Perinatal Depressive Symptoms Research Articles

Effect of Parenting Interventions on Perinatal Depression and Implications for Infant Developmental Outcomes: A Systematic Review and Meta-Analysis.

Considering the significant impact of perinatal depression on both maternal wellbeing and infant development, it is important to examine the effectiveness of interventions designed to prevent or reduce these risks. This systematic review and meta-analysis synthesised evidence on parenting intervention in relation to how such programs affect symptoms of perinatal depression and infant outcomes within 12months of postpartum. We followed the Cochrane Collaboration guidelines on conducting systematic reviews and meta-analyses. A total of five electronic databases were searched for controlled trials that met pre-determined eligibility criteria. Outcomes of interest were maternal depressive symptoms and infants' language, motor and socioemotional development. Seventeen studies involving 1665 participants were included in the systematic review. Estimates from a random effects model of 15 studies in the final meta-analysis revealed statistically significant reductions in maternal depressive symptoms at post-intervention for mothers allocated to receive parenting interventions (SMD = - 0.34, 95%CI - 0.44, - 0.24; z = 5.97, p < 0.001; I2 = 0%). Data on infant development outcomes from the included studies were scarce, and therefore, infant outcomes were not analysed in this review. For individual study outcomes, the majority of studies reported a general trend for reductions in maternal depressive symptoms from pre- to post-intervention. Although parenting interventions are frequently considered preventive strategies that are designed to offer support to parents and impart skills that promote their physical and psychological wellbeing, our findings suggest that these interventions have a positive effect on perinatal depressive symptoms. Implications and recommendations for future research are addressed. The systematic review protocol was registered with PROSPERO 2020 CRD42020184491.

Teenage Mothers in Yaoundé, Cameroon-Risk Factors and Prevalence of Perinatal Depression Symptoms.

Background: Perinatal depression is defined as a non-psychotic depressive episode occurring during pregnancy or during the first year following childbirth. This depressive disorder is highly prevalent among teenage women but there is a lack of data in low- and middle-income countries. The objective of this study was to provide baseline data on the sociodemographic characteristics of pregnant teenagers or teenage mothers in an urban zone in Yaoundé, Cameroon. Risk factors were assessed, and prevalence of depressive disorders was determined. Methods: Women aged 20 years old or less in the perinatal period were invited to participate in the study. A total of 1344 women participated in the four-stage data collection process involving a questionnaire including questions on sociodemographic background, an assessment of their risk of perinatal depression using the EPDS questionnaire (Edinburgh Postnatal Depression Scale), a clinical interview based on the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders), and a final section focusing on risk factors of perinatal depression. Results: The EPDS score was obtained for 1307 women. The prevalence of depressive disorder symptoms among teenage or young pregnant women is estimated to be 70.0%. This risk is significantly increased by different factors including unintended or unplanned pregnancy (aOR: 1.33, 1.14–1.56 CI95%), being separated or single (aOR: 1.34, 1.12–1.60 CI95%), experiencing depression and anxiety before childbirth (aOR: 1.50, 1.02–2.27 CI95%), abortion experience (aOR: 2.60, 1.03–7.14 CI95%) and domestic violence (aOR: 1.76, 1.12–2.83 CI95%). Conclusion: The results of this study reveal a high prevalence of depressive disorder symptoms within the study population. These findings highlight the need to develop maternal care programs to support both mothers and their infants.

Perinatal maternal depressive symptoms and risk of behavioral problems at five years.

Evidence on the association between perinatal maternal depression and children's behavioral development is limited. We investigated the association between maternal depressive symptoms during pregnancy and postpartum and the risk of childhood behavioral problems using data from a birth cohort study. Study subjects were 1199 mother-child pairs. Maternal depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale during pregnancy and the Edinburgh Postnatal Depression Scale at 4 months postpartum. Children's behavioral development at 5 years of age was assessed with the Strengths and Difficulties Questionnaire. Compared with children whose mothers did not experience depressive symptoms during pregnancy, those whose mothers did experience depressive symptoms during pregnancy had increased risk of emotional symptoms, conduct problems, hyperactivity, peer problems, and low prosocial behavior. Maternal depressive symptoms at around 4 months postpartum were associated with increased risk of childhood emotional problems. Compared with children whose mothers did not experience depressive symptoms during the perinatal period, those whose mothers did experience depressive symptoms both during pregnancy and postpartum had a fivefold increased risk of childhood emotional symptoms and a threefold increased risk of peer problems. Our findings suggest that perinatal maternal depression is associated with behavioral problems in children. Several epidemiological studies in Western countries have examined the association between perinatal maternal depression and children's behavioral development, yet the results are conflicting and inconclusive. There is limited evidence on this topic in Asia. In our study using data from a prospective pregnancy birth cohort, maternal depressive symptoms around 4 months postpartum were associated with an increased risk of emotional symptoms in children aged 5 years. Children whose mothers had exhibited depressive symptoms both during pregnancy and postpartum had a fivefold increased risk of childhood emotional symptoms and a threefold increased risk of peer problems.

Trajectories of perinatal depressive symptoms in the context of the COVID-19 pandemic.

This study sought to advance understanding of the potential long‐term consequences of the COVID‐19 pandemic for child development by characterizing trajectories of maternal perinatal depression, a common and significant risk factor for adverse child outcomes. Data came from 393 women (86% White, 8% Latina; mean age = 33.51 years) recruited during pregnancy (n = 247; mean gestational age = 22.94 weeks) or during the first year postpartum (n = 146; mean child age = 4.50 months; 55% female). Rates of depression appear elevated, relative to published reports and to a pre‐pandemic comparison group (N = 155). This study also provides evidence for subgroups of individuals who differ in their depressive symptom trajectories over the perinatal period. Subgroup membership was related to differences in maternal social support, but not to child birth outcomes.

Prevalence and risk factors associated with perinatal depression in sexual minority women.

Perinatal depression is associated with wide-ranging negative outcomes for women and their families, though little research has examined perinatal depression in sexual minority women. We examined depression in sexual minority women in the perinatal period, and whether there were unique minority stress-related risk and protective factors that predicted perinatal depression. One hundred ninety-four perinatal sexual minority women aged 18 years and older were recruited from the US and Australia. Participants completed an online questionnaire incorporating the Edinburgh Postnatal Depression Scale (EPDS) and measures of minority stress and social support. Over one third (35.6%) of the sample scored in the clinical range on the EPDS. Experiences of discrimination were associated with greater depression symptoms via poor social support from family. Higher concealment motivation was associated with greater depression symptoms via poor family and partner support. There were no direct or indirect effects of internalized stigma on depression. Rates of clinically elevated perinatal depression symptoms among sexual minority women are high, extending previous research demonstrating mental health disparities between sexual minorities and their heterosexual counterparts to the perinatal period. The role of social support in mediating the relationships between minority stress and depression suggests that increasing partner and family support might be effective targets for therapeutic interventions during the perinatal period.

Impact of parental perinatal depressive and anxiety symptoms trajectories on early parent-infant impaired bonding: a cohort study in east and west coasts of Malaysia.

The association between maternal depressive and anxiety symptoms and impaired bonding with infants were widely studied, but not in fathers and none in Malaysia. We investigated the impact of different trajectories of perinatal depressive and anxiety symptoms on parent-infant impaired bonding during 2-3months postpartum in both mothers and fathers in two areas of Malaysia. This study originated from a psychiatric morbidity cohort study carried out in health clinics in east and west Malaysia. Edinburgh Postnatal Depression Scale and anxiety subscale of Depression, Anxiety, and Stress Scale at late pregnancy and 2-3months postpartum and Postpartum Bonding Questionnaire were completed by 566 mothers and 457 fathers. About 11.7% mothers and 16.1% fathers reported depressive symptoms during pregnancy, 6.5% mothers and 10.5% fathers during 2-3months postpartum, and 3-4% mothers and fathers both depressive and anxiety symptoms 2-3months postpartum. The mean impaired bonding score was highest in mothers and fathers who had both depressive and anxiety symptoms 2-3months postpartum. Impaired bonding is associated with higher EPDS and DASS (anxiety subscale) scores 2-3months postpartum in both parents. Physical partner violence and deteriorated marital relationship were associated with increased risk of impaired bonding in mothers. The association between depressive, anxiety, and comorbidity of depressive and anxiety symptoms in both mothers and fathers and parent-infant impaired bonding during 2-3months postpartum urges for screening and treatment of depressive and anxiety symptoms in both parents during early parenthood.

Validation of a Dari translation of the Edinburgh Postnatal Depression Scale among women of refugee background at a public antenatal clinic.

Identifying women at risk of depression and anxiety during pregnancy provides an opportunity to improve health outcomes for women and their children. One barrier to screening is the availability of validated measures in the woman's language. Afghanistan is one of the largest source countries for refugees yet there is no validated measure in Dari to screen for symptoms of perinatal depression and anxiety. The aim of this study was to assess the screening properties of a Dari translation of the Edinburgh Postnatal Depression Scale. This cross-sectional study administered the Edinburgh Postnatal Depression Scale Dari version to 52 Dari-speaking women at a public pregnancy clinic in Melbourne, Australia. A clinical interview using the depressive and anxiety disorders modules from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) was also conducted. Interview material was presented to an expert panel to achieve consensus diagnoses. The interview and diagnostic process was undertaken blind to Edinburgh Postnatal Depression Scale screening results. Cronbach's alpha coefficient for the Edinburgh Postnatal Depression Scale Dari version was good (α = 0.79). Criterion validity was assessed using the receiver operating characteristics curve and generated excellent classification accuracy for depression diagnosis (0.90; 95% confidence interval [0.82, 0.99]) and for anxiety diagnosis (0.94; 95% confidence interval [0.88, 1.00]). For depression, a cut-off score of 9, as recommended for culturally and linguistically diverse groups, demonstrated high sensitivity (1.00; 95% confidence interval [0.79, 1.00]) and specificity (0.88; 95% confidence interval [0.73, 0.97]). For anxiety, a cut-off score of ⩾5 provided the best balance of sensitivity (1.00; 95% confidence interval [0.72, 1.00]) and specificity (0.80; 95% confidence interval [0.65, 0.91]). These results support the use of this Edinburgh Postnatal Depression Scale Dari version to screen for symptoms of depression and anxiety during pregnancy as well as the use of a lowered cut-off score.

Perinatal Depression, Birth Experience, Marital Satisfaction and Childcare Sharing: A Study in Russian Mothers.

Background: Over 300,000 women in Russia face perinatal depressive disorders every year, according to the data for middle-income countries. This study is the first attempt to perform a two-phase study of perinatal depressive disorders in Russia. The paper examines risk factors for perinatal depressive symptoms, such as marital satisfaction, birth experience, and childcare sharing. Methods: At 15–40 gestational weeks (M = 30.7, SD = 6.6), 343 Russian-speaking women, with a mean age of 32 years (SD = 4.4), completed the Edinburgh Postnatal Depression Scale, Couples Satisfaction Index, Birth Satisfaction Scale, and provided socio-demographic data. Two months after childbirth, 190 of them participated in the follow-up. Results: The follow-up indicated that 36.4% of participants suffered from prenatal depression and 34.3% of participants had postnatal depression. Significant predictors of prenatal depression were physical well-being during pregnancy (β = −0.25; p = 0.002) and marital satisfaction during pregnancy (β = −0.01; p = 0.018). Birth satisfaction (β = −0.08; p = 0.001), physical well-being at two months after delivery (β = −0.36; p < 0.01), and marital satisfaction during pregnancy (β = 0.01; p = 0.016) and after delivery (β = −0.02; p < 0.01) significantly predicted postnatal depression at 2 months after delivery. Conclusion: Our study identified that physical well-being during pregnancy and marital satisfaction during pregnancy significantly predicted prenatal depression. Birth satisfaction, physical well-being at 2 months after delivery, and marital satisfaction during pregnancy and after delivery significantly predicted postnatal depression. To our knowledge, this is the first study of perinatal depressive disorders in the context of marital satisfaction and birth satisfaction in the Russian sample. The problem of unequal childcare sharing is widely spread in Russia. Adjusting spousal expectations and making arrangements for childcare may become the focus of psychological work with the family. The availability of psychological support during pregnancy and labor may be important in the context of reducing perinatal depression risks.

Perinatal Depressive Symptoms, Human Immunodeficiency Virus (HIV) Suppression, and the Underlying Role of Antiretroviral Therapy Adherence: A Longitudinal Mediation Analysis in the IMPAACT P1025 Cohort.

BackgroundWomen with HIV have higher risk of depressive symptoms in the perinatal period. Evidence on how perinatal depressive symptoms affect viral suppression (VS) and adherence to antiretroviral therapy (ART) remains limited.MethodsPerinatal depressive symptoms were assessed using 6 items from the AIDS Clinical Trials Group (ACTG) Quality of Life questionnaire. VS (viral load <400 copies/mL) was the outcome. Adherence was defined as no missed dose in the past 1–4 weeks using the ACTG Adherence Questionnaire. Generalized mixed-effects structural equation models estimated the association of depressive symptoms on VS and the mediating role of ART adherence among women enrolled in the IMPAACT P1025 Perinatal Core Protocol (2002–2013).ResultsAmong 1869 participants, 47.6% were 21–29 years, 57.6% non-Hispanic Black. In the third trimester, the mean depressive symptoms score was 14.0 (±5.2), 68.0% had consistent adherence, and 77.3% achieved VS. At 6 months postpartum, depressive symptoms declined while adherence and VS fell to 59.8% and 53.0%, respectively. In the fully adjusted model, a 1-SD increase in depressive symptoms was associated with a 3.8-percentage-point (95% CI: −5.7, −1.9) decline in VS. This effect is the sum of the indirect effect of depressive symptoms on VS via ART adherence (−0.4; 95% CI: −.7, −.2) and the direct effect through other pathways (−3.4; −5.2, −1.5). The decline in adherence driven by depressive symptoms accounted for ≥11% of the total negative effect of depressive symptoms on VS.ConclusionsPerinatal depressive symptoms were associated with decreased adherence and VS, highlighting the need to screen for, diagnose, and treat perinatal depression to optimize maternal outcomes.Clinical Trials RegistrationNCT00028145.

Anxiety and depressive symptoms of women in the perinatal period during the COVID-19 pandemic: A systematic review and meta-analysis.

The prevalence of perinatal anxiety and depressive symptoms have been speculated to increase during an infectious disease outbreak but remains unknown in the context of the COVID-19 situation. Therefore, this review aimed to examine the prevalence of antenatal and postnatal anxiety and depressive symptoms among pregnant women and postpartum mothers during the COVID-19 period. Six electronic databases were systematically searched for articles from November 2019 to December 2020. Twenty-six observational studies and brief reports were included in the meta-analysis. Overall, the prevalence of anxiety was greater than depression in both antenatal and postnatal periods, and the prevalence of depression was higher in the antenatal period than the postnatal period. The pooled prevalence for antenatal anxiety symptoms, antenatal depressive symptoms and postnatal depressive symptoms were 40% (95% confidence intervals (CI): 0.27-0.52), 27% (95% CI: 0.20-0.33) and 17% (95% CI: 0.10-0.24), respectively. Europe (56%, 95% CI: 0.28-0.85) had significantly higher prevalence of antenatal anxiety than Asia (16%, 95% CI: 0.09-0.23). The heightened prevalence of perinatal psychological disorders served as an impetus for healthcare professionals and policy makers to ramp up their support and mitigation strategies for pregnant women and mothers in times of health crisis.

Maternal perinatal depressive symptoms and oppositional-defiant disorder in children and adolescents

IntroductionThere is evidence that maternal perinatal depression is associated with adverse neurodevelopmental and mental health outcomes in children. No study has yet examined the association between maternal depressive symptoms during pregnancy and the postpartum period and the risk of oppositional-defiant disorder (ODD) in children and adolescents.ObjectivesThis study aimed to investigate whether there is an association between perinatal depressive symptoms and the risk of ODD in offspring from age 7 to 15 years.MethodsWe used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based prospective birth cohort study in the UK. Offspring ODD at the age of 7, 10, 13 and 15 years were assessed by using parental reports the Development and Well-Being Assessment (DAWBA). We applied Generalized Estimating Equation (GEE) modelling to examine associations across the four time points.ResultsMaternal postnatal depressive symptoms were associated with more a two-fold increased risk of ODD overall. Third trimester depressive symptoms (measured at 32 weeks of gestation) increased risk of ODD by 72%. Offspring of mothers who had depressive symptoms both during pregnancy and in the first year of postpartum period have a four-fold increased risk of ODD over time (adjusted OR = 3.59 (1.98-6.52).Conclusions Offspring of mothers with perinatal depressive symptoms are at an increased risk of developing behavioural disorders.

The impact of hypertensive disorders during pregnancy on maternal perinatal depressive and anxiety symptoms

IntroductionExisting evidence regarding the association between hypertensive disorders of pregnancy (HDP) and the risk of maternal mental illness is inconclusive.ObjectivesThis study aimed (i) to investigate the relationship between HDP (pre-eclampsia and gestational hypertension) and the risk of depressive and anxiety symptoms during pregnancy and in the postpartum period and (ii) to test whether parity moderates the association between HDP and antenatal and postnatal anxiety and depressive symptoms.MethodsThe study cohort consisted of more than 8500 mothers who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC), UK. Maternal antenatal and postnatal depressive and anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Crown-Crisp Experiential Index (CCEI), respectively. Univariable and multivariable logistic and linear regression analyses were used to examine the associations.ResultsMothers with pre-eclampsia had a 53% (aOR= 1.53; 95% CI, 1.06-2.23) increased risk of antenatal depressive symptoms compared with those without pre-eclampsia. Having pre-eclampsia and being a nulliparous woman resulted in a 2.75 fold increased risk of antenatal depressive symptoms (p-value for interaction = 0.03). Gestational hypertension was associated with antenatal depressive and anxiety symptoms. We found no associations between pre-eclampsia and/or gestational hypertension and postnatal anxiety and depressive symptoms.ConclusionsOur study showed that mothers with HDP were at higher risk of antenatal depressive and anxiety symptoms. Nulliparous women with pre-eclampsia are a higher risk group for depression during pregnancy.DisclosureNo significant relationships.

Canonical TGF-\u03b2 signaling regulates the relationship between prenatal maternal depression and amygdala development in early life

Canonical transforming growth factor-beta (TGF-β) signaling exerts neuroprotection and influences memory formation and synaptic plasticity. It has been considered as a new target for the prevention and treatment of depression. This study aimed to examine its modulatory role in linking prenatal maternal depressive symptoms and the amygdala volumes from birth to 6 years of age. We included mother–child dyads (birth: n = 161; 4.5 years: n = 131; 6 years: n = 162) and acquired structural brain images of children at these three time points. Perinatal maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) questionnaire to mothers at 26 weeks of pregnancy and 3 months postpartum. Our findings showed that the genetic variants of TGF-β type I transmembrane receptor (TGF-βRI) modulated the association between prenatal maternal depressive symptoms and the amygdala volume consistently from birth to 6 years of age despite a trend of significance at 4.5 years of age. Children with a lower gene expression score (GES) of TGF-βRI exhibited larger amygdala volumes in relation to greater prenatal maternal depressive symptoms. Moreover, children with a lower GES of the TGF-β type II transmembrane receptor (TGF-βRII), Smad4, and Smad7 showed larger amygdala volumes at 6 years of age in relation to greater prenatal maternal depressive symptoms. These findings support the involvement of the canonical TGF-β signaling pathway in the brain development of children in the context of in utero maternal environment. Such involvement is age-dependent.

Developing a task-sharing psychological intervention to treat mild to moderate symptoms of perinatal depression and anxiety in South Africa: a mixed-method formative study

BackgroundSymptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study is to develop a task-sharing psychological counselling intervention for routine treatment of mild to moderate symptoms of perinatal depression and anxiety in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study.MethodsWe conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on delivery format and common counselling components used across task-sharing interventions. Semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore perceptions and needs relating to mental health. Stakeholder engagements further informed the intervention design and appropriate service provider. A four-day pilot training with community-based health workers refined the counselling content and training material.ResultsThe manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions using a variety of delivery formats. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms, and lay health workers and pregnant women demonstrated their understanding through a range of local idioms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three-session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method.ConclusionInput from health workers and pregnant women is a critical component of adapting existing maternal mental health protocols to the context of routine care in South Africa, providing valuable data to align therapeutic content with contextual needs. Multisector stakeholder engagements is vital to align the intervention design to health system requirements and guidelines.

Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) through non-specialist providers and telemedicine: a study protocol for a non-inferiority randomized controlled trial

BackgroundDepression and anxiety impact up to 1 in 5 pregnant and postpartum women worldwide. Yet, as few as 20% of these women are treated with frontline interventions such as evidence-based psychological treatments. Major barriers to uptake are the limited number of specialized mental health treatment providers in most settings, and problems with accessing in-person care, such as childcare or transportation. Task sharing of treatment to non-specialist providers with delivery on telemedicine platforms could address such barriers. However, the equivalence of these strategies to specialist and in-person models remains unproven.MethodsThis study protocol outlines the Scaling Up Maternal Mental healthcare by Increasing access to Treatment (SUMMIT) randomized trial. SUMMIT is a pragmatic, non-inferiority test of the comparable effectiveness of two types of providers (specialist vs. non-specialist) and delivery modes (telemedicine vs. in-person) of a brief, behavioral activation (BA) treatment for perinatal depressive and anxiety symptoms. Specialists (psychologists, psychiatrists, and social workers with ≥ 5 years of therapy experience) and non-specialists (nurses and midwives with no formal training in mental health care) were trained in the BA protocol, with the latter supervised by a BA expert during treatment delivery. Consenting pregnant and postpartum women with Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 10 (N = 1368) will be randomized to one of four arms (telemedicine specialist, telemedicine non-specialist, in-person specialist, in-person non-specialist), stratified by pregnancy status (antenatal/postnatal) and study site. The primary outcome is participant-reported depressive symptoms (EPDS) at 3 months post-randomization. Secondary outcomes are maternal symptoms of anxiety and trauma symptoms, perceived social support, activation levels and quality of life at 3-, 6-, and 12-month post-randomization, and depressive symptoms at 6- and 12-month post-randomization. Primary analyses are per-protocol and intent-to-treat. The study has successfully continued despite the COVID-19 pandemic, with needed adaptations, including temporary suspension of the in-person arms and ongoing randomization to telemedicine arms.DiscussionThe SUMMIT trial is expected to generate evidence on the non-inferiority of BA delivered by a non-specialist provider compared to specialist and telemedicine compared to in-person. If confirmed, results could pave the way to a dramatic increase in access to treatment for perinatal depression and anxiety.Trial registrationClinicalTrials.gov NCT 04153864. Registered on November 6, 2019.

Genome-wide gene expression changes in postpartum depression point towards an altered immune landscape

Maternal postpartum depression (PPD) is a significant public health concern due to the severe negative impact on maternal and child health and well-being. In this study, we aimed to identify genes associated with PPD. To do this, we investigated genome-wide gene expression profiles of pregnant women during their third trimester of pregnancy and tested the association of gene expression with perinatal depressive symptoms. A total of 137 women from a cohort from the University of North Carolina, USA were assessed. The main phenotypes analysed were Edinburgh Postnatal Depression Scale (EPDS) scores at 2 months postpartum and PPD (binary yes/no) based on an EPDS cutoff of 10. Illumina NextSeq500/550 transcriptomic sequencing from whole blood was analysed using the edgeR package. We identified 71 genes significantly associated with postpartum depression scores at 2 months, after correction for multiple testing at 5% FDR. These included several interesting candidates including TNFRSF17, previously reported to be significantly upregulated in women with PPD and MMP8, a matrix metalloproteinase gene, associated with depression in a genome-wide association study. Functional annotation of differentially expressed genes revealed an enrichment of immune response-related biological processes. Additional analysis of genes associated with changes in depressive symptoms from recruitment to 2 months postpartum identified 66 genes significant at an FDR of 5%. Of these genes, 33 genes were also associated with depressive symptoms at 2 months postpartum. Comparing the results with previous studies, we observed that 15.4% of genes associated with PPD in this study overlapped with 700 core maternal genes that showed significant gene expression changes across multiple brain regions (P = 7.9e-05) and 29–53% of the genes were also associated with estradiol changes in a pharmacological model of depression (P values range = 1.2e-4–2.1e-14). In conclusion, we identified novel genes and validated genes previously associated with oestrogen sensitivity in PPD. These results point towards the role of an altered immune transcriptomic landscape as a vulnerability factor for PPD.

Impact of the COVID-19 pandemic on mental health, access to care, and health disparities in the perinatal period

BackgroundThe COVID-19 pandemic has affected mental health and created barriers to healthcare. In this study, we sought to elucidate the pandemic's effects on mental health and access to care for perinatal individuals. MethodsThis cross-sectional study of individuals in Massachusetts who were pregnant or up to three months postpartum with a history of depressive symptoms examined associations between demographics and psychiatric symptoms (via validated mental health screening instruments) and the COVID-19 pandemic's effects on mental health and access to care. Chi-square associations and multivariate regression models were used. ResultsOf 163 participants, 80.8% perceived increased symptoms of depression and 88.8% of anxiety due to the pandemic. Positive screens for depression, anxiety, and/or PTSD at time of interview, higher education, and income were associated with increased symptoms of depression and anxiety due to the pandemic. Positive screens for depression, anxiety, and/or PTSD were also associated with perceived changes in access to mental healthcare. Compared to non-Hispanic White participants, participants of color (Black, Asian, Multiracial, and/or Hispanic/Latinx) were more likely to report that the pandemic changed their mental healthcare access (aOR:3.25, 95%CI:1.23, 8.59). LimitationsLimitations included study generalizability, given that participants have a history of depressive symptoms, and cross-sectional design. ConclusionsThe pandemic has increased symptoms of perinatal depression and anxiety and impacted perceived access to care. Self-reported increases in depression and anxiety and changes to healthcare access varied by education, race/ethnicity, income, and positive screens. Understanding these differences is important to address perinatal mental health and provide equitable care.

Impact of the Covid-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19): protocol for an international prospective cohort study

BackgroundCorona Virus Disease 19 (COVID-19) is a new pandemic, declared a public health emergency by the World Health Organization, which could have negative consequences for pregnant and postpartum women. The scarce evidence published to date suggests that perinatal mental health has deteriorated since the COVID-19 outbreak. However, the few studies published so far have some limitations, such as a cross-sectional design and the omission of important factors for the understanding of perinatal mental health, including governmental restriction measures and healthcare practices implemented at the maternity hospitals. Within the Riseup-PPD COST Action, a study is underway to assess the impact of COVID-19 in perinatal mental health. The primary objectives are to (1) evaluate changes in perinatal mental health outcomes; and (2) determine the risk and protective factors for perinatal mental health during the COVID-19 pandemic. Additionally, we will compare the results between the countries participating in the study.MethodsThis is an international prospective cohort study, with a baseline and three follow-up assessments over a six-month period. It is being carried out in 11 European countries (Albania, Bulgaria, Cyprus, France, Greece, Israel, Malta, Portugal, Spain, Turkey, and the United Kingdom), Argentina, Brazil and Chile. The sample consists of adult pregnant and postpartum women (with infants up to 6 months of age). The assessment includes measures on COVID-19 epidemiology and public health measures (Oxford COVID-19 Government Response Tracker dataset), Coronavirus Perinatal Experiences (COPE questionnaires), psychological distress (BSI-18), depression (EPDS), anxiety (GAD-7) and post-traumatic stress symptoms (PTSD checklist for DSM-V).DiscussionThis study will provide important information for understanding the impact of the COVID-19 pandemic on perinatal mental health and well-being, including the identification of potential risk and protective factors by implementing predictive models using machine learning techniques. The findings will help policymakers develop suitable guidelines and prevention strategies for perinatal mental health and contribute to designing tailored mental health interventions.Trial registrationClinicalTrials.gov Identifier: NCT04595123.

224 The association between perinatal depressive symptoms and child neurodevelopment

Prior studies suggest that maternal depression adversely impacts child development. Our objective is to determine the association between perinatal depressive symptoms and child neurodevelopment. Secondary analysis of a RCT of thyroxine therapy for low risk pregnant women with subclinical hypothyroidism. Patients without a clinical diagnosis of depression were assessed for depressive symptoms using the Center for Epidemiological Studies-Depression (CESD) scale at 11-20 and 34-38 weeks, and 1-year postpartum. The CESD was not scored until completion of the trial. A CESD score ≥16 is considered screen positive for depression. In the primary trial, thyroxine therapy did not improve child cognitive outcomes or maternal depressive symptoms, thus all patients with available CESD scores were included in this analysis. Our primary outcome was child IQ score <85 at 5 years of age using the WPPSI-III Full Scale test. Associations between a positive depression screen and neurodevelopmental outcomes were determined with multivariable logistic regressions. 209 maternal/child dyads were analyzed. 24% of patients screened positive for depression at baseline and 15% at 1-year postpartum. Compared to patients with a CESD <16, those who screened positive had a higher BMI, were more likely to smoke, and less likely to have higher education. Children born to patients with a positive depression screen, either antenatally or at 1-year postpartum, had a higher rate of IQ <85 at 5 years of age (35% vs. 18 % and 47% vs. 21%) compared with children born to patients with a CES-D <16. Additionally, they had higher rates of other adverse neurodevelopmental outcomes. However, these associations did not persist on multivariable analysis (Tables). Findings were similar for patients with a positive antepartum screen that persisted to 1 year postpartum. In this cohort of pregnant women with subclinical hypothyroidism, having a positive perinatal depression screen was not associated with child neurodevelopmental outcomes after controlling for covariates including social determinants of health.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

593 Racial and ethnic disparities in perinatal depression symptoms and symptom trajectories

Improved awareness of racial/ethnic disparities in perinatal depression is important to understand areas for improvement in care. This retrospective cohort includes individuals enrolled in a perinatal collaborative care program (COMPASS) between 2/17-12/19 who completed at least 2 Patient Health Questionnaire-9 (PHQ9) screens for perinatal depression. Perinatal collaborative care is a health services intervention designed to integrate mental health care into obstetric care. All eligible clinics can refer women to COMPASS’ mental health care, irrespective of insurance status, from initiation of prenatal care until one-year postpartum. Individuals in COMPASS receive PHQ9s every 2-4 weeks with the cadence informed by their prior scores. The proportion of individuals with a positive screen (i.e., PHQ9 > 9) across time were compared across self-identified racial/ethnic groups using generalized estimating equations with a binomial distribution and a log link assumption. A segmented multiple regression model was used to compare change in rate over time before and after delivery across racial/ethnic groups. A total of 873 individuals (26% Black, 20% Latinx, 54% White) completed 6410 PHQ9 screens. Of these 6410 screens, 1477 (23%) were positive. The trajectories of positive depressive screens diverged across races/ethnicities (Figure). Compared to White individuals who experienced a population-aggregated decrease, Latinx (p=0.066) and Black (p=0.035) individuals experienced a stable or increasing prevalence of positive depression screens postpartum. In this cohort of individuals with access to perinatal mental health care via collaborative care, White individuals demonstrated an improved trajectory of positive depression screens postpartum, whereas Black and Latinx individuals did not improve postpartum. These data suggest that relieving the financial burden to mental health care is an insufficient approach to mental health equity. Determining optimal and acceptable interventions to prevent symptom worsening and delayed symptom onset of those at increased risk are next steps.