This Week in Women’s Mental Health

Another busy week.  There are several interesting articles which look at non-pharmacological treatment of perinatal mood and anxiety disorders.  Yoga and other complementary treatments show promise but the studies are too small to reach firm conclusions.

Ruta Nonacs, MD PhD

PMS AND PMDD

No articles this week.

INFERTILITY AND MENTAL HEALTH

No articles this week.

PSYCHIATRIC ILLNESS DURING PREGNANCY

A meta-analysis of the effectiveness of yoga-based interventions for maternal depression during pregnancy.

Ng QX, Venkatanarayanan N, Loke W, Yeo WS, Lim DY, Chan HW, Sim WS.  Complement Ther Clin Pract. 2019 Feb;34:8-12.

While yoga may have beneficial effects, most trials examined were preliminary, recruited only participants with mild depression, did not blind study participants and had relatively small sample sizes. 

Complementary Health Practices for Treating Perinatal Depression.

Reza N, Deligiannidis KM, Eustis EH, Battle CL.  Obstet Gynecol Clin North Am. 2018 Sep;45(3):441-454. 

While there is evidence that some of these treatments may be reasonable to consider in women during pregnancy or the postpartum period, there are little data on the comparative safety and efficacy of these relative to traditional treatments (eg, psychotherapy, pharmacotherapy). 

A systematic review of psychological treatments for clinical anxiety during the perinatal period.

Loughnan SA, Wallace M, Joubert AE, Haskelberg H, Andrews G, Newby JM.  Arch Womens Ment Health. 2018 Oct;21(5):481-490. 

Of the five studies included, four were open trials and one was a randomised controlled trial. Three studies evaluated group-based interventions; one study evaluated an online-delivered intervention; and one study a combined pharmacologic-psychological intervention. More studies are warranted.

An evaluation of the contribution of maladaptive attitudes specific to motherhood and metacognitions in perinatal depression.

Leach DM, Marino C, Nik?evi? AV.  Psychiatry Res. 2019 Apr;274:159-166. 

Maladaptive attitudes specific to motherhood and negative beliefs about the uncontrollability and danger of worry were independently associated with perinatal depressive symptomatology, with the latter variable having the strongest association with depressive symptoms. 

Feasibility of perinatal mood screening and text messaging on patients’ personal smartphones.

La Porte LM, Kim JJ, Adams MG, Zagorsky BM, Gibbons R, Silver RK.  Arch Womens Ment Health. 2019 Jun 15.

Texts were based on the Mothers and Babies Course, a CBT-based preventative program that addresses limited social support, lack of pleasant activities, and harmful thought patterns.  Smartphone mood screening and supportive texting were technically feasible. Screen completion was lower among single women with public insurance.

MEDICATIONS AND PREGNANCY

Use of benzodiazepine medications during pregnancy and potential risk for birth defects, National Birth Defects Prevention Study, 1997-2011.

Tinker SC, Reefhuis J, Bitsko RH, Gilboa SM, Mitchell AA, Tran EL, Werler MM, Broussard CS; National Birth Defects Prevention Study.  Birth Defects Res. 2019 Mar 19.

Exposure to benzodiazepines during pregnancy was rare (N?=?93/11,614; 0.8%).  Researchers observed significantly elevated ORs for any benzodiazepine and Dandy-Walker malformation (cOR: 3.1; 95% CI: 1.1, 8.6); for alprazolam and anophthalmia or microphthalmia (cOR: 4.0; 95% CI: 1.2, 13.1) and esophageal atresia or stenosis (aOR: 2.7; 95% CI: 1.2, 5.9); and lorazepam and pulmonary valve stenosis (cOR: 4.1; 95% CI: 1.2, 14.2), but sample sizes were limited and therefore CIs were wide.

POSTPARTUM PSYCHIATRIC ILLNESS

Self-harm in women with postpartum mental disorders.

Johannsen BM, Larsen JT, Laursen TM, Ayre K, Howard LM, Meltzer-Brody S, Bech BH, Munk-Olsen T.  Psychol Med. 2019 Jul 12:1-7.

Women with postpartum mental disorder had a hazard ratio (HR) for self-harm of 6.2 (95% CI 4.9-8.0), compared to mothers without mental disorders; but self-harm risk was lower in women with postpartum mental disorders compared to mothers with non-postpartum illness [HR: 10.1, (95% CI 9.6-10.5)] and childless women with mental disorders [HR: 9.3 (95% CI 8.9-9.7)]. 

Effect of couple-based cognitive behavioural intervention on prevention of postnatal depression: multisite randomised controlled trial.

Ngai FW, Wong PW, Chung KF, Chau PH, Hui PW.  BJOG. 2019 Jul 7. 

Depressive symptoms were significantly more improved at 6 weeks postpartum for mothers in couple-based CBI than in women-alone CBI (difference 1.46, 95% CI 0.11-2.81) or control groups (difference 1.71, 95% CI 0.29-3.13). The proportion of mothers with postnatal depression (EPDS score ? 10) was significantly lower at 6 weeks postpartum in couple-based CBI than in control (difference 17.8%, 95% CI 3.6-32·0%). However, the treatment effect was not maintained at 6 and 12 months. There was no significant intervention effect among fathers.

Relationship between trait neuroticism and suicidal ideation among postpartum women in China: Testing a mediation model.

Duan Z, Wang Y, Tao Y, Bower JL, Yu R, Wang S, Wu Z, Lv Y, Yang X, Li X, Huang L, Ma L, Dong Q, Sun J, Li S, Yang Y, Yang Y, Peng K, Chen R.

J Affect Disord. 2019 Jun 29;256:532-535. 

Intrusive thoughts and compulsive behaviors in postpartum women: Psychometric properties of the Parental Thoughts and Behaviors Checklist.

Thiséus J, Perrin S, Cervin M.  Psychiatry Res. 2019 Jun 12;278:194-198.

Cost-effectiveness of PoNDER health visitor training for mothers at lower risk of depression: findings on prevention of postnatal depression from a cluster-randomised controlled trial.

Henderson C, Dixon S, Bauer A, Knapp M, Morrell CJ, Slade P, Walters SJ, Brugha T.  Psychol Med. 2019 Jun;49(8):1324-1334.  Free Article

PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.

Scores on the PTBC and its subscales showed good to excellent internal consistency, correlated in the expected direction with the other measures in the study, and discriminated between women with and without a history of OCD.

The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohortstudy.

Silveira MF, Mesenburg MA, Bertoldi AD, De Mola CL, Bassani DG, Domingues MR, Stein A, Coll CVN.  J Affect Disord. 2019 Jun 5;256:441-447. Free Article

Physical abuse increased the odds of having marked/severe PD (OR?=?2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR?=?2.90; 95%CI 1.30 – 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42).

Infant Vagal Tone and Maternal Depressive Symptoms: A Bottom-Up Perspective.

Somers JA, Curci SG, Luecken LJ.  J Clin Child Adolesc Psychol. 2019 Jun 20:1-13. When raising an infant with low arousal, mothers at risk of depression may experience decreased parenting self-efficacy and increased depressive symptoms.

MEDICATIONS AND BREASTFEEDING

No articles this week.

MATERNAL MENTAL HEALTH AND CHILD OUTCOMES

Negative impact of maternal antenatal depressive symptoms on neonate’s behavioral characteristics.  

Gressier F, Letranchant A, Glatigny-Dallay E, Falissard B, Sutter-Dallay AL.  Eur Child Adolesc Psychiatry. 2019 Jul 11. 

This study demonstrated a significant negative correlation between prenatal CES-D scores and NBAS scores on “habituation” (p?=?0.0001), “orientation” (p?=?0.015), “motor system” (p?<?0.0001), “autonomic stability” (p?<?0.0001) dimensions, independently of other variables, including pre/postnatal anxiety and postnatal depressive symptoms. 

Perinatal depression and infant mental health.

Goodman JH.  Arch Psychiatr Nurs. 2019 Jun;33(3):217-224.

PERINATAL SUBSTANCE USE DISORDERS

Depressive Symptoms Assessed Near the End of Pregnancy PredictDifferential Response to Postpartum Smoking Relapse PreventionIntervention.

Levine MD, Emery RL, Kolko Conlon RP, Marcus MD, Germeroth LJ, Salk RH, Cheng Y.  Ann Behav Med. 2019 Jun 1. 

Women with clinically significant end-of-pregnancy depressive symptoms (20%) were more likely to sustain abstinence through 52 weeks postpartum if they received STARTS. In contrast, women with few end-of-pregnancy depressive symptoms were more likely to sustain abstinence through 52 weeks postpartum if they received SUPPORT. 

Anxiety and depression symptoms among pregnant women with different smoking habits.

Tojal C, Costa R.  Psychol Health Med. 2019 Jun 24:1-8.

Among mothers with non-university education, smokers are more likely to have clinically significant anxiety symptoms than quitters (53.6% vs 24.3%) while among mothers in higher income families, smokers are more likely to have clinically significant depressive symptoms than quitters (100% vs 11.1%).

MENOPAUSE AND MENTAL HEALTH

Vortioxetine for major depressive disorder, vasomotor, and cognitive symptoms associated with the menopausal transition.

Freeman MP, Cheng LJ, Moustafa D, Davies A, Sosinsky AZ, Wang B, Petrillo LF, Hogan C, Cohen LS.  Ann Clin Psychiatry. 2017 Nov;29(4):249-257.

Vortioxetine was helpful or treating depressive symptoms but had no impact on cognitive function.  

OTHER TOPICS IN WOMEN’S MENTAL HEALTH

Polycystic ovary syndrome and autism: A test of the prenatal sex steroid theory.

Cherskov A, Pohl A, Allison C, Zhang H, Payne RA, Baron-Cohen S.  Transl Psychiatry. 2018 Aug 1;8(1):136.Free Article

In women with PCOS, the odds of having a child with autism were significantly increased, even after adjustment for maternal psychiatric diagnoses, obstetric complications, and maternal metabolic conditions (unadjusted OR: 1.60, 95% CI: 1.28-2.00; adjusted OR: 1.35, 95% CI: 1.06-1.73).