Postpartum Affective Disorders Research Articles

Associations Between Early-Pregnancy Vitamin D Status and Postpartum Depressive and Anxiety Symptoms.

Maternal postpartum depressive and anxiety symptoms are risk factors for subsequent maternal and child mental health problems. Little is known about the potential role of antepartum vitamin D and C-reactive protein (CRP) in the etiology of maternal postpartum affective symptoms. We investigated associations between antepartum vitamin D status and postpartum depressive and anxiety symptoms and whether antepartum CRP mediated these associations. In 2483 participants of the Amsterdam Born Children and their Development prospective cohort, maternal serum vitamin D and CRP were measured at a median of 13 weeks' gestation. Vitamin D status was defined as deficient (≤29.9 nM), insufficient (30-49.9 nM), sufficient (50-79.9 nM), or normal (≥80 nM). Maternal depressive symptoms (Center for Epidemiologic Studies-Depression) and anxiety (State-Trait Anxiety Inventory) were assessed 3 months postpartum. After adjustments for confounders, vitamin D deficiency was only associated with increased postpartum anxiety symptoms ( B = 0.17, 95% confidence interval [CI] = 0.03-0.30, p = .017) compared to normal vitamin D levels (≥80 nM). In women not taking vitamin D supplementation ( n = 2303), vitamin D deficiency was associated with increased postpartum depressive and anxiety symptoms ( B = 0.14, 95% CI = 0.03-0.28, p = .045; and B = 0.17, 95% CI = 0.03-0.32, p = .015). Antepartum CRP did not mediate these links. We found some evidence that antepartum vitamin D deficiency was associated with increased postpartum affective symptoms, especially in women not taking vitamin D supplementation. Clinical trials should determine whether vitamin D supplementation can reduce the risk for postpartum affective disorders.

Baby blues, premenstrual syndrome and postpartum affective disorders: intersection of risk factors and reciprocal influences.

The aetiology and consequences of 'baby blues' (lower mood following childbirth) are yet to be sufficiently investigated with respect to an individual's clinical history. The primary aim of the study was to assess the symptoms of baby blues and the relevant risk factors, their associations with clinical history and premenstrual syndrome (PMS), and their possible contribution to the early recognition of postpartum depression (PPD). Beginning shortly after childbirth, 369 mothers were followed up for 12 weeks. Information related to their clinical history, PMS, depression, stress and mother-child attachment was collected. At 12 weeks, mothers were classified as non-depressed, or with either PPD or adjustment disorder. A correlation was found between the severity of baby blues and PMS (r = 0.397, P < 0.001), with both conditions increasing the possibility of adjustment disorder and PPD (baby blues: OR = 6.72, 95% CI 3.69-12.25; PMS: OR = 3.29, 95% CI 2.01-5.39). Baby blues and PMS independently predicted whether a mother would develop adjustment disorder or PPD after childbirth (χ2(64) = 198.16, P < 0.001). Among the non-depressed participants, baby blues were found to be associated with primiparity (P = 0.012), family psychiatric history (P = 0.001), PMS (P < 0.001) and childhood trauma (P = 0.017). Baby blues are linked to a number of risk factors and a history of PMS, with both conditions adding to the risk of PPD. The neuroendocrine effects on mood need be understood in the context of individual risk factors. The assessment of both baby blues and PMS symptoms within the first postpartum days may contribute to an early identification of PPD.

Treating postpartum affective and/or anxiety disorders in a mother-baby day hospital: preliminary results

Introduction Women experiencing perinatal mental-health illness have unique needs. The present study analyzes preliminary data about the effectiveness of MBDH in treating postpartum women with affective and anxiety disorders. Methods We analysed 33 mothers with affective and/or anxiety disorders treated at the MBDH with their babies between March 2018 and December 2019. All women were assessed at admission, discharge and three months after discharge. Outcomes included symptoms of depression (EPDS) and anxiety (STAI-S), mother-infant bonding (PBQ) and functional impairment (HoNOs). We also assessed the clinical significance of changes in patients’ scores on these scales and patient satisfaction. Results At discharge, no patients still met the full criteria for the main diagnosis. Between admission and discharge, symptoms of depression and anxiety, mother-infant bonding, functional impairment and autonomy in caring for babies improved significantly. These gains were maintained at three months follow-up. Patient satisfaction was high. Conclusions These preliminary results suggest that multidisciplinary intervention for postpartum women with affective or anxiety disorders at the MBDH improves maternal psychopathology, mother-infant bonding and mothers’ ability to care for their babies. MBDHs are a promising approach for delivering specialised perinatal mental-health care for mother-baby dyads.

The severity of anxiety and depression in women in the postpartum period and mother-child interaction

The purpose of the study was to study the relationship of quantitative indicators of anxiety and depression in women in the postpartum period with the types of mother-child interaction. The main group consisted of 93 women in the postpartum period with a total score on the Beck Depression Self-Assessment Inventory (BDI) of 10 or higher. The comparison group consisted of 33 women with a total BDI score of 9 points or less. Double testing using the Spielberger Personal and Situational Anxiety Scale (STAI) was carried out on days 5-7 of admission and 1 week after the initial testing. The questionnaire of maternal selfassessment of interaction with the child (MSIR) and the method of objective assessment of maternal-child interaction (OMDV) from 7 to 15 days of stay were used. The results showed that in the absence of age differences and length of stay in the hospital, those examined, whose total BDI score was 10 or more, had significantly higher values of personal and situational anxiety during the initial and repeated examinations. The value of the HRMS score was also significantly higher in the main group, which indicates that mothers with high rates of depression tend to underestimate the level of their interaction with the child, are more selfcritical about the ability to understand the newborn and the skills of educational competence. The dynamics of personal and situational anxiety revealed a significant decrease in the main group and the comparison group, which indicates a reduction in the intensity of affective experiences. In the main group, the number of women with a formal type of mother-child interactions significantly prevailed, and in the comparison group - with a harmonious type. Thus, the experience of women in the postpartum period with BDI values of 10 and above of insufficient “maternal competence” is a consequence not only of a high level of self-criticism, but also of objective difficulties in interacting with the child, which indirectly confirms the positive role of pediatric patronage and psychosocial support in the treatment of postpartum affective disorders. experiences

Catatonia in the Structure of Affective and Schizoaffective Disorders of the Postpartum Period

Background: аt the present stage of psychiatry, within the framework of the dimensional paradigm, catatonia is considered as a transnosological entity that manifests within the clinical space of various affective and schizoaffective disorders. In the 21st century studies, devoted to the analysis of motor disorders that appear in the clinical space of postpartum affective and schizoaffective disorders, become increasingly relevant (J.Y. Lai, T.L. Huang, 2004; A. Nahar and et al., 2017; C. Kamau, 2017; L. Csihi and et al., 2022). However, research on this issue is very limited. The objective: the analysis of catatonic phenomenon, manifesting in the postpartum period, based on the observations of three clinical cases.Patients and methods: 3 clinical cases of patients, undergoing treatment in the clinical department of the FSBSI “Mental Health Research Centre” with established diagnoses of bipolar affective disorder (ICD-10: F31.1; 1 case) and schizoaffective disorder (ICD-10: F25.2; 2 cases) with a predominance of motor disorders in the clinical picture of the disease. The main method was clinical with the use of psychological examination and data from instrumental (EEG) diagnostics.Results: movement disorders registered in the structure of apathoanesthetic depressions within the exacerbation of bipolar affective disorder are represented by the phenomena of hypokinetic catatonia and act as an amplifier of affective disorders. Catatonic symptoms within the clinical space of schizoaffective disorders, are limited by manifestations of parakinetic catatonia, do not have a direct correlation with the structure and severity of affective disorders, and indicate an increase in the progredient endogenous process.Conclusion: the analysis of clinical observations testifies in favor of the heterogeneity of affective-catatonic states not only in terms of the structure of motor phenomena, but also in terms of the psychopathological profile of affective disorders.

Prevalence and associated psychological risk factors of postpartum depression: a cross-sectional study

This cross-sectional study aimed to evaluate the prevalence of postpartum depression and the associated risk factors in a sample of Italian women at three months after delivery. Eighty women were screened by completing the Edinburgh Postnatal Depression Scale (EPDS). Women with a score ≥10 were evaluated as positive and other variables were detected through the administration of the Postpartum Depression Predictors Inventory. The prevalence of postpartum depression in the sample was 11.25% (EPDS score >10). A statistically significant relationship was found between the predisposition to postnatal depression and various risk factors such as prenatal depression, stressful life experiences marital problems. Furthermore, strong emotional and instrumental support from the partner and a good economic status can represent protective factors. It is essential to promote an integrated approach to postpartum affective disorders in which psychosocial risk factors are taken into account, and adequate screening programs are implemented. Impact Statement What is already known on this subject? Pregnancy can cause emotional stress for women with consequent development, in some cases, of mood disorders such as postpartum depression. What do the results of this study add? According to this study, women suffering from postpartum depression showed a significant tendency to anxiety and depression, low perceived support from the partner, and low socio-economic status. What are the implications of these findings for clinical practice and/or further research? It would be desirable to promote an integrated approach to postpartum affective disorders in which psychosocial risk factors are taken into account and adequate screening programs are implemented.

Parental postpartum affective disorders as a risk factor for infant bedtime resistance

IntroductionInfant intrinsic factors, parental mental health, and parenting functioning could influence infant sleep development (Camerota et al., 2019). The current study was designed to advance understanding of parental mental health in influencing bedtime resistance in infants aging 8-12 months.ObjectivesThe main aim of the present study was to examine the role of parental postpartum affective disorders, infants’ temperament and paternal involvement at bedtime in predicting infants’ bedtime resistance (e.g. fussing, crying or protesting).Methods60 Italian families of infants (34 boys and 26 girls) aging from 8 to 12months (M =10.73, SD = 2.54) participated in this study. Parents completed Brief Infant Sleep Questionnaire (Sadeh et al., 2009), Perinatal Assessment of Paternal and Maternal Affectivity (Baldoni et al., 2018), QUIT for infants’ temperament (Axia, 2002) and an ad-hoc questionnaire for fathers’ involvement. Two multiple linear regressions (MR), one for fathers and one for mothers, and relative weight analyses (RWA) were conducted.ResultsInfants’ involvement in constant bedtime routines (reported by fathers: β = −.35, p &lt; .05; mothers: β = −.31, p &lt; .05) and paternal involvement at bedtime (fathers: β = −.45, p &lt; .01; mothers: β = −.27, p &lt; .05) represented protective factors for infants’ bedtime difficulties. Paternal affective disorders, accounted for 17.2% of the explained variance for mothers’ and 12.5% for fathers’ reports of infant bedtime difficulties, more than did maternal postpartum affective disorders.ConclusionsFindings support that parental mental health can interfere with infants’ bedtime resistance.

Parental Mental Health, Fathers\u2019 Involvement and Bedtime Resistance in Infants

BackgroundAround the age of 6 months, difficulties in settling to sleep and frequent night awakenings are generally occurring in 20 to 30% of infants. According to the transactional model parental factors can play a significant role in influencing infant sleep development. The purpose of the current study was to explore the combined effect of infants’ factors (temperament and sleep onset problems), and parental factors (parental mental health in terms of post-partum affective disorders, consistent bedtime routines and fathers’ involvement at bedtime), on infant bedtime difficulties (e.g. fussing, crying or protesting), including both maternal and paternal perspectives.MethodsSixty Italian intact two-parent families of infants (34 boys and 26 girls) ageing from 8 to 12 months (M = 10.73, SD = 2.54) were enrolled in the study. The parents filled out self-report questionnaires to measure the aforementioned variables. To investigate which infant and parental factors predicted infants’ bedtime difficulties, two multiple linear regressions (MR), one for fathers and one for mothers, and relative weight analyses (RWA) were conducted.ResultsWith regard to infants’ bedtime difficulties reported by fathers (R2 = .35) they were explained by infant involvement in constant bedtime routines (β = −.35, p = .030) and paternal involvement at bedtime (β = −.45, p = .007). Instead infants’ bedtime difficulties reported by mothers (R2 = .32) were explained by minutes the child taken to fall asleep (β = .24, p = .04), infant involvement in constant bedtime routines (β = −.31, p = .01) and bedtime paternal involvement (β = −.27, p = .05).ConclusionsThe main results of this study emphasized the protective role of consistent bedtime routines and bedtime paternal involvement in reducing infants’ bedtime difficulties perceived both from mothers and fathers. Future research could help to raise awareness and improve understanding of the familial influences on children’s sleep, providing recommendations for educating families, school professionals, healthcare providers, and the general public on risk and protective factors that could play a meaningful role in infants and children’s developing sleep patterns.

The dynamic serotonin system of the maternal brain.

Many pregnant and postpartum women worldwide suffer from high anxiety and/or depression, which can have detrimental effects on maternal and infant well-being. The first-line pharmacotherapies for prepartum and postpartum affective disorders continue to be the selective serotonin reuptake inhibitors (SSRIs), despite the lack of large well-controlled studies demonstrating their efficacy in reproducing women and the potential for fetal/neonatal exposure to the drugs. Prepartum or postpartum use of SSRIs or other drugs that modulate the brain's serotonin system is also troubling because very little is known about the typical, let alone the atypical, changes that occurin the female central serotonin system across reproduction. We do know from a handful of studies of women and female laboratory rodents that numerous aspects of the central serotonin system are naturally dynamic across reproduction and are also affected by pregnancy stress (a major predisposing factor for maternal psychopathology). Thus, it should not be assumed that the maternal central serotonin system being targeted by SSRIs is identical to non-parous females or males. More information about the normative and stress-derailed changes in the maternal central serotonin system is essential for understanding how serotonin is involved in the etiology of, and the best use of SSRIs for potentially treating, affective disorders in the pregnant and postpartum populations.

Risk, treatment duration, and recurrence risk of postpartum affective disorder in women with no prior psychiatric history: A population-based cohort study.

BackgroundSome 5%–15% of all women experience postpartum depression (PPD), which for many is their first psychiatric disorder. The purpose of this study was to estimate the incidence of postpartum affective disorder (AD), duration of treatment, and rate of subsequent postpartum AD and other affective episodes in a nationwide cohort of women with no prior psychiatric history.Methods and findingsLinking information from several Danish national registers, we constructed a cohort of 457,317 primiparous mothers with first birth (and subsequent births) from 1 January 1996 to 31 December 2013 (a total of 789,068 births) and no prior psychiatric hospital contacts and/or use of antidepressants. These women were followed from 1 January 1996 to 31 December 2014. Postpartum AD was defined as use of antidepressants and/or hospital contact for PPD within 6 months after childbirth. The main outcome measures were risk of postpartum AD, duration of treatment, and recurrence risk. We observed 4,550 (0.6%) postpartum episodes of AD. The analyses of treatment duration showed that 1 year after the initiation of treatment for their first episode, 27.9% of women were still in treatment; after 4 years, 5.4%. The recurrence risk of postpartum AD for women with a PPD hospital contact after first birth was 55.4 per 100 person-years; for women with postpartum antidepressant medication after first birth, it was 35.0 per 100 person-years. The rate of postpartum AD after second birth for women with no history of postpartum AD was 1.2 per 100 person-years. After adjusting for year of birth and mother’s age, women with PPD hospital contact after first birth had a 46.4 times higher rate (95% CI 31.5–68.4) and women with postpartum antidepressant medication after their first birth had a 26.9 times higher rate (95% CI 21.9–33.2) of a recurrent postpartum episode after their second birth compared to women with no postpartum AD history. Limitations include the use of registry data to identify cases and limited confounder control.ConclusionsIn this study, an episode of postpartum AD was observed for 0.6% of childbirths among women with no prior psychiatric history. The observed episodes were characterized by a relatively short treatment duration, yet the women had a notably high rate of later AD and recurrent episodes of postpartum AD. The recurrence risk of postpartum AD was markedly higher among women with PPD hospital contact after first birth compared to women with postpartum antidepressant medication after first birth. Our results underline the necessity of measures targeted at specific vulnerable groups, such as women who experience PPD as a first psychiatric episode.

Depression and Anxiety in the Postpartum Period and Risk of Bipolar Disorder: A Danish Nationwide Register-Based Cohort Study.

The first-onset affective episode requiring inpatient treatment in the postpartum period can be a marker of bipolar disorder, but it is unknown whether milder postpartum affective episodes are also indicators of underlying bipolarity. Therefore, we aimed to study whether women with a nonpsychotic postpartum affective episode treated with antidepressants have an increased risk of bipolar disorder. A register-based cohort study was conducted in Denmark of 122,622 parous women without psychiatric history who received a first-time antidepressant prescription during 1997-2012. We compared women with a first-time antidepressant prescription, which was our indicator of a first-onset affective disorder, within 1 year postpartum to women with a first-time antidepressant prescription outside the postpartum period. Our outcome was psychiatric contact for bipolar disorder (ICD-10 criteria) during follow-up, and we estimated hazard ratios using Cox regressions. The risk of bipolar disorder among women with a postpartum affective episode was higher than that in women with an affective episode outside the postpartum period. The risk of bipolar disorder was 1.66 (95% CI, 1.12-2.48) for postpartum antidepressant monotherapy and 10.15 (95% CI, 7.13-14.46) for postpartum antidepressant therapy plus a subsequent prescription for anxiolytics when these therapies were compared to antidepressant monotherapy outside the postpartum period. First-onset nonpsychotic postpartum affective disorder can be a marker of underlying bipolarity. Women who fill an antidepressant prescription following childbirth should be asked about hypomanic or manic symptoms and monitored long term. Clinically, when antidepressant monotherapy is ineffective or the individual woman experiences persistent and concerning symptoms, health professionals should consider a possible bipolar spectrum disorder.

Unplanned pregnancy and subsequent psychological distress in partnered women: a cross-sectional study of the role of relationship quality and wider social support

BackgroundResearch into the impact of unintended pregnancy on the wellbeing of women tends to focus on pregnancies ending in either termination or lone motherhood. Unintended pregnancy is common in partnered women, but little is known about the association between unintended pregnancy and postpartum affective disorders, such as depression and anxiety in this group. Poor relationship quality and lack of social support are considered risk factors for psychological distress (PD). We examined the association between unplanned motherhood and subsequent PD in partnered women, for whom evidence is sparse, accounting for the role of relationship quality and social support.MethodsData for 12,462 partnered mothers were drawn from the first survey of Millennium Cohort Study, completed at 9 months postpartum. Women reported whether their baby was planned, and how they felt when they discovered that they were pregnant. Pregnancy intention is categorised as “planned”, “unplanned/happy”, “unplanned/ambivalent” and “unplanned/unhappy”. PD was assessed using the modified 9-item Rutter Malaise Inventory. Social support was measured by a composite score for perceived support, and a measure of actual support from friends and family. Relationship quality was assessed using a modified Golombok-Rust Inventory of Marital State. The effect of pregnancy intention on the odds of PD at 9 months was estimated, adjusting for potential confounding factors. All analyses were weighted for response and design effects.ResultsIn total 32.8%(weighted) (4343/12462) of mothers reported an unplanned pregnancy: 23.3 wt% (3087) of mothers felt happy, 3.5 wt% (475) ambivalent, and 6.0 wt% (781) unhappy upon discovery. Unplanned pregnancy was associated with a significantly increased odds of PD compared to planned (OR 1.73 (95%CI: 1.53, 1.95)). This was more pronounced among women who reported negative or ambivalent feelings in early pregnancy (OR 2.72 (95%CI:2.17, 3.41) and 2.56 (95%CI:1.95, 3.34), respectively), than those who reported positive feelings (OR 1.39 (95%CI:1.21, 1.60)). Adjustment for relationship quality, in particular, reduced odds of PD after unplanned pregnancy (e.g. from 2.19 (95%C: 1.74, 2.74) to 1.63 (95% CI: 1.29, 2.07 in the unplanned, unhappy group compared to the planned).ConclusionsA third of partnered mothers reported that their pregnancy was unintended, yet this group is under-researched. Unplanned motherhood was associated with increased risk of PD at 9 months postpartum, particularly among women who felt unhappy or ambivalent at the start. The roles of relationship quality and social support require further investigation, as possible means to intervene and improve maternal wellbeing.

Post-partum psychosis

IntroductionPostpartum psychosis (or puerperal psychosis) is a term that covers a group of mental illnesses with the sudden onset of psychotic symptoms following childbirth. A typical example occurs when after childbirth, a woman becomes irritable, has extreme mood swings and hallucinations with the possibility of needing psychiatric hospitalization. Often, out of fear of stigma or misunderstanding, women hide their condition.Aims and objectivesTo review the evidence regarding prophylactic treatment and acute management of postpartum psychosis and affective disorders in the puerperium.MethodsOnline search/review of the literature has been carried out, using Medline/Pubmed, concerning “postpartum psychosis”, “postpartum”, “mental disorders”, “mania” and “depression”.ResultsPostpartum psychosis is a rare and severe psychiatric condition requiring rapid restoration of health in view of significant risks to both mother and the infant. The known risk factors and negative consequences of postpartum psychosis point to the importance of preventive and acute treatment measures. The majority of patients who develop psychosis immediately following childbirth suffer from bipolar disorder.ConclusionsUnderstanding the relationship between postpartum psychosis and affective disorders has implications for perinatal and long-term treatment. The rapid and accurate diagnosis of postpartum psychosis is essential to expedite appropriate treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Maternally responsive neurons in the bed nucleus of the stria terminalis and medial preoptic area: Putative circuits for regulating anxiety and reward.

Postpartum neuropsychiatric disorders are a major source of morbidity and mortality and affect at least 10% of childbearing women. Affective dysregulation within this context has been identified in association with changes in reproductive steroids. Steroids promote maternal actions and modulate affect, but can also destabilize mood in some but not all women. Potential brain regions that mediate these effects include the medial preoptic area (mPOA) and ventral bed nucleus of the stria terminalis (vBNST). Herein, we review the regulation of neural activity in the mPOA/vBNST by environmental and hormonal concomitants in puerperal females. Such activity may influence maternal anxiety and motivation and have significant implications for postpartum affective disorders. Future directions for research are also explored, including physiological circuit-level approaches to gain insight into the functional connectivity of hormone-responsive maternal circuits that modulate affect.

Serum NGF, BDNF and IL-6 levels in postpartum mothers as predictors of infant development: the influence of affective disorders.

BackgroundEarly adverse experiences are associated with increased risk of developing psychiatric disorders, although little is known about the neurobiological mediators involved. The mechanisms by which early environmental influences may mediate vulnerability in the development of offspring await further investigation. The present study correlated the NGF, BDNF, IL-6 and cortisol levels of mothers with postpartum affective disorders (PPAD) with infant development.MethodsA longitudinal study was performed with 152 pregnant women and their infants. Between 60 and 120 days after delivery, women were interviewed and provided biological samples for biochemical analysis, and the infants were examined for neurobiological-motor development.ResultsOverall, the mothers' history of affective disorders, PPAD and anxiety disorder were associated with infant motor development. Using an adjusted linear regression analysis, PPAD (p = 0.049), maternal anxiety disorder (p = 0.043), NGF level (p = 0.034) and infant cortisol level (p = 0.013) were associated with infant motor development. Using a factorial analysis of primary components, two components were retained. The psychological factor was characterized by a positive loading of a history of affective disorder, PPAD and anxiety disorder. For the biological factor, infant cortisol adhered negatively with infant motor development, but NGF was positively associated. The psychological factor had a negative association, but the biological factor had a positive association with infant motor development.ConclusionsThere are few studies that have focused on the relationship of biomarkers and infant neurodevelopment. Our study points that psychological and biological factors are associated with infant motor development, however the causal relationship between these factors is still to be defined.

Brain-Derived Neurotrophic Factor Levels in Women with Postpartum Affective Disorder and Suicidality

Our aim was to investigate serum brain-derived neurotrophic factor (BDNF) levels in postpartum women, according to the presence of postpartum affective disorder (PPAD) and suicidality. A cross-sectional study was carried out with women between 45 and 90 days after delivery. PPAD (depression, manic and mixed episode) and suicide risk were assessed using the Mini International Neuropsychiatric Interview. BDNF was assessed using a commercial ELISA kit. Linear regression was used for multivariate analyses. A hundred ninety women participated in the study, 15.3 % had PPAD, 7.4 % showed PPAD with suicide risk. BDNF levels were lower in subjects with three or more Stressful Life Events (P = 0.01). The serum BDNF levels of women with PPAD presenting suicide risk were significantly lower than those of women without suicide risk (1.50 ± 1.38 and 2.33 ± 1.28 ng/ml, P = 0.02). Clinicians should enquire postpartum women about their history of stressful life events, PPAD, and suicidality. This study shows the potential role of BDNF in the neurobiology of the association of PPAD and suicidality.

Differences in Mouse Maternal Care Behavior – Is There a Genetic Impact of the Glucocorticoid Receptor?

Depressive episodes are frequently preceded by stressful life events. Evidence from genetic association studies suggests a role for the glucocorticoid receptor (GR), an essential element in the regulation of stress responses, in the pathophysiology of the disorder. Since the stress response system is affected by pregnancy and postpartum-associated changes, it has also been implicated in the pathophysiology of postpartum depression. Using a 2×2 factorial design, we investigated whether a heterozygous deletion of GR would influence maternal care behavior in C57BL/6 and Balb/c mice, two inbred strains known to display qualitative differences in this behavior. Behavioral observation was carried out between postnatal days 1 and 7, followed by a pup retrieval test on postnatal days 7 or 8. While previously noted inter-strain differences were confirmed for different manifestations of caring behavior, self-maintenance and neglecting behaviors as well as the pup retrieval test, no strain-independent effect of the GR mutation was noted. However, an interaction between GR genotype and licking/grooming behavior was observed: it was down-regulated in heterozygous C57BL/6 mice to the level recorded for Balb/c mice. Home cage observation poses minimal disturbance of the dam and her litter as compared to more invasive assessments of dams' emotional behavior. This might be a reason for the absence of any overall effects of the GR mutation, particularly since GR heterozygous animals display a depressive-like phenotype under stressful conditions only. Still, the subtle effect we observed may point towards a role of GR in postpartum affective disorders.

Employment conditions and maternal postpartum mental health: results from the Longitudinal Study of Australian Children

Maternal postpartum mental health is influenced by a broad range of risk and protective factors including social circumstances. Forty percent of Australian women resume employment in the first year postpartum, yet poor quality employment (without security, control, flexibility or leave) has not been investigated as a potential social determinant of maternal psychological distress. This paper examines whether poor quality jobs are associated with an increased risk of maternal postpartum psychological distress. Data were collected from employed mothers of infants ≤12 months (n = 1,300) participating in the Longitudinal Study of Australian Children. Logistic regression analyses estimated the association between job quality and maternal psychological distress, adjusting for prior depression, social support, quality of partner relationship, adverse life events and sociodemographic characteristics. Only 21% of women reported access to all four optimal job conditions. After adjustment for known risk factors for poor maternal mood, mothers were significantly more likely to report psychological distress (adjusted OR = 1.39, 95% CI 1.09, 1.77) with each reduction in the number of optimal employment conditions. Interventions for maternal postpartum affective disorders are unlikely to be successful if major risk factors are not addressed. These results provide strong evidence that employment conditions are associated with maternal postpartum mood, and warrant consideration in psychosocial risk assessments and interventions.

The evaluation of emotional facial expressions in early postpartum depression mood: A difference between adult and baby faces?

Research suggests that depressive individuals exhibit disturbances in the evaluation of emotional facial expressions. Owing to the specific character of postnatal depressive mood, the purpose of the present study was to examine whether postpartum depressive mood intensity in the mothers would involve the same disturbances as depression or a specific distortion in the emotional evaluation of baby faces as compared to adult faces. Three days after birth, the participants (N=79) completed the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the Toronto Alexithymia Scale. They also evaluated the facial expressions of adults and babies displaying anger, happiness, sadness and neutrality in terms of the intensity of five emotions: Anger, disgust, sadness, happiness and neutrality. Our findings suggest that judgements of emotional facial expressions depend to a great extent on anxiety, which specifically increased negative perception of babies' emotions. Moreover, the only difference between mothers with and without postpartum depressive mood lays in their assessment of the babies' faces, neutral baby faces being judged to be less neutral, thus demonstrating the specificity of postpartum affective disorders.

The Use of Electroconvulsive Therapy in Postpartum Affective Disorders

Postpartum affective disorders continue to be a major health issue for women. There is a general belief that electroconvulsive therapy (ECT) is effective in treating severe or treatment-refractory postpartum affective illnesses, but evidence to support this assertion is lacking. In this case series, we present 5 cases of women with postpartum depression and psychosis, all of whom had failed prior pharmacological therapy. All 5 women had a significant response within 3 to 6 treatments with ECT. Our findings suggest that ECT is overall an effective treatment of postpartum illnesses. In addition to being an excellent choice for women who have failed prior medication trials, ECT may also be considered for women whose severity of illness necessitates rapid symptom resolution.