Abstract
Post-Partum Depression (PPD) is the most common health issue impacting emotional well being in women and is often comorbid with anxiety (PPD-A). Previous studies have shown that adequate social support can protect against PPD and PPD-A. However, how the brain connectome is disrupted in PPD and PPD-A and the neural basis underlying the role of social support in PPD and PPD-A remains unclear. The present study aims to explore these issues in patients with PPD and PPD-A. Well-established questionnaires and resting-state functional Magnetic Resonance Imaging (rsfMRI) were performed in 45 PPD, 31 PDD-A patients and 62 Healthy Postnatal Women (HPW). Brain functional integration was measured by analysis of Functional Connectivity Strength (FCS). Association and mediation analyses were performed to investigate relationships between FCS, PPD and PPD-A symptoms and social support. PPD patients showed specifically higher FCS in right parahippocampus, whereas PPD-A patients showed specifically higher FCS in left ventrolateral prefrontal cortex. In all postpartum women, depression symptoms positively correlated with FCS in left paracentral lobule; depression and anxiety symptoms were negatively correlated with FCS in right cerebellem posterior lobe (CPL), a brain region implicated in supporting social cognition and regulation of emotion. Subsequent mediation analysis revealed that perceived social support mediated the association between right CPL FCS and PPD and PPD-A symptoms. Measurement of FCS in disorder-specific neural circuits offers a potential biomarker to study and measure the efficacy of social support for PPD and PPD-A.
Highlights
Postpartum women experience large changes in physiology, emotional, financial and social support and are susceptible to onset or relapse of mental illnesses such as depression and anxiety [1]
Demographics and clinical characteristics There were no significant differences in age (p = 0.11), education level (p = 0.84), expected social support (p = 0.48), or postpartum time (p = 0.90) between patients with Postpartum depression (PPD) and PPD is comorbid with anxiety disorders (PPD-A), or in comparison of patient groups and Healthy Postnatal Women (HPW)
Perceived social support was lower in both PPD and PPDA relative to HPW, but no significant differences were observed between the PPD and PPD-A patient groups (Table 1)
Summary
Postpartum women experience large changes in physiology, emotional, financial and social support and are susceptible to onset or relapse of mental illnesses such as depression and anxiety [1]. In nearly two-thirds of women PPD is comorbid with anxiety disorders (PPD-A) [3]. Several psycho-social and biological factors include a history of depression/anxiety, marital difficulties, hormones fluctuations, life stress and inadequate social support etc., are known to be associated with an increased risk of developing PPD [7,8,9]. Down-regulation of stress responses including dampened sympathetic, hypothalamicpituitary-adrenal (HPA) axis and inflammatory reactivity to stressors together with appropriate social support have all been proposed as important buffers for stressful life events [10] and a significant relationship has been reported between low levels of perceived social support and severity of PPD and PPD-A [11, 12]. The neural basis underlying the role of social support in PPD and PPD-A remains unclear. Damage to hubs in the brain network which play a key role in the transmission and integration of information [15] is likely to seriously affect network efficiency and integrity [16]
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