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Kee MZL, Cremaschi A, De Iorio M, Chen H, Montreuil T, Nguyen TV, Côté SM, O’Donnell KJ, Giesbrecht GF, Letourneau N, Chan SY, Meaney MJ. Perinatal Trajectories of Maternal Depressive Symptoms in Prospective, Community-Based Cohorts Across 3 Continents. JAMA Netw Open 2023; 6:e2339942. [PMID: 37883082 PMCID: PMC10603499 DOI: 10.1001/jamanetworkopen.2023.39942] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
Importance Depressive symptoms during pregnancy influence the development and health of the offspring, underscoring the need for timely intervention. However, the course of depressive symptoms across the perinatal period remains unclear, thus complicating screening and referral guidelines. Objective To examine the course and stability of depressive symptoms across the perinatal period in multiple, ethnically diverse independent observational cohorts. Design, Setting, and Participants This cohort study included self-reported depressive symptoms at multiple time points from 7 prospective cohorts spanning 3 continents (United Kingdom: Avon Longitudinal Study of Parents and Children from 1991 to 1995; Canada: Maternal Adversity, Vulnerability and Neurodevelopment from 2003 to 2007; Montreal Antenatal Well-being Study from 2019 to 2022; Alberta Pregnancy Outcomes and Nutrition from 2009 to 2014; and Singapore: Growing Up in Singapore Toward Healthy Outcomes from 2009 to 2013; Singapore Preconception Study of Long-Term Maternal and Child Outcomes from 2015 to 2019; and Mapping Antenatal Maternal Stress from 2019 to 2022). Participants were recruited either during preconception or pregnancy and observed into the postnatal period. All data from each cohort were analyzed from July 2022 to April 2023. Main Outcomes and Measures Self-reported depressive symptoms from pregnancy to 2 years following childbirth using either the Edinburgh Postnatal Depression Scale or the Center for Epidemiological Studies Depression were analyzed independently within each cohort using item response theory (IRT) techniques. K-means clustering was used to identify groups of participants with similar trajectories. Results A total of 11 563 pregnant women (mean [SD] age, 29 [5] years; 569 [4.9%] East Asian women; 304 [2.6%] Southeast Asian women; 10 133 [87.6%] White women) self-reported depressive symptoms from pregnancy to 2 years following childbirth. Analytic methods from Item Response Theory identified 3 groups of mothers based on depressive symptoms: low, mild, and high levels in each of the 7 cohorts. Mothers within and across all cohorts had stable trajectories of maternal depressive symptoms from pregnancy onwards. Mothers with clinical levels of depressive symptoms likewise showed stable trajectories from pregnancy into the postnatal period. Conclusions and Relevance In this study, trajectories of depressive symptoms remained stable from pregnancy across the perinatal period, a finding that conflicts with a continuing emphasis on postpartum or postnatal onset of depression that persists in some health policy guidelines. Interventions and public health initiatives should focus on reducing depressive symptoms during pregnancy in addition to following birth.
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Affiliation(s)
- Michelle Z. L. Kee
- Translational Neuroscience, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Republic of Singapore
| | - Andrea Cremaschi
- Biostatistics, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Republic of Singapore
| | - Maria De Iorio
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Helen Chen
- Department of Psychological Medicine, KK Women’s and Children’s Hospital, Singapore, Republic of Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Republic of Singapore
| | - Tina Montreuil
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tuong Vi Nguyen
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Sylvana M. Côté
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Kieran J. O’Donnell
- Yale Child Study Center and Department of Obstetrics Gynecology and Reproductive Science, Yale School of Medicine, New Haven, Connecticut
- Child and Brain Development Program, Canadian Institute for Advanced Research, Ontario, Canada
| | - Gerald F. Giesbrecht
- Owerko Centre for Children’s Neurodevelopment and Mental Health, Departments of Pediatrics, Psychiatry and Community Health Sciences, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Letourneau
- Departments of Pediatrics, Psychiatry and Community Health Sciences, Faculty of Nursing, and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shiao Yng Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Department of Obstetrics and Gynecology, National University Hospital, Singapore, Republic of Singapore
| | - Michael J. Meaney
- Translational Neuroscience, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Republic of Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
- Child and Brain Development Program, Canadian Institute for Advanced Research, Ontario, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
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Hoare J, Vythilingum B. Postpartum depression: Addressing misinformation and harmful attitudes. S Afr Med J 2023; 113:4-5. [PMID: 37882124 DOI: 10.7196/samj.2023.v113i9.1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- J Hoare
- Neuroscience Institute and Division of Consultation Liaison Psychiatry, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
| | - B Vythilingum
- Convenor, Women's Mental Health Special Interest Group, South African Society of Psychiatrists.
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Madsen KB, Liu X, Albiñana C, Vilhjálmsson BJ, Agerbo E, Mortensen PB, Hougaard DM, Nordentoft M, Werge T, Mors O, Børglum AD, Munk-Olsen T. Genetic liability to posttraumatic stress disorder and its association with postpartum depression. Psychol Med 2023; 53:5052-5059. [PMID: 35811373 PMCID: PMC10782827 DOI: 10.1017/s0033291722002045] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childbirth may be a traumatic experience and vulnerability to posttraumatic stress disorder (PTSD) may increase the risk of postpartum depression (PPD). We investigated whether genetic vulnerability to PTSD as measured by polygenic score (PGS) increases the risk of PPD and whether a predisposition to PTSD in PPD cases exceeds that of major depressive disorder (MDD) outside the postpartum period. METHODS This case-control study included participants from the iPSYCH2015, a case-cohort of all singletons born in Denmark between 1981 and 2008. Restricting to women born between 1981 and 1997 and excluding women with a first diagnosis other than depression (N = 22 613), 333 were identified with PPD. For each PPD case, 999 representing the background population and 993 with MDD outside the postpartum were matched by calendar year at birth, cohort selection, and age. PTSD PGS was calculated from summary statistics from the Psychiatric Genomics Consortium with LDpred2-auto. Odds ratios (ORs) were estimated using conditional logistic regression adjusted for parental psychiatric history and country of origin, PGS for MDD and age at first birth, and the first 10 principal components. RESULTS The PTSD PGS was significantly associated with PPD (OR 1.42, 95% CI 1.20-1.68 per standard deviation increase in PTSD PGS) compared to healthy female controls. Genetic PTSD vulnerability in PPD cases did not exceed that of matched female depression cases outside the postpartum period (OR 1.10, 95% CI 0.94-1.30 per standard deviation increase). CONCLUSIONS Genetic vulnerability to PTSD increased the risk of PPD but did not differ between PPD cases and women with depression at other times.
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Affiliation(s)
- Kathrine Bang Madsen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Xiaoqin Liu
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Clara Albiñana
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
| | - Bjarni Jóhann Vilhjálmsson
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Preben Bo Mortensen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CIRRAU – Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - David Michael Hougaard
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Merete Nordentoft
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- CORE – Copenhagen Research Centre for Mental Health, Mental Health Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Werge
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- Lundbeck Foundation Center for GeoGenetics, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
| | - Anders D. Børglum
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Department of Biomedicine and the iSEQ Center, Aarhus University, Aarhus, Denmark
- Center for Genomics and Personalized Medicine, CGPM, Aarhus, Denmark
| | - Trine Munk-Olsen
- NCRR – National Centre for Register-based Research, Business and Social Sciences, Aarhus University, Aarhus, Denmark
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Denmark
- Research Unit of Psychiatry, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
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Luo F, Zhu Z, Du Y, Chen L, Cheng Y. Risk Factors for Postpartum Depression Based on Genetic and Epigenetic Interactions. Mol Neurobiol 2023; 60:3979-4003. [PMID: 37004608 DOI: 10.1007/s12035-023-03313-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Abstract
Postpartum depression (PPD) is a serious mood disorder that tends to occur after the delivery, which may bring lifelong consequences to women and their families in terms of family relationships, social relationships, and mental health. Currently, various risk factors including environmental factors and genetic factors that may induce postpartum depression have been extensively studied. In this review, we suggest that postpartum women's susceptibility to postpartum depression may be the result of the interaction between the genes associated with postpartum depression as well as the interaction between genetic and environmental factors. We reviewed the genes that have been studied in postpartum depression, including genes related to the synthesis, metabolism, and transport of monoamine neurotransmitters, key molecules of the HPA axis, and the kynurenine pathway. These studies have found more or less gene-gene and gene-environment interactions, so we will discuss these issues in more detail. However, so far, the conclusions of these risk factors, especially genetic factors, are not completely consistent in the occurrence and exacerbation of symptoms in postpartum depression, and it is not clear how these risk factors specifically participate in the pathological mechanism of the disease and play a role. We conclude that the role of genetic polymorphisms, including genetic and epigenetic processes, in the occurrence and development of postpartum depression, is complex and ambiguous. We also note that interactions between multiple candidate genes and the environment have been suggested as causes of depression, suggesting that more definitive research is needed to understand the heritability and susceptibility of PPD. Overall, our work supports the hypothesis that postpartum depression is more likely to be caused by a combination of multiple genetic and environmental factors than by a single genetic or environmental influence.
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Affiliation(s)
- Fan Luo
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Zimo Zhu
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Yang Du
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Lei Chen
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China
| | - Yong Cheng
- NHC Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, China.
- Center on Translational Neuroscience, College of Life and Environmental Sciences, Minzu University of China, Beijing, China.
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Carona C, Xavier S, Araújo-Pedrosa A, Canavarro MC, Fonseca A. Mental health profiles of women at high-risk for postpartum depression: a latent profile analysis. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2023. [DOI: 10.1080/00207411.2022.2163352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Carlos Carona
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Sandra Xavier
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Anabela Araújo-Pedrosa
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Clinical Psychology Service, Department of Gynecology, Obstetrics, Reproduction and Neonatology (Maternity Daniel de Matos), Coimbra Hospital and University Centre, Rua Miguel Torga, Coimbra, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Ana Fonseca
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
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Postpartum Psychosis: The Role of Women's Health Care Providers and the Health Care System. Obstet Gynecol Surv 2022; 77:763-777. [PMID: 36477388 DOI: 10.1097/ogx.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Importance The postpartum period is a time of high risk for serious psychiatric symptoms and hospitalization. Postpartum psychosis (PPP) is the most severe disorder that emerges during this time, with significant and wide-ranging consequences that can include suicide and infanticide. Evidence Acquisition A PubMed, MEDLINE, and PsycINFO search was completed for English-language publications about PPP, including subtopics (eg, infanticide, maternal suicide). Citations in these articles were also reviewed for relevant references. Results Although it is clear that the triggering event for PPP is childbirth, the processes by which this occurs are not fully understood, which is a critical need for being able to predict, prevent, and manage PPP. There are risk factors that contribute to PPP, and specific groups of women may be at increased risk (eg, women with bipolar disorder). Many questions and challenges remain related to the phenomenology, nosology, prevention, and treatment of PPP. However, there are changes that women's health care providers and systems can take to improve the care of women at risk of and experiencing PPP. Results Of the 1382 articles reviewed, 8 met eligibility criteria, representing 6 distinct cohorts and 726 subjects. Synthetic slings available for review were either tension-free vaginal tape (TVT) or minisling. The vast majority of studies demonstrated similar short- and long-term success rates of AFS and SS procedures utilizing a range of outcome measures. Both AFS and TVT sling had low recurrence rates in short- and long-term follow-up. However, AFS had significantly longer operative time, and longer hospital stay. Bladder perforation, on the other hand, occurred more commonly in TVT sling. Health-related quality-of-life scores, including sexual function, were similar between groups. Conclusions and Relevance Postpartum psychosis is a rare but serious condition. However, recovery is possible. Women's health care providers and systems can improve the care by better understanding the needs of women and families, offering patient-centered discussions and options for care, particularly those that promote recovery, minimize risk, and limit the interruption of the maternal-infant bond. Improving the prevention and treatment of PPP can have a broad impact for women, children, and families.
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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.
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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
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Lancaster EE, Lapato DM, Peterson RE. Understanding the genetics of peripartum depression: Research challenges, strategies, and opportunities. Front Genet 2022; 13:1022188. [PMID: 36468033 PMCID: PMC9714263 DOI: 10.3389/fgene.2022.1022188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/18/2022] [Indexed: 09/12/2023] Open
Abstract
Peripartum depression (PD) is a common mood disorder associated with negative outcomes for mother and child. PD is an understudied disorder in psychiatric genetics, and progress characterizing its genetic architecture has been limited by a lack of disorder-specific research, heterogeneous and evolving phenotypic definitions, inadequate representation of global populations, low-powered studies, and insufficient data amenable to large meta-analyses. The increasing availability of large-scale, population-level efforts, like biobanks, have the potential to accelerate scientific discovery and translational research by leveraging clinical, molecular, and self-report data from hundreds of thousands of individuals. Although these efforts will not fully equip researchers to confront every challenge posed by systemic issues in data collection, such as the reliance on minimal phenotyping strategies, the field is in a position to learn from other successful psychiatric genetic investigations. This review summarizes the current state of PD genetics research and highlights research challenges, including the impact of phenotype depth, measurement, and definition on the replicability and interpretability of genomic research. Recommendations for advancing health equity and improving the collection, analysis, discussion, and reporting of measures for PD research are provided.
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Affiliation(s)
- Eva E. Lancaster
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
| | - Dana M. Lapato
- Department of Human and Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
| | - Roseann E. Peterson
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, United States
- Department of Psychiatry and Behavioral Health, Institute for Genomics in Health, State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
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Jermy BS, Hagenaars S, Coleman JRI, Vassos E, Lewis CM. Risk factor profiles for depression following childbirth or a chronic disease diagnosis: case-control study. BJPsych Open 2022; 8:e182. [PMID: 36205003 PMCID: PMC9634597 DOI: 10.1192/bjo.2022.586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Progress towards understanding the aetiology of major depression is compromised by its clinical heterogeneity. The variety of contexts underlying the development of a major depressive episode may contribute to such heterogeneity. AIMS To compare risk factor profiles for three subgroups of major depression according to episode context. METHOD Using self-report questionnaires and administrative records from the UK Biobank, we characterised three contextual subgroups of major depression: postpartum depression (3581 cases), depression following diagnosis of a chronic disease (409 cases) and a more typical (named heterogeneous) major depression phenotype excluding the two other contexts (34 699 cases). Controls with the same exposure were also defined. We tested each subgroup for association with the polygenic risk scores (PRS) for major depression and with other risk factors previously associated with major depression (bipolar disorder PRS, neuroticism, reported trauma in childhood and adulthood, socioeconomic status, family history of depression, education). RESULTS Major depression PRS was associated with all subgroups, but postpartum depression cases had higher PRS than heterogeneous major depression cases (OR = 1.06, 95% CI 1.02-1.10). Relative to heterogeneous depression, postpartum depression was more weakly associated with adulthood trauma and neuroticism. Depression following diagnosis of a chronic disease had weaker association with neuroticism and reported trauma in adulthood and childhood relative to heterogeneous depression. CONCLUSIONS The observed differences in risk factor profiles according to the context of a major depressive episode help provide insight into the heterogeneity of depression. Future studies dissecting such heterogeneity could help reveal more refined aetiological insights.
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Affiliation(s)
- Bradley S. Jermy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Correspondence: Bradley Jermy.
| | - Saskia Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Jonathan R. I. Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Cathryn M. Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK; and Department of Medical & Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, UK
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Moran RL. Spitting on my sources: Depression, DNA, and the ambivalent historian. JOURNAL OF THE HISTORY OF THE BEHAVIORAL SCIENCES 2022; 58:449-458. [PMID: 35839130 DOI: 10.1002/jhbs.22219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
While writing a book on the history of postpartum depression in the United States, I became interested in an ongoing study about possible genetic markers of postpartum mental illness. I participated in the first step, an online survey. When I qualified for the next step, saliva collection, I was torn over whether or not to continue. Making this decision required reflecting on some overlapping issues: gender, medicalization, genetic research, and the political functions of DNA donation. In this perspectives essay, I explore tensions around situating myself in my historical research project.
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Zeng M, Gong A, Wu Z. Paroxetine combined with traditional chinese medicine prescriptions in the treatment of postpartum depression: A systematic review of randomized controlled trials. Front Neuroendocrinol 2022; 67:101019. [PMID: 35926637 DOI: 10.1016/j.yfrne.2022.101019] [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: 04/20/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Postpartum depression is a common mental disease in obstetric puerperium. Its etiology is not completely clear, and its clinical manifestations are complex. It has serious adverse effects on the body and mind of mothers and infants. Treatment should also follow the principle of individualization. Preliminary studies have shown that traditional chinese medicine prescriptions combined with paroxetine is effective in treating postpartum depression. In order to better determine the therapeutic effect, further exploration was carried out. HYPOTHESIS Does the study better evaluate the therapeutic effect and provide data support for clinical promotion? STUDY DESIGN The search comes from using the following electronic databases established until January 2022. STUDY RESULTS The meta analysis results show that paroxetine combined with traditional chinese medicine prescriptions can reduce the Hamilton Depression Scale (HAMD) score [WMD = -7.35, 95 % CI (-10.84, -3.87), P<0.001] and Edinburgh Postpartum Depression Scale (EPDS) score [WMD = -3.24, 95 % CI (-5.96, -0.53), P < 0.001].And better than paroxetine treatment alone in terms of improving clinical efficacy [RR = 1.22, 95 % CI (1.16, 1.30), P < 0.001]. CONCLUSIONS Based on the combination of paroxetine and traditional chinese medicine prescriptions in the treatment of postpartum depression, there is a certain clinical effect, and a strong research design and a certain number of RCTs are required at the same time. Future research should clarify the specific composition and composition of traditional Chinese medicine prescriptions.
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Affiliation(s)
- Mengjie Zeng
- Department of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Aimin Gong
- Department of Traditional Chinese Medicine, Hainan medical university, Haikou, China.
| | - Zhiquan Wu
- Department of rehabilitation medicine, Sanya Central Hospital, Sanya, China.
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Badiya PK, Siddabattuni S, Dey D, Hiremath AC, Nalam RL, Srinivasan V, Vaitheswaran S, Ganesh A, Prabhakar Y, Ramamurthy SS. Effect of mode of administration on Edinburgh Postnatal Depression Scale in the South Indian population: A comparative study on self-administered and interviewer-administered scores. Asian J Psychiatr 2021; 66:102890. [PMID: 34717110 DOI: 10.1016/j.ajp.2021.102890] [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] [Received: 07/20/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Edinburgh Postnatal Depression Scale (EPDS) is a validated screening tool widely used to assess perinatal depression (PND). However, due to stigma associated with PND, respondents could answer sensitive questions differently depending on the mode of administration, especially in culturally and linguistically diverse country like India. The present study explored longitudinal differences in EPDS scores between self-administered and interviewer-administered modes. METHODS 177 women from rural South India were administered EPDS, self-administration followed by interviewer-administered for four visits, twice each during prenatal and postnatal visits. EPDS scores were compared between the two modes descriptively, graphically and by repeated mixed measure models. Classification of antenatal depression (AD), postnatal depression (PD) and PND based on the two modes were compared by McNemar Chi-square test. Clinical and psychosocial characteristics were examined to identify factors associated with differences in the scoring modes. Concordance rates and Goodman Kruskal's Gamma coefficients were measured for individual EPDS items. RESULTS Longitudinal EPDS scores and rates of AD, PD and PND were significantly higher in self-administered mode. Recent adverse life events were the only factor observed to be significantly associated with the differences between the two modes. Rank correlation and concordance rates suggested stronger association for EPDS items relating to anhedonia subscale and moderate/weaker association for EPDS items relating to anxiety/depression subscales. CONCLUSION Our study findings suggest that the effect of mode of administration should be taken into account while using PND screening tools such as EPDS, especially in countries such as India with higher levels of illiteracy.
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Affiliation(s)
- Pradeep Kumar Badiya
- STAR Laboratory, Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, 515134, Anantapur, Andhra Pradesh, India
| | - Sasidhar Siddabattuni
- STAR Laboratory, Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, 515134, Anantapur, Andhra Pradesh, India
| | | | - Akkamahadevi C Hiremath
- Department of Obstetrics and Gynecology, Sri Sathya Sai General Hospital, Whitefield, Bangalore 560066, India
| | - Raj Lakshmi Nalam
- Department of Obstetrics and Gynecology, Sri Sathya Sai General Hospital, Prasanthi Nilayam, 515134, Anantapur, Andhra Pradesh, India
| | - Venkatesh Srinivasan
- STAR Laboratory, Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, 515134, Anantapur, Andhra Pradesh, India
| | | | - Aarthi Ganesh
- Schizophrenia Research Foundation, Chennai 600101, Tamil Nadu, India
| | - Yendluri Prabhakar
- Department of Psychiatry, Government Medical College/Government general hospital, Anantapur 515001, Andhra Pradesh, India
| | - Sai Sathish Ramamurthy
- STAR Laboratory, Department of Chemistry, Sri Sathya Sai Institute of Higher Learning, Prasanthi Nilayam, 515134, Anantapur, Andhra Pradesh, India.
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Amit G, Girshovitz I, Marcus K, Zhang Y, Pathak J, Bar V, Akiva P. Estimation of postpartum depression risk from electronic health records using machine learning. BMC Pregnancy Childbirth 2021; 21:630. [PMID: 34535116 PMCID: PMC8447665 DOI: 10.1186/s12884-021-04087-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Postpartum depression is a widespread disorder, adversely affecting the well-being of mothers and their newborns. We aim to utilize machine learning for predicting risk of postpartum depression (PPD) using primary care electronic health records (EHR) data, and to evaluate the potential value of EHR-based prediction in improving the accuracy of PPD screening and in early identification of women at risk. METHODS We analyzed EHR data of 266,544 women from the UK who gave first live birth between 2000 and 2017. We extracted a multitude of socio-demographic and medical variables and constructed a machine learning model that predicts the risk of PPD during the year following childbirth. We evaluated the model's performance using multiple validation methodologies and measured its accuracy as a stand-alone tool and as an adjunct to the standard questionnaire-based screening by Edinburgh postnatal depression scale (EPDS). RESULTS The prevalence of PPD in the analyzed cohort was 13.4%. Combing EHR-based prediction with EPDS score increased the area under the receiver operator characteristics curve (AUC) from 0.805 to 0.844 and the sensitivity from 0.72 to 0.76, at specificity of 0.80. The AUC of the EHR-based prediction model alone varied from 0.72 to 0.74 and decreased by only 0.01-0.02 when applied as early as before the beginning of pregnancy. CONCLUSIONS PPD risk prediction using EHR data may provide a complementary quantitative and objective tool for PPD screening, allowing earlier (pre-pregnancy) and more accurate identification of women at risk, timely interventions and potentially improved outcomes for the mother and child.
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Affiliation(s)
- Guy Amit
- KI Research Institute, Kfar Malal, Israel.
| | | | | | - Yiye Zhang
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Vered Bar
- Women's Mental Health, Sheba Medical Center, Ramat Gan, Israel
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Maguire J, McCormack C, Mitchell A, Monk C. Neurobiology of maternal mental illness. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:97-116. [PMID: 32736761 DOI: 10.1016/b978-0-444-64239-4.00005-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This chapter provides an overview of current research discoveries beginning to uncover the neurobiology of maternal mental illness. Results are described according to standard diagnostic categories (specifically, perinatal depression, perinatal anxiety and OCD, postpartum psychosis and bipolar disorder, and trauma and posttraumatic stress disorder), yet we aim to put this approach in context with the introduction of a classification model for psychiatric research, the research domain criteria, gaining traction in basic and clinical translational fields. We first review a new area of study, the neuroplasticity of the pregnant and postpartum brain, as work here has relevance for understanding the pathophysiology of mental disorders and may provide clues to changes in brain functioning that are related to compromised parenting in the context of postpartum depression. We next provide background information on neuroendocrine and immune changes during pregnancy and, to a lesser extent, the postpartum period, as alterations in these systems are significantly implicated in underlying neurobiology of mental illness for peripartum women. Our discussion of the major mental illnesses for pregnant and postpartum women includes neuroendocrine changes, neuroinflammation, and neurotransmitter alterations, as well as circuit dysfunction. Overall, remarkable progress has been made in identifying variations in neurobiology (and related systems) involved in maternal mental illness; yet, it is clear that, as classified with standard diagnostic systems, these are heterogeneous disorders and there is individual variability in the alterations in neurobiology for the same illness.
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Affiliation(s)
- Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Clare McCormack
- Center for Science and Society, Columbia University, New York, NY, United States
| | - Anika Mitchell
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
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