Archives of Women's Mental Health最新文献

Purpose

This study examines the challenges and opportunities of implementing gender-equitable substance use disorder (SUD) treatment models in Brazil by revisiting a public policy initiative carried out between 2004 and 2006. During this initiative, a structured model of care, the Women’s Drug Dependent Treatment Program (PROMUD), was replicated in two additional psychosocial care units in São Paulo. The study seeks to contribute to the visibility of a historically hidden population of women with SUD by comparing treatment retention across the three centers and identifying risk factors associated with dropout.

Method

This observational, non-randomized post hoc analysis examined clinical data from 200 women who enrolled in PROMUD-based programs across three distinct psychosocial care centers—CAPS-AD Centro (DT), CAPS-AD Jardim Nélia (JN), and the original PROMUD site. All centers implemented the model concurrently using a standardized protocol. Treatment retention was defined as weeks between program admission and dropout (max follow-up: 104 weeks). Drop-out was defined as leaving treatment for reasons other than referral, improved discharge, administrative discharge, or death. Kaplan–Meier survival curves were used to estimate retention, and Cox proportional hazards models identified predictors of dropout.

Results

200 women were included, PROMUD had a higher percentage of white, educated and employed participants. DT had the highest prevalence of unstable housing and prostitution history. PROMUD and JN showed comparable retention at 104 weeks (44.8% and 42.4%), whereas DT exhibited the lowest retention (17.3%). Age was a protective factor (HR = 0.94, p < 0.001), substance of choice was not significantly associated with dropout.

Conclusion

Gender-specific care models can be effectively implemented in resource-limited, community-responsive care units, though their success depends on local population characteristics and territorial dynamics. Despite the time gap since the original project, the challenges remain similar or have intensified.

Purpose

Children of mothers experiencing mental illness are known to exhibit elevated rates of developmental delays. However, there is little evidence-based research on the impact of perinatal psychiatric admissions. Here we aim to quantify the association between maternal mental illness that leads to admission, and the likelihood of child developmental delay. In addition, we aim to understand the association between the timing of admission, the maternal diagnosis and the developmental domain in which delays manifest.

Methods

Retrospective cohort study of data from well-child visits of 634,918 term-born children assessed between 2016 and 2022 at the ages of 1 to 36 months. Likelihood of failure in milestone attainment was modelled based on maternal psychiatric information available through the national registry, and adjusted for demographic and birth data from the Israeli national program of Maternal Child Health Clinics. Secondary analyses examined stratification by maternal diagnosis, timing of admission and developmental domain, as well as comparison to the association between the likelihood of child developmental delay and maternal high scores on the Edinburgh Postnatal Depression Scale.

Results

Maternal mental illness that leads to psychiatric admission was associated with an increased odds ratio for child developmental delay (OR ~ 1.7). Higher odds ratio was associated with psychotic disorders diagnoses, multiple admissions and admissions between birth and child assessment. Nonetheless, increased odds were suggested also when first admission occurred after child assessment. In addition, increased odds were more evident when children were assessed at an older age.

Conclusions

Children of mothers experiencing mental illness exhibit higher rates of developmental delays, especially when mothers are admitted. Identifying and supporting high-risk dyads during the peripartum period is therefore critical for both mother and child.

Purpose

This retrospective study aimed to investigate the association between premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) and the presence of autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) in adolescent females. While PMS and PMDD are well-studied in the general population, limited research exists on their prevalence and impact in adolescent females with ASD or ADHD.

Methods

Retrospective data collection was conducted using electronic medical records, covering 290 patients aged 10–19 years. PMS severity, depressive symptoms, and autistic tendencies were assessed using standardized tools, including the Quick Inventory of Depressive Symptomatology (QIDS) for depressive symptoms, Autism-Spectrum Quotient (AQ) for autistic tendencies, and a PMDD assessment scale for PMS severity.

Results

The results revealed a significant association between moderate to severe PMS and ADHD (odds ratio [OR]: 2.43) as well as comorbid ASD + ADHD (OR: 3.27). In contrast, ASD alone did not exhibit a significant link to PMS severity.

Conclusion

These findings highlight the heightened vulnerability of females with ADHD or comorbid ASD + ADHD to premenstrual psychological distress, emphasizing the importance of early detection and intervention. The study underscores the need for tailored treatment strategies addressing the unique challenges faced by this population.

Purpose

Understanding mechanism of action of effective agents for Premenstrual Dysphoric Disorder (PMDD) is necessary to advance care of these patients. It can be successfully treated with fluoxetine, but its efficacy with intermittent use is difficult to understand because of documented delays in the onset of antidepressant action of this drug.

Methods

Targeted review of the literature is used to examine the hypothesis that fluoxetine’s inhibiton of CYP3A4, which is needed to metabolize estrogen, underlies its utility when dosed intermittently.

Results

We propose that fluoxetine slows the degradation of estrogen the late luteal phase, thereby increasing its levels and reducing the PMDD symptoms that typically are associated with alterations in hormone concentrations. The hypothesis can be tested by using a potent CYP3A4 inhibitor that has no antidepressant action. Such agents include the antiviral drugs ritonavir and cobicistat which are potent CYP3A4 inhibitors and are currently being used to boost the levels of other antivirals in the treatment of human immunodeficiency virus (HIV). Prospective studies with women with PMDD in this population before and after initiation of CYP3A4 inhibiting anti-retrovirals would help clarify this question.

Conclusion

Confirmation of this mechanism may open the door to non-SRI treatments for women that do not tolerate SRI agents.

This letter provides recommendations regarding the study titled “Psychiatric disorders, impulsivity and borderline personality in patients with polycystic ovary syndrome” published by Husni et al. on May 6, 2025.

Purpose

Maternal anxiety, depression, and cognitive changes during pregnancy are recognized as significant public health issues. While previous research has primarily focused on singleton pregnancies, little is known about how twin pregnancies impact maternal mental health and cognitive function. This prospective study aimed to compare anxiety, depression, and cognitive function between women with twin and singleton pregnancies.

Methods

A total of 160 pregnant women were recruited, including 104 with singleton and 56 with twin pregnancies. Anxiety was assessed using the State-Trait Anxiety Inventory Scale (STAI-S), depression using the Edinburgh Postnatal Depression Scale (EPDS), and cognitive function using the Montreal Cognitive Assessment (MOCA) test.

Results

Women with twin pregnancies had significantly higher anxiety levels and a higher rate of severe anxiety, with over 50% scoring in the severe anxiety range. Their mean cognitive function scores were significantly lower compared to women with singleton pregnancies. However, depression scores were similar between the two groups. These differences in anxiety and cognitive function remained significant after adjusting for maternal age, BMI, use of psychiatric medications, education level, nulliparity, pregnancy complications, and multifetal gestation.

Conclusions

Women with twin pregnancies experience greater psychological burden and cognitive decline compared to those with singleton pregnancies. Further research is necessary to explore the long-term effects of these outcomes and to develop interventions aimed at improving mental health and cognitive function in this population.