Archives of Women's Mental Health最新文献

Purpose

Female sex hormones as well as the synthetic hormones contained within combined oral contraceptives (COCs) may influence emotional and cognitive functioning including learning and memory; however, findings are inconsistent. We here present the largest study to date investigating the effect of COC use on verbal memory in healthy women.

Methods

COC use and verbal memory scores were available from the CIMBI database for 205 healthy women in the reproductive age. We assessed if verbal memory and affective bias differed between COC users and non-users. In a subgroup of natural cycling women in the follicular phase, we assessed if verbal memory was associated with plasma estradiol levels.

Results

We found no statistically significant group differences in either overall memory performance (p = 0.16) or affective memory bias (p = 0.18) between COC users and non-users, although there was a trend suggesting COC users may exhibit slightly better recall for short-term (p = 0.09) and long-term task (p = 0.08) conditions. Similarly, COC users tended to have slightly better overall memory compared with women in the follicular phase (p = 0.05). Follicular phase plasma estradiol levels were not associated with verbal memory.

Conclusions

We found no support for COC use to negatively impact verbal memory, if anything COC users tended to perform better than natural cycling women in follicular phase; however, this could be influenced by a healthy user bias. In conclusion, these findings highlight that women who tolerate COCs well should not be concerned about potential adverse effects on memory.   

Purpose

Screening is necessary to identify patients with postpartum depression or anxiety and facilitate access to mental healthcare. This study evaluated a quality improvement initiative for inpatient postpartum depression screening, which was implemented to better identify patients in need of mental healthcare. This initiative replaced the Patient Health Questionnaire (PHQ-9) administered verbally by nurses with the Edinburgh Postnatal Depression Scale (EPDS-10) self-administered by patients via iPads.

Methods

Electronic medical records for patients who delivered June 2020-October 2023 at Cedars-Sinai were analyzed (N = 17,403). Differences in completed screenings, positive depression screenings, suicidal ideation, and social work referrals before and after the initiative were examined with chi-square tests and multiple logistic regression models. Factors associated with positive anxiety screenings on the EPDS-10 were also identified.

Results

Overall, 98.6% of patients completed depression screenings. Among those who completed screenings, positive depression screenings increased from 4.0 to 11.4%, identified suicidal ideation increased from 0.2 to 1.1%, and social work referrals increased from 64.1 to 84.0%, before and after the initiative. Post-initiative, patients had higher odds of positive depression screenings, indicating suicidal ideation, and receiving social work referrals compared to pre-initiative. Among those who completed EPDS-10 screenings, 31% were positive for anxiety.

Conclusions

Compared to the PHQ-9 administered verbally by nurses, the EPDS-10 self-administered by patients via iPads resulted in higher rates of positive depression screenings, identified suicidal ideation, and social work referrals. It is imperative to accurately screen patients for postpartum depression and anxiety to facilitate access to mental healthcare and address morbidity and mortality.

Clinical trial number

Not applicable.

This is a follow up on a 2016 article discussing the rise in punitive perinatal substance use laws. From 2016–2023, there has been a 39% increase in laws equating perinatal substance use with child abuse, and a 73% increase in mandated reporting laws, despite limited evidence that these laws are helpful. We write this update to raise awareness for providers, so they may better counsel patients on this topic and help advocate for treatment focused policies in their state.

Introduction

Polycystic ovarian syndrome (PCOS) is a common endocrine condition in women. Studies have shown that PCOS is associated with poor quality of life, anxiety, sadness, dissatisfaction with one's appearance, and sexual dysfunction.

Objective

This study was conducted to determine whether a strong psycho-pathological personality is related to PCOS and whether this personality is related to the hyperandrogenic state.

Methods

Anthropometric, metabolic, hormonal, clinical, and psychological characteristics were examined in 90 Bahraini women with PCOS. After confirming the diagnosis of PCOS via Rotterdam criteria, including ovarian ultrasound, each patient was evaluated via the following questionnaires: 1) the GAD-7 (General Anxiety Disorder-7) to measure the severity of anxiety; 2) the Patient Health Questionnaire-9 (PHQ-9) to confirm and measure the severity of depression; 3) the Barratt Impulsiveness Scale (BIS‐11) to measure aggression; and 4) the McLean Screening Instrument to identify borderline personality disorders (MSI-BPDs). The study was approved by the Institutional Review Board.

Results

Compared to controls, PCOS patients exhibited significantly higher rates of severe depression (8% vs. 0%, p < 0.001), severe anxiety (7% vs. 0%, p < 0.001), impulsivity (BIS-11: 39.43 ± 9.69 vs. 26.64 ± 2.92, p < 0.001), and borderline personality traits (McLean: 2.41 ± 2.44 vs. 1.2 ± 0.94, p < 0.001). Metabolic comorbidities, including obesity (BMI 28.88 vs. 20.27, p < 0.001) and hypothyroidism (48% vs. 0%, p < 0.001), were prevalent in PCOS. Hyperandrogenism correlated weakly with psychiatric outcomes (all p > 0.05).

Conclusion

Women with PCOS demonstrate markedly elevated psychiatric and medical burdens compared to healthy controls. While hyperandrogenism showed limited direct associations, metabolic dysfunction (e.g., obesity) may mediate psychiatric risk. These findings underscore the need for multidisciplinary care integrating psychological and endocrine management, particularly in populations where cultural norms exacerbate PCOS-related distress.

Purpose

Postpartum depression (PPD), the most common childbirth complication in the United States, can be treated using brexanolone, an intravenous form of allopregnanolone.

Methods

This retrospective chart review study evaluated clinical outcomes of 64 postpartum women who received brexanolone infusion for PPD in a real-world setting.

Results

Treatment was associated with improved depression and anxiety symptoms, and 71% of patients reported significant improvement in their PPD.

Conclusions

While further research is needed, this study supports brexanolone as an efficacious treatment for PPD.

Purpose

Postpartum maternal mental health plays a crucial role in the development of children’s social and emotional competencies. This study aimed to investigate the influence of postpartum maternal depression and mother-to-infant bonding on children’s emotional and behavioral difficulties in sixth grade.

Methods

Data from the maternal Edinburgh Postnatal Depression Scale (EPDS) and the Mother-to-Infant Bonding Scale-Japanese version (MIBS-J), administered to mothers approximately 2 weeks to 1 month postpartum during postnatal health checkups in Okaya, Japan, were analyzed alongside Strengths and Difficulties Questionnaire (SDQ) data collected from their sixth-grade children and their caregivers. The study included 245 mother–child pairs of children born between April 2, 2009, and April 1, 2012.

Results

Postpartum maternal depressive symptoms, as assessed by the EPDS, were significantly associated with mother-to-infant bonding difficulties, as assessed by the MIBS-J. Structural equation modeling revealed that EPDS, MIBS-J, and sex significantly predicted psychosocial difficulties of children. Bonding difficulties mediated 34.6% of the total effect of EPDS on child difficulties. The models explained 26.1% of the variance in psychosocial difficulties, with 43.0% of the variance explained for parent-rated SDQ scores and 36.4% for self-rated SDQ scores.

Conclusions

The negative impact of maternal depressive symptoms on mother-to-infant bonding may have contributed to increased difficulties for the child, highlighting the critical role of bonding in moderating the effects of maternal mental health on child development. These findings underscore the importance of early postpartum interventions targeting both maternal depression and bonding difficulties to mitigate long-term effects on child development.

Background

Despite a growing body of evidence on maternal mental health in Africa, significant gaps remain in understanding its overall landscape, risk factors/determinants, immediate and long-term effects, accessibility to healthcare and services, and availability of practicable/effective interventions. This paper provides a thorough review of both peer-reviewed and grey literature and makes key recommendations and directions for future research and development.

Methods

We systematically reviewed extant evidence using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Peer-reviewed studies published in English between 2010, and June 2024 were included based on a priori criteria. The National Institutes of Health (NIH) and Critical Appraisal Skill Program (CASP) quality assessment tools were used to critically appraise the reliability, validity and overall quality of included articles. A qualitative narrative synthesis was perfomed to summarize the findings effectively.

Results

A total of 206 full-text articles evaluated for eligibility and inclusion in the systematic review, predominantly observational studies with a minority employing randomized controlled trial (RCT) designs, were included, with 70%, 22%, and 8% of the articles rated as good, fair, and poor quality, respectively. Women in Africa experience a wide range of common perinatal mental disorders, including major depressive disorders and psychosis, either discretely or comorbid. Socioeconomic disadvantages and other intertwined poverty-related factors at the individual, family, social, and environmental levels are implicated in maternal mental health disorders. Currently, there is insufficient evidence regarding the short- and long-term health, development, and social impacts of maternal mental health. Addtionally, there is limited knowledge about the availability and accessibility of mental healthcare, evidence-based context-specific interventions, and healthcare-seeking behaviors of women in Africa, as well as their access to and utilization of mental health services.

Conclusion

The evidence base on maternal mental health in Africa suffers from considerable variability, inconsistency, and equivocal findings resulting from heterogeneity across the studies. This restricts generalizability and the ability to draw valid conclusions. Published studies also likely underestimate the scale and health impacts of perinatal mental disorders. Evidence from these studies are rarely used to inform policies and programs. The maternal mental health ecosystem in Africa needs to be better understood. More rigorous study designs should be implemented to focus on evidence generation and the evaluation of interventions, alongside robust integration of mental health services within health systems. Policy initiatives aimed at reducing socioeconomic disparities in maternal, newborn, and child health, par