The Experience of Pregnancy for Women with Bipolar Disorder: An Exploratory Study

Background: Bipolar disorder often emerges in an individual’s late teens and early twenties, thus women with bipolar disorder are impacted for the majority of their childbearing years. Pregnancy brings a unique set of challenges to this population, including risk of relapse, teratogenicity of medications, and increased risk of postpartum psychosis, yet no research exists on this population’s experience of pregnancy. Design: This study utilized semi-structured telephone interviews to gather preliminary qualitative data on the experience of pregnancy for women with bipolar disorder with the long-term goal of developing patient education materials and improving nursing-led interventions to help manage illness during pregnancy and postpartum. Method: A purposive sample of four English-speaking women, age 29-39, with a confirmed diagnosis of bipolar disorder I or II and who had given birth within the last eighteen months, was recruited nationally via the electronic and mass media, and postings on bulletin boards in a range of educational and related settings. One open-ended focused telephone interview was held with each client, and conducted by the first author. She was also responsible for doing the audiotaping, transcription, and coding of the data using a descriptive qualitative design.  Results: Women with bipolar disorder described a unique pregnancy experience, influenced by the intersection of mental illness, pregnancy, and pharmacotherapy. Recurrent themes included hopefulness, patient and healthcare provider as advocates, the importance of interdisciplinary care, education, community support and the mixed impact of medication. Discussion & Conclusion: This research contributes to initiatives designed to improve healthcare for pregnant women with bipolar disorder, augment patient education materials, and inform the design of nurse-led interventions. Empirical research findings become even more valuable tools for improving patient care when paired with the voices of patients themselves. As pregnant women are a historically under-studied population, this study also contributes to the larger body of scientific research on this population.&nbsp

Blunted neuroactive steroid and HPA axis responses to stress are associated with reduced sleep quality and negative affect in pregnancy: a pilot study

Anxiety during pregnancy has been linked to adverse maternal health outcomes, including postpartum depression (PPD). However, there has been limited study of biological mechanisms underlying behavioral predictors of PPD during pregnancy

Histories of abuse predict stronger within-person covariation of ovarian steroids and mood symptoms in women with menstrually related mood disorder

Individual differences in sensitivity to cyclical changes in ovarian steroids estradiol (E2) and progesterone (P4) have been implicated in the pathophysiology of menstrually related mood disorder (MRMD). However, no prospective studies have investigated psychosocial risk factors for sensitivity to hormone effects on mood in MRMD. Using a repeated measures approach and multilevel models, we tested the hypothesis that a history of abuse provides a context in which within-person elevations of E2 and P4 prospectively predict daily symptoms

Association between ovarian hormones and smoking behavior in women.

Studies examining the association between menstrual cycle phases and smoking behavior in women have yielded mixed results. The purpose of this study was to elucidate the associations between ovarian hormones and smoking by directly measuring ovarian hormone levels and obtaining a laboratory assessment of smoking behaviors. Four hypotheses were tested: increased smoking will be associated with 1) low absolute levels of estradiol and progesterone; 2) decreasing (i.e., dynamic changes in) estradiol and progesterone; 3) lower ratios of progesterone to estradiol, and 4) higher ratios of estradiol to progesterone. Female smokers (≥10 cigarettes/day) with regular menstrual cycles were recruited as part of a larger, ongoing study examining the influence of ovarian hormones on smoking cessation treatment. Participants completed two study visits, including a one-hour adlib smoking topography session, which provided a detailed assessment of smoking behavior. Both the change in hormone levels over time and the relative ratios of ovarian hormones were associated with smoking behavior, but each to a limited extent. Decreases in estradiol (r=−.21, p=.048), and decreases in progesterone (r=−.23, p=.03) were associated with increased puff intensity. Lower ratios of progesterone to estradiol were associated with a greater number of puffs (r=−.26, p=.01) and weight of cigarettes smoked (r=−.29, p=.005). The best predictors of smoking behavior were the ratio of progesterone to estradiol (z=−2.7, p=.004) and the change in estradiol and progesterone over time (z=−2.1, p=.02). This pattern of results may help to explain inconsistent findings in previous studies and suggest potential mechanisms by which hormones influence nicotine addiction

Association between ovarian hormones and smoking behavior in women.

Studies examining the association between menstrual cycle phases and smoking behavior in women have yielded mixed results. The purpose of this study was to elucidate the associations between ovarian hormones and smoking by directly measuring ovarian hormone levels and obtaining a laboratory assessment of smoking behaviors. Four hypotheses were tested: increased smoking will be associated with 1) low absolute levels of estradiol and progesterone; 2) decreasing (i.e., dynamic changes in) estradiol and progesterone; 3) lower ratios of progesterone to estradiol, and 4) higher ratios of estradiol to progesterone. Female smokers (≥10 cigarettes/day) with regular menstrual cycles were recruited as part of a larger, ongoing study examining the influence of ovarian hormones on smoking cessation treatment. Participants completed two study visits, including a one-hour adlib smoking topography session, which provided a detailed assessment of smoking behavior. Both the change in hormone levels over time and the relative ratios of ovarian hormones were associated with smoking behavior, but each to a limited extent. Decreases in estradiol (r=−.21, p=.048), and decreases in progesterone (r=−.23, p=.03) were associated with increased puff intensity. Lower ratios of progesterone to estradiol were associated with a greater number of puffs (r=−.26, p=.01) and weight of cigarettes smoked (r=−.29, p=.005). The best predictors of smoking behavior were the ratio of progesterone to estradiol (z=−2.7, p=.004) and the change in estradiol and progesterone over time (z=−2.1, p=.02). This pattern of results may help to explain inconsistent findings in previous studies and suggest potential mechanisms by which hormones influence nicotine addiction

Psychological distress and treatment preferences among parents amidst the COVID-19 pandemic

The COVID-19 pandemic has presented many stressors for parents. This study was conducted to examine treatment preferences and barriers to care amidst COVID-19. Parents (N ​= ​95) completed self-report measures. Education was provided on interventions (e.g., individual therapy, medication), and acceptability assessed. Elevated stress and distress were observed. Parents indicated interest in services for parenting concerns, stress, anxiety, and depression. Individual therapy and telehealth were highly acceptable, while medication and group therapy were less accepted. Findings highlight the need for specific supports among parents amidst the pandemic. Factors that influence treatment preference warrant further attention. Implications for healthcare service delivery are discussed

Histories of abuse predict stronger within-person covariation of ovarian steroids and mood symptoms in women with menstrually related mood disorder

OBJECTIVE: Individual differences in sensitivity to cyclical changes in ovarian steroids estradiol (E2) and progesterone (P4) have been implicated in the pathophysiology of menstrually related mood disorder (MRMD). However, no prospective studies have investigated psychosocial risk factors for sensitivity to hormone effects on mood in MRMD. Using a repeated measures approach and multilevel models, we tested the hypothesis that a history of abuse provides a context in which within-person elevations of E2 and P4 prospectively predict daily symptoms. METHOD: 66 women with prospectively-confirmed MRMD recruited for a trial of oral contraceptives provided 1 month of baseline hormone and mood data prior to randomization. Lifetime physical and sexual abuse experiences were assessed. Across one cycle, women completed daily measures of symptoms and provided blood samples on 5 days across the menstrual cycle. Current E2 and P4 were centered within person (CWP) such that higher values represented cyclical elevations in hormones. RESULTS: Rates of physical (27%) and sexual (29%) abuse were high, consistent with previous work documenting a link between trauma and MRMD. In women with a history of physical abuse, cyclical increases in P4 predicted greater mood and interpersonal symptoms on the three days following that sample. In women with a history of sexual abuse, cyclical increases in E2 predicted greater anxiety symptoms on the three days following that sample. CONCLUSIONS: Results inform further inquiry into the role of severe life stressors and stress response systems in MRMD. We discuss areas for future research on the psychosocial and physiological pathways through which abuse may influence the link between hormones and symptoms

Efficacy of Virtual Care for Depressive Disorders: Systematic Review and Meta-analysis

BackgroundThe COVID-19 pandemic has created an epidemic of distress-related mental disorders such as depression, while simultaneously necessitating a shift to virtual domains of mental health care; yet, the evidence to support the use of virtual interventions is unclear. ObjectiveThe purpose of this study was to evaluate the efficacy of virtual interventions for depressive disorders by addressing three key questions: (1) Does virtual intervention provide better outcomes than no treatment or other control conditions (ie, waitlist, treatment as usual [TAU], or attention control)? (2) Does in-person intervention provide better outcomes than virtual intervention? (3) Does one type of virtual intervention provide better outcomes than another? MethodsWe searched the PubMed, EMBASE, and PsycINFO databases for trials published from January 1, 2010, to October 30, 2021. We included randomized controlled trials of adults with depressive disorders that tested a virtual intervention and used a validated depression measure. Primary outcomes were defined as remission (ie, no longer meeting the clinical cutoff for depression), response (ie, a clinically significant reduction in depressive symptoms), and depression severity at posttreatment. Two researchers independently selected studies and extracted data using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was evaluated based on Agency for Healthcare and Research Quality guidelines. We calculated odds ratios (ORs) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes. ResultsWe identified 3797 references, 24 of which were eligible. Compared with waitlist, virtual intervention had higher odds of remission (OR 10.30, 95% CI 5.70-18.60; N=619 patients) and lower posttreatment symptom severity (SMD 0.81, 95% CI 0.52-1.10; N=1071). Compared with TAU and virtual attention control conditions, virtual intervention had higher odds of remission (OR 2.27, 95% CI 1.10-3.35; N=512) and lower posttreatment symptom severity (SMD 0.25, 95% CI 0.09-0.42; N=573). In-person intervention outcomes were not significantly different from virtual intervention outcomes (eg, remission OR 0.84, CI 0.51-1.37; N=789). No eligible studies directly compared one active virtual intervention to another. ConclusionsVirtual interventions were efficacious compared with control conditions, including waitlist control, TAU, and attention control. Although the number of studies was relatively small, the strength of evidence was moderate that in-person interventions did not yield significantly better outcomes than virtual interventions for depressive disorders

Scaling up quality-assured psychotherapy : The role of therapist competence on perinatal depression and anxiety outcomes

Objectives: To examine: (1) the psychometric properties of two therapist competence measures-multiple choice questionnaire (MCQ) and standardized role-plays; (2) whether therapist competence differed between non-specialist (NSPs) and specialist (SPs) providers; and (3) the relations between therapist competence and pa-tient outcomes among perinatal patients receiving brief psychotherapy.Methods: This study is embedded within the SUMMIT Trial-a large, ongoing psychotherapy trial for perinatal women with depressive and anxiety symptoms. We assessed the: (1) psychometric properties of therapist competence measures using Cronbach's alpha and inter-class correlation; (2) differences in therapist competence scores between n = 23 NSPs and n = 22 SPs using a two-sample t-test; and (3) relations between therapist competence measures and perinatal patient outcomes through a linear regression model.Results: Internal consistency for role-play was acceptable (alpha = 0.71), whereas MCQ was excellent (alpha = 0.97). Role-play showed good inter-rater reliability (ICC = 0.80) and scores were higher for SPs compared with NSPs (t (2,38) =-2.86, p = 0.0069) and associated with outcomes of anxiety (B = 1.52, SE = 0.60, p = 0.01) and depressive (B = 0.96, SE = 0.55, p = 0.08) symptom scores.Conclusions: Our study highlights the importance of demonstrating psychological treatment skills through standardized role-plays over knowledge-based competence to predict perinatal patient outcomes. Using well-defined evidence-based tools is critical for deploying NSPs to provide high-quality psychotherapy and increase accessibility to psychological treatments for perinatal populations worldwide.Peer reviewe