healthcare providers need to be alert of the risk of PND among expecting mothers with history of ACEs.
Collapse
Affiliation(s)
- Emma Bränn
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Alexandra Vaina
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Qian Yang
- Department of Medicine, Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Miuli A, Pettorruso M, Stefanelli G, Giovannetti G, Cavallotto C, Susini O, Pasino A, Bubbico G, De Risio L, Petta GD, Sensi SL, D'Antonio F, Martinotti G. Beyond the efficacy of transcranial magnetic stimulation in peripartum depression: A systematic review exploring perinatal safety for newborns. Psychiatry Res 2023; 326:115251. [PMID: 37270864 DOI: 10.1016/j.psychres.2023.115251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Peripartum depression is defined as the onset of depressive symptoms during pregnancy or within 12 months postpartum and affects 11.9% of women. Currently, its treatment often involves psychotherapy and antidepressants, though only one medication has been specifically approved to treat it. In this context, novel, safe non-pharmacological treatment options have gained growing interest. The present review aims to assess current literature on possible side effects on the developing fetus/newborn of Transcranial Magnetic Stimulation (TMS) use in women with peripartum depression. METHOD A systematic search was performed using the PubMed, Scopus and Web of Science databases. PRISMA and PROSPERO guidelines were applied. The risk of bias assessment was performed using the Cochrane risk of bias tool version 2.0. RESULTS Twenty-three studies were included in our systematic review, two were randomized controlled trials. Eleven studies reported mothers experienced mild side effects; none of the included studies reported major side effects for newborns. CONCLUSION The present systematic review demonstrated that TMS use in women with peripartum depression is safe, feasible and well-tolerated by the developing fetus/newborn, with a good safety and tolerability profile even during breastfeeding.
Collapse
Affiliation(s)
- Andrea Miuli
- Department of Mental Health, ASL 2 Abruzzo Lanciano-Vasto-Chieti, Chieti, Italy; Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.
| | - Giulia Stefanelli
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giulia Giovannetti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Clara Cavallotto
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Ottavia Susini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Arianna Pasino
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Giovanna Bubbico
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Department of Neurology, University of California Irvine
| | - Luisa De Risio
- Department of Psychiatry and Addiction, ASL Roma 5, Colleferro, Rome, Italy
| | - Gilberto Di Petta
- SPDC, Mental Health Department, Santa Maria delle Grazie Hospital, Naples ASL 2, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesco D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy; Department of Pharmacy, Pharmacology, Clinical Science, University of Hertfordshire, Herts, UK
| |
Collapse
|
7
|
Santos IS, Blumenberg C, Munhoz TN, Matijasevich A, Santos Júnior HG, Dos Santos LM, Correia LL, de Souza MR, Lira PI, Bortolotto CC, Barcelos R, Altafim E, Chicaro MF, Macana EC, da Silva RS, Victora CG. Course of depression during the first 2 years postpartum among Brazilian women enrolled in a conditional cash transfer program. Int J Soc Psychiatry 2023; 69:1193-1201. [PMID: 36938959 DOI: 10.1177/00207640231154376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Women living in low- and middle-income countries are more exposed to known risk factors for depression occurrence and persistency over time. AIM Our aim was to investigate the course of depression in the first 2 years postpartum among Brazilian women enrolled in a cash transfer program. METHOD Longitudinal analysis of baseline (T0; mean 3.7 months postpartum) and first follow-up data (T1; mean 18.6 months postpartum) from a trial to assess the impact of a child development promotion program in 30 municipalities from six Brazilian states. The program does not include any interventions against maternal depression. The Edinburgh Postnatal Depression Scale (EPDS) at cutoff ⩾10 was applied. Women were categorized into four groups based on EPDS at T0 and T1: absence of depression, persistence, discontinuity, or emergence pattern. Adjusted Poisson regressions were run using a multilevel hierarchical model. RESULTS Two thousand eight hundred sixty-three women were assessed. Prevalence of depression was 26.4% [24.8, 28.1] at T0 and 24.4% [22.8, 26.0] at T1. Persistence, discontinuation, and emergence were found in 14.1% [11.3, 17.6%], 12.8% [11.4, 14.3%], and 10.2% [8.0, 13.0], respectively. In adjusted analyses, the persistence pattern was directly associated with parity and inversely associated with schooling of the woman and of the child's father. Living with husband/partner and support from the child's father and family members during pregnancy were protective against persistence. The discontinuity and the emergence patterns were not associated with any of the exposure variables. CONCLUSIONS Depressive symptoms were highly prevalent during the first 2 years postpartum. About half of the women with depression at T1 were persistent cases that could have been detected earlier. Screening for maternal depression should be an essential component in every encounter of women with health professionals in primary health care settings.
Collapse
Affiliation(s)
- Ina S Santos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Cauane Blumenberg
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Tiago N Munhoz
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
- Curso de Psicologia, Universidade Federal de Pelotas, Rio Grande do Sul, Brasil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Letícia Marques Dos Santos
- Instituto de Humanidades Artes de Ciências da Universidade Federal da Bahia (UFBA); Salvador, Bahia, Brazil
| | - Luciano L Correia
- Departamento de Saúde Comunitária, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Marta Rovery de Souza
- Departamento de Saúde Coletiva, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
| | - Pedro Ic Lira
- Departamento de Nutrição do Centro de Ciências da Saúde, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Caroline C Bortolotto
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Raquel Barcelos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Elisa Altafim
- Fundação Maria Cecília Souto Vidigal, São Paulo, São Paulo, Brazil
| | | | | | - Ronaldo Souza da Silva
- Secretaria de Avaliação e Gestão da Informação (SAGI), Ministério da Cidadania; Brasília, Federal District, Brazil
| | - Cesar G Victora
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| |
Collapse
|
8
|
Serra R, Giacchetti N, Bersani FS, Cappannini G, Martucci M, Panfili M, Sogos C, Aceti F. The relationship between personality traits and individual factors with perinatal depressive symptoms: a cross-sectional study. BMC Pregnancy Childbirth 2023; 23:382. [PMID: 37231375 DOI: 10.1186/s12884-023-05701-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Pregnancy is a crucial transition moment exposing women to potential mental health problems, especially depressive disturbances. Sociodemographic, pregnancy-related, and psychological factors have been related to depressive symptoms in the perinatal period. This study aims at (1) exploring personality and individual factors related with perinatal depressive symptoms, and (2) testing the mediating role of personality in the relation between characteristics of the woman's family of origin and depressive symptoms. METHODS Women in the perinatal period admitted to the gynecology unit for motherhood-related routine assessments (n = 241) were included in the study. A survey on individual sociodemographic, clinical, and pregnancy-related factors was administered, also including the Edinburgh Postnatal Depression Scale (EPDS) and the BIG-5 personality test. RESULTS Couple conflict and neuroticism were independent and directly correlated with EPDS total score (respectively: B = 2.337; p = .017; B = 0.303; p < .001). Neuroticism was a significant mediator of the relation between the presence of a psychiatric disorder diagnosis in participant's parents and the EPDS total score (indirect b = 0.969; BCCI95%=0.366-1.607). CONCLUSIONS Couple relation and neuroticism traits are individual factors related to depressive symptoms in the perinatal period. The family of origin also plays an indirect role on perinatal depressive symptoms. Screening of these factors could lead to early recognition and more tailored treatments, ultimately leading to better outcome for the entire family.
Collapse
Affiliation(s)
- Riccardo Serra
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università, 30, Rome, Italy.
| | - Nicoletta Giacchetti
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università, 30, Rome, Italy
| | - Francesco Saverio Bersani
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università, 30, Rome, Italy
| | - Gaia Cappannini
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università, 30, Rome, Italy
| | - Melania Martucci
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università, 30, Rome, Italy
| | - Matteo Panfili
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università, 30, Rome, Italy
| | - Carla Sogos
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università, 30, Rome, Italy
| | - Franca Aceti
- Department of Human Neurosciences, Sapienza University of Rome, Viale delle Università, 30, Rome, Italy
| |
Collapse
|
9
|
Lombardi BN, Jensen TM, Parisi AB, Jenkins M, Bledsoe SE. The Relationship Between a Lifetime History of Sexual Victimization and Perinatal Depression: A Systematic Review and Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:139-155. [PMID: 34132148 PMCID: PMC9660263 DOI: 10.1177/15248380211021611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The association between a lifetime history of sexual victimization and the well-being of women during the perinatal period has received increasing attention. However, research investigating this relationship has yet to be systematically reviewed or quantitatively synthesized. AIM This systematic review and meta-analysis aims to calculate the pooled effect size estimate of the statistical association between a lifetime history of sexual victimization and perinatal depression (PND). METHOD Four bibliographic databases were systematically searched, and reference harvesting was conducted to identify peer-reviewed articles that empirically examined associations between a lifetime history of sexual victimization and PND. A random effects model was used to ascertain an overall pooled effect size estimate in the form of an odds ratio and corresponding 95% confidence intervals (CIs). Subgroup analyses were also conducted to assess whether particular study features and sample characteristic (e.g., race and ethnicity) influenced the magnitude of effect size estimates. RESULTS This review included 36 studies, with 45 effect size estimates available for meta-analysis. Women with a lifetime history of sexual victimization had 51% greater odds of experiencing PND relative to women with no history of sexual victimization (OR = 1.51, 95% CI [1.35, 1.67]). Effect size estimates varied considerably according to the PND instrument used in each study and the racial/ethnic composition of each sample. CONCLUSION Findings provide compelling evidence for an association between a lifetime history of sexual victimization and PND. Future research should focus on screening practices and interventions that identify and support survivors of sexual victimization perinatally.
Collapse
Affiliation(s)
- Brooke N. Lombardi
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Todd M. Jensen
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Anna B. Parisi
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Melissa Jenkins
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| | - Sarah E. Bledsoe
- School of Social Work, University of North Carolina at Chapel Hill,
NC, USA
| |
Collapse
|
10
|
Maternal Metabolites Indicative of Mental Health Status during Pregnancy. Metabolites 2022; 13:metabo13010024. [PMID: 36676949 PMCID: PMC9865687 DOI: 10.3390/metabo13010024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Approximately 25% of individuals report poor mental health during their pregnancy or postpartum period, which may impact fetal neurodevelopment, birth outcomes, and maternal behaviors. In the present study, maternal serum samples were collected from pregnancies at 28-32 weeks gestation from the All Our Families (Alberta, Canada) cohort and assessed using nuclear magnetic resonance spectroscopy (1H-NMR) and inductively coupled plasma-mass spectrometry (ICP-MS). Individuals with poor mental health at 34-36 weeks gestation were age-matched with mentally healthy pregnant controls. Metabolites were examined against validated self-reported mental health questionnaires for associations with depressive symptoms (Edinburgh Perinatal Depression Scale) and anxiety symptoms (Spielberger State-Trait Anxiety Inventory). 1H-NMR metabolites were identified for depression (alanine, leucine, valine, methionine, phenylalanine, glucose, lactate, 3-hydroxybutyrate, and pyruvate) and anxiety (3-hydroxybutyrate). For ICP-MS, antimony and zinc were significant for depression and anxiety, respectively. Upon false discovery rate (FDR) correction at 10%, five 1H-NMR metabolites (alanine, leucine, lactate, glucose, and phenylalanine) for depression remained significantly increased. Although results warrant further validation, the identified metabolites may serve as a predictive tool for assessing mental health during pregnancy as earlier identification has the potential to aid intervention and management of poor mental health symptomology, thus avoiding harmful consequences to both mother and offspring.
Collapse
|
11
|
Huller Harari L, Blasbalg U, Arnon S, Ben-Sheetrit J, Toren P. Risk factors for postpartum depression among sexual minority and heterosexual parents. Australas Psychiatry 2022; 30:718-721. [PMID: 36264652 DOI: 10.1177/10398562221133990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Postpartum depression (PPD), a major depressive episode with postpartum onset, develops in 15% of mothers. Although findings suggest sexual minority parents may be at risk for PPD, research among this population is scarce. We evaluated risk factors for PPD in a sample of sexual minority and heterosexual parents. METHOD Four hundred and twenty seven heterosexual and one hundred and eleven sexual minority parents responded to a questionnaire distributed via social media that included demographics, the Edinburgh Postnatal Depression Scale, and the Multidimensional Scale of Perceived Social Support. RESULTS Sexual minority identity was not associated with increased risk for PPD. Pregnancy had no significant effect on the likelihood for PPD. Social support was negatively and significantly associated with probability for PPD. CONCLUSIONS Our data suggest that sexual minority parents are not at increased risk for PPD, contrary to previous findings. The parental role, a psychosocial factor, is a more dominant risk factor than pregnancy itself, in the development of PPD.
Collapse
Affiliation(s)
- Liat Huller Harari
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel, Faculty of Medicine, 58408Tel-Aviv University Sackler, Israel
| | - Uri Blasbalg
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel
| | - Shay Arnon
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel
| | - Joseph Ben-Sheetrit
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel
| | - Paz Toren
- Clalit Health Services, 61307Tel-Aviv Brüll Community Mental Health Center, Israel, Faculty of Medicine, 58408Tel-Aviv University Sackler, Israel
| |
Collapse
|
12
|
Bauer AE, Guintivano J, Krohn H, Sullivan PF, Meltzer-Brody S. The longitudinal effects of stress and fear on psychiatric symptoms in mothers during the COVID-19 pandemic. Arch Womens Ment Health 2022; 25:1067-1078. [PMID: 36151337 PMCID: PMC9510199 DOI: 10.1007/s00737-022-01265-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/06/2022] [Indexed: 12/14/2022]
Abstract
The COVID-19 pandemic has been particularly difficult for mothers. Women with a history of peripartum depression (PPD) may be vulnerable to relapse. We sought to understand changes in depressive and anxious symptoms throughout the pandemic and which stressors increased symptoms in women with a history of PPD. In June 2020, all US participants with a history of PPD (n = 12,007) in the global MomGenes Fight PPD study were invited to the COVID-19 follow-up study. Respondents (n = 2163, 18%) were sent biweekly and then monthly surveys until January 31, 2022. We employed time-varying effects models to evaluate trajectories of depressive (patient health questionnaire, PHQ-9) and anxious (generalized anxiety disorder, GAD-7) symptoms and to estimate longitudinal associations between perceived stress, fears, COVID-19 case rates, and symptoms. Peaks of PHQ-9, GAD-7, PSS, and perceived COVID-19 risk scores corresponded with timing of national COVID-19 case surges. High perceived stress was the strongest predictor of PHQ-9 (beta = 7.27; P = 1.48e - 38) and GAD-7 (beta = 7.73; P = 6.19e - 70). Feeling lack of control and unlikely to survive increased PHQ-9 and GAD-7 scores by 2 points. COVID-19 case rates, pandemic restrictions, and region were not independently associated with symptoms. This study suggests that the collective trauma of the pandemic has significantly affected mothers with a history of PPD, exemplified by high levels of perceived stress and the strong association with depressive and anxious symptoms. The next pandemic phase is uncertain, but will continue to influence mental health collectively and dynamically. Interventions must be flexible and responsive and should address fear, trauma, and feelings of control, particularly for mothers with a history of PPD.
Collapse
Affiliation(s)
- Anna E Bauer
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 234 Medical Wing C, Chapel Hill, NC, 27599, USA.
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 234 Medical Wing C, Chapel Hill, NC, 27599, USA
| | - Holly Krohn
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 234 Medical Wing C, Chapel Hill, NC, 27599, USA
| | - Patrick F Sullivan
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 234 Medical Wing C, Chapel Hill, NC, 27599, USA
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 234 Medical Wing C, Chapel Hill, NC, 27599, USA
| |
Collapse
|
13
|
Collaton J, Dennis CL, Taylor VH, Grigoriadis S, Oberlander TF, Frey BN, Van Lieshout R, Guintivano J, Meltzer-Brody S, Kennedy JL, Vigod SN. The PPD-ACT app in Canada: feasibility and a latent class analysis of participants with postpartum depression recruited to a psychiatric genetics study using a mobile application. BMC Psychiatry 2022; 22:735. [PMID: 36434566 PMCID: PMC9700884 DOI: 10.1186/s12888-022-04363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) and postpartum psychosis (PPP) are linked to negative consequences for women and families. Virtual applications present a solution to the challenge of recruiting large samples for genetic PPD/PPP research. This study aimed to evaluate the feasibility of a protocol for enrolling Canadian women with PPD and PPP to a large international psychiatric genetics study using a mobile application (PPD-ACT), and identify clinically distinct subtypes of PPD in the recruited sample. METHODS From April 2017-June 2019, Canadian women provided phenotypic data through the PPD-ACT app. Requests for a genetic sample were made from those with a current or past PPD episode based on an Edinburgh Postnatal Depression Scale (EPDS) score > 12 with onset in pregnancy or 0-3 months postpartum, and from those self-reporting lifetime PPP. Latent class analysis (LCA) was used to identify clinically distinct PPD subgroups based on participant responses to the EPDS scale. RESULTS We identified 797 PPD cases, 404 of whom submitted DNA. There were 109 PPP cases, with 66 submitting DNA. PPD cases (86.7% White, mean 4.7 +/- 7.0 years since their episode) came from across Canadian provinces/territories. LCA identified two PPD classes clinically distinct by symptom severity: [1] moderate-severity (mean EPDS = 18.5+/- 2.5; 8.6% with suicidality), and [2] severe (mean EPDS = 24.5+/- 2.1; 52.8% with suicidality). CONCLUSIONS A mobile application rapidly collected data from individuals with moderate and severe symptoms of PPD, an advantage for genetics where specificity is optimal, as well as from women with a history of PPP, supporting future work using this approach.
Collapse
Affiliation(s)
- Joanna Collaton
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Hospital and Research Institute, 76 Grenville Street, Toronto, ON Canada
| | - Cindy-Lee Dennis
- grid.417199.30000 0004 0474 0188Women’s College Hospital and Research Institute, 76 Grenville Street, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON Canada
| | - Valerie H. Taylor
- grid.417199.30000 0004 0474 0188Women’s College Hospital and Research Institute, 76 Grenville Street, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Sophie Grigoriadis
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.413104.30000 0000 9743 1587Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Tim F. Oberlander
- grid.17091.3e0000 0001 2288 9830BC Women’s Hospital and Health Centre, University of British Columbia, Vancouver, BC Canada
| | - Benicio N. Frey
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton ON, Hamilton, ON L8N 4A6 Canada
| | - Ryan Van Lieshout
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada ,grid.416721.70000 0001 0742 7355Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton ON, Hamilton, ON L8N 4A6 Canada
| | - Jerry Guintivano
- grid.410711.20000 0001 1034 1720University of North Carolina, Chapel Hill, NC USA
| | | | - James L. Kennedy
- grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Simone N. Vigod
- grid.417199.30000 0004 0474 0188Women’s College Hospital and Research Institute, 76 Grenville Street, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| |
Collapse
|
14
|
Borgsted C, Høgh S, Høgsted ES, Fonnesbech‐Sandberg L, Ekelund K, Albrechtsen CK, Wiis JT, Hegaard H, Cvetanovska E, Juul A, Frederiksen H, Pinborg A, Weikop P, Frokjaer V. The role of central serotonergic markers and estradiol changes in perinatal mental health. Acta Psychiatr Scand 2022; 146:357-369. [PMID: 35729864 PMCID: PMC9796905 DOI: 10.1111/acps.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Women have an increased risk for mental distress and depressive symptoms in relation to pregnancy and birth. The serotonin transporter (SERT) may be involved in the emergence of depressive symptoms postpartum and during other sex-hormone transitions. It may be associated with cerebrospinal fluid (CSF) levels of the main serotonin metabolite 5-hydroxyindolacetic acid (5-HIAA). In 100 healthy pregnant women, who were scheduled to deliver by cesarean section (C-section), we evaluated 5-HIAA and estradiol contributions to mental distress 5 weeks postpartum. METHODS Eighty-two women completed the study. CSF collected at C-section was analyzed for 5-HIAA, with high performance liquid chromatography. Serum estradiol concentrations were quantified by liquid chromatography tandem mass spectrometry before C-section and postpartum. Postpartum mental distress was evaluated with the Edinburgh Postnatal Depression Scale (EPDS). Associations between EPDS, 5-HIAA, and Δestradiol were evaluated in linear regression models adjusted for age, parity and SERT genotype. RESULTS Higher levels of postpartum mental distress symptoms were negatively associated with a large decrease in estradiol concentrations (βΔE2 = 0.73, p = 0.007) and, on a trend level, positively associated with high antepartum 5-HIAA levels (β5-HIAA = 0.002, p = 0.06). CONCLUSION In a cohort of healthy pregnant women, postpartum mental distress was higher in women with high antepartum 5-HIAA (trend) and lower in women with a large perinatal estradiol decrease. We speculate that high antepartum 5-HIAA is a proxy of SERT levels, that carry over to the postpartum period and convey susceptibility to mental distress. In healthy women, the postpartum return to lower estradiol concentrations may promote mental well-being.
Collapse
Affiliation(s)
- Camilla Borgsted
- Neurobiology Research UnitCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark,Mental Health Services in the Capital Region of DenmarkCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Stinne Høgh
- Neurobiology Research UnitCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Emma Sofie Høgsted
- Neurobiology Research UnitCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | | | - Kim Ekelund
- Department of Anaesthesiology, Juliane Marie CenterCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Charlotte Krebs Albrechtsen
- Department of Anaesthesiology, Juliane Marie CenterCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Julie Therese Wiis
- Department of AnaesthesiologyCopenhagen University Hospital ‐ HerlevHerlevDenmark
| | - Hanne Hegaard
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of ObstetricsCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Eleonora Cvetanovska
- Department of Obstetrics and Gynaecology, Herlev HospitalCopenhagen University HospitalHerlevDenmark
| | - Anders Juul
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of Growth and ReproductionCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Hanne Frederiksen
- Department of Growth and ReproductionCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Anja Pinborg
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark,Department of FertilityCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Pia Weikop
- Center for Translational NeuromedicineUniversity of CopenhagenCopenhagenDenmark
| | - Vibe Frokjaer
- Neurobiology Research UnitCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark,Mental Health Services in the Capital Region of DenmarkCopenhagenDenmark,Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
15
|
Kiewa J, Meltzer-Brody S, Milgrom J, Bennett E, Mackle T, Guintivano J, Hickie IB, Colodro-Conde L, Medland SE, Martin N, Wray N, Byrne E. Lifetime prevalence and correlates of perinatal depression in a case-cohort study of depression. BMJ Open 2022; 12:e059300. [PMID: 35973706 PMCID: PMC9621163 DOI: 10.1136/bmjopen-2021-059300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study sought to evaluate the prevalence, timing of onset and duration of symptoms of depression in the perinatal period (PND) in women with depression, according to whether they had a history of depression prior to their first perinatal period. We further sought to identify biopsychosocial correlates of perinatal symptoms in women with depression. DESIGN AND SETTING The Australian Genetics of Depression Study is an online case cohort study of the aetiology of depression. For a range of variables, women with depression who report significant perinatal depressive symptoms were compared with women with lifetime depression who did not experience perinatal symptoms. PARTICIPANTS In a large sample of parous women with major depressive disorder (n=7182), we identified two subgroups of PND cases with and without prior depression history (n=2261; n=878, respectively). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was a positive screen for PND on the lifetime version of the Edinburgh Postnatal Depression Scale. Descriptive measures reported lifetime prevalence, timing of onset and duration of PND symptoms. There were no secondary outcome measures. RESULTS The prevalence of PND among parous women was 70%. The majority of women reported at least one perinatal episode with symptoms both antenatally and postnatally. Of women who experienced depression prior to first pregnancy, PND cases were significantly more likely to report more episodes of depression (OR=1.15 per additional depression episode, 95% CI 1.13 to 1.17, p<0.001), non-European ancestry (OR 1.5, 95% CI 1.0 to 2.1, p=0.03), severe nausea during pregnancy (OR 1.3, 95% CI 1.1 to 1.6, p=0.006) and emotional abuse (OR 1.4, 95% CI 1.1 to 1.7, p=0.005). CONCLUSIONS The majority of parous women with lifetime depression in this study experienced PND, associated with more complex, severe depression. Results highlight the importance of perinatal assessments of depressive symptoms, particularly for women with a history of depression or childhood adverse experiences.
Collapse
Affiliation(s)
- Jacqueline Kiewa
- Child Health Research Centre, The University of Queensland Faculty of Medicine and Biomedical Sciences, Brisbane, Queensland, Australia
| | | | - Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Heights, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | | | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nick Martin
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Naomi Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Enda Byrne
- Child Health Research Centre, The University of Queensland Faculty of Medicine and Biomedical Sciences, Brisbane, Queensland, Australia
| |
Collapse
|
16
|
Charrois EM, Mughal MK, Arshad M, Wajid A, Bright KS, Giallo R, Kingston D. Patterns and predictors of depressive and anxiety symptoms in mothers affected by previous prenatal loss in the ALSPAC birth cohort. J Affect Disord 2022; 307:244-253. [PMID: 35339570 DOI: 10.1016/j.jad.2022.03.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/13/2022] [Accepted: 03/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies investigating the patterns or predictors of psychological distress in expecting and postpartum mothers affected by previous prenatal loss, are limited. The study objectives were to explore longitudinal trajectory patterns of depressive and anxiety symptoms in mothers affected by previous prenatal loss from early in a subsequent pregnancy up to pre-adolescence, and to identify early factors predictive of elevated symptom trajectory patterns. METHODS A total of 2854 mothers from the Avon Longitudinal Study of Parents and Children self-identified as having experienced a previous prenatal loss. A latent class analysis identified trajectory patterns of symptoms across 10 timepoints from 18-weeks' gestation up to 134-months postpartum, multivariate regression analysis identified predictors of elevated symptom trajectories, and hierarchical regression analysis determined predictive accuracy between predictors and elevated trajectory patterns. RESULTS Three distinct longitudinal trajectory patterns of depressive and anxiety symptoms reflected low (54%), sub-clinical (34%), and clinical symptoms (12%). Key factors that predicted elevated symptom trajectory patterns better than increased symptom scores early in subsequent pregnancy include history of severe depression or other psychiatric problem, experiencing three or more stressful events from mid-pregnancy, inadequate social support, history of induced abortion, and history of abuse. Predictive accuracy of elevated trajectories was 0.542 (depression) and 0.432 (anxiety). LIMITATIONS Generalizability may be compromised by attrition, under-reporting, and recall bias. CONCLUSION Including factors predictive of long-term sub-clinical or clinical depressive and anxiety symptoms in early assessments will improve clinician's ability to identify mothers who may benefit from immediate and/or ongoing monitoring, and psychotherapeutic intervention after prenatal loss.
Collapse
Affiliation(s)
- Elyse M Charrois
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
| | - Muhammad Kashif Mughal
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
| | - Muhammad Arshad
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Bioinformatics Core, Centre for Genomics and Systems Biology, New York University, Abu Dhabi, UAE.
| | - Abdul Wajid
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
| | - Katherine S Bright
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
| | - Rebecca Giallo
- Deakin University, Geelong, Australia; Murdoch Children's Research Institute.
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.
| |
Collapse
|
17
|
Pawils S, Kochen E, Weinbrenner N, Loew V, Döring K, Daehn D, Martens C, Kaczmarek P, Renneberg B. [Postpartum depression-who cares? Approaches to care via midwifery, gynaecology, paediatrics and general practice]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:658-667. [PMID: 35554610 PMCID: PMC9132831 DOI: 10.1007/s00103-022-03545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is one of the most common mental illnesses in the postpartum period. If left untreated, it can have serious consequences for the mother-child relationship and the development of the child. In order to prevent possible negative effects, early diagnosis of affected mothers and professional care are essential. AIM OF THE STUDY This article explores the sense of responsibility of the four primary care providers in the postpartum period-midwives, gynaecologists, general practitioners and paediatricians-and examines how they deal with the disease as well as the barriers and possibilities for optimisation in care. MATERIALS AND METHODS The primary care providers of postpartum women in Germany were interviewed in four independent studies. Quantitative questionnaires were used to interview midwives, gynaecologists and general practitioners, and a qualitative telephone survey was conducted with representatives of the German Association of Paediatricians and Adolescents (BVKJ). A systematic comparative analysis was carried out. RESULTS AND DISCUSSION Midwives and gynaecologists showed a significantly higher sense of responsibility for the recognition and treatment of PPD than general practitioners and paediatricians. Closer interdisciplinary cooperation and thus a wider range of referral and therapy options were named by all four professional groups as a central prerequisite for improving the care situation in Germany. A uniform regulation of financial remuneration is also an important aspect for all providers.
Collapse
Affiliation(s)
- Silke Pawils
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Eileen Kochen
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Nora Weinbrenner
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Viola Loew
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Kornelia Döring
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Daria Daehn
- Fachbereich Erziehungswissenschaften und Psychologie, Klinische Psychologie und Psychotherapie, Freie Universität Berlin, Berlin, Deutschland
| | - Claudia Martens
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Philip Kaczmarek
- Zentrum für Medizinische Psychologie, Institut und Poliklinik für Medizinische Psychologie, Universitätsklinik Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - Babette Renneberg
- Fachbereich Erziehungswissenschaften und Psychologie, Klinische Psychologie und Psychotherapie, Freie Universität Berlin, Berlin, Deutschland
| |
Collapse
|
18
|
Sleep, Anxiety, and Vitamin D Status and Risk for Peripartum Depression. Reprod Sci 2022; 29:1851-1858. [DOI: 10.1007/s43032-022-00922-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
|
19
|
Krohn H, Guintivano J, Frische R, Steed J, Rackers H, Meltzer-Brody S. App-Based Ecological Momentary Assessment to Enhance Clinical Care for Postpartum Depression: Pilot Acceptability Study. JMIR Form Res 2022; 6:e28081. [PMID: 35319483 PMCID: PMC8987954 DOI: 10.2196/28081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 01/23/2023] Open
Abstract
Background Wearable tracking devices and mobile health technology are increasingly used in an effort to enhance clinical care and the delivery of personalized medical treatment. Postpartum depression is the most frequently diagnosed complication of childbirth; however, significant gaps in screening and treatment remain. Objective This study aims to investigate the clinical utility, predictive ability, and acceptability of using ecological momentary assessment to collect daily mood, sleep, and activity data through the use of an Apple Watch and mobile app among women with postpartum depression. Methods This was a pilot study consisting of 3 in-person research visits over the course of a 6-week enrollment period. Questionnaires to assess depression, anxiety, and maternal functioning were periodically collected, along with daily self-reported symptoms and passively collected physiological data via an Apple Watch. Feedback was collected from study participants and the study clinician to determine the utility and acceptability of daily tracking. Logistic regression was used to determine whether mood scores in the 2 weeks before a visit predicted scores at follow-up. Compliance with daily assessments was also measured. Results Of the 26 women enrolled, 23 (88%) completed the 6-week study period. On average, the participants completed 67% (34.4/51.5 days) of all active daily assessments and 74% (38/51.5 days) of all passive measures. Furthermore, all 23 participants completed the 3 required visits with the research team. Predictive correlations were found between self-reported mood and Edinburgh Postnatal Depression Scale score at follow-up, self-reported anxiety and EDPS, and sleep quality and Edinburgh Postnatal Depression Scale. Conclusions Using ecological momentary assessment to track daily symptoms of postpartum depression using a wearable device was largely endorsed as acceptable and clinically useful by participants and the study clinician and could be an innovative solution to increase care access during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Holly Krohn
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rachel Frische
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jamie Steed
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Hannah Rackers
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
20
|
Kiewa J, Meltzer-Brody S, Milgrom J, Guintivano J, Hickie IB, Whiteman DC, Olsen CM, Colodro-Conde L, Medland SE, Martin NG, Wray NR, Byrne EM. Perinatal depression is associated with a higher polygenic risk for major depressive disorder than non-perinatal depression. Depress Anxiety 2022; 39:182-191. [PMID: 34985809 DOI: 10.1002/da.23232] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Distinctions between major depressive disorder (MDD) and perinatal depression (PND) reflect varying views of PND, from a unique etiological subtype of MDD to an MDD episode that happens to coincide with childbirth. This case-control study investigated genetic differences between PND and MDD outside the perinatal period (non-perinatal depression or NPD). METHODS We conducted a genome-wide association study using PND cases (Edinburgh Postnatal Depression Scale score ≥ 13) from the Australian Genetics of Depression Study 2018 data (n = 3804) and screened controls (n = 6134). Results of gene-set enrichment analysis were compared with those of women with non-PND. For six psychiatric disorders/traits, genetic correlations with PND were evaluated, and logistic regression analysis reported polygenic score (PGS) association with both PND and NPD. RESULTS Genes differentially expressed in ovarian tissue were significantly enriched (stdBeta = 0.07, p = 3.3e-04), but were not found to be associated with NPD. The genetic correlation between PND and MDD was 0.93 (SE = 0.07; p = 3.5e-38). Compared with controls, PGS for MDD are higher for PND cases (odds ratio [OR] = 1.8, confidence interval [CI] = [1.7-1.8], p = 9.5e-140) than for NPD cases (OR = 1.6, CI = [1.5-1.7], p = 1.2e-49). Highest risk is for those reporting both antenatal and postnatal depression, irrespective of prior MDD history. CONCLUSIONS PND has a high genetic overlap with MDD, but points of distinction focus on differential expression in ovarian tissue and higher MDD PGS, particularly for women experiencing both antenatal and postpartum PND.
Collapse
Affiliation(s)
- Jacqueline Kiewa
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jeanette Milgrom
- Parent-Infant Research Institute, Austin Health, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - David C Whiteman
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Catherine M Olsen
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Naomi R Wray
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Enda M Byrne
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
21
|
Han Y, Li P, Miao M, Tao Y, Kang X, Zhang J. S-ketamine as an adjuvant in patient-controlled intravenous analgesia for preventing postpartum depression: a randomized controlled trial. BMC Anesthesiol 2022; 22:49. [PMID: 35172727 PMCID: PMC8848809 DOI: 10.1186/s12871-022-01588-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/10/2022] [Indexed: 02/08/2023] Open
Abstract
Background Postpartum depression (PPD) is a common complication of cesarean section. S-ketamine given intravenously during surgery can help prevent PPD. However, whether S-ketamine in patient-controlled intravenous analgesia (PCIA) can reduce the incidence of PPD is unknown. This study assessed the effect of S-ketamine as an adjuvant in PCIA for preventing PPD in women undergoing cesarean delivery. Methods A total of 375 parturients scheduled to undergo cesarean section and then receive PCIA were recruited from a single center and were randomly assigned to control (C) group (sufentanil 2 μg/kg + tropisetron 10 mg) or S-ketamine (S) group (S-ketamine 0.5 mg/kg + sufentanil 2 μg/kg + tropisetron 10 mg). The primary outcome was the incidence of PPD measured by the Edinburgh postnatal depression scale (EPDS) after surgery. The secondary outcomes were EPDS scores, visual analog scale (VAS) scores, Ramsay sedation scale (RSS) scores, and the rate of adverse events, including headache, nausea, dizziness, drowsiness, and vomit. Results A total of 275 puerperal women were included in the study. The rate of depression in parturient on postoperative days 3, 14, 28 in the C group and S group were 17.6 and 8.2% (p < 0.05), 24.2 and 9.8% (p < 0.05), and 19.0 and 17.2% (p = 0.76) respectively. EPDS scores in the C group and S group on postoperative days 3,14, and 28 were 7.65 ± 3.14 and 6.00 ± 2.47 (p < 0.05), 7.62 ± 3.14 and 6.38 ± 2.67 (p < 0.05), and 7.35 ± 3.17 and 6.90 ± 2.78 (p = 0.15), respectively. The rate of adverse events in the C group and S group were headache 3.3 and 4.1% (p = 0.755), nausea 5.9 and 8.2% (p = 0.481), dizziness 9.2 and 12.3% (p = 0.434), drowsiness 6.5 and 10.7%(p = 0.274), and vomit 5.9 and 5.7% (p = 0.585). Conclusions S-ketamine (0.01 mg/kg/h) as an adjuvant in PCIA significantly reduces the incidence of PPD within 14 days and relieves pain within 48 h after cesarean delivery, without increasing the rate of adverse reactions. Trial registration Registered in the Chinese Clinical Trial Registry (ChiCTR2100050263) on August 24, 2021.
Collapse
Affiliation(s)
- Yaqian Han
- Department of Anesthesiology and Perioperative Medicine, Henan University People's Hospital; Henan Provincial People's Hospital, Zhengzhou, China
| | - Pule Li
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Mengrong Miao
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Yuan Tao
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Xia Kang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.
| |
Collapse
|
22
|
Personality traits as a risk factor for postpartum depression: A systematic review and meta-analysis. J Affect Disord 2022; 298:577-589. [PMID: 34763034 DOI: 10.1016/j.jad.2021.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Certain personality traits increase vulnerability to depression, but the evidence linking personality and postpartum depression (PPD) is less robust. This systematic review aimed to identify personality traits that increase the risk of PPD. METHODS We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, Scopus, CINAHL, and Cochrane, following the PRISMA guidelines for reporting. We carried out a meta-analysis on the association between neuroticism and PPD. RESULTS A total of 34 studies were analyzed. Of these, 31 considered at least one trait associated with PPD; 10 studies considered at least one trait not associated with PPD. The meta-analysis included 13 studies, concluding that neuroticism was associated with PPD (OR: 1.37; 95%CI: 1.22-1.53; p<0.001). LIMITATIONS Study design and approach to personality assessment influence results. Prospective longitudinal studies of persons with no prior history of mood disorder would provide stronger evidence about whether particular personality traits predict PPD. Most studies reviewed used self-report measures to assess personality. Study design and approach to personality assessment influence results, and indications of publication bias were found. CONCLUSIONS Neuroticism is the personality trait most widely studied in relation to PPD. Our meta-analysis found this trait is strongly related with PPD. Moreover, vulnerable personality style and trait anxiety are also associated with PPD. Screening for these traits might help identify women at risk, improving prevention, early detection, and possibly treatment.
Collapse
|
23
|
Bull E, Al-Janabi S, Gittens CB. Are women with traits of perfectionism more likely to develop perinatal depression? A systematic review and meta-analysis. J Affect Disord 2022; 296:67-78. [PMID: 34592658 DOI: 10.1016/j.jad.2021.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/14/2021] [Accepted: 09/12/2021] [Indexed: 11/25/2022]
Abstract
Women who present with a maladaptive form of the perfectionism trait may be vulnerable to perinatal depression (PND). The studies examining this association, though, differ in the specific time-points at which PND is measured, the tool/s used to assess PND and/or perfectionism, and the sample of women used; consequently, extant results reflecting this association can be difficult to integrate and interpret. This systematic review and meta-analysis seeks to clarify the association between PND and perfectionism by surveying literature on the relationship. Literature search strategies were developed using medical subject headings (MeSH) and text words related to PND and perfectionism. Nine electronic databases of published and unpublished literature were searched for relevant studies, which were selected for inclusion in this systematic review and meta-analysis if they contained data on female participants aged 18 or over and pregnant or who were within 12 months post-birth; additionally, studies were included if they contained quantitative reporting of depressive symptoms and trait perfectionism symptoms within the perinatal period (between pregnancy and up to 12 months post-birth). Ten publications were selected for inclusion based on independent review against the selection criteria by the authors. Eight of the 10 publications provided substantial correlational data and were analysed using meta-analytic techniques. All studies showed a significant positive relationship between measures of perfectionism and depression at various time points within the perinatal period (3rd trimester to 12-months postpartum), including concurrently in pregnancy, concurrently in postpartum, and longitudinally between pregnancy and postpartum. Interestingly, however, moderation analyses identified that the relationship between perfectionism and PND in the 3rd trimester may emerge only when a perinatal-specific, but not when a general, depression screening tool is used. These analyses also revealed that the strength of the relationship between perfectionism and PND may increase with length of time postpartum. The findings of this systematic review and meta-analysis, thus, suggest that medical professionals should consider perfectionism when formulating PND prevention strategies and assessing for PND using perinatal-specific screening tools.
Collapse
Affiliation(s)
- Emilie Bull
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | - Shahd Al-Janabi
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia.
| | - Catherine B Gittens
- College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| |
Collapse
|
24
|
Bellomo A, Severo M, Petito A, Nappi L, Iuso S, Altamura M, Marconcini A, Giannaccari E, Maruotti G, Palma GL, Vicino M, Perrone A, Tufariello AM, Sannicandro V, Milano E, Arcidiacono G, Di Salvatore M, Caroli A, Di Pinto I, Ventriglio A. Perinatal depression screening and prevention: Descriptive findings from a multicentric program in the South of Italy. Front Psychiatry 2022; 13:962948. [PMID: 35990082 PMCID: PMC9389401 DOI: 10.3389/fpsyt.2022.962948] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Perinatal depression (PD) is a cluster of clinical depressive symptoms occurring globally during pregnancy or after childbirth, with a prevalence of 11.9%. Risk factors for PD among pregnant women may include personality traits of neuroticism, low personal resilience, higher anxiety, avoidance in close relationships, as well as dysfunctional coping strategies. METHODS We report on descriptive findings of a screening/prevention program aimed to detect depressive symptoms and associated risk factors in a large sample of women (N = 1,664) accessing the gynecological departments of the Regione Puglia (South of Italy) from July to November 2020. Pregnant women were assessed in their third trimester of pregnancy (T0), after childbirth (T1), and those at risk for PD within 1 year from delivery (T2-T4); The Edinburgh Postnatal Depression Scale (EPDS) has been employed for the screening of PD over time as well as other standardized measures for neuroticism, resilience, coping strategies, and quality of life. RESULTS Of 1,664, n = 1,541 were tested at T1, and 131 scored ≥ 12 at EPDS (14.6 ± 2.95), showing a higher risk for PD. They were followed over time at 1, 6, and 12 months after childbirth (T2-T4), and 15 of them scored ≥ 12 (EPDS) at T4. Women with a higher risk of PD also reported higher levels of neuroticism, lower levels of personal resilience, more anxiety and avoidance in close relationships, higher employment of dysfunctional coping strategies (e.g., denial, self-blame, etc.), and lower quality of life (0.0008 < all p < 0.0001). CONCLUSION This study confirmed the benefit of screening programs for the early detection of PD among pregnant women. We may suggest a set of risk factors to be considered in the clinical assessment of PD risk as well as the promotion of similar programs to improve depressive outcomes and pathways to care for PD on the basis of a more accurate assessment and referral.
Collapse
Affiliation(s)
- Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Melania Severo
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Annamaria Petito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Salvatore Iuso
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | | | - Giuseppe Maruotti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Mario Vicino
- Unit of Gynecology, Di Venere Hospital, Bari, Italy
| | | | - Anna Maria Tufariello
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Valeria Sannicandro
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Eleonora Milano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Giulia Arcidiacono
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Melanie Di Salvatore
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | - Isabella Di Pinto
- Dipartimento Promozione Della Salute e del Benessere Animale, Regione Puglia, Bari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| |
Collapse
|
25
|
Al-Zahrani A, Almutairi W, Elsaba H, Alzahrani S, Alzahrani S, Althobaiti L, Turkestani O. Primiparous Adaptation with Postpartum Health Issues in Jeddah City, Kingdom of Saudi Arabia: A Quantitative Study. NURSING REPORTS 2021; 11:775-786. [PMID: 34968268 PMCID: PMC8715463 DOI: 10.3390/nursrep11040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The postpartum or puerperium period is the first 6 weeks after giving birth to an infant. The postpartum period can have negative implications, especially in first-time mothers. With their transition into motherhood, new mothers adopt new lifestyles, which can affect their physical wellbeing. Childbirth has physical, psychological, and emotional effects on women as they try to adapt to their new roles in order to get through this period with no or minimal health issues. Study Aim: The current study aims to explore primiparous adaptations with postpartum health issues in Jeddah City at Kingdom of Saudi Arabia. Methods: The research design is quantitative cross-sectional. A structured questionnaire was developed to collect data in relation to depression and weight gain, which consider the most common postpartum health issues. The inclusion criteria of the participants are: primipara, 2 to 6 months postpartum, and living in Jeddah. Results: 140 participants were included in the study. Mothers gained approximately 9.2 kg within the fifth to ninth month after giving birth. Discussion: Postpartum weight retention is a primary challenge in the majority of primiparous mothers and results in reduced quality of life. Nurses were always available to answer questions related to the postpartum health issues and explained the expectations to the family members. Conclusions: Childbirth and the postpartum period for first-time mothers are crucial in their lives as they try to adapt to a new way of life. The postpartum period can have negative implications, especially in first-time mothers. With their transition into motherhood, new mothers adopt new lifestyles, which can affect their physical wellbeing. More research is needed to explore the impact of postpartum health issues in Saudi Arabia.
Collapse
Affiliation(s)
- Ahlam Al-Zahrani
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (W.A.); (S.A.); (S.A.); (L.A.); (O.T.)
| | - Wedad Almutairi
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (W.A.); (S.A.); (S.A.); (L.A.); (O.T.)
| | - Howaida Elsaba
- Maternity, Obstetric and Gynecological Nursing Department, Faculty of Nursing, Port Said University, Port Said 32223, Egypt;
| | - Sanaa Alzahrani
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (W.A.); (S.A.); (S.A.); (L.A.); (O.T.)
| | - Shouq Alzahrani
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (W.A.); (S.A.); (S.A.); (L.A.); (O.T.)
| | - Linah Althobaiti
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (W.A.); (S.A.); (S.A.); (L.A.); (O.T.)
| | - Ohoud Turkestani
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (W.A.); (S.A.); (S.A.); (L.A.); (O.T.)
| |
Collapse
|
26
|
Leppers I, Veth CPM, de Waardt DA, Migchels H, Traa MJ. Perinatal mental health around the world: priorities for research and service development in The Netherlands. BJPsych Int 2021. [DOI: 10.1192/bji.2021.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Netherlands has an unique system of perinatal and postpartum healthcare. Pregnancy care is delivered predominantly by primary care midwives and childbirth services predominantly involve hospital care. The first week postpartum, all women receive daily care from maternity nurses. In addition, hospitals and out-patient clinics offer perinatal mental healthcare. More specifically, ‘POP care’ (psychiatry, obstetrics and paediatrics) was developed to promote multidisciplinary collaboration in this regard. Although clinical practices and government initiatives to improve pregnancy-related mental healthcare work well, they have yet to be fully described and evaluated. The current COVID-19 pandemic has an impact on health services and perinatal mental health.
Collapse
|
27
|
Pacheco F, Guiomar R, Brunoni AR, Buhagiar R, Evagorou O, Roca-Lecumberri A, Poleszczyk A, Lambregtse-van den Berg M, Caparros-Gonzalez RA, Fonseca A, Osório A, Soliman M, Ganho-Ávila A. Efficacy of non-invasive brain stimulation in decreasing depression symptoms during the peripartum period: A systematic review. J Psychiatr Res 2021; 140:443-460. [PMID: 34147932 DOI: 10.1016/j.jpsychires.2021.06.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Non-invasive brain stimulation (NIBS) techniques have been suggested as alternative treatments to decrease depression symptoms during the perinatal period. These include brain stimulation techniques that do not require surgery and that are nonpharmacological and non-psychotherapeutic. NIBS with evidence of antidepressant effects include repetitive transcranial magnetic stimulation (rTMS), transcranial electric stimulation (TES) and electroconvulsive therapy (ECT). OBJECTIVES This systematic review aims to summarize evidence on NIBS efficacy, safety and acceptability in treating peripartum depression (PPD). METHODS We included randomized, non-randomized and case reports, that used NIBS during pregnancy and the postpartum. The reduction of depressive symptoms and neonatal safety were the primary and co-primary outcomes, respectively. RESULTS rTMS shows promising results for the treatment of PPD, with clinically significant decreases in depressive symptoms between baseline and end of treatment and overall good acceptability. Although the safety profile for rTMS is adequate in the postpartum, caution is warranted during pregnancy. In TES, evidence on efficacy derives mostly from single-arm studies, compromising the encouraging findings. Further investigation is necessary concerning ECT, as clinical practice relies on clinical experience and is only described in low-quality case-reports. LIMITATIONS The reduced number of controlled studies, the lack of complete datasets and the serious/high risk of bias of the reports warrant cautious interpretations. CONCLUSIONS AND IMPLICATIONS Existing evidence is limited across NIBS techniques; comparative studies are lacking, and standard stimulation parameters are yet to be established. Although rTMS benefits from the most robust research, future multicenter randomized clinical trials are needed to determine the position of each NIBS strategy within the pathways of care.
Collapse
Affiliation(s)
- Francisca Pacheco
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
| | - Raquel Guiomar
- Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Andre R Brunoni
- Department of Internal Medicine and Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Olympia Evagorou
- University General Hospital of Alexandroupolis, Department of Psychiatry, Greece
| | - Alba Roca-Lecumberri
- Perinatal Mental Health Unit, Psychiatry and Clinical Psychology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Mijke Lambregtse-van den Berg
- Departments of Psychiatry and Child & Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Ana Fonseca
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Osório
- Graduate Program on Developmental Disorders, Center for Biological and Health Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Mahmoud Soliman
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive-Behavior Interventions, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
| |
Collapse
|
28
|
Gordon JL, Sander B, Eisenlohr-Moul TA, Sykes Tottenham L. Mood sensitivity to estradiol predicts depressive symptoms in the menopause transition. Psychol Med 2021; 51:1733-1741. [PMID: 32156321 DOI: 10.1017/s0033291720000483] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The risk for depression markedly rises during the 5-6 years leading up to the cessation of menstruation, known as the menopause transition. Exposure to extreme estradiol levels may help explain this increase but few studies have examined individual sensitivity to estradiol in predicting perimenopausal depression. METHOD The current study recruited 101 perimenopausal women. During Phase 1, we quantified each woman's sensitivity to changes in estradiol using 12 weekly measures of estrone-3-glucuronide (E1G), a urinary metabolite of estradiol, and concurrent depressive symptoms. The weekly cortisol awakening response was measured to examine the hypothalamic-pituitary-adrenal (HPA) axis in mediating mood sensitivity to estradiol. In Phase 2, depressive symptoms and major depression diagnoses were assessed monthly for 9 months. The relationship between Phase 1 E1G sensitivity and Phase 2 depressive symptoms and major depressive episodes was examined. Several baseline characteristics were examined as potential moderators of this relationship. RESULTS The within-person correlation between weekly E1G and mood varied greatly from woman to woman, both in strength and direction. Phase 1 E1G mood sensitivity predicted the occurrence of clinically significant depressive symptoms in Phase 2 among certain subsets of women: those without a prior history of depression, reporting a low number of baseline stressful life events, and reporting fewer months since their last menstrual period. HPA axis sensitivity to estradiol fluctuation did not predict Phase 2 outcomes. CONCLUSION Mood sensitivity to estradiol predicts risk for perimenopausal depression, particularly among women who are otherwise at low risk and among those who are early in the transition.
Collapse
Affiliation(s)
- Jennifer L Gordon
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Bethany Sander
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | | | | |
Collapse
|
29
|
Goedde D, Zidack A, Li YH, Arkava D, Mullette E, Mullowney Y, Brant JM. Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination. J Am Psychiatr Nurses Assoc 2021; 27:123-133. [PMID: 31898913 DOI: 10.1177/1078390319897311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic's experience serves as a role model for other centers to replicate this successful integrated model of care.
Collapse
Affiliation(s)
- Diane Goedde
- Diane Goedde, MSN, APRN, Billings Clinic, Billings, MT, USA
| | - Astri Zidack
- Astri Zidack, EdD, LCPC, CRC, Billings Clinic, Billings, MT, USA
| | - Ya-Huei Li
- Ya-Huei Li, PhD, Billings Clinic, Billings, MT, USA
| | - Diane Arkava
- Diane Arkava, MSW, LCSW, Billings Clinic, Billings, MT, USA
| | | | | | - Jeannine M Brant
- Jeannine M. Brant, PhD, APRN AOCN, FAAN, Billings Clinic, Billings, MT, USA
| |
Collapse
|
30
|
Schweizer-Schubert S, Gordon JL, Eisenlohr-Moul TA, Meltzer-Brody S, Schmalenberger KM, Slopien R, Zietlow AL, Ehlert U, Ditzen B. Steroid Hormone Sensitivity in Reproductive Mood Disorders: On the Role of the GABA A Receptor Complex and Stress During Hormonal Transitions. Front Med (Lausanne) 2021; 7:479646. [PMID: 33585496 PMCID: PMC7873927 DOI: 10.3389/fmed.2020.479646] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/20/2020] [Indexed: 12/16/2022] Open
Abstract
Women worldwide are two to three times more likely to suffer from depression in their lifetime than are men. Female risk for depressive symptoms is particularly high during the reproductive years between menarche and menopause. The term “Reproductive Mood Disorders” refers to depressive disorders triggered by hormonal fluctuations during reproductive transitions including the perimenarchal phase, the pre-menstrual phase, pregnancy, the peripartum period and the perimenopausal transition. Here we focus on reproductive mood disorders manifesting in adult life. We propose a research agenda that draws together several reproductive mood disorders and investigates which genetic, endocrinological, neural, and psychosocial factors can explain depressive symptoms during phases of hormonal transitions in women. Based on current research it is assumed that some women experience an increased sensitivity to not only fluctuations in reproductive steroids (estrogen and progesterone), but also stress-related steroids. We integrate both dynamics into the concept of “steroid hormone sensitivity,” expanding on the concept of “reproductive hormone sensitivity.” We suggest that a differential response of the stress steroid system including corticosteroids, neurosteroids, like allopregnanolone and the GABA-A Receptor complex, as well as a differential (epi)genetic risk in serotonergic and GABAergic signaling, are moderators or mediators between changes in the reproductive steroid system and the physiological, affective, and cognitive outcomes manifesting in reproductive mood disorders. We point to the lack of research on the role of psychosocial factors in increasing a woman's stress level and at some point also the sensitivity of her stress steroid system within the etiology of Reproductive Mood Disorders. Drawing together the evidence on various reproductive mood disorders we seek to present a basis for the development of more effective pharmacological, social, and psychological treatment interventions and prevention strategies for women susceptible to these disorders. This could pave the way for new research as well as medical and psychological teaching and practice- such as a new type of Practice for Gynecological Psychoneuroendocrinology- with the aim of working on and ultimately offering more integrative forms of support not yet available to women suffering from depression during hormonal transitions. In medical history women have been left alone with this integrative challenge.
Collapse
Affiliation(s)
- Sophie Schweizer-Schubert
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany.,Practice for Psychoendocrinology and Psychotherapy, Heilbronn, Germany
| | | | - Tory A Eisenlohr-Moul
- Women's Mental Health Research Program, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Katja M Schmalenberger
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| | - Radoslaw Slopien
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna-Lena Zietlow
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Ehlert
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Beate Ditzen
- Center for Psychosocial Medicine, Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
31
|
Flynn H, Deichen Hansen M, Shabaka-Haynes A, Chapman S, Roussos Ross K. Case Report: Implementation of a Multi-Component Behavioral Health Integration Program in Obstetrics for Perinatal Behavioral Health. Front Psychiatry 2021; 12:734883. [PMID: 34887784 PMCID: PMC8649687 DOI: 10.3389/fpsyt.2021.734883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Despite growing research and policy attention, perinatal behavioral health conditions (i.e., mental health and substance use disorders) remain prevalent, burdensome for families, and largely untreated in the US. Researchers have documented an array of barriers to accurate detection, linkage with effective treatment, and improved outcomes for perinatal women with behavioral health disorders. It is clear that a multi-component approach that integrates evidence-based detection and management of perinatal behavioral health in the context of obstetrics care can be effective. This paper presents the initial development of a clinical quality improvement program that includes evidence-based components of behavioral health integration in obstetrics in the state of Florida in the US. The FL BH Impact (Improving Maternal and Pediatric Access, Care and Treatment for Behavioral Health) program, guided by the RE-AIM model for program implementation, has been developed over the past 2 years. Program components, initial implementation, and preliminary findings are presented. Following the implementation phase, the program has enrolled 12 obstetrics practices and 122 obstetrics providers in program engagement and training activities. The primary program component allows for obstetrics clinician telephone access to a statewide listing of behavioral health referral resources for patients and access to consultation with psychiatry. Since program implementation, the program has received a total of 122 calls to this line, with an expected increasing trajectory of calls over time. Results suggest this program is feasible to implement across a large geographic area. Challenges to implementation and future directions are discussed. These types of multi-component approaches to improved management and outcomes for perinatal behavioral health are promising and must be expanded and sustained in the US.
Collapse
Affiliation(s)
- Heather Flynn
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Megan Deichen Hansen
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Amandla Shabaka-Haynes
- Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, United States
| | - Shay Chapman
- Florida Department of Health, Tallahassee, FL, United States
| | - Kay Roussos Ross
- Department of Obstetrics & Gynecology, College of Medicine, University of Florida, Gainesville, FL, United States
| |
Collapse
|
32
|
Boekhorst MGBM, Beerthuizen A, Hillegers M, Pop VJM, Bergink V. Mother-to-Infant Bonding in Women With a Bipolar Spectrum Disorder. Front Pediatr 2021; 9:646985. [PMID: 33816406 PMCID: PMC8017118 DOI: 10.3389/fped.2021.646985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose: Offspring of mothers with a bipolar disorder are at high-risk for impaired developmental outcomes and psychopathology (e. g., mood, anxiety, sleep disorders) later in life. This increased risk of psychopathology is not only because of genetic vulnerability, but environmental factors may play an important role as well. The often long and debilitating mood episodes of mothers with bipolar disorder might hamper their qualities as a caregiver and may impact the child. We examined early mother-to-infant bonding 1 year postpartum in mothers with bipolar spectrum disorder as compared to mothers of the general population. The association between mother-to-infant bonding and the type of bipolar spectrum diagnosis (bipolar I, bipolar II, bipolar Not Otherwise Specified) as well as relapse within 12 months postpartum was also assessed. Methods: In total, 75 pregnant women with a bipolar spectrum disorder participated in the current study. The participants were included in a longitudinal cohort study of women with bipolar spectrum disorder and were prospectively followed from pregnancy until 1 year postpartum. Mother-to-infant bonding was assessed using the Pre- and Postnatal Bonding Scale. A longitudinal population-based cohort of 1,419 pregnant women served as the control group. Multiple linear regression analyses were used to assess the association between bipolar spectrum disorder and mother-to-infant bonding scores, controlling for several confounders. Results: Women with bipolar spectrum disorder perceived the bonding with their child as less positive compared to the control group. The type of bipolar spectrum disorder was not associated with poorer bonding scores. Relapse during the 1st year after delivery also did not affect bonding scores in women with bipolar spectrum disorder. Conclusions: Our findings could imply that women with bipolar spectrum disorder are more vulnerable to impairments in bonding due to the nature of their psychopathology, regardless of the occurrence of postpartum relapse. Careful follow-up including monitoring of mother-to-infant bonding of pregnant women with a history of bipolar spectrum disorder should be a standard to this vulnerable group of women. In addition, regardless of severity and mood episode relapse, an intervention to improve bonding could be beneficial for all mothers with bipolar spectrum disorder and their newborns.
Collapse
Affiliation(s)
- Myrthe G B M Boekhorst
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Annemerle Beerthuizen
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Manon Hillegers
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Victor J M Pop
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Veerle Bergink
- Department of Psychiatry, Erasmus MC, University Medical Center, Rotterdam, Netherlands.,Departments of Psychiatry and Obstetrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| |
Collapse
|
33
|
Zhang W, Liu L, Cheng Q, Chen Y, Xu D, Gong W. The Relationship Between Images Posted by New Mothers on WeChat Moments and Postpartum Depression: Cohort Study. J Med Internet Res 2020; 22:e23575. [PMID: 33252343 PMCID: PMC7735903 DOI: 10.2196/23575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 01/12/2023] Open
Abstract
Background As social media posts reflect users’ emotions, WeChat Moments, the most popular social media platform in China, may offer a glimpse into postpartum depression in the population. Objective This study aimed to investigate the features of the images that mothers posted on WeChat Moments after childbirth and to explore the correlation between these features and the mothers' risk of postpartum depression. Methods We collected the data of 419 mothers after delivery, including their demographics, factors associated with postpartum depression, and images posted on WeChat Moments. Postpartum depression was measured using the Edinburgh Postnatal Depression Scale. Descriptive analyses were performed to assess the following: content of the images, presence of people, the people’s facial expressions, and whether or not memes were posted on WeChat Moments. Logistic regression analyses were used to identify the image features associated with postpartum depression. Results Compared with pictures of other people, we found that pictures of their children comprised the majority (3909/6887, 56.8%) of the pictures posted by the mothers on WeChat Moments. Among the posts showing facial expressions or memes, more positive than negative emotions were expressed. Women who posted selfies during the postpartum period were more likely to have postpartum depression (P=.003; odds ratio 2.27, 95% CI 1.33-3.87). Conclusions The vast majority of mothers posted images conveying positive emotions during the postpartum period, but these images may have masked their depression. New mothers who have posted selfies may be at a higher risk of postpartum depression. Trial Registration International Clinical Trials Registry Platform ChiCTR-ROC-16009255; http://www.chictr.org.cn/showproj.aspx?proj=15699
Collapse
Affiliation(s)
- Weina Zhang
- XiangYa School of Public Health, Central South University, Changsha, China.,Changsha Hospital for Maternal and Child Health Care, Changsha, China
| | - Lu Liu
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Qijin Cheng
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong, China
| | - Yan Chen
- Changsha Hospital for Maternal and Child Health Care, Changsha, China
| | - Dong Xu
- Global Health and Health Systems, School of Health Management, Southern Medical University, Guangzhou, China
| | - Wenjie Gong
- XiangYa School of Public Health, Central South University, Changsha, China.,Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom.,Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| |
Collapse
|
34
|
Deligiannidis KM, Kroll-Desrosiers AR, Tan Y, Dubuke ML, Shaffer SA. Longitudinal proneuroactive and neuroactive steroid profiles in medication-free women with, without and at-risk for perinatal depression: A liquid chromatography-tandem mass spectrometry analysis. Psychoneuroendocrinology 2020; 121:104827. [PMID: 32828068 PMCID: PMC7572700 DOI: 10.1016/j.psyneuen.2020.104827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Neuroactive steroids (NAS) are derivatives of cholesterol or steroidal precursors made in the gonads, adrenal gland, placenta and brain. We characterized longitudinal plasma proneuroactive and NAS in healthy perinatal comparison women (HPCW), women at-risk for perinatal depression (AR-PND), and women with PND with/without comorbid anxiety. We hypothesized that AR-PND women who either did or did not go on to develop PND would have elevated NAS concentrations as compared to HPCW and that NAS would be correlated to depressive and anxiety symptoms. METHODS A prospective cohort study evaluated 75 medication-free perinatal women (HPCW, n = 30; AR-PND, n = 19; PND, n = 26). Standardized depression and anxiety assessments and blood samples were completed across 5 visits. Structured Clinical Interviews for DSM-IV TR Disorders were administered at study entry and exit. Plasma pregnenolone, progesterone, 5α- and 5β-dihydroprogesterone, pregnanolone, allopregnanolone, deoxycorticosterone and tetrahydrodeoxycorticosterone were quantified by liquid chromatography-tandem mass spectrometry. Longitudinal relationships between risk-group, depression and anxiety symptoms, and NAS concentrations were analyzed using generalized estimating equations to control for repeated measures correlations. RESULTS Perinatal 5α-dihydroprogesterone, 5β-dihydroprogesterone, allopregnanolone, deoxycorticosterone, and tetrahydrodeoxycorticosterone concentrations were higher in AR-PND and PND women compared to HPCW (β = 3.57 ± 1.40 and β = 2.11 ± 1.12, p = 0.03; β = 0.18 ± 0.06 and β = 0.03 ± 0.05, p = 0.02; β = 1.06 ± 0.42 and β = 1.19 ± 0.47, p = 0.01; β = 0.17 ± 0.07 and β = 0.11 ± 0.06, p = 0.05; β = 0.03 ± 0.01 and β = 0.03 ± 0.01, p = 0.05, respectively). Perinatal allopregnanolone, 5α-dihydroprogesterone and tetrahydrodeoxycorticosterone were positively associated with HAM-D17 (all p < 0.02). HAM-A was positively associated with 5α- and 5β-dihydroprogesterone, pregnanolone, allopregnanolone, deoxycorticosterone and tetrahydrodeoxycorticosterone (all p < 0.05). A history of depression was associated with increased 5α-dihydroprogesterone (2.20 ± 1.09, p = 0.05), deoxycorticosterone (0.13 ± 0.06, p = 0.03) and tetrahydrodeoxycorticosterone (0.03 ± 0.01, p = 0.02). CONCLUSION To our knowledge, this study represents the largest prospective study of 5-α and 5-β reductase products of progesterone and deoxycorticosterone in HPCW and women AR-PND. Data suggest that PND is associated with both a reduction of progesterone to 5β-dihydroprogesterone, 5α-dihydroprogesterone, and allopregnanolone, and the 21-hydroxylation to deoxycorticosterone and tetrahydrodeoxycorticosterone. The shift towards 5α-dihydroprogesterone, deoxycorticosterone and tetrahydrodeoxycorticosterone was associated with a history of depression, a significant risk factor for PND.
Collapse
Affiliation(s)
- Kristina M Deligiannidis
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, 11030, USA; Department of Psychiatry, Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, Queens, NY, 11004, USA; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11549, USA; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
| | - Aimee R Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA, 01053, USA; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
| | - Yanglan Tan
- Mass Spectrometry Facility, University of Massachusetts Medical School, Shrewsbury, MA, 01545, USA; Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
| | - Michelle L Dubuke
- Mass Spectrometry Facility, University of Massachusetts Medical School, Shrewsbury, MA, 01545, USA; Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
| | - Scott A Shaffer
- Mass Spectrometry Facility, University of Massachusetts Medical School, Shrewsbury, MA, 01545, USA; Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, MA, 01655, USA.
| |
Collapse
|
35
|
Frokjaer VG. Pharmacological sex hormone manipulation as a risk model for depression. J Neurosci Res 2020; 98:1283-1292. [PMID: 32399989 PMCID: PMC7383584 DOI: 10.1002/jnr.24632] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 04/06/2020] [Accepted: 04/11/2020] [Indexed: 12/19/2022]
Abstract
Sex hormone transition may trigger severe depressive episodes in some women. In order to map mechanisms related to such phenomena we developed a pharmacological preclinical human model using sex hormone manipulation with gonadotropin releasing hormone agonist (GnRHa) in a placebo‐controlled design. Here the findings from this model is synthesized and discussed in the context of related literature on hormonal contributions to reproductive mental health disorders. The GnRha model work points to an estradiol‐dependent depressive response in healthy women undergoing short‐term sex hormone manipulation with GnRHa, which is linked to serotonin transporter changes (a key regulator of synaptic serotonin), a disengagement of hippocampus, and overengagement of brain networks recruited when processing emotional salient information. Further, the GnRHa model suggest that key brain regions in the reward circuit are less engaged in positive stimuli when undergoing sex hormone manipulation, which may underlie anhedonia. Also, the work supports that enhanced sensitivity to estrogen signaling at the level of gene expression may drive increased risk for depressive symptoms when exposed to sex steroid hormone fluctuations. In conclusion, the GnRHa model work highlights the brain signatures of rapid and profound changes in sex steroid hormone milieu, which reflect plausible mechanisms by which risk for mood disorders works. This model points to the role of estrogen dynamics and sensitivity, and offers a rationale for personalized prevention in hormonal transition phases, for example pregnancy to postpartum transition, perimenopause, and hormone treatments, which now can move into clinical translation and ideally pave the way for protecting mental and cognitive health.
Collapse
Affiliation(s)
- Vibe G Frokjaer
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Copenhagen, Denmark.,Psychiatric Center Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
36
|
Walsh K, McCormack CA, Webster R, Pinto A, Lee S, Feng T, Krakovsky HS, O'Grady SM, Tycko B, Champagne FA, Werner EA, Liu G, Monk C. Maternal prenatal stress phenotypes associate with fetal neurodevelopment and birth outcomes. Proc Natl Acad Sci U S A 2019; 116:23996-24005. [PMID: 31611411 PMCID: PMC6883837 DOI: 10.1073/pnas.1905890116] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Maternal prenatal stress influences offspring neurodevelopment and birth outcomes including the ratio of males to females born; however, there is limited understanding of what types of stress matter, and for whom. Using a data-driven approach with 27 variables from questionnaires, ambulatory diaries, and physical assessments collected early in the singleton pregnancies of 187 women, 3 latent profiles of maternal prenatal stress emerged that were differentially associated with sex at birth, birth outcomes, and fetal neurodevelopment. Most women (66.8%) were in the healthy group (HG); 17.1% were in the psychologically stressed group (PSYG), evidencing clinically meaningful elevations in perceived stress, depression, and anxiety; and 16% were in the physically stressed group (PHSG) with relatively higher ambulatory blood pressure and increased caloric intake. The population normative male:female secondary sex ratio (105:100) was lower in the PSYG (2:3) and PHSG (4:9), and higher in the HG (23:18), consistent with research showing diminished male births in maternal stress contexts. PHSG versus HG infants were born 1.5 wk earlier (P < 0.05) with 22% compared to 5% born preterm. PHSG versus HG fetuses had decreased fetal heart rate-movement coupling (P < 0.05), which may indicate slower central nervous system development, and PSYG versus PHSG fetuses had more birth complications, consistent with previous findings among offspring of women with psychiatric illness. Social support most strongly differentiated the HG, PSYG, and PHSG groups, and higher social support was associated with increased odds of male versus female births. Stress phenotypes in pregnant women are associated with male vulnerability and poor fetal outcomes.
Collapse
Affiliation(s)
- Kate Walsh
- Ferkauf Graduate School of Psychology, Yeshiva University, The Bronx, NY 10461
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Clare A McCormack
- Center for Science and Society, Columbia University, New York, NY 10027
| | - Rachel Webster
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Anita Pinto
- Data Science, Columbia University, New York, NY 10027
| | - Seonjoo Lee
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - Tianshu Feng
- Department of Biostatistics (in Psychiatry), Mailman School of Public Health, Columbia University, New York, NY 10032
| | - H Sloan Krakovsky
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Sinclaire M O'Grady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
| | - Benjamin Tycko
- Hackensack-Meridian Health Center for Discovery and Innovation, Nutley, NJ 07110
| | - Frances A Champagne
- Department of Psychiatry, Columbia University, New York, NY 10032
- Department of Psychology, University of Texas at Austin, Austin, TX 78712
| | - Elizabeth A Werner
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Grace Liu
- Department of Psychiatry, Columbia University, New York, NY 10032
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032;
- Division of Behavioral Medicine, New York State Psychiatric Institute, New York, NY 10032
- Department of Psychiatry, Columbia University, New York, NY 10032
| |
Collapse
|
37
|
Childhood trauma and depressive symptoms in pregnant adolescents in Southern Brazil. Int J Public Health 2019; 65:197-205. [PMID: 31745616 DOI: 10.1007/s00038-019-01311-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the association between child maltreatment and depressive symptomatology during gestation in adolescents. METHODS This was a cross-sectional study with pregnant adolescents aged 12 to 19 years. Data were collected with the Beck Depression Inventory, Childhood Trauma Questionnaire, and Mini International Neuropsychiatric Interview. RESULTS Compared to adolescents who did not experience each type of neglect or abuse, experiencing them was associated with a higher proportion of depressive symptoms: emotional neglect PR = 1.4 (95% CI 1.1; 1.8); physical neglect PR = 1.7 (95% CI 1.3; 1.7); emotional abuse PR = 1.8 (95% CI 1.4; 2.2); and physical abuse PR = 1.3 (95% CI 1.1; 1.7). CONCLUSIONS This study demonstrates the association between childhood experiences and mental health in adolescence, especially in vulnerable samples, such as pregnant adolescents. This finding reveals the importance of studying early trauma in life and enabling preventive help, especially in adolescents. High-quality evidence of perinatal mental health problems should be generated to make pregnancy safer for women in low- and middle-income countries.
Collapse
|
38
|
Guintivano J, Putnam KT, Sullivan PF, Meltzer-Brody S. The international postpartum depression: action towards causes and treatment (PACT) consortium. Int Rev Psychiatry 2019; 31:229-236. [PMID: 30810405 DOI: 10.1080/09540261.2018.1551191] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The International Postpartum depression: Action towards Causes and Treatment (PACT) Consortium was founded with the overarching goal of creating an international perinatal psychiatry consortium to conduct novel investigations with large sample sizes to understand the genetic signature of perinatal mood disorders. PACT uses a collaborative and team science approach that includes investigators across 19 institutions and seven continents. The large sample sizes allow for statistically rigorous analyses to investigate perinatal psychiatric disorders, with an initial focus on postpartum depression (PPD). Our current aims are to identify clinical sub-types of PPD that contribute diagnostic heterogeneity, and to elucidate the genetic basis of PPD by conducting the first large genome-wide association study of PPD. To accomplish the latter aim, we are partnering with the Major Depressive Disorder Working Group of the Psychiatric Genomics Consortium. To date, our consortium members have recruited 17,912 participants and 11,344 participants have been identified using the PPD ACT mobile app, of which 8,432 are PPD cases. Ultimately, we hope this approach will improve detection, diagnosis, and treatment of women who suffer from perinatal psychiatric disorders.
Collapse
Affiliation(s)
- Jerry Guintivano
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Karen T Putnam
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Patrick F Sullivan
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,b Department of Genetics , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.,c Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden
| | - Samantha Meltzer-Brody
- a Department of Psychiatry , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| |
Collapse
|
39
|
Kimmel MC, Bauer A, Meltzer-Brody S. Toward a framework for best practices and research guidelines for perinatal depression research. J Neurosci Res 2019; 98:1255-1267. [PMID: 30924191 PMCID: PMC10127524 DOI: 10.1002/jnr.24425] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/09/2018] [Accepted: 10/26/2018] [Indexed: 02/06/2023]
Abstract
This review article highlights the current state of perinatal depression (PND) research including established standards of care and innovative research in progress. PND can have a significant adverse impact on mother, child, and family; however, to date, wide-scale identification, prevention, and treatment have been limited. PND is heterogenous in presentation with likely multifactorial etiologies for each woman. Challenges in PND research are discussed including a need for universal tools, standardized measures, benchmarks, and best practices. Current examples are reviewed that highlight approaches to novel treatment paradigms and interventions. This includes reviewing epidemiologic studies in PND research, examining the biological underpinnings of PND, and discussing examples from this field and other fields currently developing translational research that spans from bench to bedside. Current and future challenges and opportunities in developing best practices for the treatment of PND are outlined. We also discuss the use of the NIMH Research Domain Criteria approach for PND research and provide recommendations for future directions in PND research collaboration. In conclusion, greater precision in perinatal psychiatry can be possible in the future with the development of guidelines and best practices that build on current work and apply innovative and collaborative approaches of scientists, providers, patients, community members, and government officials.
Collapse
Affiliation(s)
- Mary C Kimmel
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Anna Bauer
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Samantha Meltzer-Brody
- Department of Psychiatry, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
40
|
Maguire J. Neuroactive Steroids and GABAergic Involvement in the Neuroendocrine Dysfunction Associated With Major Depressive Disorder and Postpartum Depression. Front Cell Neurosci 2019; 13:83. [PMID: 30906252 PMCID: PMC6418819 DOI: 10.3389/fncel.2019.00083] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/19/2019] [Indexed: 12/21/2022] Open
Abstract
Stress and previous adverse life events are well-established risk factors for depression. Further, neuroendocrine disruptions are associated with both major depressive disorder (MDD) and postpartum depression (PPD). However, the mechanisms whereby stress contributes to the underlying neurobiology of depression remains poorly understood. The hypothalamic-pituitary-adrenal (HPA) axis, which mediates the body's neuroendocrine response to stress, is tightly controlled by GABAergic signaling and there is accumulating evidence that GABAergic dysfunction contributes to the impact of stress on depression. GABAergic signaling plays a critical role in the neurobiological effects of stress, not only by tightly controlling the activity of the HPA axis, but also mediating stress effects in stress-related brain regions. Deficits in neuroactive steroids and neurosteroids, some of which are positive allosteric modulators of GABAA receptors (GABAARs), such as allopregnanolone and THDOC, have also been implicated in MDD and PPD, further supporting a role for GABAergic signaling in depression. Alterations in neurosteroid levels and GABAergic signaling are implicated as potential contributing factors to neuroendocrine dysfunction and vulnerability to MDD and PPD. Further, potential novel treatment strategies targeting these proposed underlying neurobiological mechanisms are discussed. The evidence summarized in the current review supports the notion that MDD and PPD are stress-related psychiatric disorders involving neurosteroids and GABAergic dysfunction.
Collapse
Affiliation(s)
- Jamie Maguire
- Neuroscience Department, Tufts University School of Medicine, Boston, MA, United States
| |
Collapse
|
41
|
Resting-state functional connectivity, cortical GABA, and neuroactive steroids in peripartum and peripartum depressed women: a functional magnetic resonance imaging and spectroscopy study. Neuropsychopharmacology 2019; 44:546-554. [PMID: 30327498 PMCID: PMC6333815 DOI: 10.1038/s41386-018-0242-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/24/2018] [Accepted: 10/03/2018] [Indexed: 01/17/2023]
Abstract
Postpartum depression (PPD) is associated with abnormalities in resting-state functional connectivity (RSFC) but the underlying neurochemistry is unclear. We hypothesized that peripartum GABAergic neuroactive steroids (NAS) are related to cortical GABA concentrations and RSFC in PPD as compared to healthy comparison women (HCW). To test this, we measured RSFC with fMRI and GABA+/Creatine (Cr) concentrations with proton magnetic resonance spectroscopy (1H MRS) in the pregenual anterior cingulate (pgACC) and occipital cortices (OCC) and quantified peripartum plasma NAS. We examined between-group differences in RSFC and the relationship between cortical GABA+/Cr concentrations with RSFC. We investigated the relationship between NAS, RSFC and cortical GABA+/Cr concentrations. Within the default mode network (DMN) an area of the dorsomedial prefrontal cortex (DMPFC) had greater connectivity with the rest of the DMN in PPD (peak voxel: MNI coordinates (2, 58, 32), p = 0.002) and was correlated to depression scores (peak HAM-D17 voxel: MNI coordinates (0, 60, 34), p = 0.008). pgACC GABA+/Cr correlated positively with DMPFC RSFC in a region spanning the right anterior/posterior insula and right temporal pole (r = +0.661, p = 0.000). OCC GABA+/Cr correlated positively with regions spanning both amygdalae (right amygdala: r = +0.522, p = 0.000; left amygdala: r = +0.651, p = 0.000) as well as superior parietal areas. Plasma allopregnanolone was higher in PPD (p = 0.03) and positively correlated with intra DMPFC connectivity (r = +0.548, p = 0.000) but not GABA+/Cr. These results provide initial evidence that PPD is associated with altered DMN connectivity; cortical GABA+/Cr concentrations are associated with postpartum RSFC and allopregnanolone is associated with postpartum intra-DMPFC connectivity.
Collapse
|
42
|
Guintivano J, Krohn H, Lewis C, Byrne EM, Henders AK, Ploner A, Kirk K, Martin NG, Milgrom J, Wray NR, Sullivan PF, Meltzer-Brody S. PPD ACT: an app-based genetic study of postpartum depression. Transl Psychiatry 2018; 8:260. [PMID: 30498212 PMCID: PMC6265256 DOI: 10.1038/s41398-018-0305-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/26/2018] [Indexed: 12/16/2022] Open
Abstract
Postpartum depression (PPD) is one of the most frequent complications of childbirth and particularly is suited to genetic investigation as it is more homogenous than major depression outside of the perinatal period. We developed an iOS app (PPD ACT) to recruit, consent, screen, and enable DNA collection from women with a lifetime history of PPD to sufficiently power genome-wide association studies. In 1 year, we recruited 7344 women with a history of PPD and have biobanked 2946 DNA samples from the US. This sample of PPD cases was notably severely affected and within 2 years of their worst episode of PPD. Clinical validation was performed within a hospital setting on a subset of participants and recall validity assessed 6-9 months after initial assessment to ensure reliability of screening tools. Here we detail the creation of the PPD ACT mobile app including design, ethical, security, and deployment considerations. We emphasize the importance of multidisciplinary collaboration to correctly implement such a research project. Additionally, we describe our ability to customize the PPD ACT platform to deploy internationally in order to collect a global sample of women with PPD.
Collapse
Affiliation(s)
- Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Holly Krohn
- 0000000122483208grid.10698.36Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Carol Lewis
- 0000000122483208grid.10698.36Center for Health Innovation, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Enda M. Byrne
- 0000 0000 9320 7537grid.1003.2Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD Australia
| | - Anjali K. Henders
- 0000 0000 9320 7537grid.1003.2Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD Australia
| | - Alexander Ploner
- 0000 0004 1937 0626grid.4714.6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Kirk
- 0000 0001 2294 1395grid.1049.cQIMR Berghofer Institute for Medical Research, Brisbane, QLD Australia
| | - Nicholas G. Martin
- 0000 0001 2294 1395grid.1049.cQIMR Berghofer Institute for Medical Research, Brisbane, QLD Australia
| | - Jeannette Milgrom
- 0000 0001 2179 088Xgrid.1008.9Parent-Infant Research Institute and University of Melbourne, Melbourne, VIC Australia
| | - Naomi R. Wray
- 0000 0000 9320 7537grid.1003.2Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD Australia ,0000 0000 9320 7537grid.1003.2Queensland Brain Institute, The University of Queensland, Brisbane, QLD Australia
| | - Patrick F. Sullivan
- 0000000122483208grid.10698.36Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,0000 0004 1937 0626grid.4714.6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ,0000000122483208grid.10698.36Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Samantha Meltzer-Brody
- 0000000122483208grid.10698.36Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| |
Collapse
|
43
|
Law KH, Dimmock J, Guelfi KJ, Nguyen T, Gucciardi D, Jackson B. Stress, Depressive Symptoms, and Maternal Self-Efficacy in First-Time Mothers: Modelling and Predicting Change across the First Six Months of Motherhood. Appl Psychol Health Well Being 2018; 11:126-147. [PMID: 30345730 DOI: 10.1111/aphw.12147] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND First-time mothers commonly experience stress and depressive symptoms in the postpartum period. Maternal self-efficacy has been shown to be an important protective factor against these experiences; however, research on the dynamic nature of stress, depressive symptoms, and maternal self-efficacy is limited. The aim of this study was to document changes in these psychological factors among first-time mothers, and determine how early maternal self-efficacy perceptions may predict change in stress and depressive symptoms over the first 6 months postpartum. METHODS Sixty first-time Australian mothers were recruited during their third trimester of pregnancy. Participants completed a baseline survey during the third trimester of pregnancy (M = 32.87 weeks, SD = 2.62 weeks), and subsequently reported stress, depressive symptoms, and maternal self-efficacy every 3 weeks postpartum for 6 months. Latent growth curve modelling was used to estimate participants' change over time for stress and depressive symptoms. RESULTS First-time mothers' stress and depressive symptoms peaked, and maternal self-efficacy was weakest, at 3 weeks postpartum. Maternal self-efficacy at 3 weeks postpartum was a significant (negative) predictor of 3-week levels of, and also (positively) predicted later reductions in, stress. CONCLUSION Future interventions aimed at bolstering early maternal self-efficacy may protect against postpartum stress for first-time mothers.
Collapse
Affiliation(s)
| | | | | | - Thinh Nguyen
- The University of Western Australia, Australia
- Peel and Rockingham Kwinana Mental Health Service, Australia
| | | | - Ben Jackson
- The University of Western Australia, Australia
| |
Collapse
|
44
|
Londono Tobon A, Newport DJ, Nemeroff CB. The Role of Oxytocin in Early Life Adversity and Later Psychopathology: a Review of Preclinical and Clinical Studies. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s40501-018-0158-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
45
|
Arifin SRM, Cheyne H, Maxwell M. Review of the prevalence of postnatal depression across cultures. AIMS Public Health 2018; 5:260-295. [PMID: 30280116 PMCID: PMC6141558 DOI: 10.3934/publichealth.2018.3.260] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 07/12/2018] [Indexed: 12/15/2022] Open
Abstract
The purpose of this review was to examine articles related to recent epidemiological evidence of the prevalence of maternal postnatal depression (PND) across different countries and cultures and to identify specific epidemiological studies that have been carried out exclusively in Malaysia on the prevalence of maternal PND. The review was undertaken in two stages, an initial review and an updated review. At both stages systematic literature searches of online databases were performed to identify articles on the prevalence of maternal PND. A total of 124 articles concerning research conducted in more than 50 countries were included in the final analysis. There were wide variations in the screening instruments and diagnostic tools used although the Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument applied to identify PND. The prevalence of maternal PND ranged from 4.0% to 63.9%, with Japan and America recording the lowest and highest rates, respectively. Within continents, a wide variation in reported prevalence was also found. The reported rates of maternal PND in Malaysia were much higher than that previously documented with a range of 6.8–27.3%. This review indicated that the widely cited prevalence of maternal PND of 10–15% underestimates rates of PND worldwide. The reasons for this variability may not be fully explained by review methods. Future studies should evaluate the nature of women's PND experiences across cultures to explain these wide variations.
Collapse
Affiliation(s)
- Siti Roshaidai Mohd Arifin
- Department of Special Care Nursing, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professional (NMAHP) Research Unit, University of Stirling Scotland, United Kingdom
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professional (NMAHP) Research Unit, University of Stirling Scotland, United Kingdom
| |
Collapse
|
46
|
White matter integrity in medication-free women with peripartum depression: a tract-based spatial statistics study. Neuropsychopharmacology 2018; 43:1573-1580. [PMID: 29453442 PMCID: PMC5983547 DOI: 10.1038/s41386-018-0023-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/05/2018] [Accepted: 01/23/2018] [Indexed: 01/03/2023]
Abstract
Diffusion tensor imaging (DTI) studies in depression show decreased structural connectivity in the left anterior limb of the internal capsule and the genu of the corpus callosum but no such studies exist in peripartum depression (PPD), which affects 1 in 8 women. We analyzed fractional anisotropy (FA) as a measure of white matter integrity of these two tracts using tract-based spatial statistics (TBSS). We then conducted an exploratory whole-brain analysis to identify additional regions implicated in PPD. Seventy-five pregnant, medication-free women were evaluated with the Edinburgh Postnatal Depression Scale (EPDS) and Structured Clinical Interview (SCID) for DSM-IV-TR in pregnancy and in the postpartum. Structural MRI and DTI sequences were acquired in forty-four women within 2-8 weeks postpartum. TBSS data were analyzed between healthy comparison postpartum women (HCW) and women who developed PPD to determine differences in white matter integrity within the left anterior limb of the internal capsule and the genu of the corpus callosum, then analyzed across participants to explore correlation between FA and the EPDS score. An exploratory whole-brain analysis was also conducted to identify other potential regions showing differences in white matter integrity between groups, as well as correlation between EPDS and FA across groups. All results were corrected for multiple comparisons and analyses conducted using FSL, p < 0.05, K > 10. In comparison to HCW, women with PPD had significantly lower FA in left anterior limb of the internal capsule (p = 0.010). FA was negatively correlated with EPDS scores in the left anterior limb of the internal capsule (p = 0.019). In the whole-brain analysis, FA in the right retrolenticular internal capsule (p = 0.03) and two clusters within the body of the corpus callosum (p = 0.044, p = 0.050) were negatively correlated with EPDS; there were no between-group differences in FA. Reduced FA in the left anterior limb of the internal capsule suggests disruption of fronto-subcortical circuits in PPD. A negative correlation between FA within the body of the corpus callosum and EPDS total score could additionally reflect disrupted interhemispheric structural connectivity in women with depressive symptoms.
Collapse
|
47
|
Kim Y, Dee V. Self-Care for Health in Rural Hispanic Women at Risk for Postpartum Depression. Matern Child Health J 2018; 21:77-84. [PMID: 27435729 DOI: 10.1007/s10995-016-2096-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine factors that affect self-care of rural Hispanic women at risk for postpartum depression (PPD). METHODS This study was a descriptive cross-sectional design based on the key concepts of Orem's Self-care Deficit Nursing theory. Data were collected from 223 Hispanic postpartum women residing in Mecca, North Shore, and Thermal in California by an interviewer-administered survey. Four instruments were utilized: Edinburgh Postnatal Depression Scale (EPDS) for PPD, Multidimensional Scale of Perceived Social Support for social support, Duke University Religion Index (DUREL) for spirituality, and Self Rated Abilities for Health Practices for self-care. RESULTS The prevalence of women at risk for PPD was about 43 %. Social support, spirituality, and self-care ability were significantly correlated in women with PPD. Social support was a strong factor in predicting self-care ability for 'Nutrition', 'Psychological well-being', 'Exercise', and 'Responsible Health Practices' in the rural Hispanic women at risk for PPD. CONCLUSIONS The study findings can enable nurses and healthcare professionals to develop effective tailored interventions to assist rural Hispanic women's abilities to perform self-care for health, and in particular, during the postpartum period.
Collapse
Affiliation(s)
- Younglee Kim
- California State University San Bernardino, 5500 University Pkwy, San Bernardino, CA, 92407, USA.
| | - Vivien Dee
- Nursing Program, Azusa Pacific University, 901 E Alosta Ave, Azusa, CA, 91702, USA
| |
Collapse
|
48
|
Myers S, Johns SE. Postnatal depression is associated with detrimental life-long and multi-generational impacts on relationship quality. PeerJ 2018; 6:e4305. [PMID: 29472995 PMCID: PMC5817936 DOI: 10.7717/peerj.4305] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/10/2018] [Indexed: 01/20/2023] Open
Abstract
Postnatal depression (PND) is known to be associated with a range of detrimental child and adolescent outcomes, resulting from its disruptive impact on mother-child relationship quality. However, until now little has been known about the impact of PND on the longer-term relationships between mothers and their children, and any intergenerational effects this may have. Mother-child relationship quality is of interest from an evolutionary perspective as it plays a role in the accrual of offspring embodied capital, thus affecting offspring quality and offspring’s capacity to subsequently invest in their own children. Relationships with offspring also mediate grandparent-grandchild relations; if PND negatively affects long-term mother–offspring relationship quality, it is also likely to negatively affect grandmaternal investment via reduced grandmother–grandchild relationship quality. Here, we use responses to a retrospective questionnaire study of postmenopausal women, largely from the UK and US, to assess the impact of PND occurring in generation 1 on mother–child relationship quality across the life course of the child (generation 2) with whom it was associated, and also on the relationship quality with grandchildren (generation 3) from that child. Average mother-child relationship quality was lower when the child’s birth was associated with PND. Multi-level regression modelling found that mother-child relationship quality decreased as PND symptom severity increased after controlling for individual effects and a variety of other factors known to influence relationship quality (individual mothers n = 296, mother-child dyads n = 646). Additionally, intergenerational relationships appear to be affected, with PND negatively associated with grandmother-grandchild relations (individual grandmothers n = 125, relations with grandchildren from n = 197 grandmother-parent dyads). That PND has long-term detrimental consequences for mother-child relationships, well beyond adolescence, highlights the need for investment in strategies to prevent PND and its cascade of negative multigenerational effects.
Collapse
Affiliation(s)
- Sarah Myers
- School of Anthropology and Conservation, University of Kent, Canterbury, Kent, United Kingdom
| | - Sarah E Johns
- School of Anthropology and Conservation, University of Kent, Canterbury, Kent, United Kingdom
| |
Collapse
|
49
|
Kalra H, Reilly N, Austin MP. An evaluation of routine antenatal depression screening and psychosocial assessment in a regional private maternity setting in Australia. Aust N Z J Obstet Gynaecol 2018; 58:629-635. [PMID: 29380345 DOI: 10.1111/ajo.12777] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/20/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is limited information relating to routine depression screening and psychosocial assessment programs in private maternity settings in Australia. AIMS To describe the psychosocial profile of a sample of private maternity patients who participated in a depression screening and psychosocial risk assessment program as part of routine antenatal care, and to explore women's experience of receiving this component of pregnancy care. MATERIALS AND METHODS We conducted a retrospective medical records audit of 455 consecutive women having a routine psychosocial assessment and referral. Assessment was undertaken using the Edinburgh Postnatal Depression Scale (EPDS) and the Antenatal Risk Questionnaire (ANRQ) for psychosocial risk; 101 women completed a feedback survey about their experience of receiving routine psychosocial care. RESULTS Of the 87.7% of women who completed both EPDS and ANRQ, 4.3% scored 13 or more on the EPDS. On the ANRQ, 25.3% of women endorsed one risk factor, 11.6% two risk factors and 10.5% three or more risk factors. Elevated EPDS scores were associated with major stresses in the last 12 months, high trait anxiety and significant past mental health issue/s. Acceptability of depression screening and psychosocial risk assessment was high. CONCLUSIONS This study highlights the need for, and acceptability of, depression and psychosocial assessment in the private maternity sector. These findings are particularly timely given the provision of new Medicare Benefits Scheme items for obstetricians to undertake psychosocial assessment (both antenatally and postnally) in line with recommended clinical best practice.
Collapse
Affiliation(s)
- Harish Kalra
- Raphael Services Ballarat, St John of God Health Care and Mair St Clinic, Ballarat, Victoria, Australia
| | - Nicole Reilly
- Perinatal and Women's Mental Health Unit, St John of God Health Care and School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Marie-Paule Austin
- Perinatal and Women's Mental Health Unit, St John of God Health Care and School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Black Dog Institute, Sydney, New South Wales, Australia
| |
Collapse
|
50
|
Kim Y, Dee V. Sociodemographic and Obstetric Factors Related to Symptoms of Postpartum Depression in Hispanic Women in Rural California. J Obstet Gynecol Neonatal Nurs 2017; 47:23-31. [PMID: 29221670 DOI: 10.1016/j.jogn.2017.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the relationships among sociodemographic and obstetric factors and symptoms of postpartum depression (PPD) in Hispanic women living in rural California. DESIGN Quantitative, cross-sectional, descriptive design. SETTING Rural southern California communities. PARTICIPANTS A convenience sample of 223 Hispanic women, ages 18 to 42 years old, with one living infant younger than 12 months old. METHODS Interviewer-administered Edinburgh Postnatal Depression Scale and sociodemographic and obstetric history survey (maternal age, marital status, education, annual household income, employment, sex of infant, birth type, and number of children). Chi-square and logistic regression analyses were used to determine associations and predictive relationships among sociodemographic and obstetric factors and symptoms of PPD. RESULTS Low education levels, unemployment, cesarean birth, and more than one young child were significantly related to PPD risk (Edinburgh Postnatal Depression Scale scores ≥ 10). Many of the factors associated with PPD symptoms in this sample of Hispanic women were similar to those previously reported in the literature. CONCLUSION Our findings highlighted the need for PPD care among Hispanic women in rural areas. Early assessment and intervention for symptoms of PPD are needed to enhance health equity and promote better health for women who live in rural communities.
Collapse
|