Archives of Women's Mental Health最新文献

Objective

To assess the relationship between antidepressant treatment before, during and after childbirth.

Design

Cohort study.

Setting

Primary care in the United Kingdom (UK).

Participants

Women aged 15–49 with a single live birth (2006–2015), stratified by antidepressant history:

• Cohort A: Prescribed antidepressants ≥ 2 years before childbirth.

• Cohort B: Prescribed 1–2 years before childbirth.

• Cohort C: Prescribed within 1 year before childbirth.

• Cohort D: No antidepressants prescribed before childbirth.

Outcome measures

Changes in antidepressant treatment during the perinatal period.

Results

Of 202,303 women, 46,479 (23%) had pre-childbirth antidepressant prescriptions (Cohorts A: 37,161; B: 19,627; C: 14,363), while 155,824 (77%) did not (Cohort D). In cohort A, 76% discontinued treatment in the year before childbirth, compared to 48% in cohort B. Postpartum, 22% of those in cohort A and 33% in cohort B restarted treatment. Overall, 26,835/202,303 (13%) received antidepressants in the year after childbirth. Among women without prior treatment, 10,258/155,824 (7%) started antidepressants postpartum, compared to 16,577/46,479 (36%) of those with prior use. Cohort C had the highest postpartum prescription rate (9,232/14,363, 64%).

Conclusions

Antidepressant treatment after childbirth is common, particularly among women who have received treatment before childbirth. Many women discontinue antidepressants before or during pregnancy. The study highlights the importance of considering history of antidepressant treatment when planning postnatal care and counselling women on continuing or stopping antidepressants during pregnancy. This information can aid healthcare professionals in advising women about antidepressant use before, during, and after pregnancy, considering individual circumstances and risks.

Purpose

Severe maternal morbidity (SMM as defined by the Centers for Disease Control and Prevention) as well as other adverse pregnancy outcomes (APOs) may confer differential risk for postpartum psychiatric illness (PPI). PPI is often underrecognized, and it can have lasting and harmful effects on both the mother’s and the infant’s well-being. The purpose of this cross-sectional study is to explore whether specific pregnancy complications act as potential predictors for PPI, and how this differs across important social determinants of health (e.g. race/ethnicity).

Methods

Participant data was obtained from the electronic health record of patients (N = 19,231) who received perinatal care from HOSPITAL, a hospital system serving the most ethnically diverse large city in the United States, between 2020 and 2023. We utilized univariate and multivariate logistic regression models to obtain odds ratios for the associations desired.

Results

After accounting for premorbid psychiatric status, only APOs act as an independent predictor for the development of PPI within a year postpartum, and certain APOs are more closely associated with PPI depending on the mother’s racial/ethnic background. APOs were found to be strongly linked to PPI (OR = 1.43, CI 11.31–1.57, p < .001), specifically for non-Hispanic White women, Hispanic White women, and non-Hispanic Asian women.

Conclusions

Our findings highlight the need for a more proactive approach to screening, monitoring, and treatment in maternal mental healthcare, that would encompass both the specific APOs and the racial/ethnic differences associated with them.

Purpose

Premenstrual dysphoric disorder (PMDD) has been associated with altered grey matter architecture in a trait-like manner. Personality traits, shaped largely by genetics and linked to depressive disorders, may relate to structural properties of the brain and could represent a potential factor mediating vulnerability for PMDD. However, these possible associations remain largely unexplored.

Methods

The present study assessed personality traits in participants with PMDD and healthy controls, as well as how personality is related to symptom severity and cortical surface measures in PMDD. Healthy controls and patients completed the Swedish Universities Scale of Personality. Following prospective validation of the PMDD diagnosis, patients had their brain scanned with magnetic resonance imaging (MRI) during the symptomatic luteal phase of the menstrual cycle. Personality of controls and patients was compared using Mann-Whitney U tests. Associations of personality with symptom severity and brain surface parameters were tested through correlation analysis.

Results

PMDD was associated with higher scores in neuroticism and aggressiveness. Aggressiveness was positively correlated with the severity of irritability/anger, though not significant after correcting for multiple testing. Regarding cortical structural measures, aggressiveness was negatively correlated with cortical complexity of the parahippocampal gyrus.

Conclusion

Considering neuroticism and aggressiveness during screening for PMDD could contribute to the identification of risk factors and personalized treatment of females suffering from PMDD.

Purpose

Despite mental health conditions being the leading cause of maternal mortality in the United States, the relationship between perinatal mental health and mistreatment during childbirth has been insufficiently examined. The objective was to identify patterns of respectful care and mistreatment during childbirth and examine associations with perinatal mental health.

Methods

We conducted a cross-sectional secondary analysis of Listening to Mothers in California (N = 2,539). We conducted latent class analysis of indicator variables describing rough or rude care, discriminatory treatment, support, communication, and encouragement of autonomous decision-making. We conducted multinomial logistic regression to examine symptomatology for antenatal anxiety and antenatal depression in relation to class membership. Logistic regression was used to examine class membership in relation to symptomatology for postpartum anxiety and postpartum depression.

Results

Four latent classes were identified: Class 1 (84.54%): Respected/Supported, Class 2 (6.69%): Not Supported, Class 3 (5.39%): Rough/Rude, Class 4 (3.38%): Rough/Rude/Discriminated. Women with antenatal depression symptomatology were 3.28 times as likely to be classified in Class 4 versus Class 1 (aRRR 3.28, CI95% 1.88–5.73). Women with antenatal anxiety symptomatology had a higher risk of classification in Class 4 than Class 1 (aRRR 2.04, CI95% 1.21–3.43). Compared to women in Class 1, women in Class 2 had 2.06 higher adjusted risk of postpartum anxiety (aRRR 2.06, CI95% 1.26–3.36).

Conclusions

Women who were symptomatic for antenatal anxiety or antenatal depression were at increased risk for mistreatment and not receiving support during childbirth. Women who did not feel supported had increased risk of symptomatology for postpartum anxiety.

Purpose

This study aimed to compare transdiagnostic neuropsychological factors among women with Premenstrual Syndrome (PMS), Premenstrual Dysphoric Disorder (PMDD), and asymptomatic control groups.

Methods

Using a causal-comparative design, 150 female university students aged 20 to 35 were selected through purposive sampling. Participants were categorized into PMS, PMDD, and asymptomatic control groups based on a structured clinical interview and a screening questionnaire. Neurocognitive functioning was assessed using the Continuous Performance Test (CPT), the Go/No-Go Task, and the Iowa Gambling Task (IGT).

Results

Significant differences were observed among the three groups in sustained attention, inhibitory control, and risky decision-making. The PMDD group consistently showed lower performance than the PMS and asymptomatic control groups. Within-group phase comparisons revealed a significant decline in sustained attention only in the PMS group during the premenstrual phase, while other cognitive functions remained stable across menstrual cycle phases. No significant menstrual cycle phase changes were observed in the PMDD or asymptomatic control groups.

Conclusion

These findings indicate that women with PMDD and PMS exhibit difficulties in attention, inhibitory control, and decision-making compared to the asymptomatic control group. Such difficulties appear to be related to symptom burden, highlighting potential targets for assessment and intervention.