A Biopsychosocial Conceptual Framework of Postpartum Depression Risk in Immigrant and U.S.-born Latina Mothers in the United States

In this review, we offer a conceptual framework that identifies risk factors of postpartum depression (PPD) in immigrant and U.S.-born Latinas in the U.S. by focusing on psychosocial and neuroendocrine factors. While the evidence of the impact psychosocial stressors have on the development of PPD have been well documented, less is known about the biological etiology of PPD or how these complex stressors jointly increase the risk of PPD in immigrant and U.S.-born Latinas in the U.S

Predictors of Postpartum Depression: A Comprehensive Review of the Last Decade of Evidence

Postpartum depression (PPD) is one of the most frequent complications of childbirth affecting 500,000 women annually (prevalence 10% to 15%). Despite the documented adverse outcomes for mother and child, there remains a great need to develop prospective approaches to identify women at risk. This review examines some of the best-characterized molecular and clinical risk factors for PPD. We illustrate that this is a growing literature but there remains a lack of reliable molecular predictors for PPD. Current best predictors are clinical assessments for psychiatric history and adverse life events, highlighting the need for increased depression screening across the perinatal period

Application of assessment metrics for an academic department faculty development program

Faculty development is increasingly seen as a cornerstone of career sustainability in academic medicine, pediatrics, and other disciplines. Many current senior academic medical faculty developed their careers in systems that are distinctly different from current paradigms. Multiple internal and external variables have caused the academic environment to transform. These variables include rapidly changing technology, the opening of the academy to public scrutiny, external rankings, changes in the opportunities for academic advancement (including the increasing predominance of non–tenure track faculty), sharp reductions in protected time for teaching, increased pressure to meet measurable benchmarks for academic and financial productivity, and an increased emphasis on multidisciplinary team science to more rapidly advance biomedical research. Faculty must also become adept at assessing learning outcomes, and engaging in collaborative projects that couple scholarly expertise with the local, national, or international communities. The increasing incidence of burnout and other sequelae of chronic stress among medical faculty is well documented and has led to recommendations for more formalized institutional attention to these threats to the academic medical enterprise

The longitudinal effects of stress and fear on psychiatric symptoms in mothers during the COVID-19 pandemic

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

Perinatal psychiatric episodes: a population-based study on treatment incidence and prevalence

Perinatal psychiatric episodes comprise various disorders and symptom severity, which are diagnosed and treated in multiple treatment settings. To date, no studies have quantified the incidence and prevalence of perinatal psychiatric episodes treated in primary and secondary care, which we aimed to do in the present study. We designed a descriptive prospective study and included information from Danish population registers to study first-time ever and recurrent psychiatric episodes during the perinatal period, including treatment at psychiatric facilities and general practitioners (GPs). This was done for all women who had records of one or more singleton births from 1998 until 2012. In total, we had information on 822 439 children born to 491 242 unique mothers. Results showed first-time psychiatric episodes treated at inpatient facilities were rare during pregnancy, but increased significantly shortly following childbirth (0.02 vs 0.25 per 1000 births). In comparison, first-time psychiatric episodes treated at outpatient facilities were more common, and showed little variation across pregnancy and postpartum. For every single birth resulting in postpartum episodes treated at inpatient psychiatric facilities, 2.5 births were followed by an episode treated at outpatient psychiatric facility and 12 births by GP-provided pharmacological treatment. We interpret our results the following way: treated severe and moderate psychiatric disorders have different risk patterns in relation to pregnancy and childbirth, which suggests differences in the underlying etiology. We further speculate varying treatment incidence and prevalence in pregnancy vs postpartum may indicate that the current Diagnostic and Statistical Manual of Mental Disorders-5 peripartum specifier not adequately describes at-risk periods across moderate and severe perinatal psychiatric episodes

Oxytocin and HPA stress axis reactivity in postpartum women

Lactation is thought to buffer stress reactivity via oxytocin (OT). Dysregulation of the HPA axis has been reported in women with postpartum depression (PPD). The co-occurrence of PPD and lactation failure suggests that abnormalities in OT signaling may play a role in PPD. We hypothesized that abnormal OT signaling is implicated in dysregulated HPA axis reactivity among postpartum women with mood symptoms. In a prospective perinatal cohort, we tested associations between OT levels during breastfeeding and stress reactivity

The relationship of cumulative psychosocial adversity with antepartum depression and anxiety

Background: Exposure to multiple psychosocial risk factors may increase vulnerability for mental health conditions during pregnancy. This analysis examined the relationship of a novel psychosocial adversity index with the co-occurrence and persistence of depression and anxiety throughout pregnancy. Methods: This cross-sectional analysis included 1797 pregnant women screened in the second/third trimesters for depression and anxiety symptoms and for eight contextual and individual psychosocial factors. The factors were summed to create a psychosocial adversity index; reporting four or more factors indicated high adversity. Elevated symptoms in both trimesters indicated persistent depression/anxiety and elevated symptoms at the same trimester indicated comorbid symptoms. The associations between the psychosocial adversity index and mental health were estimated. Results: Compared with a low psychosocial adversity index, women reporting a high level of psychosocial adversities had 2.06 (95% confidence interval [CI]: 1.51–2.82) times higher adjusted odds of only depressive or anxiety symptoms, and 5.57 (95% CI: 3.95–7.85) times higher adjusted odds of comorbid symptoms. The associations for persistent symptoms were of similar direction and magnitude. Conclusion: High psychosocial adversity was associated with persistent and comorbid depressive symptoms and anxiety during pregnancy. Assessing psychosocial adversity can help identify women at increased risk who would benefit from tailored mental health interventions

Adverse life events increase risk for postpartum psychiatric episodes: a population based epidemiologic study

Background: Trauma histories may increase risk of perinatal psychiatric episodes and other comorbidity. We designed an epidemiological population-based cohort study to explore if adverse childhood experiences (ACE) in girls increases risk of later postpartum psychiatric episodes. Methods: Using Danish registers, we identified women born in Denmark between January 1980 and December 1998, (129,439 childbirths). Exposure variables were ACE between age 0-15 including: (1) family disruption, (2) parental somatic illness, (3) parental labor market exclusion, (4) parental criminality, (5) parental death, (6) placement in out-of-home care, and (7).parental psychopathology excluding substance use disorders and (8) parental substance use disorder. The primary outcome was first occurrence of in- or outpatient contact 0-6 months (0-182 days) postpartum at a psychiatric treatment facility with any psychiatric diagnoses, ICD-10, F00-F99 (N=651). We conducted survival analyses using Cox proportional hazard regressions of postpartum psychiatric episodes. Results: Approximately 52% of the sample experienced ACE that significantly increased risk of any postpartum psychiatric diagnosis. Highest risks were observed among women who experienced out of home placement, hazard ratio (HR) 2.57 (95% CI: 1.90-3.48). Women experiencing 2 adverse life events had higher risks of postpartum psychiatric diagnosis HR: 1.88 (95% CI: 1.51-2.36), compared to those with 1 ACE, HR: 1.24 (95% CI: 1.03-49) and no ACE, HR: 1.00 (reference group). Conclusions: ACE primarily due to parental psychopathology and disability contributes to increased risk of postpartum psychiatric episodes; and greater numbers of ACE increases risk for postpartum psychiatric illness with an observed dose-response effect. Future work should explore genetic and environmental factors that increase risk and/or confer resilience

Ovarian Hormone Fluctuation, Neurosteroids, and HPA Axis Dysregulation in Perimenopausal Depression: A Novel Heuristic Model

In this conceptual review, we propose a novel mechanistic candidate in the etiology of depression with onset in the menopause transition (a.k.a. perimenopausal depression) involving alterations in stress-responsive pathways, induced by ovarian hormone fluctuation