Is It Useful to Screen for Anxiety using the GAD-7 in Pregnant Women?

Research Paper Title

Validation of the Generalised Anxiety Disorder Screener (GAD-7) in Spanish Pregnant Women.

Background

Anxiety during pregnancy is one of the most common mental health problems and a significant risk factor for postpartum depression. The Generalised Anxiety Disorder-7 (GAD-7) is one of the most widely used self-report measures of anxiety symptoms available in multiple languages. This study evaluates the psychometric properties and underlying factor structures of the Spanish GAD-7 among pregnant women in Spain.

Methods

Spanish-speaking pregnant women (N = 385) were recruited from an urban obstetrics setting in Northern Spain. Women completed the GAD-7 and the anxiety subscale of the Symptom Checklist (SCL90-R) at three time points, once per trimester. The reliability, concurrent validity, and factor analyses were conducted to evaluate the psychometric properties and factor structure, respectively.

Results

In the first trimester, the GAD-7 demonstrated good internal consistency (a = 0.89). GAD-7 is positively correlated with SCL90-R (anxiety subscale; r=0.75; p < 0.001). The proposed one-factor structure is found using exploratory factor analysis -FACTOR programme – with Unweighted Least Squares procedure and optimal implementation of parallel analysis (GFI = 0.99).

Conclusions

Health providers should screen for anxiety using the GAD-7 during pregnancy among urban Spanish-speaking samples to provide appropriate follow-up care.

Reference

Soto-Balbuena, C. Rodriguez-Munoz, M.F. & Le, H-N. (2021) Validation of the Generalized Anxiety Disorder Screener (GAD-7) in Spanish Pregnant Women. Psicothema. 33(1), pp.164-170. doi: 10.7334/psicothema2020.167.

What is the Prevalence & Risk Factors of Perinatal Depression Among Women in Rural Bihar?

Research Paper Title

Prevalence and risk factors of perinatal depression among women in rural Bihar: A community-based cross-sectional study.

Background

Perinatal depression (PND) is one of the most common mental disorders occurring during the perinatal period among women. Few studies examined prevalence and risk factors of PND from rural settings in India. This study aimed to estimate the prevalence of perinatal depression and identify social risk factors for it among women from rural Bihar.

Methods

A cross sectional study was conducted in a community setting in rural areas of Bihar. All perinatal women were screened through a door to door survey and recruited after obtaining informed consent. A semi-structured proforma was used to collect sociodemographic characteristics and family related variables. Edinburgh postnatal depression scale (EPDS) was used to screen for perinatal depression.

Results

A total of 564 perinatal women were recruited into the study. The estimated prevalence of PND was 23.9 % (95 % CI: 20.6,27.6). Multivariate analysis showed perinatal depression was associated with physical illness in the mother, previous history of abortion, poor financial status and ill-treatment by in-laws.

Conclusions

Prevalence of perinatal depression among women is high in rural settings of North India. A multitude of factors ranging from physical, obstetric, economic and family related confer a high risk for PND. Comprehensive interventions are needed to address these risk factors of perinatal depression.

Reference

Raghavan, V., Khan, H.A., Seshu, U., Rai, S.P., Durairaj, J., Aarthi, G., Sangeetha, C., John, S. & Thara, R. (2021) Prevalence and risk factors of perinatal depression among women in rural Bihar: A community-based cross-sectional study. Asian Journal of Psychiatry. doi: 10.1016/j.ajp.2021.102552. Online ahead of print.

Can Probiotics Improve Mental Health Outcomes in Pregnant Women with Obesity?

Research Paper Title

Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity.

Background

Poor maternal mental health has been associated with a myriad of pregnancy and child health complications.

Obesity in pregnancy is known to increase one’s risk of experiencing poor maternal mental health and associated physical and mental health complications.

Probiotics may represent a novel approach to intervene in poor mental health and obesity.

Methods

The reseaschers conducted this pre-specified secondary analysis of the Healthy Mums and Babies (HUMBA) randomised controlled trial to investigate whether probiotics would improve maternal mental health outcomes up to 36 weeks of pregnancy.

Two-hundred-and-thirty pregnant women with obesity (BMI ≥ 30.0 kg/m2) were recruited and randomised to receive probiotic (Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12, minimum 6.5 × 109 CFU) or placebo capsules.

Depression, anxiety, and functional health and well-being were assessed at baseline (120-176 weeks’ gestation) and 36 weeks of pregnancy.

Results

Depression scores remained stable and did not differ between the probiotic (M = 7.18, SD = 3.80) and placebo groups (M = 6.76, SD = 4.65) at 36 weeks (p-values > 0.05).

Anxiety and physical well-being scores worsened over time irrespective of group allocation, and mental well-being scores did not differ between the two groups at 36 weeks.

Conclusions

Probiotics did not improve mental health outcomes in this multi-ethnic cohort of pregnant women with obesity.

Reference

Dawe, J.P., McCowan, L.M.E., Wilson, J., Okesene-Gafa, K.A.M. & Serlachius, A.S. (2020) Probiotics and Maternal Mental Health: A Randomised Controlled Trial among Pregnant Women with Obesity. Scientific Reports. 10(1), pp.1291. doi: 10.1038/s41598-020-58129-w.

Linking Prenatal Antidepressant Use & Risk of Adverse Neonatal Outcomes

Depression is common among pregnant women and, untreated, is associated with morbidity in both mother and child.

But what about the risks of treatment?

A large database study from the US, with information on the timing, dose, and type of antidepressant treatment in pregnancy, identifies a dose dependent increase in risk for newborn respiratory distress and a small increase in risk of preterm birth in those taking higher doses.

Maternal Mental Health MATTERS: Yes it Does

Research Paper Title

Maternal Mental Health MATTERS.

Background

Depression and anxiety during pregnancy and the postpartum period are common and have significant negative impacts on mother and child.

Suicide is a leading cause of maternal mortality.

Evidence-based efforts for screening, assessment, and treatment improve maternal and infant mental health, as well as overall family health, throughout the lives of women and children.

Reference

Kimmel, M. (2020) Maternal Mental Health MATTERS. North Carolina Medical Journal. 81(1), pp.45-50. doi: 10.18043/ncm.81.1.45.

The Importance of Positive Mental Health for both Mother & Child

Research Paper Title

Positive Maternal Mental Health, Parenting, and Child Development.

Background

While maternal mental health is an important influence on child development, the existing literature focuses primarily on negative aspects of maternal mental health, particularly symptoms of depression, anxiety, or states of distress.

The researchers provide a review of the evidence on the potential importance of positive mental health for both mother and child.

The evidence suggests that positive mental health is a distinct construct that is associated with improved birth outcomes and potentially with specific forms of parenting that promote both academic achievement and socioemotional function.

They review studies that provide a plausible biological basis for the link between positive mental health and parenting, focusing on oxytocin-dopamine interactions.

They caution that the evidence is largely preliminary and suggest directions for future research, noting the importance of identifying the operative dimensions of positive maternal mental health in relation to specific outcomes.

Finally, they suggest that the inclusion of positive maternal mental health provides the potential for a more comprehensive understanding of parental influences on child development.

Reference

Phua, D.Y., Lee, M.Z.L. & Meaney, M.J. (2020) Positive Maternal Mental Health, Parenting, and Child Development. Biological Psychiatry. 87(4), pp.328-337. doi: 10.1016/j.biopsych.2019.09.028. Epub 2019 Oct 16.

Preparation for Life…

“How has your field of study changed in the time you have been working in it?

We understand a lot more about how many mental health problems originate in early life. Experience in pregnancy sends a kind of weather report to the fetus to give it indicators of how life might be and to begin the process of preparation for that life. That is extraordinary and there is still a huge amount to learn.”

Reference

Ramchandani, P. (2020) The Back Pages: Q&A. New Scientist. 11 January 2020, pp.56.

Education & Training should Aim to improve the Recognition & Treatment of Postpartum OCD

Research Paper Title

Advances in the pharmacological management of obsessive-compulsive disorder in the postpartum period.

Background

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterised by obsessions and compulsions.

Obsessions are defined as intrusive, recurrent and distressing thoughts, images or impulses, whereas compulsions are defined as repetitive behaviours or mental acts.

While there is an associated distress, and indeed oftentimes, the individual’s awareness that these behaviours are excessive and unreasonable, the individual continues to be disabled by an inability to cease their compulsions.

The postpartum period may herald the onset of OCD or precipitate an exacerbation of the preexisting OCD symptoms.

Common OCD symptom clusters occur in the postpartum period, with specific challenges associated with motherhood and lactation.

Areas Covered

This brief review aims to review the extent and nature of publications evaluating pharmacological treatment of OCD in the postpartum period.

Expert Opinion

Education and training should aim to improve the recognition and treatment of postpartum OCD.

Due to the limited nature of studies, more research is required to assess the role of selective serotonin reuptake inhibitors in the postpartum period.

Reference

Brakoulias, V., Viswasam, K., Dwyer, A., Raine, K.H. & Starcevic, V. (2020) Advances in the pharmacological management of obsessive-compulsive disorder in the postpartum period. Expert Opinion on Pharmacotherapy. 21(2), pp.163-165. doi: 10.1080/14656566.2019.1700229. Epub 2020 Jan 1.

Postpartum: Linking Poor Body Image & Depressive Symptoms

Research Paper Title

A qualitative insight into the relationship between postpartum depression and body image.

Background

This study qualitatively explored the experience of depression and body image concerns in women diagnosed with depression in the postpartum period.

Women’s bodies undergo substantial changes during the perinatal period which can impact their body image and mood post-birth.

However, it remains unknown how women diagnosed with depression experience their body image in the postpartum period.

Methods

Seventeen women in their first postpartum year completed qualitative telephone interviews: seven women diagnosed with depression and ten without depression.

Thematic content analysis identified the main themes of the women’s narratives:

  • Expectations and adjustments to motherhood;
  • Mood in response to changing postpartum body;
  • The context of feeling bad about my body; and
  • Body letting me down and relationship to mood.

Results

Differences in the relationship between body image and mood for postpartum women with depression compared to women without depression were revealed.

Other themes seemed to be experienced in the same way by women with and without depression.

Conclusions

Poor body image and depressive symptoms appear linked during postpartum.

An improved understanding of this association may assist postpartum women to manage negative body image post-birthand prevent the exacerbation of negative emotional health in this period.

Reference

Hartley, E., Fuller-Tyszkiewicz, M., Skouteris, H. & Hill, B. (2020) A qualitative insight into the relationship between postpartum depression and body image. Journal of Reproductive and Infant Psychology. 1-13. doi: 10.1080/02646838.2019.1710119. [Epub ahead of print].

Could Light Therapy Help Relieve the Symptoms of Perinatal Depression?

Research suggests that women with perinatal depression appear to have altered circadian rhythms, and using light to reset the body clock seems to improve their symptoms.

Our bodies run on internal clocks that are regulated by a suite of genes. In concert with light, they wake us up in the morning and leave us sleepy by night-time.

People with severe depression tend to have disrupted circadian rhythms, experiencing daytime sleepiness and night-time insomnia.

Research has found higher activity in some circadian genes in people with the condition.

Perinatal depression – which occurs during and after pregnancy – seems to be similar.

Women tend to get less sleep when they are pregnant, particularly if they have perinatal depression.

To find out if circadian genes might play a role, Massimiliano and colleagues (2019) analysed seven genes in 44 women in the third trimester of pregnancy. Thirty of the women were diagnosed with perinatal depression.

By looking at whether epigenetic tags, called methyl groups, were attached to the genes, the researchers could tell how active these genes were.

They found that three circadian genes were more active and one was less active in the women who had been diagnosed with depression. They also found that the more methyl groups there were, the more severe a woman’s symptoms were likely to be.

This suggests that the greater the difference in circadian gene activity, the more likely a woman is to experience symptoms of depression, say the researchers.

Other (unpublished) research by Katherine Sharkey, Brown University in Rhode Island, has found that using a light box to mimic natural daylight improves the symptoms of perinatal depression. In this small trial of 44 women with the condition, sharkey found that those given a light box and sleep routine alongside routine treatment saw their symptoms improve. Although all the women got better, the women given a circadian intervention did better than those without.

The evidence is not yet strong enough to recommend the treatment more widely, but there is evidence that a good sleep routine and outdoor exposure to sunlight is beneficial for mental health. For example, in a typical office space, the light level is 300 to 400 lux, but on a bright, sunny day, outside can be 50,000 lux.

References

Buoli, M., Grassi, S., Iodice, S., Carnevali, G.S., Esposito, C.M., Tarantini, L., Barkin, J.L. & Bollati, V. (2019) The Role of Clock Genes in Perinatal Depression: THe Light in the Darkness. Acta Psychiatrica Scandinavica. 140(4), pp.382-384. https://doi.org/10.1111/acps.13084.

Hamezlou, J. (2019) Light Therapy May Help Relieve Symptoms of Perinatal Depression. New Scientist. 21 September 2019, pp.15.