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Wriedt SC, Müller M, Reck C, Nonnenmacher N, Zietlow AL, Woll CFJ. The effect of antepartum depressive and anxiety symptoms on mother-infant interaction: The mediating role of antepartum maternal emotional stress. Infant Behav Dev 2024; 75:101942. [PMID: 38522348 DOI: 10.1016/j.infbeh.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/13/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
Anxiety disorders, depression, and emotional stress during the antepartum period are interlinked with adverse child development. The quality of the dyadic interaction seems to play a crucial role in the transmission of these effects. In this study, we explored the mediating effect of antepartum maternal emotional stress (assessed via the Prenatal Emotional Stress Index) regarding the relationship of antepartum maternal depressive (assessed via the Edinburgh Postpartum Depression Scale), anxiety symptoms (assessed via the Stat-Trait-Anxiety-Inventory), and depressive and anxiety disorders (assessed according to the DSM-IV-TR) in the antepartum period on postpartum interactive quality in a longitudinal design. The Face-to-Face-Still-Face Paradigm (FFSF) and the Infant and Caregiver Engagement Phases (ICEP-R) coding system were used to assess the postpartum interactive qualities of the mother-infant dyads. The sample consisted of 59 women, 38 in the clinical and 21 in the control group. We found significant indirect effects of antepartum depressive symptoms and maternal diagnostic status on the mother's neutral engagement and on the latency to the first social positive interactive match during the interaction - effects that were mediated by antepartum stress. Moreover, there was an indirect effect of state anxiety on neutral engagement - mediated by antepartum stress. Therapeutic intervention studies focusing on maternal antepartum regulation of emotional stress and postpartum interactive patterns might be crucial to encounter maladaptive developmental trajectories.
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Affiliation(s)
- Sophia Cécile Wriedt
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany
| | - Mitho Müller
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany.
| | - Corinna Reck
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany
| | - Nora Nonnenmacher
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany; Department of Medical Psychology, Heidelberg University Hospital, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Anna-Lena Zietlow
- Department of Psychology, Clinical Psychology of Childhood and Adolescence, Technical University Dresden, Chemnitzer Straße 46a, 01187 Dresden, Germany
| | - Christian Franz Josef Woll
- Department of Psychology, Clinical Psychology of Childhood and Adolescence and Counselling Psychology, LMU Munich, Leopoldstraße 13, 80802 Munich, Germany
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Mills-Koonce WR, Grewen K, O'Shea NG, Pearson B, Strange CG, Meltzer-Brody SE, Guintivano JD, Stuebe AM. The Mood, Mother and Child Study: Protocol for a Prospective Longitudinal Study and Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e51132. [PMID: 37883133 PMCID: PMC10636628 DOI: 10.2196/51132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/25/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Perinatal depression affects >400,000 mother-child dyads in the United States every year and is associated with numerous adverse maternal and child developmental outcomes. Previous research implicates the dysregulation of oxytocin and the hypothalamic-pituitary-adrenal (HPA) axis functioning in mothers and children as potential mechanisms mediating or moderating the transmission of risk associated with maternal depression. OBJECTIVE The Mood, Mother and Child study will examine the psychobiological sources of risk and resilience within mother-child dyads affected by maternal depression. This manuscript describes (1) the study rationale and aims, (2) the research design and procedures and how they were altered in response to the COVID-19 pandemic, and (3) the data analysis plan to test the study hypotheses. METHODS This is a prospective longitudinal study with an embedded randomized controlled trial that examines (1) correlations among postpartum depression and anxiety symptoms, maternal and child oxytocin and HPA axis functioning, and child developmental outcomes and (2) the causal relationship between exogenous oxytocin and HPA reactivity. This study is funded by the National Institute of Child Health and Human Development with institutional review board approval. RESULTS Recruitment and data collection have commenced, and the expected results will be available in 2024. Analyses are presented for testing the proposed hypotheses. CONCLUSIONS The unique combination of a prospective longitudinal research design with an embedded randomized controlled trial will allow the Mood, Mother and Child study to apply a developmental lens to the study of maternal depression and anxiety symptoms from birth to middle childhood and the psychobiological mechanisms promoting risk and resiliency for both mother and child outcomes. This will be the first study that simultaneously evaluates (1) the role of oxytocin using multiple methodologies, (2) the causal relationships between exogenous oxytocin and HPA axis functioning among mothers with differing levels of depression and anxiety symptoms, and (3) the multiple mediating and moderating roles of parenting behaviors and maternal and child psychobiological characteristics. The goals of these aims are to provide insights into the psychobiological effects of oxytocin in women and inform future clinical trials to treat perinatal mood disorders. TRIAL REGISTRATION ClinicalTrials.gov NCT03593473; https://classic.clinicaltrials.gov/ct2/show/NCT03593473. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51132.
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Affiliation(s)
- W Roger Mills-Koonce
- School of Education, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karen Grewen
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Brenda Pearson
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Chelsea Grace Strange
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Samantha E Meltzer-Brody
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jerry Dolph Guintivano
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alison M Stuebe
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Verde-Cagiao M, Nieto C, Campos R. Mother-infant co-regulation from 0 to 2 years: The role of copy behaviors. A systematic review. Infant Behav Dev 2022; 68:101749. [PMID: 35952425 DOI: 10.1016/j.infbeh.2022.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 04/19/2022] [Accepted: 07/16/2022] [Indexed: 11/28/2022]
Abstract
The purpose of this review was twofold: (1) to examine how copy behaviors (CB) have been studied in mother-infant natural interactions from 0 to 24 months, and (2) to determine to what extent they can be considered co-regulation processes between both members of the dyad. To do this, 36 studies published between 1975 and 2021 were systematically examined, classified and discussed. The analyzed evidence showed that CB in spontaneous mother-infant interactions have been examined under different perspectives, that such behaviors might be differentially classified as distinct modes of copying according to their traits and, lastly, that CB operate as social facilitators that foster the co-regulation of both affects and behaviors and direct mothers and infants, most of the times, towards a mutual sense of interpersonal matching that adds quality to their interactions.
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Affiliation(s)
| | - Carmen Nieto
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ruth Campos
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
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Weingarten S, Diop S, Specht C, Turmes L, Juckel G, Mavrogiorgou P. Differences in interactional behaviour in postpartum depression with and without pre-existing mental disorder. Compr Psychiatry 2021; 108:152248. [PMID: 34044326 DOI: 10.1016/j.comppsych.2021.152248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Mothers with postpartum depression (PPD) show impaired affects and behaviour patterns in the mother-child interaction, which affects an infant's emotional and cognitive development and the maternal course of disease. However, impairment of the mother-child relationship does not occur in every case of PPD. AIM The aim of this exploratory-descriptive video-based study was to investigate the possible associations between mother-child interactions and aspects of maternal biography and clinical history, with a focus on pre-existing mental disorder. METHODS Sixty-two mother-child dyads (31 mothers with PPD and pre-existing mental disorders and 31 mothers with PPD but no further mental disorder) hospitalized at the mother and baby unit (MBU) of the LWL-Hospital Herten were included in this study. The Marcé Clinical Checklist and the "Mannheimer Beurteilungsskala zur Erfassung der Mutter-Kind-Interaktion im Säuglingsalter" (MBS-MKI-S) were used to explore sociodemographic and clinical parameters, and video-based interaction behaviour was examined. RESULTS Mother-infant interaction behaviour showed a significant group difference on the MBS-MKI-S-Vm subscale (variability in maternal behaviour) before psychiatric treatment (exact Mann-Whitney U test: U = 555, p = 0.023), with higher scores in mothers with a pre-existing mental disorder. Furthermore, significant differences were shown on the MBS-MKI-S-RSm (maternal reactivity/sensitivity) (U = 259, p = 0.019) and MBS-MKI-S-Rc (child's reactivity) subscales at discharge (U = 251, p = 0.021). Among mothers with a pre-existing diagnosis, the MBS-MKI-S-Tm (maternal tenderness) and MBS-MKI-S-Rc (child's reactivity) subscales were significantly correlated after treatment. CONCLUSIONS Mothers with PPD and a pre-existing mental disorder displayed significantly more behavioural variability than mothers with only PPD. Maternal behaviour seems to influence the child's responsive behaviour; thus, mothers and their children can benefit from inpatient treatment at an MBU. Further investigations with larger samples should be conducted.
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Affiliation(s)
- Sina Weingarten
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Shirin Diop
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Christina Specht
- Department of Psychiatry, Psychotherapy, Psychosomatic Medicine and Preventive Medicine, LWL-Hospital Herten, Im Schloßpark 20, 45699 Herten, Germany
| | - Luc Turmes
- Department of Psychiatry, Psychotherapy, Psychosomatic Medicine and Preventive Medicine, LWL-Hospital Herten, Im Schloßpark 20, 45699 Herten, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany.
| | - Paraskevi Mavrogiorgou
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital, Alexandrinenstr. 1-3, 44791 Bochum, Germany
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Madigan S, Oatley H, Racine N, Fearon RMP, Schumacher L, Akbari E, Cooke JE, Tarabulsy GM. A Meta-Analysis of Maternal Prenatal Depression and Anxiety on Child Socioemotional Development. J Am Acad Child Adolesc Psychiatry 2018; 57:645-657.e8. [PMID: 30196868 DOI: 10.1016/j.jaac.2018.06.012] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/23/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Observed associations between maternal prenatal stress and children's socioemotional development have varied widely in the literature. The objective of the current study was to provide a synthesis of studies examining maternal prenatal anxiety and depression and the socioemotional development of their children. METHOD Eligible studies through to February 2018 were identified using a comprehensive search strategy. Included studies examined the association between maternal prenatal depression or anxiety and the future development of their children's socioemotional development (eg, difficult temperament, behavioral dysregulation) up to 18 years later. Two independent coders extracted all relevant data. Random-effects meta-analyses were used to derive mean effect sizes and test for potential moderators. RESULTS A total of 71 studies met full inclusion criteria for data analysis. The weighted average effect size for the association between prenatal stress and child socioemotional problems was as follows: odds ratio (OR) = 1.66 (95% CI = 1.54-1.79). Effect sizes were stronger for depression (OR = 1.79; 95% CI = 1.61-1.99) compared to anxiety (OR = 1.50; 95% CI = 1.36-1.64). Moderator analyses indicated that effect sizes were stronger when depression was more severe and when socio-demographic risk was heightened. CONCLUSION Findings suggest that maternal prenatal stress is associated with offspring socioemotional development, with the effect size for prenatal depression being more robust than for anxiety. Mitigating stress and mental health difficulties in mothers during pregnancy may be an effective strategy for reducing offspring behavioral difficulties, especially in groups with social disadvantage and greater severity of mental health difficulties.
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Affiliation(s)
| | - Hannah Oatley
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | - Emis Akbari
- George Brown College, Toronto, Ontario, Canada
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Erickson NL, Gartstein MA, Dotson JAW. Review of Prenatal Maternal Mental Health and the Development of Infant Temperament. J Obstet Gynecol Neonatal Nurs 2017; 46:588-600. [DOI: 10.1016/j.jogn.2017.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 01/17/2023] Open
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Jobst A, Brakemeier EL, Buchheim A, Caspar F, Cuijpers P, Ebmeier KP, Falkai P, Jan van der Gaag R, Gaebel W, Herpertz S, Kurimay T, Sabaß L, Schnell K, Schramm E, Torrent C, Wasserman D, Wiersma J, Padberg F. European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe. Eur Psychiatry 2016; 33:18-36. [PMID: 26854984 DOI: 10.1016/j.eurpsy.2015.12.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. METHODS We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. RESULTS We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. DISCUSSION The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. CONCLUSION Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
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Affiliation(s)
- A Jobst
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - E-L Brakemeier
- Department of Clinical Psychology and Psychotherapy, Berlin University of Psychology, Berlin, Germany
| | - A Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria
| | - F Caspar
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - P Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - K P Ebmeier
- Department of Psychiatry, Division of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - P Falkai
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | | | - W Gaebel
- Department of Psychiatry und Psychotherapy, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - S Herpertz
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - T Kurimay
- Institute of Behaviour Sciences, Semmelweis University, Budapest, Hungary
| | - L Sabaß
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - K Schnell
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - E Schramm
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - C Torrent
- Clinical Institute of Neuroscience, Hospital Clinic Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - D Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - J Wiersma
- Department of Psychiatry, GGZinGeest, Amsterdam, The Netherlands
| | - F Padberg
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
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Stuebe AM, Grewen K, Pedersen CA, Propper C, Meltzer-Brody S. Failed lactation and perinatal depression: common problems with shared neuroendocrine mechanisms? J Womens Health (Larchmt) 2012; 21:264-72. [PMID: 22204416 PMCID: PMC3298672 DOI: 10.1089/jwh.2011.3083] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
In the early postpartum period, mother and infant navigate a critical neuroendocrine transition from pregnancy to lactation. Two major clinical problems that occur during this transition are failed lactation and perinatal mood disorders. These disorders often overlap in clinical settings. Failed lactation is common. Although all major medical organizations recommend 6 months of exclusive breastfeeding, only 13% of women in the United States achieve this recommendation. Perinatal mood disorders affect 10% of mothers, with substantial morbidity for mother and child. We hypothesize that shared neuroendocrine mechanisms contribute to both failed lactation and perinatal mood disorders. In this hypothesis article, we discuss data from both animal models and clinical studies that suggest neuroendocrine mechanisms that may underlie these two disorders. Research to elucidate the role of these underlying mechanisms may identify treatment strategies both to relieve perinatal depression and to enable women to achieve their infant feeding goals.
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Affiliation(s)
- Alison M Stuebe
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA.
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Costa R, Figueiredo B. Infants' behavioral and physiological profile and mother–infant interaction. INTERNATIONAL JOURNAL OF BEHAVIORAL DEVELOPMENT 2012. [DOI: 10.1177/0165025411428248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to (a) identify and profile groups of infants according to their behavioral and physiological characteristics, considering their neurobehavioral organization, social withdrawal behavior, and endocrine reactivity to stress, and to (b) analyze group differences in the quality of mother–infant interaction. Ninety-seven 8-week-old infants were examined using the Neonatal Behavioral Assessment Scale and the Alarm Distress Baby Scale. Cortisol levels were measured both before and after routine inoculation between 8 and 12 weeks. At 12 to 16 weeks mother–infant interaction was assessed using the Global Rating Scales of Mother–Infant Interaction. Three groups of infants were identified: (a) “withdrawn”; (b) “extroverted”; (c) “underaroused.” Differences between them were found regarding both infant and mother behaviors in the interaction and the overall quality of mother–infant interaction. The identification of behavioral and physiological profiles in infants is an important step in the study of developmental pathways.
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White H, Flanagan TJ, Martin A, Silvermann D. Mother–infant interactions in women with borderline personality disorder, major depressive disorder, their co-occurrence, and healthy controls. J Reprod Infant Psychol 2011. [DOI: 10.1080/02646838.2011.576425] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Prenatal depression effects on early development: A review. Infant Behav Dev 2011; 34:1-14. [DOI: 10.1016/j.infbeh.2010.09.008] [Citation(s) in RCA: 379] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 08/17/2010] [Accepted: 09/24/2010] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW Dysthymia is a relatively less-studied condition within the spectrum of depressive disorders. New and important information about its status has emerged in recent scientific literature. This review highlights some of the findings of that literature. RECENT FINDINGS Even though studies addressing the cross-cultural validity of dysthymia are being awaited, results of studies using comparable ascertainment procedures suggest that the lifetime and 12-month estimates of the condition may be higher in high-income than in low and middle-income countries. However, the disorder is associated with elevated risks of suicidal outcomes and comparable levels of disability whereever it occurs. Dysthymia commonly carries a worse prognosis than major depressive disorder and comparable or worse clinical outcome than other forms of chronic depression. Whereas there is some evidence that psychotherapy may be less effective than pharmacotherapy in the treatment of dysthymia, the best treatment approach is one that combines both forms of treatment. SUMMARY Dysthymia is a condition of considerable public health importance. Our current understanding suggests that it should receive more clinical and research attention. Specifically, the development of better treatment approaches, especially those that can be implemented in diverse populations, deserves research attention.
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Affiliation(s)
- Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences, Drug and Substance Abuse, Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, Nigeria.
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Abstract
Traditionally, non-bipolar depression has been viewed as an episodic, remitting condition. However, with the recognition that depressions can persist for many years, the current diagnostic classification system includes various forms of chronic depression. The distinction between chronic and nonchronic depressions is useful for reducing the heterogeneity of the disorder. Individuals with chronic depression differ from those with nonchronic depression on a variety of clinically and etiologically significant variables, including comorbidity, impairment, suicidality, history of childhood maltreatment, familial psychopathology, and long-term course. In contrast, there is little support for current distinctions between different forms of chronic depression. This suggests that it may be simpler to collapse the existing forms of chronic depression in the current classification system into a single category. However, there is growing evidence that other characteristics, such as age of onset and a childhood history of early adversity, may provide meaningful approaches to subtyping chronic depression.
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Ersek JL, Brunner Huber LR. Physical activity prior to and during pregnancy and risk of postpartum depressive symptoms. J Obstet Gynecol Neonatal Nurs 2010; 38:556-66. [PMID: 19883477 DOI: 10.1111/j.1552-6909.2009.01050.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the relationship between physical activity before and during the last trimester of pregnancy and postpartum depressive symptoms. DESIGN Secondary analysis of data from the 2004 and 2005 Pregnancy Risk Assessment Monitoring System. SETTINGS Mailed questionnaire or telephone interview of new mothers in North Carolina. PATIENTS/PARTICIPANTS Female residents of North Carolina, ages 18 to 45 (n=2,169), who had given birth to a live infant in the past 2 to 6 months. METHODS Information on physical activity and depressive symptoms was self-reported. Logistic regression was used to examine the physical activity-depressive symptom associations while controlling for confounding variables. RESULTS After adjustment for confounders, there were no statistically significant associations between being physically active before and/or during pregnancy and feeling depressed or "down." However, participants who were physically active both prepregnancy and during the last trimester had decreased odds of having little interest or pleasure compared with participants who were not physically active, after adjustment for age and marital status (odds ratio =0.66, 95% confidence interval: 0.49, 0.87). CONCLUSION Although regular physical activity is recommended for healthy women during pregnancy, additional studies are needed to investigate the physical activity-depressive symptoms association. If confirmed in other studies, physical activity may be an additional option for women who want to ease postpartum depressive symptoms.
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Affiliation(s)
- Jennifer L Ersek
- Blumenthal Cancer Center, Carolinas Medical Center, Charlotte, NC 28204, USA.
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