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
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.
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).
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.
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.
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
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
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)].
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.
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.
Thiséus J, Perrin S, Cervin M. Psychiatry Res. 2019 Jun 12;278:194-198.
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.
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).
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
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.
Goodman JH. Arch Psychiatr Nurs. 2019 Jun;33(3):217-224.
PERINATAL SUBSTANCE USE DISORDERS
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.
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
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
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).