A transdiagnostic approach to conceptualizing depression across the perinatal period in a high-risk sample

Psychological Distress in Childbearing Persons During the COVID-19 Pandemic: A Multi-Trajectory Study of Anger, Anxiety, and Depression

Psychological distress can manifest as depression, anxiety, and anger in the perinatal period. These conditions are often comorbid yet studied in isolation. A full understanding of perinatal psychopathology requires the spectrum of common psychological distress to be studied concurrently to better understand interconnected symptoms. A transdiagnostic approach provides valuable insights into how symptoms interact and cumulatively affect mental health, which can inform more effective screening and treatment strategies. This, in turn, can improve outcomes for birthing parents experiencing psychological distress. We undertook group-based multi-trajectory modeling (GBMTM) to uncover the patterns of affective disorders (anger, anxiety, and depression) over three-time points (pregnancy, 3-, and 12-months postpartum (mPP)) in a large longitudinal cohort of persons who gave birth during the COVID-19 pandemic (n = 2145). We identified five trajectory groups: high-stable (11.3%), postpartum-increase (16.0%), postpartum-decrease (21.5%), low-stable (37.9%), and minimal stable (13.2%) symptoms of anger, anxiety, and depression. Multinomial regression revealed that lower levels of sleep disturbance, less financial hardship, and lower intolerance of uncertainty predicted postpartum decreases in psychological distress compared with the high stable group. Higher levels of sleep disturbance, greater financial hardship, lower level of social support, and greater intolerance of uncertainty predicted postpartum increases in psychological distress compared with the low-stable and minimal-stable groups. Screening for psychological distress symptoms (i.e., anger, anxiety, and depression), paired with access to evidence-based management for those who screen positive, is warranted during the first postpartum year to reduce the harmful effects of unmanaged distress on families.

Postpartum anger among low-income women with high rates of trauma exposure

Few studies have examined anger concerns among postpartum women despite their risk of mood dysregulation. This study examined the performance of the Dimensions of Anger Reactions-5 (DAR-5) scale, a brief screen for problematic anger, in a sample of 1,383 postpartum women in Wisconsin who received perinatal home visiting services. We aimed to analyze the discriminant validity and measurement invariance of the DAR-5, the occurrence of problematic anger symptoms and their co-occurrence with mental health concerns, and the association between elevated anger levels and exposure to potentially traumatic events in childhood and adulthood. Descriptive statistics for anger symptoms and their associations with depression, anxiety, and PTSD were calculated. Psychometric properties of the DAR-5 were assessed via confirmatory factor analyses, and associations between trauma exposure and anger were evaluated as bivariate and partial correlations. Approximately 21% of the sample exhibited problematic anger based on an established DAR-5 cutoff score (≥ 12). Anger symptoms co-occurred with posttraumatic stress disorder (PTSD), depressive, and anxiety symptoms, though the DAR-5 sufficiently distinguished anger from these correlated symptom profiles. The DAR-5 also demonstrated acceptable measurement invariance across levels of trauma exposure. Higher levels of trauma exposure in childhood and adulthood significantly increased the risk of problematic anger even after controlling for PTSD, anxiety, and depressive symptoms, partialγ ${{\bm \gamma }}$ pb range: .07-.16. The findings suggest the DAR-5 is a valid brief screen for anger in postpartum women. Increased attention should be paid to elevated anger and the co-occurrence of other mental health concerns following childbirth.

Childhood maltreatment exposure is differentially associated with transdiagnostic perinatal depression symptoms

History of childhood maltreatment (CM) is common and robustly associated with prenatal and postpartum (perinatal) depression. Given perinatal depression symptom heterogeneity, a transdiagnostic approach to measurement could enhance understanding of patterns between CM and perinatal depression.

METHODS

In two independently collected samples of women receiving care at perinatal psychiatry clinics (n = 523 and n = 134), we categorized longitudinal symptoms of perinatal depression, anxiety, stress, and sleep into transdiagnostic factors derived from the Research Domain Criteria and depression literatures. We split the perinatal period into four time points. We conducted a latent profile analysis of transdiagnostic factors in each period. We then used self-reported history of CM (total exposure and subtypes of abuse and neglect) to predict class membership.

RESULTS

A three-class solution best fit our data. In relation to positive adaptive functioning, one class had relatively more positive symptoms (high adaptive), one class had average values (middle adaptive), and one class had fewer adaptive symptoms (low adaptive). More total CM and specific subtypes associated with threat/abuse increased an individual's likelihood of being in the Low Adaptive class in both samples (ORs: 0.90-0.97, p < .05).

LIMITATIONS

Generalizability of our results was curtailed by 1) limited racial/ethnic diversity and 2) missing data.

CONCLUSIONS

Our results support taking a person-centered approach to characterize the relationship between perinatal depression and childhood maltreatment. Given evidence that increased exposure to childhood maltreatment is associated with worse overall symptoms, providers should consider incorporating preventative, transdiagnostic interventions for perinatal distress in individuals with a history of childhood maltreatment.

Primary care physicians' perspectives on the identification and management of postnatal mental health problems

BACKGROUND

Postnatal mental health problems (PMHPs) are prevalent and negatively affect mothers, children, and society. International and local guidelines recommend that Singapore primary care physicians (PCP) screen, assess, and manage mothers with PMHPs. However, little is known about their experiences and views.

METHODS

We conducted semi-structured interviews with 14 PCPs in Singapore. Interview questions elicited perspectives on the identification and management of mothers with PMHPs. The interview guide was developed from a conceptual framework incorporating the knowledge-attitudes-practices, self-efficacy, and socio-ecological models. Interviews were audio-recorded and transcribed. Thematic analysis was used to identify emergent themes.

RESULTS

Singapore PCPs viewed themselves as key providers of first-contact care to mothers with PMHPs. They believed mothers preferred them to alternative providers because of greater accessibility and trust. In detection, they were vigilant in identifying at-risk mothers and favoured clinical intuition over screening tools. PCPs were confident in diagnosing common PMHPs and believed that mothers not meeting diagnostic criteria must be readily recognized and supported. In managing PMHPs, PCPs expressed varying confidence in prescribing antidepressants, which were viewed as second-line to supportive counselling and psychoeducation. Impeding physician factors, constraining practice characteristics and health system limitations were barriers. Looking forward, PCPs aspired to leverage technology and multidisciplinary teams to provide comprehensive, team-based care for the mother-child dyad.

CONCLUSION

Singapore PCPs are key in identifying and managing mothers with PMHPs. To fully harness their potential in providing comprehensive care, PCPs need greater multidisciplinary support and technological solutions that promote remote disclosure and enhanced preparation for their role.

Positive affect improves a transdiagnostic model of perinatal depression symptoms

INTRODUCTION

Accurate measurement of perinatal depression is vital. We aimed to 1) test whether a factor that measured positive affect (PA) bettered a transdiagnostic model of depression symptoms and 2) replicate the model in a second sample.

METHODS

We conducted secondary analyses from two samples (n's = 657 and 142) of women in treatment at perinatal psychiatric clinics. Data were derived from items from seven commonly used measures. We compared fit indices from our original factor model-one general and six specific factors derived from the Research Domain Criteria (Loss, Potential Threat, Frustrative Nonreward, and Sleep-Wakefulness) and depression literatures (Somatic and Coping)-to our novel factor model with a PA factor. The PA factor was created by recategorizing items that measured affective states with a positive valence into a new factor. Sample 1 data were split into six perinatal periods.

RESULTS

In both samples, the addition of a PA factor improved model fit. At least partial metric invariance was found between perinatal periods, with the exception of trimester 3 - postpartum period 1.

LIMITATIONS

Our measures did not operationalize PA in the same way as in the positive valence system in RDoC and we were unable to perform longitudinal analyses on our cross-validation sample.

CONCLUSIONS

Clinicians and researchers are encouraged to consider these findings as a template for understanding symptoms of depression in perinatal patients, which can be used to guide treatment planning and the development of more effective screening, prevention, and intervention tools to prevent deleterious outcomes.

Mood and anxiety disorders within the Research Domain Criteria framework of Positive and Negative Valence Systems: a scoping review

Introduction

While a growing body of research is adopting Research Domain Criteria (RDoC)-related methods and constructs, there is still a lack of comprehensive reviews on the state of published research on Positive Valence Systems (PVS) and Negative Valence Systems (NVS) in mood and anxiety disorders consistent with the RDoC framework.

Methods

Five electronic databases were searched to identify peer-reviewed publications covering research on "positive valence" and "negative valence" as well as "valence," "affect," and "emotion" for individuals with symptoms of mood and anxiety disorders. Data was extracted with a focus on disorder, domain, (sub-) constructs, units of analysis, key results, and study design. Findings are presented along four sections, distinguishing between primary articles and reviews each for PVS, NVS, and cross-domain PVS and NVS.

Results

A total of 231 abstracts were identified, and 43 met the inclusion criteria for this scoping review. Seventeen publications addressed research on PVS, seventeen on NVS, and nine covered cross-domain research on PVS and NVS. Psychological constructs were typically examined across different units of analysis, with the majority of publications incorporating two or more measures. Molecular, genetic, and physiological aspects were mainly investigated via review articles, primary articles focused on self-report, behavioral, and, to a lesser extent, physiological measures.

Conclusions

This present scoping review shows that mood and anxiety disorders were actively studied using a range of genetic, molecular, neuronal, physiological, behavioral, and self-report measures within the RDoC PVS and NVS. Results highlight the essential role of specific cortical frontal brain structures and of subcortical limbic structures in impaired emotional processing in mood and anxiety disorders. Findings also indicate overall limited research on NVS in bipolar disorders and PVS in anxiety disorders, a majority of self-report studies, and predominantly observational studies. Future research is needed to develop more RDoC-consistent advancements and intervention studies targeting neuroscience-driven PVS and NVS constructs.

Detection of differential depressive symptom patterns in a cohort of perinatal women: an exploratory factor analysis using a robust statistics approach

BACKGROUND

Postpartum depression can take many forms. Different symptom patterns could have divergent implications for how we screen, diagnose, and treat postpartum depression. We sought to utilise a recently developed robust estimation algorithm to automatically identify differential patterns in depressive symptoms and subsequently characterise the individuals who exhibit different patterns.

METHODS

Depressive symptom data (N = 548) were collected from women with neuropsychiatric illnesses at two U.S. urban sites participating in a longitudinal observational study of stress across the perinatal period. Data were collected from Emory University between 1994 and 2012 and from the University of Arkansas for Medical Sciences between 2012 and 2017. We conducted an exploratory factor analysis of Beck Depression Inventory (BDI) items using a robust expectation-maximization algorithm, rather than a conventional expectation-maximization algorithm. This recently developed method enabled automatic detection of differential symptom patterns. We described differences in symptom patterns and conducted unadjusted and adjusted analyses of associations of symptom patterns with demographics and psychiatric histories.

FINDINGS

53 (9.7%) participants were identified by the algorithm as having a different pattern of reported symptoms compared to other participants. This group had more severe symptoms across all items-especially items related to thoughts of self-harm and self-judgement-and differed in how their symptoms related to underlying psychological constructs. History of social anxiety disorder (OR: 4.0; 95% CI [1.9, 8.1]) and history of childhood trauma (for each 5-point increase, OR: 1.2; 95% CI [1.1, 1.3]) were significantly associated with this differential pattern after adjustment for other covariates.

INTERPRETATION

Social anxiety disorder and childhood trauma are associated with differential patterns of severe postpartum depressive symptoms, which might warrant tailored strategies for screening, diagnosis, and treatment to address these comorbid conditions.

FUNDING

There are no funding sources to declare.

Intergenerational Pathways Linking Mothers' Adverse Childhood Experiences and Children's Social-Emotional Problems

Despite the persistent hypothesis that adverse childhood experiences (ACE) have intergenerational implications, empirical research documenting the effects and the mechanisms of transmission remains underdeveloped. This study examined the intergenerational effects of mothers' adverse childhood experiences on their offspring's social-emotional development and whether the association was mediated by mothers' mental health, adult adversity, and perceptions of paternal involvement. The study sample included 831 mothers (19-49 years old, 47.5% White) with children aged 12-48 months who participated in a longitudinal investigation of low-income families in Wisconsin. ACEs were assessed by home visitors, and two waves of survey data were collected by researchers to assess demographics, mediators, and social-emotional outcomes. A path analysis showed that the association between maternal ACEs and children's social-emotional problems was fully mediated, with postpartum mental health acting as a primary mechanism. Implications for intervention and future research directions are discussed.

Challenges of Perinatal Depression Care in Mexico City Health Centers

Background

Perinatal depression is a common mental disorder regarded as a severe public health problem. Studies have shown that incorporating mental health care into primary health services that provide pregnancy care makes it easier for women to seek help for depressive symptoms. In this context, the following question is of interest: How prepared are primary health services in Mexico City that provide pregnancy and postpartum care to treat perinatal depression? This article seeks to explore the perceptions and knowledge of perinatal depression in health professionals and analyze the barriers to its care at primary care centers in Mexico City.

Methods

An exploratory study with a qualitative approach was conducted. Doctors, nurses, social workers who provide maternal and childcare, mental health personnel, and the directors of four centers were interviewed. Interviews were audio-recorded and transcribed for thematic analysis.

Results

Most primary care personnel are unaware of the Official Standard that recommends providing maternal mental health care during the perinatal period. There is no initiative for its incorporation into routine care. A significant barrier to its implementation is health professionals' biased, stereotyped perception of perinatal depression, motherhood, and the role of women. Other barriers include the workload of health professionals, the division of care between professionals, and the lack of communication between the latter. Women with psychological symptoms are not referred to mental health staff in a timely manner. Social workers are in closer contact with women and are more willing to address their emotional distress.

Conclusion

Maternal mental health care, contingent on pregnancy, childbirth, and puerperium care at primary care centers is currently not possible due to the lack of knowledge, barriers, and directors' dependence on hospital management decisions.

Trajectories and Correlates of Anger During the Perinatal Period

OBJECTIVES

To investigate trajectories of anger during pregnancy and the early postpartum period; to identify baseline psychosocial predictors of anger trajectory group membership; and to examine correlates of anger trajectory group membership, including symptoms of depression, anxiety, insomnia, and social support, in the postpartum period.

DESIGN

Longitudinal descriptive design.

SETTING

We recruited participants from a maternity clinic in Calgary, Alberta, Canada.

PARTICIPANTS

The sample included a convenience sample of 143 pregnant women who had basic fluency in English, were older than 17 years of age, and were less than 19 weeks gestation with a single fetus at the time of recruitment.

METHODS

Participants completed online questionnaires at four time points: early, mid-, and late pregnancy and 2 months after birth. We used group-based semiparametric mixture modeling to estimate patterns of anger. We used multinomial logistic regression to explore associations between baseline predictors and trajectory membership.

RESULTS

We identified four distinct trajectories of anger during pregnancy through 2 months after birth: minimal-stable anger (52.4%), mild-stable anger (27.5%), moderate-stable anger (12.7%), and high-decreasing anger (7.4%). Membership in the moderate-stable group was associated with greater baseline symptoms of depression, anxiety, and insomnia severity scores compared to the minimal-stable anger group. Moderate-stable trajectory group membership was also associated with greater symptoms of anxiety, depression, and insomnia at 2 months after birth.

CONCLUSION

Higher levels of anger were associated with worse mental health in pregnancy and after childbirth in our participants. Women should be made aware of anger as a possible mood disturbance by clinicians, and researchers should investigate the consequences of anger during the perinatal period.

Maternal prenatal infection and anxiety predict neurodevelopmental outcomes in middle childhood

Prenatal maternal infection and anxiety have been linked, in separate lines of study, with child neurodevelopment. We extend and integrate these lines of study in a large prospective longitudinal cohort study of child neurodevelopment. Data are based on the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort; prenatal maternal anxiety was assessed from self-report questionnaire; prenatal infection was derived from reports of several conditions in pregnancy (n = 7,042). Child neurodevelopment at approximately 8 years of age was assessed by in-person testing, reports of social and communication problems associated with autism, and psychiatric evaluation. Covariates included psychosocial, demographic, and perinatal/obstetric risks. Prenatal infection was associated with increased likelihood of co-occurring prenatal risk, including anxiety. Regression analyses indicated that both prenatal infection and prenatal anxiety predicted child social and communication problems; the predictions were largely independent of each other. Comparable effects were also found for the prediction of symptoms of attention problems and anxiety symptoms. These results provide the first evidence for the independent effects of prenatal infection and anxiety on a broad set of neurodevelopmental and behavioral and emotional symptoms in children, suggesting the involvement of multiple mechanisms in the prenatal programming of child neurodevelopment. The results further underscore the importance of promoting prenatal physical and mental health for child health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).