Past History Of Depression Research Articles

Chronic opioid prescription in veterans with spinal cord injury: Prevalence and associated factors

Objective Chronic opioid use presents long-term health risks for individuals with spinal cord injury (SCI). The purpose of the study was to characterize patterns and correlates of the chronic prescription of opioids among individuals with SCI in a population of Veterans receiving care though the Veteran’s Health Administration. Design A retrospective, longitudinal cohort study examined the US Department of Veterans Affairs electronic medical record data of veterans with SCI. The annual prevalence of prescription opioid use by type (any, acute, chronic, incident chronic) was calculated for each study year (2015–2017). Multivariable models examined associations with demographics and pre-existing medical comorbidities. Setting US Department of Veterans Affairs, Veteran’s Health Administration. Participants National sample of Veterans with SCI (N = 10,811). Main Outcome Measure Chronic prescription opioid use (≥90 days). Results All types of prescription opioid use declined across the three study years (chronic opioid use prevalence = 33.2%, 31.7%, and 29.7%, respectively). Past history of depression, COPD, diabetes, pain condition, opioid use and tobacco use disorders were associated with a greater likelihood of current chronic prescription opioid use. Non-white race, hyperlipidemia, dementia, and tetraplegia were associated with a lower likelihood of current chronic prescription opioid use. When added to the multivariable model, prior chronic opioid prescription use was robustly associated with current chronic prescription opioid use, but most other factors were no longer significantly associated with current opioid use. Conclusions This study demonstrates opioid reduction over time from 2015 to 2017, however, chronic prescription opioid use remains common among a substantial minority of Veterans with SCI. Several demographics and comorbidities may provide clinicians with important insights into factors associated with chronic prescription opioid use, with past chronic prescription opioid use being the most important.

Factors Associated with Postpartum Depression among Women in Eastern Sudan: A Cross-Sectional Study.

Background and Objectives: Postpartum depression is one of the most common complications of childbirth. While the epidemiology of postpartum depression has been extensively studied in African countries, there is little published data on the topic in Sudan. In addition, no studies have been conducted in Eastern Sudan. This study aims to evaluate the factors associated with postpartum depression among Sudanese women in Gadarif in Eastern Sudan. Materials and Methods: A cross-sectional study (using the systematic random sampling technique) of women presenting to Gadarif Maternity Hospital for postnatal follow-up within six weeks of childbirth was conducted. A questionnaire was used to collect sociodemographic information, and the Edinburgh Postnatal Depression Scale was used to assess postpartum depression. Results: Three hundred women were enrolled in the study. The median (interquartile) age and parity were 30.0 (25.0-34.0) years and 2 (1-4). Thirty-one (10.3%) of the women had postpartum depression. A univariate analysis showed that a past history of depression was the only factor associated with postpartum depression (OR = 3.04, 95% CI = 1.03-8.97). Other investigated factors (age, parity, educational level, occupation, history of previous miscarriage or intrauterine fetal death, a family history of depression, financial support, medical insurance, whether the pregnancy was planned or not, and if the gender of the newborn was known before delivery) were not associated with postpartum depression. Conclusions: The current study showed that 1 out of 10 women had postpartum depression that was associated with a past history of depression. Factors that have been reported to be associated with postpartum depression in African countries (age, parity, education, and occupation) were not found to be associated in this study. Mental health assessment needs to be employed for women in their antenatal and postpartum periods.

Emergency department mental health presentations in young children: a retrospective chart review

AimTo characterise key features of young people presenting to the emergency department (ED) with a mental health complaint when comparing children (aged 7 to 12 years) and teenagers (13 years and greater).MethodsRetrospective review of all ED mental health presentations in children aged 7–17 years presenting over a 12‐month period in 2018 to a tertiary children's hospital in Victoria, Australia. Univariate analyses were carried out to examine the relationship between children and teenagers and a number of key presentation variables. Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were calculated for ED management outcomes.ResultsThere were 1691 ED mental health presentations in 2018. Of these presentations, 407 (24%) were children aged 12 years or less. The remaining 76% (1284) were teenagers. The younger aged cohort were more likely to be male (OR 2.43, CI 1.92–3.08) and have a past history of autism spectrum disorder (OR 1.92, CI 1.45–1.84). They were more likely to have a presenting complaint of acute behavioural disturbance (OR 2.03, CI 1.59–2.60), be physically restrained (OR 2.01, CI 1.18–3.37) and have sedative medication provided (OR 2.87, CI 1.63–5.04). The older aged cohort were more likely to have a past history of depression (OR 0.19, CI 0.12–0.29) and a presenting complaint of intentional self‐poisoning (OR 0.33, CI 0.15–0.65).ConclusionsChildren aged 12 years or less represent one‐quarter of all young people presenting to the ED with a mental health concern. They experience high rates of acute behavioural disturbance and are more likely to require restrictive interventions during their presentation.

Risk factors of paternal perinatal depression during the COVID-19 pandemic in Japan

Purpose The study aims to investigate risk factors of paternal perinatal depression during the COVID-19 pandemic. Methods We conducted an online cross-sectional study of 473 prenatal fathers and 1246 postnatal fathers in August 2021. We applied a modified Poisson regression to estimate relative risk ratios of possible factors for paternal perinatal depression (measured by Edinburgh Postnatal Depression Scale), sequentially introducing the following factors into the model: individual factors, interpersonal factors, obstetric/pediatric factors, and service utilization factors. Results Prenatal fathers with the following risk factors were at an increased risk for having depressive symptoms: adverse childhood experiences (risk ratio; RR 1.61), past depression (RR 1.63), fear of COVID-19 (RR 2.09), lower social support (RR 1.91), low family resources (RR 1.95), and intimate partner violence (IPV) victimization (RR 1.29). Postnatal fathers having the following risk factors were at an increased risk for having depressive symptoms: past depression (RR 1.67), fear of COVID-19 (RR 1.26), low family resources (RR 1.85), IPV victimization. (RR 1.18), and preterm birth (RR 1.18). Conclusion The study showed risk factors such as past history of depression, high fear of COVID-19, low family functionality, and IPV victimization were associated with perinatal depressive symptoms. The findings should contribute to future directions of interventions for paternal perinatal mental health.

Prevalence and Clinical Characteristics of Depression among Elderly Patients Attending Primary Health Care Centers in Diyala Governorate

Background: Depression is one of the most common mood conditions among the elderly, which is linked to severe consequences such as difficulty in concentration and mood disturbances, followed by a lack of interest in social activities, apathy, pessimism, and changes in appetite and sleep. Aim of the study: To determine the prevalence and clinical characteristics of depression and the associated factors among 60-year-olds and over. Methodology: A descriptive cross-sectional study conducted on a group of 218 patients attending selected primary health care centers (PHCC) in Diyala governorate from Al-Khales and Baquba first sectors from first of September 2020 till first of April 2021. A direct interview was conducted by the researcher. Depression in the studied group was measured using the Arabic version of the short form of Geriatric Depression Scale (GDS). Socio-demographical factors were also inquired about in this study. Results: The prevalence of depression among the study participants was 63.3%. There was a statistically significant association between depression and gender (higher in females 69.2%), marital status (in widowed 84.8%), current residence (93.3% in those living alone), and source of monthly income (78.1% in those on financial assistance), medical illnesses (70.2%), and past history of depression (71.3%). Conclusions: Depressive symptoms are prevalent among elderly patients attending primary health centers in Diyala Governorate and are associated with female gender, being a widow, living alone, financial insecurity and chronic illnesses.

Is depression in those with Alzheimer’s Disease different to depression in those without dementia?

AbstractBackgroundDepression in individuals with Alzheimer’s disease (AD) is common, distressing, difficult to treat, may increase carer burden and is inadequately understood. It occurs more frequently in AD than in older adults without dementia. The reasons why some patients develop depression during AD and others do not remain obscure.We aimed to identify risk factors for depression in AD using 3 large cohort studies and assess whether these risk factors differed from those for depression in people with normal cognition.MethodWe used data from 3 large dementia focused cohorts: ADNI (n = 665 with AD, 669 normal cognition), NACC (n = 698 with AD, 711 normal cognition) and BDR (n = 757 with AD). Depression ratings were available using the GDS & NPI and in addition for BDR the Cornell. Intermittent depression was defined as one episode above threshold and persistent as ≥ 2 episodes. A cut‐off of ≥8 was used for the GDS and the Cornell Scale for Depression in Dementia, ≥6 for the NPI depression sub‐scale and ≥2 for the NPI‐Q depression sub‐scale.We used logistic regression and a random‐effects meta‐analysis to examine potential risk factors and an interaction term to look for interactions between each risk factor and the presence of cognitive impairment. Because we aimed to study persistent depression any participants with only study visit were excluded from the analysis, as were those with treated depression who did not meet criteria for caseness at any point.ResultIn individual studies there was no evidence of a difference in risk factors for depression in AD but combining data with meta‐analysis suggested clear differences between risk factors for depression in AD and depression in those without dementia e.g. gender (figure 1). Previous depression increased the risk in the only study with this information (OR 7.78 95%CI 4.03‐15.03).ConclusionRisk factors for depression in AD appear to differ to those for depression per se supporting suggestions of a different pathological process. We have identified that a past history of depression is the strongest risk factor for the development of depression in AD, but information on this was only available for one cohort.

The default mode network and rumination in individuals at-risk for depression.

The default mode network (DMN) is a network of brain regions active during rest and self-referential thinking. Individuals with Major Depressive Disorder (MDD) show increased or decreased DMN activity, relative to controls. DMN activity has been linked to a tendency to ruminate in MDD. It is unclear if individuals who are at-risk for, but who have no current or past history of depression, also show differential DMN activity associated with rumination. We investigated whether females with high levels of neuroticism with no current or lifetime mood or anxiety disorders (n=25) show increased DMN activation, specifically when processing negative self-referential information, compared with females with average levels of neuroticism (n=28). Participants heard criticism and praise during functional MRI scans in a 3T Siemens Prisma scanner. The at-risk group showed greater activation in two DMN regions, the medial prefrontal cortex (MPFC) and the inferior parietal lobule (IPL), after hearing criticism, but not praise (relative to females with average levels of neuroticism). Criticism-specific activation in the IPL was significantly correlated with rumination. Individuals at-risk for depression therefore may have an underlying neurocognitive vulnerability to use a brain network typically involved in thinking about oneself to preferentially ruminate about negative, rather than positive, information.

Housing conditions and changes in professional activity during lockdown and the risk of prevalent and incident depression: Findings from the CONSTANCES cohort

BackgroundMaterial conditions of lockdown and changes in regular functioning may have played a role on depressive manifestations. We aimed to examine the association between housing conditions and changes in professional activity and depression during the first COVID-19 outbreak in France. MethodParticipants of the CONSTANCES cohort were followed online. A first questionnaire covered the lockdown period (assessing housing conditions and changes in professional activity), and a second the post-lockdown period (assessing depression using the Center of Epidemiologic Studies Depression-Scale (CES-D)). Incident depression was also estimated (with a previous CES-D measure). Logistic regression models were applied. Results22,042 participants (median age 46 years, 53.2 % women) were included and 20,534 had a previous CES-D measure. Depression was associated with female gender, lower household income and past history of depression. A negative gradient between the number of rooms and the likelihood of depression was consistently observed (OR = 1.55 95 % [1.19–2.00] for one room, OR = 0.76 [0.65–0.88] for seven rooms), while a U-shape relationship was observed with the number of people living together (OR = 1.62 [1.42–1.84] for living alone, OR = 1.44 [1.07–1.92] for six persons). These associations were also observed with incident depression. Changes in professional activity were associated with depression (Started distance working (OR = 1.33 [1.17–1.50]). Starting distance working was also associated with incident depression (OR = 1.27 [1.08–1.48]). LimitationA cross-sectional design was used. ConclusionThe consequences of lockdown on depression may vary depending on living conditions and changes in professional activity, including distance working. These results could help to better identify vulnerable people to promote mental health.

Vilazodone-Induced Glycolimia

AbstractIntroductionGlycolimia is observed in a plethora of medical conditions including burning mouth syndrome, opioid withdrawal, as well as from a variety of medications including vortioxetine, l-methylfolate, lisdexamfetamine, and gabapentin. While vilazodone, an antidepressant with agonist like effects on 5-HT1A receptors, has been found to induce hyperglycemia, it has not heretofore been reported to induce glycolimia. Such a case is described.MethodCase study: A 60-year-old, left-handed (pathological) male presented with a past history of depression, minimally responsive to a variety of antidepressant medications, was begun on vilazodone, initially 20 mg and gradually increased to 60 mg a day. On 60 mg a day he noticed severe cravings for sweets, which he had never experienced prior to starting vilazodone. He found he had increased consumption, craving sweet foods including cookies and candy. For instance, in a typical day, he would eat eight Oreos, chocolate-covered graham crackers, one pint of ice cream a day, and he would crave sweets even after feeling satiated after consuming a meal. Along with this increased eating, he gained 20 pounds over the 3 months while on the vilazodone. Upon discontinuing the vilazodone, although the weight didn’t change, the sweet cravings resolved.ResultsAbnormalities on: Neurological examination: Mental status examination: Immediate recall: able to remember 6 digits forwards and 3 digits backwards. Motor examination: Drift testing: right inward drift. Gait examination: unstable tandem gait. Neuropsychiatric examination: Go-No-Go test: 6/6 (normal). Animal Fluency Test: 22 (normal).DiscussionThere are myriad mechanisms whereby vilazodone may have induced glycolimia. Possibly due to its antidepressant effects, it increased hedonics, generating appetitive behaviors, including enhanced socialization, sexual, and other consumptive behaviors, including eating. Peradventure it may have enhanced motivation and socialization. Along with socialization, there is escalation in social intercourse, with accompanying commensalism. Along with such consumptive behaviors, we could anticipate glycolimia. As a 5-HT1A receptor agonist, possibly vilazodone may have acted on the arcuate pro-opiomelanocortin neurons associated with hyperphagia, with modulation of energy homeostasis in the serotonin pathway. Alternatively, vilazodone may have triggered an enhanced insulin response with secondary reduction in blood sugar, leading to a homeostatic behavioral response of increased glucose intake. In those who are treated with vilazodone, query as to glycolimia is warranted and warning as to potential manifestations of hyperglycemia should be entertained.FundingNo Funding

Characterization of Depressive Symptoms in Dementia and Examination of Possible Risk Factors.

Depression in individuals with Alzheimer's disease (AD) is common, distressing, difficult to treat, and inadequately understood. It occurs more frequently in AD than in older adults without dementia. The reasons why some patients develop depression during AD and others do not remain obscure. We aimed to characterize depression in AD and to identify risk factors. We used data from three large dementia focused cohorts: ADNI (n = 665 with AD, 669 normal cognition), NACC (n = 698 with AD, 711 normal cognition), and BDR (n = 757 with AD). Depression ratings were available using the GDS and NPI and in addition for BDR the Cornell. A cut-off of≥8 was used for the GDS and the Cornell Scale for Depression in Dementia,≥6 for the NPI depression sub-scale, and≥2 for the NPI-Q depression sub-scale. We used logistic regression to examine potential risk factors and random effects meta-analysis and an interaction term to look for interactions between each risk factor and the presence of cognitive impairment. In individual studies there was no evidence of a difference in risk factors for depressive symptoms in AD. In the meta-analysis the only risk factor which increased the risk of depressive symptoms in AD was previous depression, but information on this was only available from one study (OR 7.78 95% CI 4.03-15.03). Risk factors for depression in AD appear to differ to those for depression per se supporting suggestions of a different pathological process, although a past history of depression was the strongest individual risk factor.

A survey of perceived traumatic birth experiences in an Irish maternity sample – prevalence, risk factors and follow up

ObjectivesTo establish the prevalence and correlates of a subjectively traumatic birth experience in an Irish maternity sample. DesignA questionnaire routinely provided to all women prior to hospital discharge post-birth was amended for data collection for this study. Two additional questions seeking information about women's perceptions of their birth were added and analysed. Women who described their birth as traumatic and agreed to follow-up, received a City Birth Trauma Scale (Ayers et al., 2018) at subsequent follow-up (6 to 12 weeks postpartum). Demographic, obstetric, neonatal variables and factors associated with birth trauma were collected from electronic maternity records retrospectively. SettingA postnatal ward in an Irish maternity hospital which provides postnatal care for public maternity patients. ParticipantsPostpartum women (N=1154) between 1 and 5 days postpartum. Measurements & findingsParticipants completed the Edinburgh Postnatal Depression Scale (EPDS) (Cox et al., 1987) with two additional questions about birth trauma. Eighteen percent (n=209) of women reported their birth as traumatic. Factors associated with reporting birth as traumatic included a history of depression, raised EPDS scores (>12), induction of labour, combined ventouse/forceps birth, and postpartum haemorrhage. Of these 209 women, 134 went on to complete the City Birth Trauma Scale (Ayers et al., 2018). The average score was 3.84 and 6 of this sample (4%) reached the threshold for postpartum post-traumatic stress disorder (PTSD). Key conclusionsThis study identified a prevalence of 18% of women experiencing birth as traumatic and the potentially important role of a current and past history of depression, postpartum haemorrhage, induction of labour and operative vaginal birth in defining a traumatic birth experience. The majority of women were resilient to birth trauma, few developed PTSD , but a larger cohort had significant functional impairment associated with sub-clinical postpartum PTSD symptoms. Implications for practiceMaternity care providers should be aware of the risk factors for traumatic birth. Introducing a trauma–informed approach amongst midwives and maternity care providers in the postnatal period may help to detect emerging or established persisting trauma-related symptoms. For women with sub-clinical postpartum PTSD symptoms a detailed enquiry may be more effective in identifying postpartum PTSD at a later postnatal stage e.g., at six weeks postpartum. Maternity services should provide ongoing supports for women who have experienced birth trauma.

Cytotoxic lesions of the corpus callosum after COVID-19 vaccination

A 23-year-old previously healthy man (Patient 1) and a 33-year-old woman with a past history of depression (Patient 2) developed neurological symptoms approximately 1 week after receipt of the first COVID-19 mRNA vaccination and deteriorated over the next week. Patient 1 reported nausea, headache, a high fever, and retrograde amnesia. Patient 2 reported visual disturbance, headache, dysarthria, a left forearm tremor, dysesthesia of the mouth and distal limbs, and visual agnosia. PCR test results for SARS-CoV-2 were negative. Complete blood cell count, biochemistry, and antibody test and cerebrospinal fluid test findings were unremarkable. Diffusion-weighted and fluid-attenuated inversion recovery MRI of the brain showed a high signal intensity lesion at the midline of the splenium of the corpus callosum compatible with cytotoxic lesions of the corpus callosum (CLOCCs). High-dose intravenous methylprednisolone improved their symptoms and imaging findings. CLOCCs should be considered in patients with neurological manifestation after COVID-19 vaccination.

Depression in Public Servants of Upper Egypt: Gender-specific Prevalence and Determining Factors.

Mental health disorders, including depression, cause more than half of worldwide disabilities. We aimed to estimate the prevalence of depression and determine its associated factors among Egyptian public servants. We collected data from 3134 subjects (1619 females and 1515 males) via a self-administered questionnaire, including the Center of Epidemiological Studies-Depression (CES-D) scale, medical history, sociodemographic, familial, occupational, and behavioral characteristics of the recruited Egyptian Public servants. We used logistic and linear regression models to assess the determinants of depression. The prevalence of depression was 43.5% (52.9% in females and 33.4% in males) among public servants. The past history of depression was a significant determining factor of depression; adjusted odds ratio (aOR): 95% confidence interval (CI) was 2.58 (1.87, 3.57) in females and 3.28 (2.20, 4.87) in males. Other determinants were daily working hours: aOR = 1.11 (1.02, 1.19) and high job demands: aOR = 2.19 (1.40–3.41) in males, and the high job control in females: aOR = 0.51 (0.36, 0.73). With the past history of depression, job demands, job control, family structure, education level, and working status of the spouse predicted 41% of the total variance in the CES-D score in females; R2 = 0.41; whereas job demands, family structure, job hours per day predicted 40% of in males; R2 = 0.40. In conclusion, the determinants of depression varied by gender. Governmental interventions aiming to improve the work environment (job demands, control, and working hours) and individual responsibilities to improve the living arrangement and education level could help to curb the emerging risk of depression.

The magnitude and determinants of depressive symptoms amongst women in early pregnancy in Southern Nigeria: A cross-sectional study.

BackgroundAntenatal depression (AD) is prevalent and associated with adverse pregnancy, maternal and child outcomes, yet no study has addressed its magnitude and predictors in early pregnancy in Nigeria.AimTo determine the prevalence and factors associated with AD in first half of pregnancy.SettingMulticentric health facilities in Southern Nigeria.MethodsA multicentric health-facilities-based cross-sectional study was conducted from January to July 2018. Using pretested structure interviewer-administered questionnaires, antenatal depressive symptoms were assessed amongst 511 pregnant mothers with the Edinburg Postnatal Depressive Scale tool. Socio-demographic, socio-economic, clinical, family and social factors were also measured. Descriptive statistics, bivariate and multivariable logistic regression analyses were employed to describe and identify factors associated with AD.ResultsThe prevalence of antenatal depressive symptoms in early pregnancy in this study was 29.4% (95% confidence interval [CI] 26.6–32.9). Factors independently associated with AD were intimate partner violence (adjusted odds ratios [AOR] = 8.10, 95% CI 5.00–13.14), marital dissatisfaction (AOR 5.48, 95% CI 3.48–8.38), poor social support (AOR 4.70; 95% CI 2.99–7.38), past history of depression (AOR 4.67; 95% CI 2.47–8.80), previous pregnancy complication (AOR 2.50, 95% CI 1.57–3.89), low socio-economic status (AOR 2.41, 95% CI 1.61–3.66) and unplanned pregnancy (AOR 2.35, 95% CI 1.47–3.64).ConclusionsThe prevalence of antenatal depression is high with modifiable risk factors requiring context-specific policies such as provision of family, social and economic support for mothers at the earliest possible contact in the antenatal period.

Prevalence of neuropsychiatric conditions in two parallel, aging study cohorts from rural and urban India

AbstractBackgroundNeuropsychiatric conditions occur more frequently among elderly. With rising proportion of elderly in India, the burden due to neuropsychiatric disorders is bound to escalate. Many of these disorders have been associated with dementia, though the relationship is complex.MethodPrevalence of neuropsychiatric conditions, such as stroke, head injury, depression and early‐life stress were assessed in two parallel, longitudinal, aging cohorts, from rural and urban India, namely, the Srinivaspura Aging Neurosenescence and COGnition (SANSCOG) study and Tata Longitudinal Study of Aging (TLSA), respectively. As part of their baseline clinical assessments, subjects from both cohorts were screened for depression using the self‐rated, Geriatric Depression Scale (GDS) and the clinician‐rated, Hamilton’s Depression Rating Scale (HDRS). Past history of depression and history of early life stressors, such as parental death and parental divorce in childhood were obtained. Self‐reported history of stroke, head injury and risk for vascular dementia using Hatchinski’s Ischemic Index (HIS) were also assessed.ResultProportion of subjects diagnosed with depression using GDS was 9.77% in the rural and 9.66% in the urban cohort, whereas corresponding numbers using HDRS were 6.55% and 3.82%, with female preponderance in both cohorts. Proportion of subjects with past history of depression was 4.82% and 5.07% in the rural and urban cohorts, respectively. Early life parental death was more in the rural 10.91%) as compared with the urban cohort (3.66%). History of stroke was reported in 1.25% and 2.31% of the rural and urban cohorts, respectively. There was no significant difference in proportion of subjects with history of head injury between the rural (4.16%) and urban (4.77%) cohorts. In the rural cohort, 0.23% scored above the threshold for vascular dementia on HIS, whereas none of the subjects scored above the threshold in the urban cohort.ConclusionGDS is a more sensitive tool than HDRS at screening for depression in elderly. Neuropsychiatric conditions such as history of stroke, head injury and risk for vascular dementia did not show any consistent trend of variation between both the cohorts. Further longitudinal assessments of these neuropsychiatric conditions along with parallel monitoring of cognitive changes will help in identifying their causal relationship with dementia.

Maternal-fetal bonding during the COVID-19 pandemic

BackgroundThe pregnant population experienced unique COVID-19 physical and psychosocial stressors such as direct health concerns related to the virus and loss of access to resources since the COVID-19 emerged as a global pandemic in early 2020. Despite these COVID-19-related stress and concerns, the maternal experience of bonding with their unborn children has not been well studied. This work aimed to study the association between mental health history, current mental health symptoms, psychological factors, COVID-19-related worries, and self-reported maternal-fetal bonding of pregnant women.MethodsThis online, survey-based cross-sectional study focused on women pregnant during the pandemic and assessed 686 women using data collected from May 19, 2020 to October 3, 2020. Enrolled respondents completed assessments in which they self-reported maternal-fetal bonding, mental health symptomatology, psychological factors, and COVID-19-related worries regarding health, pregnancy, and resources.ResultsDepressive symptoms in pregnant women were associated with lower quality maternal-fetal bonding, while a higher level of anxiety was positively associated with bonding; however, past history of depression or generalized anxiety diagnosis did not appear to be as relevant as active symptomatology. Maternal resilience, but not distress tolerance, appeared to be a protective factor resulting in improved bonding. Higher levels of worry regarding impact of COVID-19 on health were significantly associated with improved bonding, while worries regarding the impact of COVID-19 on the pregnancy or resources were not significantly associated with bonding. The study also found associations between different sociodemographic variables and bonding, including a strong positive association between first time motherhood and bonding and a negative association between higher education and income and bonding.ConclusionsThis study was the first to report potential protective and risk factors to the maternal-fetal bonding process in women pregnant during the COVID-19 pandemic. Unique COVID-19 concerns exist; however, anxiety and COVID-19 concerns do not appear to undermine maternal-fetal bonding while active depressive symptomatology may negatively influence bonding; interventions increasing maternal resilience may be particularly valuable.

Increased maternal inflammation and poorer infant neurobehavioural competencies in women with a history of major depressive disorder from the psychiatry research and motherhood – Depression (PRAM-D) study

IntroductionStress in pregnancy is associated with adverse outcomes in offspring, and developmental programming is a potential mechanism. We have previously shown that depression in pregnancy is a valid and clearly defined stress paradigm, and both maternal antenatal and offspring stress-related biology is affected. This study aims to clarify whether maternal biology in pregnancy and offspring outcomes can also be influenced by a history of a prior depression, in the absence of depression in pregnancy. Our primary hypothesis is that, similarly to women with depression in pregnancy, women with a history of depression but who are not depressed in pregnancy will have increased cortisol secretion and markers of immune system function, and that their offspring will have poorer neuro-developmental competencies and increased cortisol stress response. MethodsA prospective longitudinal design was used in 59 healthy controls and 25 women with a past history of depression who were not depressed in pregnancy, named as ‘history-only’, and their offspring. Maternal antenatal stress-related biology (cortisol and markers of immune system function) and offspring outcomes (gestational age at birth, neonatal neurobehaviour (Neonatal Behavioural Assessment Scale, NBAS), cortisol stress response and basal cortisol at 2 and 12 months) and cognitive, language and motor development (Bayley Scales of Infant and Toddler Development (BSID)) were measured. ResultsCompared with healthy pregnant women, those with a history of depression who remain free of depression in pregnancy exhibit increased markers of immune system function in pregnancy: IL-8 (d = 0.63, p = 0.030), VEGF (d = 0.40, p = 0.008) and MCP-1 (d = 0.61, p = 0.002) and have neonates with lower neurobehavioural scores in most areas, reaching statistical significance in thesocial-interactive (d = 1.26, p = 0.015) cluster. However, there were no differences in maternal or offspring HPA axis function or in infant development at 12 months. ConclusionOur study indicates that pregnant women with a history of depression have increased markers of immune system function, and their offspring show behavioural alterations that may be the effects of in utero programming, epigenetic factors or genetic predisposition.

Increased maternal mental health burden in a representative longitudinal community cohort coinciding with COVID-19 lockdown

ABSTRACT Measures to control the COVID-19 pandemic have disrupted social networks and employment security worldwide. Longitudinal data in representative samples are required to understand the corresponding mental health impacts. We aimed to estimate the prevalence of depressive symptoms in Australian women raising young families during the first Victorian lockdown and to identify risk factors. Participants comprise 347 mothers of children aged 7 (mean age: 32·11 years [4·27]), from the Barwon Infant Study (BIS). Mothers had previously completed Edinburgh Postnatal Depression Scale (EPDS) at child ages zero, two, four. Following the lock down, mothers again completed EPDS along with questions regarding current household and employment demographics. Depressive symptoms were substantially more prevalent in the lockdown sample than at any prior assessment (EPDS10+; 30·6%); and were particularly high in women with previous poor mental health. Anticipated and actual job loss were twice as common relative to previous assessment (5% to 13%, p = 0 006) and (4% to 10%, p = 0 001) and were associated with depressive symptoms. While further studies are required to confirm causal associations, these findings highlight the need to support mental health during the COVID-19 pandemic, particularly in the context of employment insecurity and previous mental illness. KEY POINTS What is already known about this topic: Emerging reports from convenience samples demonstrate elevated depressive symptoms during the COVID-19 pandemic. Maternal mental health is important for child mental health. Representative, longitudinal data are needed to further improve targeting of policy and health service delivery to prevent a post-COVID-19 mental health crisis. What this topic adds: This early report from a population-derived cohort demonstrates high rates of depression symptomatology in mothers of school aged children following the first COVID-19 lockdown. A past history of depression and current threats to employment are identified as key risk factors for adverse mental health. Our findings are consistent with concerns regarding an increase in mental health burden in the wake of the COVID-19 pandemic but further studies are required to assess causality. Interventions and broader community resources to support the mental health of women of school aged children are required, and should target those with a history of depression and current threats to employment.

The first known case of vaccine‐induced thrombotic thrombocytopenia in Australia

The first known case of vaccine‐induced thrombotic thrombocytopenia in Australia

The Double Burden of Depression and Social Isolation in Older Adults during the COVID-19 Pandemic

<h3>Introduction</h3> We are living in a global pandemic of SARS-CoV-2 (COVID-19) that has infected over 63 million people across the world to date. Even though social-distancing is recommended as a key method of reducing risk, such measures disproportionately impact older adults (OA) whose social contacts are often outside their home. Thus, it is both timely and critical to examine the impact of pandemic-related social isolation on OA's mental health. Also, it is unclear whether OAs experiencing depressive symptoms have increased risk of being adversely impacted by social isolation. The current ongoing study utilizes a combination of remotely conducted interviews and online questionnaires to investigate how OA's mental health has been impacted by pandemic-related social isolation. We present preliminary findings from the first wave of our study. We hypothesized that OAs who report higher degrees of reduced quality and frequency in social relationships and communication will be at greater risk of depression, anxiety, and loneliness. Furthermore, we predicted that OAs who endorse depressive symptoms in the recent past will show a stronger association between adverse changes resulting from limited social activity and mental health. <h3>Methods</h3> We recruited 143 OA participants aged 55 years or older (Mean age=64.9, SD=5.3, 87% female). Prospective participants were excluded for self-reported history of neurological disorders, cognitive impairment, or changes in dosage of any psychotropic medications within the past 4 weeks. Otherwise, individuals with current and/or past history of depression or anxiety were included. Following informed consent, participants were screened for cognitive impairment using the MoCA-mini. Participants then filled out a series of questionnaires related to a self-reported diagnostic screen (SAGE-SR), current symptoms of stress (Perceived Stress Scale), depression (Center for Epidemiologic Studies Depression Scale), anxiety (Geriatric Anxiety Scale), loneliness (UCLA-Loneliness), perceived social support (Multidimensional Scale of Perceived Social Support), and perceived social contribution (Social Contribution subscale of the Social Well-being scale). Moreover, we obtained participants' self-reported appraisal regarding the magnitude of adverse impact caused by COVID-19 pandemic-related social isolation on the quality of their personal social relationships and communication frequency with their loved ones. <h3>Results</h3> Overall, participants who reported greater detriment to social relationships and communication frequency also indicated higher degrees of depressive symptoms (r=.32, p<.001), and loneliness (r=.26, p<.005). Interestingly, frequency of using remote forms of communication with friends and family outside the home were inversely related to pathological mental health symptoms. In other words, those who report frequently keeping in touch with loved ones outside their homes also indicated having lower symptoms of depression (r=-.18, p<.05), anxiety (r=-.18, p<.05), and loneliness (r=-.24, p<.005). Notably, household size was not predictive of the above-mentioned symptoms, but was predictive of stress, such that greater household size was associated with higher levels of stress (r=.21, p<.05). We then separately examined two groups of OAs – those who reported having experienced at least some DSM-5 depressive disorders symptoms in the past 30 days, and those who did not. Self-reported magnitude of pandemic-related detriment to social behavior significantly predicted the severity of loneliness, but only in OAs who report some depressive disorder symptoms (r=.24, p<.05). Similarly, in this group, lower perceived social support significantly predicted higher stress (r=-.46, p<.0001) and lower self-reported social contribution predicted higher loneliness (r=-.33, p<.01) respectively. <h3>Conclusions</h3> The preliminary data from our study suggest that greater levels of pandemic-related social isolation are associated with higher severity of symptoms of depression, anxiety, and loneliness. Importantly, OAs with depressive symptoms appear to be at risk of adversely being impacted by loss of social support and absence of meaningful outlet for social contributions during prolonged social isolation. Conversely, our data suggest utilizing psychosocial interventions designed to shore up social support and greater agency in social contribution may be particularly beneficial to OAs who experience depressive symptoms. The correlational nature of our current data is a limitation that will be addressed by our future work gathering responses from the same group of participants who are expected to resume social activity outside the context of pandemic-related social isolation (i.e., Wave 2). Our future work will also address how social isolation relates to day-to-day experience and control of emotions, which is a significant dimensional predictor of functional impairment and distress across multiple psychopathologies. <h3>Funding</h3> Funding <i>support from</i> <b>Special Emphasis: Emerging COVID-19/SARS-CoV-2 Research</b> seed grant awarded to J. Kim, <i>through the Immunology, Inflammation and Infectious Diseases Initiative</i> and the Office of the Vice President for Research at the University of Utah