This week there are a series of articles related to the recommendations issued by the US Preventive Services Task Force (USPSTF) several weeks ago, stating that all pregnant and postpartum women should be evaluated in order to determine risk for depressive illness and recommends that women at increased risk for perinatal depression should be referred for counseling.  

The second editorial from Dr. Lyndsay Avalos and colleagues looks at the USPSTF recommendations from a pediatric perspective, emphasizing that improving maternal mental health is an important step in improving the health and well-being of children and that we need to overcome barriers to the implementation of screening and preventive interventions for perinatal depression.  Dr. Jennifer Felder discusses some of the challenges in terms of implementing these recommendations.

Further down on the list is an interesting article from Park and Choi looking at the impact of breastfeeding on risk for perimenopausal depression.  These researchers found that breastfeeding for longer periods of time led to a significant reduction in risk.  How exactly this happens is not so clear, but it is certainly an interesting finding.  

Ruta Nonacs, MD PhD

Attention to Prevention-Can We Stop Perinatal Depression Before it Starts?

Wisner KL, Miller ES, Tandon D.  JAMA Psychiatry. 2019 Feb 12.

Preventing Perinatal Depression to Improve Maternal and Child Health-a Health Care Imperative.

Avalos LA, Flanagan T, Li DK. JAMA Pediatr. 2019 Feb 12.

Implementing the USPSTF Recommendations on Prevention of Perinatal Depression-Opportunities and Challenges.

Felder JN.  JAMA Intern Med. 2019 Feb 12.

Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice.

Earls MF, Yogman MW, Mattson G, Rafferty J; COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH.  Pediatrics. 2019 Jan;143(1).

Recurrence of depression in the perinatal period: Clinical features and associated vulnerability markers in an observational cohort.

Molenaar NM, Brouwer ME, Kamperman AM, Burger H, Williams AD, Hoogendijk WJG, Bockting CLH, Lambregtse-van den Berg MP.  PLoS One. 2019 Feb 22. Free Article

85 pregnant women with a history of depression treated with SSRI or SNRI antidepressants at the start of the study were included.  During follow-up, 12 women (14.1%) completely discontinued their medication and four (4.7%) intended to taper medication, but did not completely discontinue during follow-up.   Eight women (9.4%) experienced a recurrence of depression; two during pregnancy and six in the first 12 weeks postpartum. Three of the 8 women had discontinued antidepressant. Of the women discontinuing, 25% experienced recurrence compared to 7% of the women continuing.

Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms.

Fisher SD, Sit DK, Yang A, Ciolino JD, Gollan JK, Wisner KL.  Depress Anxiety. 2019 Jan 15.

In this research study, researchers identified three distinct trajectories of depressive symptoms: (1) gradual remission (50.4%), (2) partial improvement (41.8%), and (3) chronic severe (7.8%). Factors which were predictive of the chronic severe trajectory (versus gradual remission and partial improvement) included parity, education, and baseline global functioning and depression severity.

Comorbid anxiety and depression: a community-based study examining symptomology and correlates during the postpartum period.

Ramakrishna S, Cooklin AR, Leach LS.  J Reprod Infant Psychol. 2019 Feb 20:1-12.

Comorbid anxiety and depression symptomology was common (13.4%), and was associated with greater symptom severity. Women in the ‘comorbid’ group more often experienced financial hardship, cessation of breastfeeding, infants with difficult temperaments, inadequate social support, and stressful adverse life events than mothers with no symptoms.

What protects at-risk postpartum women from developing depressive and anxiety symptoms? The role of acceptance-focused processes and self-compassion.

Monteiro F, Fonseca A, Pereira M, Alves S, Canavarro MC.  J Affect Disord. 2019 Mar 1;246:522-529.

Women not presenting depressive and anxiety symptoms reported significantly higher levels of psychological flexibility, nonjudgmental appraisal of thought content and self-compassion than women presenting depressive and anxiety symptoms.

Predicting postpartum depression among adolescent mothers: A systematic review of risk.

Hymas R, Girard LC.  J Affect Disord. 2019 Mar 1;246:873-885.

Fourteen studies were included in this review, ranging from weak-to-strong in quality. Results suggest several risk factors for adolescent PPD, including prior depression, lack of familial social support, and socio-economic hardship.

Breastfeeding reduces risk of depression later in life in the postmenopausal period: A Korean population-based study.

Park S, Choi NK.  J Affect Disord. 2019 Apr 1;248:13-17.

Women with a moderate (2-3) or high (4-12) number of breastfed infants had 65% [odds ratio (OR)?=?0.35] and 77% (OR?=?0.23) decreased risks of postmenopausal depression, respectively, compared to those with low numbers of infants (0-1). Women who breastfed their infants for long periods (47-432 months) had 67% (OR?=?0.33) decreased risk of depression, compared to those who breastfed for short periods (0-23 months).

Pharmacotherapy of Postpartum Depression: Current Approaches and Novel Drug Development.

Frieder A, Fersh M, Hainline R, Deligiannidis KM.  CNS Drugs. 2019 Feb 21.

Thirty years with the Edinburgh Postnatal Depression Scale: voices from the past and recommendations for the future.

Cox J.  Br J Psychiatry. 2019 Mar;214(3):127-129.

Updated recommendations for optimal use in primary and secondary care as well as research are provided.

Master Clinician Review: Parental Depression and Family Health and Wellness: What Clinicians Can Do and Reflections on Opportunities for the Future.

Beardslee WR.  J Am Acad Child Adolesc Psychiatry. 2019 Feb 19.

Buprenorphine medication-assisted treatment during pregnancy: An exploratory factor analysis associated with adherence.

Coker JL, Catlin D, Ray-Griffith S, Knight B, Stowe ZN.  Drug Alcohol Depend. 2018 Nov 1;192:146-149.

Women who were non-adherent to buprenorphine during pregnancy had higher severity of opioid withdrawal symptoms and lower doses of buprenorphine.

Are we validly assessing major depression disorder risk and associated factors among mothers of young children? A cross-sectional study involving home visitation programs.  

Owora AH, Carabin H, Garwe T, Anderson MP.  PLoS One. 2019 Jan 7. Free Article

Misclassification error and confounding by timing of MDD assessment (prenatal versus postnatal) can introduce bias and considerable uncertainty in estimating the association between potential risk factors and risk for MDD among two distinct groups of mothers involved in home visitation programs in Oklahoma City.

Postpartum post-traumatic stress disorder: Associated perinatal factors and quality of life.

Hernández-Martínez A, Rodríguez-Almagro J, Molina-Alarcón M, Infante-Torres N, Donate Manzanares M, Martínez-Galiano JM.  J Affect Disord. 2019 Feb 10;249:143-150.

Instrumental birth (aOR: 2.50; 95%CI: 1.70, 3.69) and caesarean section (aOR: 3.79; 95%CI: 2.43, 5.92) were found to be risk factors for PTSD.  Factors like having a respected birth plan (aOR: 0.52; 95%CI: 0.34, 0.80), using epidural analgesia (aOR: 0.64; 95%CI: 0.44, 0.92) and performing skin-to-skin contact (aOR: 0.37; 95%CI: 0.28, 0.50) were protective factors against PTSD.

Stress-related genetic polymorphisms in association with peripartum depression symptoms and stress hormones: A longitudinal population-based study.

Skalkidou A, Poromaa IS, Iliadis SI, Huizink AC, Hellgren C, Freyhult E, Comasco E.  Psychoneuroendocrinology. 2019 Feb 7;103:296-305.



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