Post-adoption depression: Parental classes of depressive symptoms across time

Gaps in Postnatal Support for Intended Parents

PURPOSE

To identify gaps in postnatal depression screening and support services for intended parents (parents who are intended to receive the baby from a gestational surrogacy pregnancy), also known as commissioned parents.

STUDY DESIGN AND METHODS

This descriptive study used quantitative and free-text survey questions designed to assess postnatal depression screening and postnatal services available for all parents and, more specifically, for intended parents.

SAMPLE

The survey was sent to 2,000 randomly selected postpartum nurses in the United States who are members of the Association of Women's Health, Obstetric and Neonatal Nurses.

RESULTS

Completion of the survey was offered to the 125 nurses who responded that they provided care for intended parents. Thirty-seven percent of respondents indicated that postpartum support services are available for both parents. Free-text responses describe a gap in postnatal services for intended parents. Although 85% of survey respondents reported that postpartum depression screening occurs in their setting, nurses reported neither fathers nor intended parents are screened for postnatal depression.

CLINICAL IMPLICATIONS

This study expands the known gap in postnatal support services for intended parents, including postnatal depression screening. Recommendations for nurses working in the perinatal setting include providing consistent support for all parents as they transition to parenthood. Creating standardized policies and practices reflecting the diverse needs and cultures of intended parents can help direct all clinicians toward providing more significant support. Adapting current postnatal screening and support systems could provide a continuum of support for all families.

Diagnosis and Management of Perinatal Depression

Perinatal depression is a mood disorder that may occur during pregnancy or within a year after childbirth. It can be disabling for the birthing parent and cause attachment and developmental problems for the infant. A host of risk factors, including genetics, reproductive history, and life experiences, are associated with perinatal depression. With validated screening tools, health care providers can assess individuals, initiate treatment, and/or refer as appropriate. Successful treatment, which may include modalities such as cognitive behavioral therapy and/or pharmacologic therapies, helps individuals maintain a sense of control, develop self-confidence, take control of their thinking, and learn coping skills. Integrative therapies and lifestyle changes have some success but may not be adequate for many individuals. Patients may benefit from providers learning and initiating cognitive behavioral therapy techniques while awaiting therapy.

A Fourth Trimester Action Plan for Wellness

Expectant mothers/couples often report planning for early parenting is overwhelming. Lack of anticipatory planning makes evident the need for providers, like childbirth educators, to assist expectant parents in minimizing or eliminating the problems associated with the transition to the fourth trimester, early parenthood. Planning for birth should extend beyond labor and birth to include the weeks following. The author's purpose is to explore the problems associated with the fourth trimester, to review the current health-related literature, and to propose an integrated behavioral action plan as an effective strategy. Self-efficacy constructs support a wellness plan approach to enable expectant mothers/couples to be proactive in preparing for their physical and emotional needs after the arrival of their newborn.

Depression and Anxiety Symptoms of British Adoptive Parents: A Prospective Four-Wave Longitudinal Study

The mental health of birth parents has gained attention due to the serious negative consequences for personal, family, and child outcomes, but depression and anxiety in adoptive parents remains under-recognized. Using a prospective, longitudinal design, we investigated anxiety and depression symptoms in 96 British adoptive parents over four time points in the first four years of an adoptive placement. Depression and anxiety symptom scores were relatively stable across time. Growth curve analysis showed that higher child internalizing scores and lower parental sense of competency at five months post-placement were associated with higher initial levels of parental depressive symptoms. Lower parental sense of competency was also associated with higher initial levels of parental anxiety symptoms. Parents of older children and those with higher levels of parental anxiety and sense of competency at five months post-placement had a steeper decrease in depressive symptoms over time. Support for adoptive families primarily focuses on child adjustment. Our findings suggest that professional awareness of parental mental health post-placement may be necessary, and interventions aimed at improving parents' sense of competency may be beneficial.

[GABAergic approach of postpartum depression: A translational review of literature]

INTRODUCTION

Prevalence of postpartum depression (PPD) ranges from 10 to 15 % of parturients. The impact of the PPD is major on the maternal bond and the health of both mother and child. Its physiopathological mechanisms appear to differ from other types of depression. Today, pharmacotherapy is based on nonspecific treatment, and recent therapeutic advances in this field require a comprehensive approach of the implication of the GABAergic system in the development of PPD. Neurosteroid levels during pregnancy and after parturition and the GABA-A-r modulation are thought to be involved in PPD.

OBJECTIVE

To evaluate if the GABAergic approach is relevant in postpartum depression management.

METHODS

We conducted a systematic review of literature based on the MEDLINE database with the following Medical Subject Headings (MeSH): "postpartum depression", "GABA", "ganaxolone", "brexanolone", "allopregnanolone", prior to September 2019. We selected articles in English: preclinical and clinical studies, literature review, observational and therapeutic studies.

RESULTS

Preclinical models (mouse and rat) show changes in GABAergic inhibition in the peripartum period and correlation between allopregnanolone and GABA-A-r plasticity. This plasticity in the peripartum period maintains levels of inhibition adapted despite increased neurosteroid levels. KO models for the GABA-A-r δ subunit develop depression and anxiety symptoms in the postpartum period, and a change in the expression of the gene coding for the GABA-R alpha-4 subunit was found. Artificial inhibition of progesterone metabolism during post-partum increased depression symptoms. GABAergic fluctuation seems to be interrelated with other systems such as those of oxytocins. A synthetic neurosteroid (SGE-516) was tested on mouse models of PPD, KO for δ-GABA-A-r or KCC2, and showed decreased depressive symptoms and better mothering. Clinical studies confirm neurosteroid fluctuation and changes in the GABAergic system during the peripartum period. Allopregnanolone is the neurosteroid the most studied in PPD, and it is elevated in the brain during the pregnancy. Studies disagree on the presence of significant differences in allopregnanolone plasma levels during pregnancy or postpartum between women with PPD or not. Women with a history of PPD have greater susceptibility to neurosteroid withdrawal. Imagery and genetical data also show a link between allopregnanolone and PPD. The GABA-A-r may not recover in time following a reduced number during pregnancy, and this mismatch between neurosteroid levels and their receptor may trigger PPD. Several randomized controlled trials investigated brexanolone administrated IV, a synthetic formulation of allopregnanolone, and demonstrated a rapid and well tolerated reduction in depressive symptoms. In March 2019 brexanolone obtained FDA approval in PPD indication under the name Zulresso. However, there are differences in the time of beginning of PPD, which could constitute different subgroups of this disease, and which physiopathology could respond to different mechanisms. Prenatal depression does not respond to a GABAergic approach, but women without any risk factor or previous mood disorder developing PPD in the weeks following childbirth could be particularly responsive to this kind of treatment.

CONCLUSION

Disability to modulate GABA-A-r expression during pregnancy and restore its previous state after parturition appears to trigger PPD. The GABAergic system is a promising pharmacotherapy target. From preclinical to clinical studies for about twenty years the GABAergic system has been incriminated and targeted in this challenging mental disease.

Longitudinal analyses of adoptive parents' expectations and depressive symptoms

Grounded in a theoretical model specific to adoptive parents, we examined the relationship between parental expectations and depressive symptoms across time. Assessments of 129 adoptive parents of 64 children were performed at three time points before and after placement of an adopted child with the family: 4-6 weeks pre-placement and 4-6 weeks and 5-6 months post-placement. Expectations were assessed in four dimensions: expectations of self as parents, of the child, of family and friends, and of society. Depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression scale. Associations between parental expectations and depressive symptoms were analyzed, and longitudinal multilevel modeling was conducted to explore influences on expectations over time. Parental expectations changed from pre- to post-placement. With the exception of expectations of self as parent, adoptive parents' pre-adoption expectations were affirmed in the post-adoption time periods. In each expectation dimension, higher affirmation of expectations was correlated with decreased depressive symptoms before and after placement of a child. While parental expectations are not unique to adoptive parents, the essence and characteristics of certain expectations are unique to these parents. When working with adoptive parents, nurses who care for families should assess expectations both pre- and post-placement with awareness of their relationship to depressive symptoms.

Transitions of Adoptive Parents: A Longitudinal Mixed Methods Analysis

As adoptive parents create a new family, they face myriad changes both pre-and post-placement of their child. The aim of this study was to describe parent perceptions and depressive symptoms during this transition via reports collected with an online survey. Using content analysis, we analyzed a total of 110 responses from 64 parents at three time points: 4-6weeks pre-placement, and 4-6weeks and 5-6months post-placement. Five main themes were revealed: Transition from uncertainty to a new normal; unique experiences related to adoption; rest/fatigue: out of balance; life stressors; and faith/spirituality. Two subthemes were also identified: previous losses (pre-placement) and joy and love (post-placement). During the transition from pre-to post-placement, adoptive parents experience a unique passage, with both challenges and strengths exclusive to this group of parents. While acknowledging the commonalities of some parenting experiences, healthcare and adoption professionals should recognize the unique dynamics that adoption brings to families.

Longitudinal Course of Risk for Parental Postadoption Depression

OBJECTIVE

To determine whether the Postpartum Depression Predictors Inventory-Revised (PDPI-R) could be used to reveal distinct classes of adoptive parents across time.

DESIGN

Longitudinal data were collected via online surveys at 4 to 6 weeks preplacement, 4 to 6 weeks postplacement, and 5 to 6 months postplacement.

SETTING

Participants were primarily clients of the largest adoption agency in the United States.

PARTICIPANTS

Participants included 127 adoptive parents (68 mothers and 59 fathers).

METHODS

We applied a latent class growth analysis to the PDPI-R and conducted mixed effects modeling of class, time, and class × time interaction for the following categories of explanatory variables: parental expectations, interpersonal variables, psychological symptoms, and life orientation.

RESULTS

Four latent trajectory classes were found. Class 1 (55% of sample) showed a stably low level of PDPI-R scores over time. Class 2 (32%) reported mean scores below the cut-off points at all three time points. Class 3 (8%) started with scores at an intermediate level that increased after postplacement but decreased at 5 to 6 months postplacement. Class 4 (5%) had high mean scores at all three time points. Significant main effects were found for almost all explanatory variables for class and for several variables for time. Significant interactions between class and time were found for expectations about the child and amounts of love and ambivalence in parent's intimate relationship.

CONCLUSION

Findings may help nurses be alert to trajectories of risk for postadoption depression. Additional factors not included in the PDPI-R may be needed to determine risk for postadoption depression in adoptive parents.