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Postpartum depression is prevalent among Black women and associated with intersecting systemic factors and interpersonal discrimination. However, gaps remain in understanding pregnancy-related changes in discrimination experiences that influence postpartum mental health and could inform preventive interventions. We hypothesized that young Black women would experience increasing levels of discrimination across the transition to parenthood, heightening depression risk relative to non-pregnant peers.
Methods
Participants comprised 335 Black primiparous women (ages 17-30 at delivery) and 335 age- and discriminationmatched non-pregnant controls from the Pittsburgh Girls Study. Self-reported discrimination experiences were collected at four timepoints: two years pre-pregnancy, one year pre-pregnancy, pregnancy, and one year postpartum for the childbearing sample, with corresponding data from the non-pregnant sample across the same interval (matched pairwise).
Results
Linear increases in discrimination were observed for the nonpregnant participants (BS = .480, SE = .090, p <.001), while childbearing participants showed no overall changes, though younger age predicted greater increases over time. For childbearing participants, both baseline discrimination (BI = .626, SE = .077, p < .001) and increasing discrimination (BS = 2.55, SE = .939, p < .01) predicted postpartum depressive symptoms, controlling for pre-pregnancy depression. Among non-pregnant participants, only baseline discrimination predicted later depression (BI = .912, SE = .081, p < .001).
Conclusions
Experiencing increasing levels of interpersonal discrimination across the transition to parenthood may heighten postpartum depression risk among young Black women, indicating a need for interventions supporting well-being and promoting resilience before, during and after pregnancy.
First-year postpartum depression is a common mental health problem among first-time mothers. A younger age of pregnancy often compounds the challenge due to underlying factors such as poverty and limited educational achievement. This study aimed to examine the minimal number of interpersonal supporters during pregnancy associated with lower levels of postpartum depressive symptoms among first-time mothers.
Methods
We obtained data from the population-based Mother–Infant/Newborn Tokyo Cohort (MINT cohort) in four municipalities in Tokyo on 429 first-time mothers who responded to two waves of surveys (early pregnancy and one month postpartum). They completed self-report measures of interpersonal support using one item from the Social Support Questionnaire and depressive symptoms using the Edinburgh Postnatal Depression Scale. Segmented regression analyses were conducted to determine the threshold at which the strength of the association changed between the number of interpersonal supporters and postpartum depressive symptoms, with adjustment for depressive symptoms in pregnancy. This analysis was also conducted with the sample stratified into young mothers (≤ 25 years) and older mothers (≥ 26 years).
Results
In the overall sample, postpartum depressive symptoms were found to be lower among individuals with more than 3.0 supportive individuals (prepartum). Among young mothers, this threshold was higher, with lower symptom levels observed among those with at least 5.3 supporters. Only 22.9% of young first-time mothers had this level of interpersonal support, compared to 54.8% of all first-time mothers.
Conclusions
Our results suggest that having four or more interpersonal supporters in early pregnancy is associated with lower levels of postpartum depressive symptoms among first-time mothers. Additionally, among young mothers, having six or more supporters was associated with lower postpartum depressive symptoms. These findings suggest that tailored strategies to increase supporters around first-time pregnant women might be beneficial depending on their age.
While biomarkers are widely used in other medical fields, psychiatry has yet to introduce reliable biological diagnostic tools. Female reproductive transitions provide a unique window of opportunity for investigating psychiatric biomarkers. Hormonal changes across menstruation, pregnancy, parturition and perimenopause can have dramatic effects on mental health in vulnerable individuals, enabling the identification of unique biomarkers associated with these fluctuations.
Aims
This review integrates current evidence concerning potential biomarkers, with focus on recent human studies in perinatal depression, anxiety and obsessive–compulsive disorder, postpartum psychosis, premenstrual dysphoric disorder and perimenopausal depression.
Method
We identified potential articles to be included in this narrative review by using PubMed to obtain articles in English since 2010 on the six conditions listed above, with the additional keywords of ‘biomarker’, ‘epigenetics’, ‘neuroactive steroid’, ‘immune’, ‘inflammatory’ and ‘neuroimaging’.
Results
There is substantial published evidence regarding potential biomarkers of reproductive psychiatric disorders in the areas of epigenetics, neuroactive steroids, immune function and neuroimaging. This body of research holds significant potential to advance biomarker development, uncover disease mechanisms and improve diagnostic and therapeutic strategies, but there is as yet no clinically useful biomarker in commercial development for any reproductive psychiatric disorder.
Conclusion
There is an urgent need for longitudinal, large-scale and multi-modal studies to examine potential biomarkers and better understand their functions across various stages of reproduction.
Depression occurring during pregnancy or after delivery is one of the most common complications of childbirth and is associated with maternal morbidity and mortality. Here we review the breakthrough development of the first neuroactive steroid-based antidepressants approved for postpartum depression in the USA and their potential in other psychiatric illnesses.
Perinatal mental health disorders affect more than one in five people and obstetrician/gynecologists (Ob/Gyns) are the primary providers for women during the reproductive years when there is increased risk of psychiatric morbidity. Therefore, Ob/Gyns are charged with screening and treating these disorders. Despite the availability of effective strategies for detection and treatment, perinatal mental health disorders are underrecognized and undertreated, and have significant detrimental maternal and infant consequences. Obstetrician/gynecologists should be prepared to counsel patients on the benefits and risks of psycho-pharmacotherapy, initiate psycho-pharmacotherapy, and refer patients to appropriate resources when indicated. A validated screening tool should then be used to monitor for response to treatment or remission of symptoms. Psychotherapy should be considered a first-line treatment for mild-to-moderate perinatal depression and selective serotonin reuptake inhibitors be used as first-line pharmacotherapy for perinatal depression and anxiety. Pharmacotherapy should be individualized based on prior response to therapy and optimal dosing established to avoid undertreatment. The risks associated with inadequately treated mental health conditions as well as the perinatal risks associated with psychopharmacologic agents must be addressed. Furthermore, a discussion about duration of treatment, need for long term follow-up, and considerations for future pregnancy is needed.
Early depression screening and risk stratification of modifiable risk factors during pregnancy for women at risk of perinatal mental health conditions is important to ensure safe care delivery during prenatal care and into the postpartum period. Using psychotherapy and antidepressants together with care to avoid multiple psychotrophic medications can limit exposure of medications during pregnancy while ensuring adequate treatment of depression and other mood disorders.
Aims. Parental postpartum depressive symptoms have been extensively studied, but the combined longitudinal depression trajectories of parents and their long-term development beyond the postpartum period remain largely underexplored. We identified dyadic longitudinal depressive symptom trajectories in new parents, followed over an 11-year period, and compared parental characteristics, as well as child temperament and mental health factors, across different parental trajectory classes.
Methods. A prenatal cohort of 5,518 couples was studied. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale at eight time points: in the prenatal stage, in the newborn stage, and at 6 months, 18 months, 3 years, 5 years, 7 years and 11 years after the birth of the child.
Results. Dyadic Latent Class Growth Modelling identified five classes of couples: (1) mother has elevated depressive symptoms, father is non-depressed (24%); (2) both mother and father have elevated depressive symptoms (20%); (3) both mother and father are constantly non-depressed (42%); (4) both mother and father are constantly depressed (5%); and (5) mother is constantly depressed, father has elevated depressive symptoms (9%). Relationship maintenance (particularly being married or separated) was the most strongly associated with the classes. Socio-economic resources, emotional well-being, health, obstetric history and parental background also served as meaningful covariates. Child temperament and mental health showed weak correlations with parental trajectory classes.
Conclusions. Parents with postpartum depressive symptoms often experience depressive symptoms long-term. Separated parents are particularly vulnerable to adverse depressive trajectories. Our findings underscore the importance of dyadic methods in estimating unique combinations of parental depression trajectories.
Reproductive psychiatry specializes in mental illness in patients with a female reproductive system during the years from menarche to menopause. This topic is vital for all psychiatric clinicians that treat patients during their reproductive years. Syndromes included in this subspecialty include perinatal mood and anxiety disorders (PMADs), postpartum psychosis (PPP), premenstrual dysphoric disorder (PMDD), premenstrual exacerbation of underlying illness (PME), and mood changes associated with perimenopause. This chapter covers these topics including assessment diagnosis and treatment, along with special considerations for this unique population.
Most women with epilepsy (WWE) will experience stable seizure control during pregnancy. Adverse fetal outcomes with epilepsy include spontaneous abortion, preterm birth, fetal growth restriction, major congenital malformation (MCM), hypertensive disorders of pregnancy, postpartum hemorrhage, peripartum depression, and—rarely—maternal death. Studies reporting these increased risks may be biased by differences in preexisting medical conditions, other patient characteristics, and anti-seizure medication (ASM) use and type. Poor seizure control preceding pregnancy, unplanned pregnancy, and polytherapy are associated with higher risks. Antenatal care should be coordinated by an experienced multidisciplinary team. Monotherapy with an appropriate ASM at the lowest effective dose is the goal, and drug levels should be monitored. Second trimester fetal anatomical sonography is the best screening modality for neural tube defects and other MCMs. Serial third trimester fetal growth ultrasounds are recommended. WWE are likely to have an uncomplicated labour and delivery. Epilepsy is not an indication for induction of labour or caesarean delivery. The risk of intrapartum seizures is 2−3%, and intractable seizures necessitating urgent delivery are rare. Attention is needed to avoid dehydration, missed ASM doses, sleep deprivation, and pain during labour and postpartum. WWE should be screened and counselled regarding their heightened risk of peripartum depression.
Parenting behaviors play an important role in the transmission of depressive symptoms from mothers to children. Although reduced positive affect is a central feature of depression, models of intergenerational transmission have neglected maternal socialization of positive affect as a mediating mechanism. This study investigated whether maternal responses to infant positive affect mediate the link between mothers’ and toddlers’ depressive symptoms. A community sample of 128 mothers (58% White) and their infants (Mage = 6.65 months, SD = 0.53 at first visit) participated in 3 assessments over a 1-year period. Assessments included self-reports of postpartum depressive symptoms, observational measures of maternal responses to infant positive affect and maternal sensitivity, and mother report of toddlers’ depressive problems. Mediation analyses revealed that mothers with elevated postpartum depressive symptoms displayed fewer supportive responses to their infants’ positive affect. In turn, infants who received fewer supportive responses had more depressive problems in toddlerhood. The indirect effect of postpartum depressive symptoms on toddlers’ depressive problems via maternal supportive responses remained significant after controlling for maternal sensitivity. Findings suggest that maternal responses to infant positive affect play a unique role in the intergenerational transmission of depressive symptoms. The theoretical and practical implications of these findings are discussed.
To identify the different factors associated with postpartum blues and its association with postpartum depression, from a large French cohort.
Methods
We conducted an analysis of the Interaction Gene Environment in Postpartum Depression cohort, which is a prospective, multicenter cohort including 3310 women. Their personal (according to the Diagnostic and Statistical Manual, fifth edition [DSM-5]) and family psychiatric history, stressful life events during childhood, pregnancy, and delivery were collected. Likewise, the French version of the Maternity Blues Scale questionnaire was administered at the maternity department. Finally, these women were assessed at 8 weeks and 1 year postpartum by a clinician for postpartum depression according to DSM-5 criteria.
Results
The prevalence of postpartum blues in this population was 33%, and significant factors associated with postpartum blues were found as personal (aOR = 1.2) and family psychiatric history (aOR = 1.2), childhood trauma (aOR = 1.3), obstetrical factors, or events related to the newborn, as well as an experience of stressful life events during pregnancy (aOR = 1.5). These factors had a cumulative effect, with each additional factor increasing the risk of postpartum blues by 31%. Furthermore, adjustment for sociodemographic measures and history of major depressive episode revealed a significant association between postpartum blues and postpartum depression, mainly at early onset, within 8 weeks after delivery (aOR = 2.1; 95% CI = 1.6–2.7), but also at late onset (aOR = 1.4; 95% CI = 1.1–1.9), and mainly if the postpartum blues is severe.
Conclusion
These results justify raising awareness among women with postpartum blues, including reassurance and information about postpartum depression, its symptomatology, and the need for management in case of worsening or prolongation of postpartum blues.
Peripartum psychiatric disorders are common, and it is likely that an obstetric anaesthesiologist will be involved with the care of a patient with one of these disorders. The most common psychiatric disorders encountered in the peripartum period include depression, anxiety, bipolar disorder, post-traumatic stress disorder, and schizophrenia. These conditions are commonly underdiagnosed and undertreated but may have grave maternal and neonatal consequences. Additionally, postpartum psychiatric disorders, specifically anxiety and depression, are common complications of childbirth. The rising prevalence of these disorders in the peripartum period necessitates an understanding of the epidemiology, management, and treatment options. Evidence on how psychiatric disorders and their treatment can affect the mother, baby, and the delivery of anesthesia care is presented. This chapter reviews important anesthesia considerations for pregnant patients with psychiatric disorders and interactions that may occur between anesthesia and the medical management of these disorders. Additionally, interventions and prevention techniques to improve patient care and manage postpartum psychiatric sequelae are explored.
The effects of maternal postpartum depression (PPD) on offspring emotion regulation (ER) are particularly deleterious as difficulties with ER predict an increased risk of psychopathology. This study examined the impact of maternal participation in a public health nurse (PHN)-delivered group cognitive behavioral therapy (CBT) intervention on infant ER. Mothers/birthing parents were ≥ 18 years old with an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10, and infants were < 12 months. Between 2017 and 2020, 141 mother–infant dyads were randomized to experimental or control groups. Infant ER was measured at baseline (T1) and nine weeks later (T2) using two neurophysiological measures (frontal alpha asymmetry (FAA) and high-frequency heart rate variability (HF-HRV)), and informant-report of infant temperament. Mothers were a mean of 30.8 years old (SD = 4.7), 92.3% were married/ common-law, and infants were a mean of 5.4 months old (SD = 2.9) and 52.1% were male. A statistically significant group-by-time interaction was found to predict change in HF-HRV between T1 and T2 (F(1,68.3) = 4.04, p = .04), but no significant interaction predicted change in FAA or temperament. Results suggest that PHN-delivered group CBT for PPD may lead to adaptive changes in a neurophysiological marker of infant ER, highlighting the importance of early maternal intervention.
Postpartum depression affects around 12% of mothers in developed countries, with consequences for the whole family. Many women with depressive symptoms remain undetected and untreated. The aim of this study was to investigate to what extent women with depressive symptoms at 6 weeks postpartum are identified by the healthcare system, the interventions they received, and remission rates at 6 months postpartum.
Methods
Postpartum women scoring 12–30 on the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks after delivery (n = 697) were identified from the longitudinal cohort study “Biology, Affect, Stress, Imaging and Cognition” (BASIC) in Uppsala, Sweden. A total of 593 women were included. Background and remission information at 6 months was collected from the BASIC dataset. Medical records were examined to identify interventions received.
Results
Most women (n = 349, 58.7%) were not identified by the healthcare system as having depressive symptoms and 89% lacked any record of interventions. Remission rates at 6 months postpartum were 69% in this group. Among women identified by the healthcare system, 90% received interventions and about 50% were in remission at 6 months postpartum. The EPDS reduction during the study period was largest in the group identified by the child health services (CHS, −5.15) compared to the non-identified (−4.24, p < 0.001).
Conclusions
Despite screening guidelines, many women with depressive symptoms had no documentation of screening or interventions by the healthcare system. Furthermore, a significant proportion did not achieve remission despite interventions. Being identified by CHS was associated with the largest reduction of symptoms. Research is needed to understand gaps in the healthcare processes, to better identify peripartum depression.
Although the importance of the dynamic intra-individual relationship between mother-to-infant bonding and postpartum depressive symptoms has been widely recognized, the complex interplay between them is not well understood. Furthermore, the potential role of prenatal depressive symptoms and infant temperament in this relationship remains unclear. This study aims to examine the bidirectional influence of mother-to-infant bonding on postpartum depressive symptoms within individuals and to elucidate whether prenatal depressive symptoms and infant temperament would influence deviations from stable individual states.
Methods
Longitudinal data were collected from 433 women in early pregnancy. Of these, 360 participants completed the main questionnaires measuring impaired mother-to-infant bonding and postpartum depressive symptoms at least once during the postpartum period. Data were collected at early and late pregnancy and several postpartum time points: shortly after birth and at one, four, ten, and 18 months postpartum. We also assessed prenatal depressive symptoms and infant temperament. A random-intercept cross-lagged panel model was used.
Results
Within-individual variability in mother-to-infant bonding, especially anger and rejection, significantly predicted subsequent postpartum depressive symptoms. However, the inverse relationship was not significant. Additionally, prenatal depressive symptoms and difficult infant temperament were associated with greater within-individual variability in impaired mother-to-infant bonding and postpartum depressive symptoms.
Conclusions
The present study demonstrated that the within-individual relationship between mother-to-infant bonding and postpartum depressive symptoms is likely non-bidirectional. The significance of the findings is underscored by the potential for interventions aimed at improving mother-to-infant bonding to alleviate postpartum depressive symptoms, suggesting avenues for future research and practice.
The aetiology and consequences of ‘baby blues’ (lower mood following childbirth) are yet to be sufficiently investigated with respect to an individual's clinical history.
Aims
The primary aim of the study was to assess the symptoms of baby blues and the relevant risk factors, their associations with clinical history and premenstrual syndrome (PMS), and their possible contribution to the early recognition of postpartum depression (PPD).
Method
Beginning shortly after childbirth, 369 mothers were followed up for 12 weeks. Information related to their clinical history, PMS, depression, stress and mother–child attachment was collected. At 12 weeks, mothers were classified as non-depressed, or with either PPD or adjustment disorder.
Results
A correlation was found between the severity of baby blues and PMS (r = 0.397, P < 0.001), with both conditions increasing the possibility of adjustment disorder and PPD (baby blues: OR = 6.72, 95% CI 3.69–12.25; PMS: OR = 3.29, 95% CI 2.01–5.39). Baby blues and PMS independently predicted whether a mother would develop adjustment disorder or PPD after childbirth (χ2(64) = 198.16, P < 0.001). Among the non-depressed participants, baby blues were found to be associated with primiparity (P = 0.012), family psychiatric history (P = 0.001), PMS (P < 0.001) and childhood trauma (P = 0.017).
Conclusions
Baby blues are linked to a number of risk factors and a history of PMS, with both conditions adding to the risk of PPD. The neuroendocrine effects on mood need be understood in the context of individual risk factors. The assessment of both baby blues and PMS symptoms within the first postpartum days may contribute to an early identification of PPD.
Major depression episode (MDE) and postpartum depression (PPD) have the same diagnosis criteria, but dissimilarities may be present regarding the frequency and structure of depressive symptoms.
Methods
We used data from the IGEDEPP Cohort (France) to examine DSM-5 depressive symptoms in two groups of women: 486 with PPD and 871 with a history of non-perinatal MDE. We compare (i) the frequency of each depressive symptom adjusted for the severity of depression, (ii) the global structure of depressive symptom networks, and (iii) the centrality of each symptom in the two networks.
Results
Women with PPD were significantly more likely to have appetite disturbance, psychomotor symptoms, and fatigue than those with MDE, while sadness, anhedonia, sleep disturbance, and suicidal ideation were significantly less common. There were no significant differences in the global structure of depressive symptoms of MDE and PPD. However, the most central criterion of the MDE network was “Sadness” while it was “Suicidal ideations” for the PPD network. “Sleep” and “Suicidal ideations” criteria were more central for PPD network, whereas “Culpability” was more important for MDE network than for PPD network.
Conclusion
We found differences in depressive symptoms expression between PPD and MDE, which justify continuing to clinically distinguish PPD from MDE.
It remains unclear how the COVID-19 pandemic has affected the mother–infant relationship and associations between maternal postpartum depression (PPD) and offspring temperament. This study examined the impact of the pandemic on these links and how maternal ratings of the mother–infant relationship mediated associations between PPD and infant temperament in a sample of treatment-seeking mothers in Ontario, Canada before and during the COVID-19 pandemic. Mothers with infants <12 months of age and Edinburgh Postnatal Depression Scale scores ≥10 enrolled in two separate randomized controlled trials of 1-day cognitive behavioral therapy-based workshops for PPD conducted before COVID-19 (n = 392) and during the pandemic (n = 403). Mothers reported on depressive symptomatology, infant temperament, and the mother–infant relationship. Maternal PPD was associated with more infant negative affectivity and mother–infant relationship difficulties. While associations between PPD and infant-focused anxiety were stronger during COVID-19, the pandemic did not otherwise affect associations between PPD and infant temperament. Mediation analyses suggested that aspects of the mother-infant relationship mediated associations between PPD and infant negative affectivity. Findings highlight the importance of detecting PPD and intervening to potentially improve outcomes for mothers and their children.
Postpartum depression (PPD) is a major depressive disorder developed after childbirth that negatively affects the well-being of both mother and infant. The relationship between domestic violence and the development of PPD symptoms is well documented. However, empirical evidence is lacking on how a person's perception of stress mediates this relationship.
Aims
To estimate the degree to which perceived stress may explain the association between being the victim of domestic violence and developing PPD symptoms among Bangladeshi mothers.
Method
A cross-sectional survey design was employed from October to December 2019 to collect data from 497 postpartum mothers within the first 6 months of giving birth. The associations between domestic violence victimisation and developing PPD symptoms were assessed using multivariable logistic regressions. The Karlson–Holm–Breen method was used for mediation analysis.
Results
One-third (34%) of the mothers in this sample reported experiencing PPD within 6 months. A one-item increase in the number of reported experiences (‘items’) of controlling behaviour, emotional domestic violence and physical domestic violence increased the odds of developing PPD symptoms by 27%, 40% and 31% respectively, after controlling for other variables and mediators. Furthermore, after adjusting for other variables, the mediating effect of perceived stress on the association of controlling behaviour, emotional domestic violence, physical domestic violence and any form of domestic violence with developing PPD symptoms was 45.1%, 43.0%, 31.2% and 37.5% respectively.
Conclusions
Findings suggest that perceived stress partially mediates the association between domestic violence victimisation and developing PPD symptoms. Understanding these complex relationships may help policymakers to formulate appropriate intervention strategies and support services.