Allopregnanolone in the peripartum: Correlates, concentrations, and challenges - A systematic review

BACKGROUND

Allopregnanolone (ALLO) is a metabolite of progesterone and a neuroactive steroid hormone. As a positive allosteric modulator of gamma-aminobutyric acid (GABA) receptors, ALLO seems to have antidepressant and anxiolytic effects, and was therefore approved as a specific medication for the treatment of postpartum depression in 2019. Despite the growing number of publications investigating ALLO levels, results on the biological and psychological correlates in the peripartum period remain inconsistent, possibly due to methodological challenges regarding measurement. To date, however, there is no systematic review examining the correlates, concentrations, and challenges in measuring ALLO in peripartum women.

METHOD

A systematic literature search of PubMed and PsycINFO was conducted in August 2023. Original research articles that measured ALLO concentrations in peripartum women were included. Reports were excluded if they were not original research, included non-human subjects, did not include peripartum women, did not include ALLO measurement as an outcome, included (pharmacological) interventions, constituted method validations, or used the same cohort as another study.

RESULTS

The literature search yielded 234 articles, and two articles were identified from other sources. After full-text screening, 19 articles (N = 1401) met the inclusion criteria, of which seven focused on biological correlates of ALLO and 12 on mood correlates. Of the latter, six found no association between ALLO and mood, four found a negative association, and two found a positive association. Overall, the results show an increase in ALLO levels during pregnancy and a decrease after birth, with levels then remaining low until six months postpartum. ALLO was most commonly measured in blood plasma and by gas chromatography-mass spectrometry (GC-MS). A significant matrix effect was found for blood serum and a significant method effect for radioimmunoassays (RIAs). A significant effect of time of measurement was found.

CONCLUSION

ALLO measurement shows method and matrix effects. ALLO levels are higher when measured in serum compared to in plasma, and when measured using RIA compared to other methods. Time of measurement, study design, and standardization of measurement also influence the reliability of measurement and the interpretation of results.

The role of estrogen receptor gene polymorphisms in menopausal symptoms and estradiol levels in perimenopausal women - Findings from the Swiss Perimenopause Study

OBJECTIVES

Fluctuating estradiol (E2) levels seem to be associated with menopausal symptoms, though not all women suffer from these symptoms to the same extent despite experiencing these hormonal changes. This suggests underlying, interindividual mechanisms, such as single-nucleotide polymorphisms (SNPs) influencing estrogen receptors α and β, and the g-protein-coupled estrogen receptor (GPER). As research is scarce, we aimed to address this research gap by assessing genetic traits, E2 levels, and menopausal symptoms longitudinally.

STUDY DESIGN

129 perimenopausal women (aged 40-56 years) participated in the 13-month longitudinal Swiss Perimenopause Study.

MAIN OUTCOME MEASURES

Menopausal symptoms were assessed fortnightly using the Menopause Rating Scale (MRS II). Salivary E2 levels were assessed 14 times over two non-consecutive months. Blood samples were collected using the dried blood spot (DBS) technique to analyze ESR1 rs2234693, ESR1 rs9340799, ESR2 rs1256049, ESR2 rs4906938, and GPER rs3808350. Group-based trajectory modeling was performed to identify interindividual trajectories of menopausal symptoms. Multinomial logistic regression models were employed to identify factors associated with these trajectories.

RESULTS

Four distinct trajectory groups of menopausal symptoms were identified (increase, moderate, rebound, decrease). ER gene polymorphisms and E2 fluctuation were significantly associated with group membership. Furthermore, ER gene polymorphisms modulated the effect of E2 fluctuations on menopausal symptom trajectory.

CONCLUSIONS

This study illuminates the multifaceted factors contributing to the individuality of the perimenopausal experience. ER gene polymorphisms emerged as integral factors by modulating the effect of E2 fluctuations on menopausal symptom trajectory. This underscores the intricate interplay of genetic factors, E2 fluctuations, and menopausal symptoms during perimenopause.

Emerging effects of temperature on human cognition, affect, and behaviour

Human body core temperature is tightly regulated within approximately 37 °C. Global near surface temperature has increased by over 1.2 °C between 1850 and 2020. In light of the challenge this poses to human thermoregulation, the present perspective article sought to provide an overview on the effects of varying ambient and body temperature on cognitive, affective, and behavioural domains of functioning. To this end, an overview of observational and experimental studies in healthy individuals and individuals with mental disorders was provided. Within body core temperature at approximately 37 °C, relatively lower ambient and skin temperatures appear to evoke a need for social connection, whereas comparably higher temperatures appear to facilitate notions of other as closer and more sociable. Above-average ambient temperatures are associated with increased conflicts as well as incident psychotic and depressive symptoms, mental disorders, and suicide. With mild hypo- and hyperthermia, paradoxical effects are observed: whereas the acute states are generally characterised by impairments in cognitive performance, anxiety, and irritability, individuals with depression experience longer-term symptom improvements with treatments deliberately inducing these states for brief amounts of time. When taken together, it has thus become clear that temperature is inexorably associated with human cognition, affect, and (potentially) behaviour. Given the projected increase in global warming, further research into the affective and behavioural sequelae of heat and the mechanisms translating it into mental health outcomes is urgently warranted.

Associations of maternal prenatal psychological symptoms and saliva cortisol with neonatal meconium microbiota: A cross-sectional study

Alterations in the diversity and relative abundances of the gut microbiome have been associated with a broad spectrum of medical conditions. Maternal psychological symptoms during pregnancy may impact on offspring development by altering the maternal and the foetal gut microbiome. We aimed to investigate whether self-reported maternal anxiety, depressive symptoms, and distress as well as saliva cortisol levels in late pregnancy alter the bacterial composition of the infant's meconium.

METHODS

A total of N = 100 mother-infant pairs were included. Maternal psychological symptoms were measured using psychological questionnaires (EPDS, PSS-10, STAI) at 34-36 weeks gestation and salivary cortisol was measured at 34-36 and 38 weeks gestation. Infant meconium samples were collected in the first five days postpartum and analysed using 16S rRNA amplicon sequencing.

RESULTS

Correlations showed that lower alpha diversity of the meconium microbiome was significantly associated with increased maternal prenatal depressive symptoms in late gestation (τ = -0.15, p = .04). Increased saliva cortisol AUCg at T2 was significantly related to higher beta diversity of the meconium samples (Pr(>F) = 0.003*). Pseudomonas was the most abundant phylum and was associated with maternal saliva cortisol total decline. No other associations were found.

CONCLUSIONS

Maternal prenatal depressive symptoms are associated with infant faecal microbiome alpha diversity, whereas maternal saliva cortisol AUCg is linked to increased beta diversity and total decline related to increased Psuedomonas. Future studies are warranted to understand how these microbiota community alterations are linked to child health outcomes.

Early life stress in women with autoimmune thyroid disorders

Autoimmune thyroid disorders (AITD) represent the most frequent of all autoimmune disorders. Their aetiopathogenesis is incompletely understood, but most likely multifactorial. Early life stress can have long-lasting effects on the immune system. The aim of the present study was to investigate, for the first time, whether patients with AITD are more frequently affected by early life stress. A total of N = 208 women were recruited into a case-control study. Of these, n = 78 (median age: 53, interquartile range: 15) were patients recruited from a thyroid outpatient clinic with confirmed Hashimoto's thyroiditis, Graves' disease, or AITD not otherwise specified. The remaining n = 130 age- and BMI-matched women (median age: 53, interquartile range: 12) were recruited from the general population. Early life stress was measured with the Childhood Trauma Questionnaire. Patients with AITD did not differ from controls regarding sexual abuse, physical abuse, and physical neglect. However, a greater number of patients reported emotional neglect (29.7% vs. 19.5%) and emotional abuse (41.3% vs. 32%). This study provides initial evidence for emotional neglect and abuse as potential risk factors for the development of AITD. Prospective confirmation of these findings could pave the way for the development of interventions to prevent AITD in predisposed individuals.

Effects of resilience training on mental, emotional, and physical stress outcomes in military officer cadets

Resilience is an important factor in counteracting the harmful effects of stress and is associated with healthy physiological and psychological responses to stress. Previous research has demonstrated the effectiveness of resilience fostering training programs in psychobiological stress response and recovery. Few studies, however, have examined training effects in real-life high-stress situations. In this study, we compare effects of a brief resilience training (RT) and an active control training in diversity management (DMT) on psychobiological stress response to and recovery from an intense military exercise of 81 male officer cadets. Five weeks after training completion, autonomic, endocrine, and subjective state measures of cadets were measured while undergoing stressful military exercise. The RT group perceived the military stressor as more challenging, and showed higher values in motivation and positive affect than the DMT group. Cortisol increased in both groups during stress, but showed a lower cortisol increase in the RT group thereafter. These results suggest that this brief resilience training helped cadets reframe the stressful situation in a more positive light, experiencing more positive emotions, and recovering faster from stress. To strengthen young military leaders in stressful situations, resilience promoting programs should become part of basic or leadership trainings.

The association between prenatal famine, DNA methylation and mental disorders: a systematic review and meta-analysis

BACKGROUND

Undernutrition in pregnant women is an unfavorable environmental condition that can affect the intrauterine development via epigenetic mechanisms and thus have long-lasting detrimental consequences for the mental health of the offspring later in life. One epigenetic mechanism that has been associated with mental disorders and undernutrition is alterations in DNA methylation. The effect of prenatal undernutrition on the mental health of adult offspring can be analyzed through quasi-experimental studies such as famine studies. The present systematic review and meta-analysis aims to analyze the association between prenatal famine exposure, DNA methylation, and mental disorders in adult offspring. We further investigate whether altered DNA methylation as a result of prenatal famine exposure is prospectively linked to mental disorders.

METHODS

We conducted a systematic search of the databases PubMed and PsycINFO to identify relevant records up to September 2022 on offspring whose mothers experienced famine directly before and/or during pregnancy, examining the impact of prenatal famine exposure on the offspring's DNA methylation and/or mental disorders or symptoms.

RESULTS

The systematic review showed that adults who were prenatally exposed to famine had an increased risk of schizophrenia and depression. Several studies reported an association between prenatal famine exposure and hyper- or hypomethylation of specific genes. The largest number of studies reported differences in DNA methylation of the IGF2 gene. Altered DNA methylation of the DUSP22 gene mediated the association between prenatal famine exposure and schizophrenia in adult offspring. Meta-analysis confirmed the increased risk of schizophrenia following prenatal famine exposure. For DNA methylation, meta-analysis was not suitable due to different microarrays/data processing approaches and/or unavailable data.

CONCLUSION

Prenatal famine exposure is associated with an increased risk of mental disorders and DNA methylation changes. The findings suggest that changes in DNA methylation of genes involved in neuronal, neuroendocrine, and immune processes may be a mechanism that promotes the development of mental disorders such as schizophrenia and depression in adult offspring. Such findings are crucial given that undernutrition has risen worldwide, increasing the risk of famine and thus also of negative effects on mental health.

Effects of improved on-farm crop storage on perceived stress and perceived coping in pregnant women-Evidence from a cluster-randomized controlled trial in Kenya

BACKGROUND

Food insecurity can be harmful to pregnant women, as pregnancy is a challenging period with increased maternal nutritional requirements to ensure optimal fetal development and health of the mother. Whether food insecurity negatively affects maternal health may depend on how stressful pregnant women perceive this food insecurity to be and how strongly they believe they can cope with it. In Sub-Saharan Africa (SSA), pregnant women from smallholder households suffer from food insecurity due to post-harvest losses (PHL), i.e., loss of crops because of inadequate storage. An agricultural intervention that improves crop storage has been shown to reduce food insecurity. However, it remains to be determined whether this agricultural intervention (treatment) has an additional positive effect on pregnant women's perceived stress levels and coping abilities. This study examines whether pregnant women from treatment households experience lower perceived stress levels and higher perceived coping abilities compared to pregnant women from control housholds.

METHODS AND FINDINGS

In a randomized controlled trial (RCT), short message service (SMS)-based mobile phone surveys were conducted to assess the causal effect of a food security intervention (improved on-farm storage of maize) on perceived stress and coping in pregnant women from smallholder households. Pregnant women were identified through these monthly surveys by asking whether someone in their household was currently pregnant. The significant results revealed that pregnant women from treatment households experienced more perceived stress but better perceived coping abilities compared to pregnant women from control households. Uncertainty due to lack of experience, this might have contributed to the higher perceived stress, as the women could not easily judge the benefits and risks of the new storage technology. However, the technology itself is a tangible resource which might have empowered the pregnant women to counteract the effects of PHL and thus food insecurity.

CONCLUSION

Our findings indicate that pregnant women from treatment households had higher perceived coping abilities but experienced more perceived stress. More research is needed on how this technology impacts maternal mental health in a broader sense and whether biological mechanisms, such as epigenetics, may underlie this association.

Longitudinal Course of Sex Steroids From Pregnancy to Postpartum

CONTEXT

Sex steroids (SS) typically rise during pregnancy and decline after birth, but no consistent reference values exist for these hormonal courses. We aimed to establish an overview of SS secretion patterns during the peripartum and to better understand how SS contribute to maternal and fetal pathologies.

EVIDENCE ACQUISITION

A systematic literature search was conducted in accordance with the PRISMA guidelines using PubMed, Cochrane Library, and PsycINFO. Additionally, we conducted a supplementary manual search of references. Observational studies published in English and assessing estradiol, progesterone, and testosterone over the course of the peripartum in physically healthy female subjects were included, without restrictions on year of publication. Extracted data were analyzed descriptively and visually.

EVIDENCE SYNTHESIS

SS increase progressively during pregnancy, with an extremely wide range of reported concentrations, especially in the third trimester. In fact, reported concentrations varied up to 5000-fold at comparable measurement time points.

CONCLUSIONS

A comprehensive understanding of the influence of SS levels on associated maternal and fetal pathologies is currently hindered by 2 main factors. First, reported SS levels vary widely during the peripartum period. Second, the current state of knowledge on how SS are associated with pathologies in mothers and babies is largely based on correlational studies, and causality thus remains unclear. Consequently, we recommend the development of a systematic reference framework that follows the suggestions presented in this review. This would enable the establishment of SS reference values for a healthy population, resulting in the possibility to draw conclusions about deviations and related pathologies.

Evaluation of a male-specific psychotherapeutic program for major depressive disorder compared to cognitive behavioral therapy and waitlist: study protocol for a six-arm randomized clinical superiority trial examining depressed eugonadal and hypogonadal men receiving testosterone

Background

Treatment of major depressive disorder (MDD) in men is complicated by the endorsement of traditional masculinity ideologies (TMI) often leading to reluctance toward psychotherapy, therapy interfering processes, or premature termination. In addition, it has been shown that men with MDD have a significantly increased risk of being hypogonadal (e.g., total testosterone levels <12.1 nmoL/L). Therefore, it is recommended to examine depressed men with regard to their testosterone status and if hypogonadism is present to combine psychotherapy with testosterone treatment (TT).

Aim

This project aims to evaluate a male-specific psychotherapeutic program (MSPP) for MDD in depressed eugonadal and hypogonadal men receiving testosterone in comparison to a standard cognitive behavioral therapy (CBT) for MDD and a Waitlist.

Methods

The study presents a 2×3 factorial study design. In total, 144 men aged between 25 and 50 will be stratified by testosterone status (eugonadal/hypogonadal) and then randomized into one of the three conditions (MSPP, CBT, or Waitlist). Additionally, a healthy control group of 100 men will be recruited, which will undergo only baseline assessments. Both standardized psychotherapy programs will encompass 18 sessions delivered in a weekly manner. Aligned with the TT-related medical visits of the 72 hypogonadal men, all participants will be followed up with clinical assessments and bio sampling at weeks 0, 6, 15, 24, and 36.

Expected results

Compared to Waitlist control groups, treatment groups are expected to be more effective and efficacious (depression score reduction of ≥50%) at week 24 and at the follow-up at week 36. The MSPP is expected to show higher effectiveness and efficacy for depressive symptoms and higher acceptability (lower dropout rate) as compared to CBT.

Discussion

This study represents the first attempt to test a male-specific psychotherapy for MDD in a single-setting compared to standard CBT and a Waitlist control condition using randomized clinical trial methodology. In addition, the potential positive adjunct effect of psychotherapy to TT in reducing depressive burden and improving quality of life in hypogonadal depressed men represents a neglected research area and might introduce new hypogonadism screening procedures in depressed men and combined treatment approaches for depressed men suffering from hypogonadism. Limitations are the rigorous inclusion and exclusion criteria, which limit the generalizability of the study results to first episode treatment naïve depressed men.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT05435222.

Does psychological treatment of major depression reduce cardiac risk biomarkers? An exploratory randomized controlled trial

BACKGROUND

Depression is associated with an increased risk for cardiovascular disease (CVD). Biological cardiac risk factors are already elevated in depressed patients without existing CVD. The purpose of this exploratory trial was to examine whether treating Major Depression (MD) with cognitive behavioral therapy (CBT) is associated with improvements in cardiac risk biomarkers and whether depressive symptom severity at baseline moderates treatment effects.

METHODS

Eighty antidepressant-free patients with MD were randomly assigned to CBT or waiting list (WL). Biological outcomes included long-term recordings (24-h, daytime, nighttime) of heart rate, heart rate variability (HRV), and blood pressure, as well as inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α. A sample of 40 age- and sex-matched non-clinical controls was also involved to verify biological alterations in MD at study entry.

RESULTS

Compared to WL, CBT was associated with a significant increase in overall HRV, as indexed by the 24-h and daytime HRV triangular index, as well as trend improvements in 24-h low-frequency HRV and daytime systolic blood pressure. Self-rated depressive symptom severity moderated (or tended to moderate) improvements in CBT for 24-h and daytime heart rate and several indices of HRV (especially daytime measures). Inflammatory treatment effects were not observed.

CONCLUSIONS

CBT increased overall HRV in patients with MD. Initially more depressed patients showed the most pronounced cardiovascular improvements through CBT. These exploratory findings may provide new insights into the biological effects of psychological treatment against depression and must be confirmed through future research.

Testosterone and cortisol responses to acute and prolonged stress during officer training school

Prolonged or severe stress has been found to inhibit the hypothalamic-pituitary-gonadal axis (HPG) and its testosterone release. In contrast, acute stress, including competition, social evaluation, or physical challenges, shows more inconsistent response patterns. This study examined changes in cortisol and testosterone across different types and durations of stress in the same individuals. We further explored the influence of baseline levels on hormonal stress responses. Sixty-seven male officer cadets in the Swiss Armed Forces (mean age 20.46 years ± 1.33) were assessed during two different acute stressors-the Trier Social Stress Test for Groups (TSST-G) and a brief military field exercise-and in the long-term during the 15-week officer training school. Several saliva samples were collected before and after the acute stressors for cortisol and testosterone. Morning testosterone was assessed four times during officer training school. There were significant increases in cortisol and testosterone during the TSST-G and the field exercise. Baseline levels of testosterone were negatively associated with acute cortisol response during the field exercise but not during the TSST-G. Morning saliva testosterone decreased during the first 12 weeks of officer training school and increased again in week 15, with no differences to baseline levels. The findings suggest that group stress tests such as the TSST-G or field exercises in groups may be particularly challenging for young men. The results also point to an adaptive role of testosterone during acute challenges during prolonged stress.

Associations between indices of 24-hour heart rate variability and inflammation in individuals with major depressive disorder

Biological cardiac risk factors, including reduced heart rate variability (HRV) and inflammation, are already prominent in patients with major depressive disorder (MDD) without existing cardiovascular disease. Although inverse relations between HRV and inflammation have been found across several populations, little work has been done concerning MDD. The present work thus intended to examine whether measures of HRV indices based on 24-h electrocardiograph recordings (24-h, daytime, nighttime) relate to levels of circulating inflammatory markers such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-α in eighty antidepressant-free individuals with MDD. A sample of 40 age- and sex-matched non-clinical controls was also involved to verify biological alterations in MDD. Individuals with MDD exhibited reduced total 24-h HRV (i.e., triangular index) and reduced daytime HRV (i.e., triangular index, HF-HRV, LF-HRV, RMSSD), as well as increased levels of all inflammatory markers. Multivariate analyses adjusted for age, sex, body mass index, and smoking revealed robust inverse associations of total 24-h HRV (i.e., triangular index) and daytime HRV (i.e., Triangular index, HF-HRV, LF-HRV, RMSSD) with IL-6. An attenuated daytime HRV may relate to higher circulating levels of IL-6 in the context of MDD. These findings show that biological cardiac risk factors may act in concert in MDD.

How do traditional masculinity ideologies and emotional competence relate to aggression and physical domestic violence in cisgender men?

Background

Men are disproportionately often perpetrators of physical domestic violence (DV). Gender role constructs, such as traditional masculinity ideologies (TMI), are broadly accepted as an explanation for this effect. Emotional competence further constitutes an important role in TMI and the prevention of DV. However, the interactions between these constructs remains unclear.

Objective

The present study aims to investigate associations of TMI with aggression, DV perpetration, and emotional competence, while also examining emotional competence as a potential moderator.

Method

A sample of 428 cisgender men (Mage = 43.9 ± 15.3) from German-speaking countries in Europe completed an anonymous online survey that assessed TMI, aggression, and DV perpetration as well as alexithymia, emotion regulation, and self-compassion as indicators of emotional competence.

Results

Strong TMI were associated with high levels of aggression and overall reduced emotional competence, as reflected by high levels of alexithymia, frequent use of expressive suppression, and low levels of self-compassion. Strong conformity to TMI was associated with a higher likelihood for DV perpetration when considering relevant sociodemographic covariates. Moderation analyses revealed that expressive suppression buffered the association between TMI and DV perpetration.

Conclusion

Men with strong TMI report high levels of aggression and impaired emotional competence. While strong conformity to TMI was associated with more frequent perpetration of DV, higher expressive suppression seems to buffer the association between TMI and DV perpetration. The present study highlights the importance of addressing gender ideologies when working on aggression, DV perpetration and emotional competence in men.

Positive body perception and its link to sexual satisfaction in aging women - findings from the Women 40+ Healthy Aging Study

Research on the relation between physical appearance and sexual satisfaction in aging women is scarce. This study uniquely links attractiveness, body perception, and sexual satisfaction in 124 healthy aging women. Two-thirds reported being highly sexually satisfied. BMI and fat mass correlated significantly with sexual satisfaction. Weight and shape concerns moderated this relationship, affecting sexual satisfaction beyond the effect of body size and composition. Given the "unattractive stereotype" of older women related to the enduring social beauty ideal of a youthful and thin body, positive body perceptions in light of age-associated bodily changes should be promoted.

Individual and Work-Related Psychological Characteristics Contributing to Subjective Well-Being in Air Rescue Employees

OBJECTIVE

Air rescue staff are subject to stressors, including frequent traumatic events, shift work, and unfavorable conditions during rescue missions. We investigated subjective well-being among employees of the Swiss Air-Rescue organization and the potential determining factors, such as sense of coherence, self-esteem, coping, stress, and mental health status.

METHODS

All employees (N = 142) received a questionnaire battery composed of the Trier Inventory for the Assessment of Chronic Stress, the Salutogenic Subjective Work Analysis, the Stress Coping Questionnaire, the Health and Stress Questionnaire, the Sense of Coherence Scale 13-item scale, the Inventory for the Measurement of Self-Efficacy and Externality, the Brief Symptom Inventory, the 12-item General Health Questionnaire, and the Posttraumatic Stress Diagnostic Scale. A discriminant analysis was conducted (input: subjective well-being, output: potential determining factors). A total of 48 participants provided complete data.

RESULTS

The discriminant analysis was significant (χ² = 40.80, P < .001; correct classification: 89.4%) and revealed that sense of coherence (F_1,45 = 40.46) and self-esteem (F_1,45 = 36.20) were the most important discriminating factors for subjective well-being.

CONCLUSION

Sense of coherence and self-esteem play an important role in the subjective well-being of emergency and rescue personnel. Fostering these traits should be included in preventive programs.

Trajectories of reproductive transition phase mood disorder from pregnancy to postpartum: A Swiss longitudinal study

BACKGROUND

Depressive symptoms are common in the peripartum period and pose a great risk to the well-being of the mother, the infant, and the entire family. Evidence from longitudinal studies suggests that affected women do not constitute one homogeneous group in terms of severity, chronicity, and onset of symptoms. To account for individual differences regarding the longitudinal course of depressive symptoms from pregnancy to the postpartum period, growth mixture models have proven to be useful.

METHODS

We conducted a group-based trajectory modeling analysis to identify perinatal depressive symptom trajectories in a Swiss sample (n = 151). Depressive symptoms were assessed six times, covering nearly 6 months from the third trimester of pregnancy to 3 months postpartum. In addition to determining perinatal depressive symptom trajectories, we aimed to examine whether these trajectories are linked to psychopathological risk factors such as a history of premenstrual syndrome (PMS), anxiety, prenatal stress, and somatic symptoms after delivery that are associated with hormonal fluctuations.

RESULTS

The findings revealed three trajectories of perinatal depressive symptoms that were relatively stable over time and differed in symptom load (low, medium, high), as well as one trajectory of decreasing symptoms, with a significant symptom reduction after giving birth. Women with a higher depressive symptom load experienced a greater degree of prior premenstrual symptoms, prenatal anxiety, and birth anxiety, as well as somatic symptoms after delivery.

CONCLUSION

Further research is needed to account for the distinct trajectories of perinatal depressive symptoms in order to provide appropriate care for affected women. A focus on somatic symptoms after delivery and their association with depressive mood is essential to better understand the potential shared etiopathology of reproductive transition phase mood disorders.

Effects of intranasal oxytocin and positive couple interaction on immune factors in skin wounds

BACKGROUND

Intimate social relationships improve individual health and longevity, an effect which is supposed to be mediated through stress-sensitive endocrine and immune mechanisms in response to positive interaction behavior. On a neuroendocrine level, oxytocin (OT) buffers stress responses, modulates social attachment behavior and has been associated with cytokine expression. Consequently, the aim of the present study was to investigate instructed positive couple interaction, observed behavior, and OT in their effect on immune function.

METHODS

In a 4-group design, 80 healthy couples (N = 160 individuals) received four standard dermal suction blister wounds and were randomized to instructed positive interaction/control and intranasal OT/placebo. Unstimulated cytokines (IL-1β, IL-6, TNF-α) were assessed from wound liquid at 40 min, 105 min and 24 hrs after wounding.

RESULTS

Overall, group assignment did not affect friendly or dominant behavior during the interaction sequence. IL-1β and IL-6 levels, however, were moderated by group assignment with lowest levels in women in the positive interaction and OT condition in IL-1 and highest levels in IL-6. TNF-α responses to wounding were not affected from group assignment, however observed friendliness in women was associated with lower TNF-α levels.

DISCUSSION

These findings support the immune-regulating role of friendly behavior in romantic couples. Above this, the data provide the first empirical evidence that an intervention that simultaneously targets neuroendocrine mediators and behavior could affect immune function in a sex specific manner and with potential long-term health relevance.

New directions in male-tailored psychotherapy for depression

Purpose of review

Societal, cultural, and contextual norms about how men should be and behave (so called traditional masculinity ideologies; TMI) affect men's presentation of depressive disorders, psychotherapy use, and treatment engagement. Only recently, however, male-tailored psychotherapy approaches for depressive disorders have been developed, which aim to systematically soften dysfunctional TMI. In this review, we outline the necessary groundwork as well as recent advances in research on TMI, men's help-seeking, male depression, and their interrelatedness. Subsequently, we discuss the potential value of these findings for male-tailored psychotherapy for depressive disorders.

Recent findings

A preliminary evaluation of a male-specific psychoeducation program found that a male-specific psychoeducation text could reduce negative affect as well as state shame and potentially elicit a shift from externalizing depression symptoms toward more prototypical depression symptoms. The James' Place program, a male-tailored community-based service, improved suicidal men's overall well-being, problems, functioning, and suicide risk. The Heads Up Guys! program, an eHealth resource aimed at depressed men, reported a high and increasing global interest in their website, with considerable visitor engagement. The Man Therapy online resource improved depressive symptoms, suicidal ideation, and help-seeking behavior. Finally, the Men in Mind program, an online training program for clinical practitioners, increased practitioners' capacity to engage and support men in therapy.

Summary

Male-tailored psychotherapy programs for depressive disorders, which are informed by recent advances in TMI research, may potentially increase therapeutic effectiveness, engagement, and adherence. While recent preliminary analyses of individual male-tailored treatment programs show promising results, extensive and systematic primary studies evaluating these programs are pending but greatly needed.

Internet-based interventions for perinatal depression and anxiety symptoms: an ethnographic qualitative study exploring the views and opinions of midwives in Switzerland

Background

Mental disorders such as depression and anxiety are common during pregnancy and postpartum, but are frequently underdiagnosed and untreated. In the last decades, internet-based interventions have emerged as a treatment alternative showing similar effectiveness to face-to-face psychotherapy. We aimed to explore midwives’ perceptions of the acceptability of internet-based interventions for the treatment of perinatal depression and anxiety symptoms.

Methods

In this ethnographic qualitative study, semi-structured interviews were conducted with 30 midwives. We followed the Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ). Audio-recorded interviews were transcribed verbatim and analysed using framework analysis. The identified framework categories were rated individually by two independent raters. Krippendorff’s alpha coefficient was used to ensure the reliability of the rating.

Results

Four main themes emerged: midwives’ experience with patients’ mental health issues; the role of healthcare workers in women’s utilisation of internet-based interventions in the perinatal period; the overall perception of internet-based interventions; and recommendation of internet-based interventions to perinatal women. Twenty-five of the 30 participants viewed internet-based interventions as an acceptable type of intervention, which they would recommend to a subgroup of patients (e.g. women who are well-educated or younger). All except for two midwives identified themselves and medical doctors as key figures regarding patients’ utilisation of internet-based interventions, although a third of the interviewees highlighted that they needed sufficient information about such interventions. Finally, several participants suggested features which could be relevant to develop more acceptable and feasible internet-based interventions in the future.

Discussion

Participants’ overall perception of internet-based interventions for perinatal depression and anxiety symptoms was positive. This study underlines the importance of considering midwives’ views about internet-based interventions for perinatal mental health care. Our findings have implications for the practice not only of midwives but also of other maternity care professionals. Future studies examining the views of other health professionals are warranted.

• There is a lack of studies on health professionals’ views about women’s utilisation of internet-based interventions in the perinatal period.

• Our findings suggest that midwives have a positive perception of internet-based interventions, despite identifying disadvantages and having concerns about their use.

• These findings are encouraging and contribute to the continued efforts to develop internet-based mental health interventions as a way to support perinatal women screened or diagnosed with anxiety and/or depressive symptoms.

Similarities and differences between postpartum depression and depression at other stages of female life: a systematic review

BACKGROUND

Women are nearly twice as likely as men to suffer from depression throughout the life span. In particular, reproductive transition phases mark a period of vulnerability for female mood disorders. The life events of being pregnant and giving birth harbor multiple psychological and physiological challenges, and a lack of adjustment to these events can result in mood swings and depression. The purpose of this review is to provide an overview of the symptomatology of postpartum depression (PPD), including tools that have been used to assess PPD, and potential phenomenological differences to major depression during other life phases.

METHODS

A systematic literature search in the databases PubMed, Cochrane Library and PsycINFO was conducted with the keywords "postpartum depression" and "symptomatology". A total of 33 studies fulfilled the chosen criteria and were selected for the review.

RESULTS

Within the studies, 22 different tools were used to assess depressive symptoms throughout pregnancy and the postpartum period. A total of 29 questionnaires or interviews were applied to detect additional psychopathological symptoms present in the perinatal period, such as anxiety. Most studies that included a control group of non-perinatal women concluded that postpartum depression is nosologically distinct from depression occurring at other stages of female life.

DISCUSSION

Somatic symptoms in the puerperium contribute to psychopathological burden and might result in diverse clinical representations of postpartum depression. Anxiety frequently co-occurs with depression during the perinatal period. However, the diversity of screening instruments for postpartum depression does not allow for general conclusions to be drawn about similarities or differences in the psychopathological profiles of postpartum women with depression and women with depression at other stages of life.

Examining the Role of Traditional Masculinity and Depression in Men's Risk for Contracting COVID-19

In the light of the COVID-19 pandemic and claims that traditional masculinity may put some men at increased risk for infection, research reporting men's health behaviors is critically important. Traditional masculine norms such as self-reliance and toughness are associated with a lower likelihood to vaccinate or follow safety restrictions. Furthermore, infection risk and traditional masculinity should be investigated in a differentiated manner including gender role orientation, underlying traditional masculine ideologies and male gender role conflict. In this pre-registered online survey conducted during March/April 2021 in German-speaking countries in Europe, 490 men completed questionnaires regarding contracting COVID-19 as confirmed by a validated test, fear of COVID-19 (FCV-19S), and experience of psychological burden due to COVID-19. In addition, depression symptomatology was assessed by using prototypical internalizing and male-typical externalizing depression symptoms. Furthermore, self-identified masculine gender orientation, endorsement of traditional masculinity ideologies, and gender role conflict were measured. A total of 6.9% of men (n = 34) reported having contracted COVID-19 since the beginning of the pandemic. Group comparisons revealed that men who had contracted COVID-19 exhibited higher overall traditional masculine ideology and gender role conflict. Logistic regression controlling for confounders (age, income, education, and sexual orientation) indicated that only depression symptoms are independently associated with the risk of having contracted COVID-19. While prototypical depression symptoms were negatively associated with the risk of having contracted COVID-19, male-typical externalizing depression symptoms were positively associated with the risk of contracting COVID-19. For traditional masculinity, no robust association for an increased risk of contracting COVID-19 could be established, while higher male-typical externalizing depression symptoms were associated with an increased risk of contracting COVID-19.

Endogenous oestradiol and progesterone as predictors of oncogenic human papillomavirus (HPV) persistence

Background

High-risk human papillomavirus (HR-HPV) is the main aetiological factor for the development of cervical cancer. While nearly 70% of HR-HPV infections are cleared within 12 months, in the remainder of women they persist and can progress into cervical cancer. Oestradiol and progesterone have been shown to be involved in the development and progression of cervical cancer. The objective of this study was to investigate, for the first time, whether diurnal oestradiol and progesterone are also involved in HR-HPV persistence – before cervical cancer develops.

Methods

A total of N = 39 women between 18 and 31 years of age were investigated. All were nulliparous and regular users of combined oral contraceptives. Presence of HR-HPV was determined by cervical swabs. Salivary oestradiol and progesterone were measured upon awakening and at 11 am, 2 pm, and 5 pm. All HR-HPV positive women were re-tested in terms of HR-HPV status 12 months later.

Results

HR-HPV positive women had significantly higher morning (p = .007, partial eta² = .221) and daily oestradiol levels (p < .001, partial eta² = .442) when compared to HR-HPV negative women. In addition, those with persistent HR-HPV 12 months later had significantly elevated morning (p = .005, partial eta² = .534) and daily (p = .027, partial eta² = .346) oestradiol. Progesterone was found to be unrelated to HR-HPV.

Conclusions

Oestradiol was positively linked to HR-HPV presence and persistence. Provided that these findings are replicated, regular monitoring of oestradiol levels may prove useful in identifying women who are at risk of developing cervical cancer.

Steroid Hormone Secretion Over the Course of the Perimenopause: Findings From the Swiss Perimenopause Study

Background: Perimenopause is characterized by a decline in the steroid hormones, estradiol, and progesterone. By contrast, the steroid hormone cortisol, a marker of the hypothalamic–pituitary–adrenal (HPA) axis, increases. Recent longitudinal studies reported fluctuations in steroid hormone levels during perimenopause, and even increases in estradiol levels. To understand these confounding results, it is necessary to conduct a longitudinal, highly standardized assessment of steroid hormone secretion patterns in perimenopausal women.

Methods: This longitudinal study investigated 127 perimenopausal women aged 40–56 years for 13 months. Estradiol, progesterone, and cortisol were assessed using saliva samples, which were collected for two (during months 2 and 12 for estradiol and progesterone) or three (during months 2, 7, and 12 for cortisol) non-consecutive months over the course of the study. A total of 14 saliva samples per participant were analyzed to investigate the courses of estradiol and progesterone. Cortisol awakening response and fluctuations of cortisol throughout the day were measured using a total of 11 saliva samples per participant (on awakening, +30 min, +60 min, at 12:00 p.m., and before going to bed) for months 2, 7, and 12.

Results: Multilevel analyses revealed variance in intercept and slope across participants for estradiol [intercept: SD = 5.16 (95% CI: 4.28, 6.21), slope: SD = 0.50 (95% CI: 0.39, 0.64)], progesterone [intercept: SD = 34.77 (95% CI: 25.55, 47.31), slope: SD = 4.17 (95% CI: 2.91, 5.99)], and cortisol (intercept: SD = 0.18 (95% CI: 0.14, 0.23), slope: SD = 0.02 (95% CI: 0.01, 0.02)]. Time predicted cortisol levels [b = −0.02, t₍₉₇₉₎ = −6.63, p < 0.0001]. Perimenopausal status (early vs. late) did not predict estradiol [b = −0.36, t₍₁₆₀₈₎ = −0.84, p = 0.400], progesterone [b = −4.55, t₍₁₇₂₃₎ = −0.87, p = 0.385], or cortisol [b = 0.01, t₍₁₁₂₄₎ = 0.61, p = 0.542] scores over time.

Discussion: Our results are consistent with previous findings emphasizing highly individual fluctuations of estradiol and progesterone levels during perimenopause. However, our findings do not suggest a continuous decline during the observed transition phase, implying relatively stable periods of fluctuating hormone levels. Furthermore, given the lack of significant group differences, it may not be necessary to differentiate between early and late perimenopause from the standpoint of hormonal progression.

Resilience and Post-traumatic Stress Disorder in the Swiss Alpine Rescue Association

OBJECTIVE

The present study aimed to assess the frequency of trauma exposure, the prevalence of possible post-traumatic stress disorder (PTSD), the extent of resilience, and sense of coherence among personnel of the Swiss alpine rescue association (ARS).

METHODS

Using a trilingual online survey approach, 465 mountain rescuers of the ARS were surveyed using the Posttraumatic Diagnostic Scale (PDS), the PTSD Checklist 5 (PCL-5), the Resilience Scale 13 and 14 (RS-13/-14), the Perceived Stress Scale 10 (PSS-10), the General Health Questionnaire 12 (GHQ-12), the Pittsburg Sleep Quality Index (PSQI), the Sense of Coherence Scale 13 (SOC-13), and the Berlin Social Support Scales (BSSS).

RESULTS

Although the rate of mountain rescuers having witnessed or experienced a traumatic event was high (71%), the prevalence of possible PTSD was low (0.9%). The sample showed high resilience and high sense of coherence. Resilience was positively correlated with work experience. Low perceived stress and high sense of coherence predicted resilience. The severity of PTSD symptoms was mainly predicted by low sense of coherence. Sense of coherence mediated the interaction between resilience and severity of PTSD symptoms.

CONCLUSION

The findings suggest that resilience and sense of coherence are indicative for the low prevalence of possible PTSD among mountain rescuers, and may therefore represent valuable screening and training parameters for mountain rescue personnel.

Mindfulness predicts less depression, anxiety, and social impairment in emergency care personnel: A longitudinal study

Medical personnel working in emergency rooms (ER) are at increased risk of mental health problems and suicidality. There is increasing evidence that mindfulness-based interventions can improve burnout and other mental health outcomes in health care providers. In contrast, few longitudinal prospective studies have examined protective functions of dispositional mindfulness in this population. The objective of this study was to examine whether mindfulness prospectively predicts anxiety, depression, and social impairment in a sample of emergency care professionals. The authors administered online surveys to ER personnel prior to work in ER, and at 3 and 6 months follow up. Participants were 190 ER personnel (73% residents, 16% medical students, 11% nurses). Linear mixed effects regression was used to model longitudinal 3-month and 6-month follow up of depression, anxiety, and social impairment. Predictors included time-varying contemporaneous work stressors, perceived social support at work and life events, and baseline dispositional mindfulness, demographics, and workplace characteristics. Mindfulness indexed when starting ER work predicted less depression, anxiety, and social impairment 6 months later. Mindfulness remained a strong predictor of mental health outcomes after controlling for time-varying stressful events in emergency care, negative life events, and social support at work. Mindfulness moderated the adverse impact of poor social support at work on depression. To our knowledge, this is the first longitudinal study to show that mindfulness prospectively and robustly predicts anxiety, depression, and social impairment. Results support the role of mindfulness as a potential resilience factor in at-risk health care providers.

Female Intrasexual Competition and Its Link to Menopausal Stage, Sex Hormone Levels, and Personality Characteristics

Background: Female intrasexual competition (ISC) represents a unique form of social interaction. It describes behaviors primarily applied to enhance a woman's ability to outcompete other women. Previous research suggests that female ISC is influenced by personality characteristics and sex hormones. Although these factors most likely interact to predict female ISC, no previous study has investigated those factors in parallel in order to link theories from social psychology and biology. Women at the end of the reproductive lifespan represent the ideal study population, as they allow for a controlled hormonal environment.

Materials and Methods: Healthy pre- (N = 53) and postmenopausal (N = 56) women were classified according to the Stages of Reproductive Aging Workshop (STRAW+10) criteria. In the follicular phase (for premenopausal women) or on a random day (for postmenopausal women), questionnaires were administered to assess the general tendency to compete intrasexually and the tendency to compete on appearance, attention/interpersonal success, and competence. Additionally, personality characteristics (neuroticism, extraversion, openness, agreeableness, conscientiousness, and self-esteem) were assessed. On the same day, each subject provided an 8 a.m. saliva sample for estradiol, testosterone, progesterone, and dehydroepiandrosterone sulfate. T-tests tested for between-group differences and separate multiple linear regression models tested for an effect of continuous hormone levels and personality characteristics on ISC. Further models were run, testing for an interaction with menopausal stage.

Results: No group differences in ISC were evident (all p > 0.05). In premenopausal women, estradiol levels positively predicted the competition for attention (β = 2.103, p = 0.022). In postmenopausal women, self-esteem predicted the tendency to compete overall (β = −0.208, p < 0.001), on appearance (β = −0.061, p = 0.01), on competence (β = −0.087, p < 0.001), and on attention/interpersonal success (β = −0.060, p = 0.01).

Discussion: These results, though cross-sectional, suggest that women continue to compete intrasexually in postmenopause, giving rise to new questions about the function of female ISC. If confirmed, the findings will indicate that hormones guide competitiveness in fertile women, whereas self-esteem accounts for individual differences in competitiveness post-reproduction. Particularly the function of postmenopausal ISC warrants further investigation.

Pregnancy-related hormones and COMT genotype: Associations with maternal working memory

Women experience different degrees of subjective cognitive changes during pregnancy. The exact mechanism underlying these changes is unknown, although endocrine alterations and genetics may be contributing factors. We investigated whether multiple pregnancy-related hormones were associated with working memory function assessed with the Digit Span Test (DST) in late pregnancy. Moreover, we examined whether the catechol-O-methyltransferase (COMT) genotype, previously related to working memory, was an effect modifier in this association. In this population-based panel study, we recorded psychiatric history, medication use, socio-demographic characteristics, and psychological well-being, gathered blood and saliva samples, and administered the DST at gestational weeks 35-39 (N = 216). We conducted multivariate linear regressions with DST as outcome, with different hormones and COMT genotype, adjusting for covariates including maternal age, BMI, education, depressive symptoms, and parity. We repeated these analyses excluding women with elevated depressive symptoms. Higher DST total scores were associated with increased free estradiol concentrations (B = 0.01, p = 0.03; B = 0.01, p = 0.02) in all participants and in participants without depressive symptoms, respectively, whereas DST forward was positively associated with free estradiol only in women without depressive symptoms (B = 0.01, p = 0.04). Lower total testosterone concentrations (B = -0.03, p = 0.01) enhanced DST backward performance in non-depressed women. Maternal higher education was significantly associated with the DST subscales in all participants. No significant differences emerged when considering the COMT genotype. Our results suggest differential associations of free estradiol and total testosterone levels with working memory function in late pregnancy.

Genes and hormones of the hypothalamic-pituitary-adrenal axis in post-traumatic stress disorder. What is their role in symptom expression and treatment response?

BACKGROUND

Less than half of all individuals with post-traumatic stress disorder (PTSD) remit spontaneously and a large proportion of those seeking treatment do not respond sufficiently. This suggests that there may be subgroups of individuals who are in need of augmentative or alternative treatments. One of the most frequent pathophysiological findings in PTSD is alterations in the hypothalamic-pituitary-adrenal (HPA) axis, including enhanced negative feedback sensitivity and attenuated peripheral cortisol. Given the role of the HPA axis in cognition, this pattern may contribute to PTSD symptoms and interfere with key processes of standard first-line treatments, such as trauma-focused cognitive behavioural therapy (TF-CBT).

METHODS

This review provides a comprehensive summary of the current state of research regarding the role of HPA axis functioning in PTSD symptoms and treatment.

RESULTS

Overall, there is preliminary evidence that hypocortisolaemia contributes to symptom manifestation in PTSD; that it predicts non-responses to TF-CBT; and that it is subject to change in parallel with positive treatment trajectories. Moreover, there is evidence that genetic and epigenetic alterations within the genes NR3C1 and FKBP5 are associated with this hypocortisolaemic pattern and that some of these alterations change as symptoms improve over the course of treatment.

CONCLUSIONS

Future research priorities include investigations into the role of the HPA axis in day-to-day symptom variation, the time scale in which biological changes in response to treatment occur, and the effects of sex. Furthermore, before conceiving augmentative or alternative treatments that target the described mechanisms, multilevel studies are warranted.

Aldosterone hyperreactivity to acute psychosocial stress induction in men with essential hypertension

Essential hypertension is a pivotal risk factor for the development of cardiovascular disease (CVD). Hypertensives exhibit greater stress-induced responses in various physiological systems considered to contribute to CVD progression. Whether this stress hyperreactivity extends to the adrenal hormone aldosterone has not yet been investigated in essential hypertension. Here, we investigated reactivity of plasma aldosterone to acute psychosocial stress induction in hypertensive and normotensive men. 21 hypertensive men and 25 normotensive controls underwent the standardized Trier-Social-Stress-Test (TSST). We repeatedly assessed plasma aldosterone before and up to 1 h after TSST cessation. Acute psychosocial stress induced significantly greater increases in hypertensives as compared to normotensives (F(3.60, 158.50) = 3.75; p = .008, f = 0.29). Our findings suggest stress-induced hyperreactivity of aldosterone in essential hypertension. Potential implications for stress-related cardiovascular risk remain to be elucidated.

Variation in genes and hormones of the hypothalamic-pituitary-ovarian axis in female mood disorders - A systematic review and meta-analysis

Women's increased risk for depression during reproductive transitions suggests an involvement of the hypothalamic-pituitary-ovarian (HPO) axis. This is the first systematic review and meta-analysis of HPO functioning in female mood disorders. Inclusionary criteria were: i) women suffering from premenstrual dysphoric disorder (PMDD) or a depressive disorder, ii) assessment of HPO-axis related biomarkers, iii) a case-control design. Sixty-three studies (N = 5,129) were included. There was evidence for PMDD to be paralleled by lower luteal oestradiol levels. Women with depression unrelated to reproductive transition showed lower testosterone levels than healthy controls and there was some evidence for lower dehydroepiandrosterone sulfate levels. There were no differences in HPO-related parameters between women with pregnancy, postpartum, and perimenopausal depression and controls. Women with PMDD and depression unrelated to reproductive transitions exhibit specific changes in the HPO-axis, which potentially contribute to their symptoms. Further research into reproductive mood disorders characterised by extreme endocrine changes is warranted.

The Lausanne Infant Crying Stress Paradigm: Validation of an Early Postpartum Stress Paradigm with Women at Low vs. High Risk of Childbirth-Related Posttraumatic Stress Disorder

Stress reactivity is typically investigated in laboratory settings, which is inadequate for mothers in maternity settings. This study aimed at validating the Lausanne Infant Crying Stress Paradigm (LICSP) as a new psychosocial stress paradigm eliciting psychophysiological stress reactivity in early postpartum mothers (n = 52) and to compare stress reactivity in women at low (n = 28) vs. high risk (n = 24) of childbirth-related posttraumatic stress disorder (CB-PTSD). Stress reactivity was assessed at pre-, peri-, and post-stress levels through salivary cortisol, heart rate variability (high-frequency (HF) power, low-frequency (LF) power, and LF/HF ratio), and perceived stress via a visual analog scale. Significant time effects were observed for all stress reactivity outcomes in the total sample (all p < 0.01). When adjusting for perceived life threat for the infant during childbirth, high-risk mothers reported higher perceived stress (p < 0.001, d = 0.91) and had lower salivary cortisol release (p = 0.023, d = 0.53), lower LF/HF ratio (p < 0.001, d = 0.93), and marginally higher HF power (p = 0.07, d = 0.53) than low-risk women. In conclusion, the LICSP induces subjective stress and autonomic nervous system (ANS) reactivity in maternity settings. High-risk mothers showed higher perceived stress and altered ANS and hypothalamic-pituitary-adrenal reactivity when adjusting for infant life threat. Ultimately, the LICSP could stimulate (CB-)PTSD research.

Estradiol and progesterone as resilience markers? - Findings from the Swiss Perimenopause Study

While resilience seems to be associated with a variety of biological markers, studies assessing such correlates in women during the perimenopause are lacking. The perimenopause constitutes a phase of major biopsychosocial changes, during which the sex hormones estradiol (E2) and progesterone (P4) eventually decrease significantly. The aim of this study was to examine the extent to which the declining levels of E2 and P4 serve as resilience markers in perimenopausal women. In 129 healthy perimenopausal women aged 40-56 years, saliva samples were collected on every fourth day over a period of four weeks in order to investigate E2 and P4 levels. All participants completed psychosocial questionnaires including variables related to resilience, well-being, and mental health. Perimenopausal status was determined using the Stages of Reproductive Aging Workshop (STRAW) criteria. The results indicate that P4 is linked to psychosocial resilience. More precisely, women with higher P4 levels seem to be more resilient than women with lower P4 levels, irrespective of the perimenopausal status. No such relation was found for E2 levels. Further analyses revealed that women with higher P4 levels experience significantly higher life satisfaction, lower perceived stress, and lower depressive symptoms than women with lower P4 levels. Accordingly, P4 can be considered as a biological marker of resilience in perimenopause.

Is stress related to the presence and persistence of oncogenic human papillomavirus infection in young women?

Background

Persistent infection with high-risk human papillomavirus (HR-HPV) is the most important risk factor for the development of cervical cancer, but factors contributing to HR-HPV persistence are incompletely understood. The objective of this study was to test for associations of chronic stress and two aspects of diurnal cortisol secretion (i.e., the cortisol awakening response [CAR] and total cortisol output over the day [AUCgday]) with HR-HPV status at baseline and 12 months later (follow-up).

Methods

We evaluated 188 women (25 ± 3 years) at baseline. Follow-up investigation was restricted to HR-HPV infected women at baseline. Of the initial 48 HR-HPV positive participants, 42 completed the follow-up (16 HR-HPV positive and 26 HR-HPV negative). At baseline and follow-up, we determined HR-HPV status in cervical smears, assessed chronic stress, and repeatedly measured salivary cortisol over the day. At baseline, we analyzed salivary cortisol only in a subgroup of 90 participants (45 HR-HPV negative and 45 HR-HPV positive).

Results

At baseline, higher chronic stress (excessive demands at work: p = .022, chronic worrying: p = .032), and a higher CAR (p = .014) were related to baseline HR-HPV positivity. At follow-up, there was a statistical trend for a positive association between the CAR and HR-HPV positivity (p = .062). Neither the CAR nor the AUCgday mediated the associations between chronic stress and HR-HPV status.

Conclusions

Our findings suggest that both chronic stress and diurnal cortisol are related to the presence of HR-HPV infection and may thus play a role in HPV-associated cervical carcinogenesis.

Real-world stress resilience is associated with the responsivity of the locus coeruleus

Individuals may show different responses to stressful events. Here, we investigate the neurobiological basis of stress resilience, by showing that neural responsitivity of the noradrenergic locus coeruleus (LC-NE) and associated pupil responses are related to the subsequent change in measures of anxiety and depression in response to prolonged real-life stress. We acquired fMRI and pupillometry data during an emotional-conflict task in medical residents before they underwent stressful emergency-room internships known to be a risk factor for anxiety and depression. The LC-NE conflict response and its functional coupling with the amygdala was associated with stress-related symptom changes in response to the internship. A similar relationship was found for pupil-dilation, a potential marker of LC-NE firing. Our results provide insights into the noradrenergic basis of conflict generation, adaptation and stress resilience.

Dysfunctional Eating Behaviour and Leptin in Middle-Aged Women: Role of Menopause and a History of Anorexia Nervosa

BACKGROUND

Weight gain is common as women approach mid-life. Reduced levels of leptin, an anorexigenic hormone, may facilitate this. Studies in middle-aged women with obesity have shown that dysfunctional eating behaviour, such as restrained eating, is linked to lower leptin. Furthermore, states of low oestradiol signalling, as are found in post-menopause or anorexia nervosa, have been found to impact leptin levels. The aim of this study was to investigate, for the first time, how different aspects of dysfunctional eating, menopausal status, and a history of anorexia nervosa relate to leptin levels in normal-weight middle-aged women.

METHODS

A total of N = 57 women were recruited. Thirty-one were post-menopausal, and 27 had a history of anorexia nervosa. Dysfunctional eating behaviour was measured by the Three-Factor Eating Questionnaire, which contains three subscales: susceptibility/responsiveness to hunger, restraint, and disinhibition. Body composition was assessed by bioelectrical impedance analysis. A fasting blood sample was obtained to determine leptin.

RESULTS

Controlling for age, body mass index, and fat mass, susceptibility/responsiveness to hunger was positively associated with leptin (β = 0.267, p = 0.031), whereas restrained eating (β = - 0.183, p = 0.079) and a history of anorexia nervosa (β = - 0.221, p = 0.059) were, by trend, negatively associated with leptin. Neither disinhibited eating nor menopausal status was related to leptin.

CONCLUSIONS

Leptin may decline as a response to repeated states of a negative energy balance. A possible implication is that mid-life weight management should avoid extreme changes in eating behaviour and instead focus on the macronutrient composition of diet and physical activity. Further, longitudinal enquiries are warranted to investigate these relationships.

Cortisol and estriol responses to awakening in the first pregnancy trimester: Associations with maternal stress and resilience factors

BACKGROUND

Little is known about the maternal cortisol awakening response (CAR) in the first pregnancy trimester. Similarly unknown is how the CAR in early gestation relates to other steroid hormones, such as estriol. Maternal estriol in blood and urine is used to monitor fetal well-being since it is produced by the fetoplacental unit from fetal precursors. Low levels have been associated with maternal-fetal complications. We were recently able to show that estriol is measurable in maternal saliva from 6 weeks' gestation onwards. However, its pattern following morning awakening and potential links with salivary cortisol in early gestation is relatively unknown. In this prospective study, we explored the cortisol and estriol responses to morning awakening in first-trimester pregnant women, the potential association of these endocrine variables with maternal stress and resilience factors, and their predictive value for the further pregnancy course.

METHODS

Fifty-one women with an uncomplicated, singleton pregnancy responded to questionnaires measuring chronic and pregnancy-specific stress, emotional support, and daily uplifts at 6 weeks' gestation. At 8 and 10 weeks, the women collected saliva samples immediately, 30, and 60 min after morning awakening. After 12 weeks, 40 women reported on the further pregnancy course, of whom 6 had developed complications.

RESULTS

In response to morning awakening, cortisol levels increased significantly at 10 weeks (p = .04), while estriol levels decreased significantly at both 8 and 10 weeks (p < .001). A stronger cortisol increase was linked to a stronger estriol decrease at 8 (p = .03), but not at 10 weeks. Then, perceived emotional support at 6 weeks was negatively associated with cortisol baseline at 8 (p = .01) and positively with estriol baseline at 10 weeks (p = .03). Moreover, higher pregnancy-specific stress was related to a lower estriol baseline at 8 weeks (p = .047). Furthermore, compared to healthy women, those with complications at follow-up had already reported less emotional support (p = .03) and fewer daily uplifts (p = .03) at 6 weeks. These women also seemed to lack a significant estriol response to morning awakening at 8 weeks (p > .10).

DISCUSSION

These findings advance our knowledge of cortisol and estriol secretion following morning awakening and encourage the investigation of E3 in addition to cortisol when researching prenatal stress and its consequences for maternal and fetal health.

Improved storage mitigates vulnerability to food-supply shocks in smallholder agriculture during the COVID-19 pandemic

Millions of smallholder farmers in low-income countries are highly vulnerable to food-supply shocks, and reducing this vulnerability remains challenging in view of climatic changes. Restrictions to limit the spread of the COVID-19 pandemic produced a severe supply-side shock in rural areas of Sub-Saharan Africa, including through frictions in agricultural markets. We use a large-scale field experiment to examine the effects of improved on-farm storage on household food security during COVID-19 restrictions. Based on text message survey data we find that the prevalence of food insecurity increased in control group households during COVID-19 restrictions (coinciding with the agricultural lean season). In treatment households, equipped with an improved on-farm storage technology and training in its use, food insecurity was lower during COVID-19 restrictions. This underscores the benefits of improved on-farm storage for mitigating vulnerability to food-supply shocks. These insights are relevant for the larger, long-term question of climate change adaptation, and also regarding trade-offs between public health protection and food security.

Oxytocin and positive couple interaction affect the perception of wound pain in everyday life

A large body of animal and human laboratory research has linked social interaction and support to pain perception, with a possible role for the neuropeptide oxytocin as a neuroendocrine mediator. However so far, it has been unclear whether these effects translate to ecologically valid everyday life behavior and pain perception. In a randomized placebo-controlled study, a standard suction blister skin wound was induced to N = 80 romantic couples (N = 160 individuals). Couples then received intranasal oxytocin or placebo twice daily and were either instructed to perform a positive social interaction (partner appraisal task, PAT) once in the laboratory and two times during the following five days, or not. During these days, all participants reported their subjective pain levels multiple times a day using ecologically momentary assessment. Results from hierarchical linear modeling suggest that pain levels within the couples were inter-related. In men, but not in women, oxytocin reduced pain levels. Women reported lower pain levels in the group of positive social interaction, while this effect did not show in men. These results suggest that intranasal oxytocin might have sex-specific effects with pain reducing effects in men but the opposite effects in women. In contrast, especially women benefit from positive interaction in terms of dampened pain levels after positive interaction. The results add to the evidence for health-beneficial effects of positive couple interaction and point to underlying neuroendocrine mechanisms in everyday life pain specifically. The sex-specific effects, in particular, may have implications for psychopharmacological treatment of pain in men and women.

Steroid Hormone Sensitivity in Reproductive Mood Disorders: On the Role of the GABAA Receptor Complex and Stress During Hormonal Transitions

Women worldwide are two to three times more likely to suffer from depression in their lifetime than are men. Female risk for depressive symptoms is particularly high during the reproductive years between menarche and menopause. The term “Reproductive Mood Disorders” refers to depressive disorders triggered by hormonal fluctuations during reproductive transitions including the perimenarchal phase, the pre-menstrual phase, pregnancy, the peripartum period and the perimenopausal transition.

Here we focus on reproductive mood disorders manifesting in adult life. We propose a research agenda that draws together several reproductive mood disorders and investigates which genetic, endocrinological, neural, and psychosocial factors can explain depressive symptoms during phases of hormonal transitions in women. Based on current research it is assumed that some women experience an increased sensitivity to not only fluctuations in reproductive steroids (estrogen and progesterone), but also stress-related steroids. We integrate both dynamics into the concept of “steroid hormone sensitivity,” expanding on the concept of “reproductive hormone sensitivity.” We suggest that a differential response of the stress steroid system including corticosteroids, neurosteroids, like allopregnanolone and the GABA-A Receptor complex, as well as a differential (epi)genetic risk in serotonergic and GABAergic signaling, are moderators or mediators between changes in the reproductive steroid system and the physiological, affective, and cognitive outcomes manifesting in reproductive mood disorders. We point to the lack of research on the role of psychosocial factors in increasing a woman's stress level and at some point also the sensitivity of her stress steroid system within the etiology of Reproductive Mood Disorders.

Drawing together the evidence on various reproductive mood disorders we seek to present a basis for the development of more effective pharmacological, social, and psychological treatment interventions and prevention strategies for women susceptible to these disorders. This could pave the way for new research as well as medical and psychological teaching and practice- such as a new type of Practice for Gynecological Psychoneuroendocrinology- with the aim of working on and ultimately offering more integrative forms of support not yet available to women suffering from depression during hormonal transitions. In medical history women have been left alone with this integrative challenge.

Breastfeeding, prenatal depression and children's IQ and behaviour: a test of a moderation model

Background

We aimed to determine the associations between breastfeeding and children’s neurodevelopment indexed by intelligence quotient (IQ) and emotional and behavioural problems through mid-childhood adjusting for prenatal and postnatal depression and multiple confounders; and to test the novel hypothesis that breastfeeding may moderate the effects of prenatal depression and anxiety on children’s neurodevelopment.

Methods

The study is based on women and their children from the longitudinal Avon Longitudinal Study of Parents and Children (n=11,096). Children’s IQ was derived from standardized in-person testing; behaviour problems were assessed according to parent-report; information on breastfeeding, prenatal depression and anxiety and multiple confounders were derived from self-report questionnaires. We conducted hierarchical multiple regression adjusting for several covariates.

Results

43% women were exclusively breastfeeding at 1 month and an additional 16.8% were engaged in mixed or partial breastfeeding. Both exclusive breastfeeding (B = 2.19; SD = 0.36, p =.00) and mixed feeding (B = 1.59; SD= 0.52; p=.00) were positively associated with IQ at 8 years of age, after adjusting for covariates. Exclusive breastfeeding was negatively associated with hyperactivity/attention deficit at 4 years (B = −.30, SD = .05; p < .01); mixed feeding was related to hyperactivity/attention deficit at age 9 (B = .20; SD = .08; p = .03) after adjustments. There was no association between breastfeeding and emotional or conduct problems. Breastfeeding did not moderate the association between prenatal depression and anxiety and children’s neurodevelopment.

Conclusions

The selective association between breastfeeding and neurodevelopmental measures suggests a nutritional rather than broader beneficial psychological effect on child neurodevelopment. Breastfeeding did not moderate the associations between prenatal depression and anxiety and child neurodevelopment, suggesting separate mechanisms of action.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03520-8.

Psychosocial factors promoting resilience during the menopausal transition

Despite significant biological, psychological, and social challenges in the perimenopause, most women report an overall positive well-being and appear to be resilient to potentially negative effects of this life phase. The objective of this study was to detect psychosocial variables which contribute to resilience in a sample of perimenopausal women. A total of 135 healthy perimenopausal women aged 40-56 years completed a battery of validated psychosocial questionnaires including variables related to resilience, well-being, and mental health. First, using exploratory factor analysis, we examined which of the assessed variables related to resilience can be assigned to a common factor. Second, linear regression analyses were performed to investigate whether a common resilience factor predicts well-being and mental health in the examined sample of women. Optimism (LOT-R-O), emotional stability (BFI-K-N), emotion regulation (ERQ), self-compassion (SCS-D), and self-esteem (RSES) in perimenopausal women can be allocated to a single resilience-associated factor. Regression analyses revealed that this factor is related to higher life satisfaction (SWLS; β = .39, p < .001, adj. R² = .20), lower perceived stress (PSS-10; β = - .55, p < .001, adj. R² = .30), lower psychological distress (BSI-18; β = - .49, p < .001, adj. R² = .22), better general psychological health (GHQ-12; β = - .49, p < .001, adj. R² = .22), milder menopausal complaints (MRS II; β = - .41, p < .001, adj. R² = .18), and lower depressive symptoms (ADS-L; β = - .32, p < .001, adj. R² = .26). The α levels were adjusted for multiple testing. Our findings confirm that several psychosocial variables (optimism, emotional stability, emotion regulation, self-compassion, and self-esteem) can be allocated to one common resilience-associated factor. This resilience factor is strongly related to women's well-being as well as mental health in perimenopause.

Altered Experienced Thermoregulation in Depression-No Evidence for an Effect of Early Life Stress

Objectives: Accumulating evidence suggests that individuals with depression are characterised by difficulties in thermoregulatory cooling. The aim of this study was to investigate, for the first time, whether depressed individuals are aware of these alterations, what their physical consequences are and whether they may be rooted in early life stress. Methods: A total of N = 672 medically healthy individuals from the general population were recruited to participate in an online survey. Participants were divided into depressed vs. non-depressed using the Patient Health Questionnaire. Experienced autonomic and behavioural thermoregulation as well as vigilance problems in response to temperature increases were assessed by the Experienced Temperature Sensitivity and Regulation Survey. The Childhood Trauma Questionnaire was administered to assess early life stress. Results: Controlling for age, sex, body mass index, and physical activity, depressed vs. non-depressed individuals did not differ in their experienced autonomic and behavioural responses to temperature increases. However, the depressed individuals reported comparably greater difficulties in concentrating and drowsiness/fatigue in warm environments (p = 0.029), during physical exertion (p = 0.029), and during stress (p < 0.001). There were no differences in the experienced thermoregulation between depressed individuals with vs. without early life stress. Conclusions: Depressed individuals experienced more severe physical impairments (i.e., greater vigilance problems) in response to intense warmth when compared to non-depressed individuals. These differences were not attributable to comorbid illnesses, the intake of medication, or physical deconditioning. Further enquiries in clinical populations are warranted to investigate to what extent the observed alterations map onto specific symptoms of depression (e.g., sleep disturbances).

Prior depression affects the experience of the perimenopause - findings from the Swiss Perimenopause Study

BACKGROUND

There is a prevalence peak of depression in the perimenopause, with this reproductive phase being considered a window of vulnerability due to major biopsychosocial changes. Depression has been associated with physical and psychosocial impairment. Prior depression has been shown to be a risk factor for the development of several somatic and mental diseases. We assume that women with prior depression will exhibit increased burdensome symptoms in the perimenopause compared to women without prior depression.

METHODS

A total of 135 perimenopausal women aged 40-56 years participated in the longitudinal Swiss Perimenopause Study. For the purpose of this investigation, a cross-sectional design was chosen. A wide range of validated psychosocial questionnaires were used to compare women with and without prior depression regarding their experience of the perimenopause. Findings were statistically adjusted for multiple testing.

RESULTS

Women with prior depression showed significantly more depressive symptoms (U = 1215.5, p < .01), more menopausal symptoms (U = 1395.0, p < .01), and more sleep disturbances (U = 1583.5, p < .05) than women without prior depression. Moreover, women with a history of depression reported lower subjective mental health (U = 1573.0, p <  05) and felt more isolated (U = 1524.0, p < .05) than those without prior depression.

LIMITATIONS

Self-report data may affect the results. Furthermore, due to the cross-sectional design, causality cannot be inferred.

CONCLUSIONS

Prior depression affects women's experience of the perimenopause. Women with prior depression exhibit significantly more negative health outcomes in the perimenopause than those without prior depression.