Temperament and character in women with postpartum depression

Summary Objective: To investigate whether women with postpartum depression differ in personality traits from healthy postpartum women, healthy controls from the normal Swedish population and non-postpartum women with major depression. Methods: Forty-five women with postpartum depression were compared with 62 healthy postpartum women, 62 age-matched, healthy, non-postpartum women from a normal sample and 74 non-postpartum women with major depression from a clinical sample. The edinburgh postnatal depression scale was used in order to screen for postpartum depression. A clinical diagnostic interview was done including a rating with the Montgomery-Asberg depression rating scale. Personality i.e. temperament and character was measured by the temperament and character inventory. Results: Harm avoidance (HA) was higher (p < 0.001) and self-directedness (SD) scored lower (p < 0.001) in women with postpartum depression compared to healthy postpartum women. These differences were the most important differences between these two groups. Women with postpartum depression scored lower (p = 0.001) in cooperativeness (CO) and higher (p = 0.019) in self-transcendence (ST) compared to healthy postpartum women. Women with postpartum depression scored overall similar to women with major depression. Conclusion: High HA and low SD can be seen as vulnerability factors for developing a depression and especially in a stressful situation as childbirth.     

Screening women for postpartum depression at well baby visits: resistance encountered and recommendations

Summary Objective: Postpartum major depression afflicts 10–15% of childbearing women and can have serious consequences. Unrecognized and therefore untreated episodes of postpartum major depression can predispose women to future depressive episodes, especially those related to other reproductive events. In the United States, women typically have one visit at six weeks postpartum with their obstetrican which is focused on physical recovery from delivery. Pediatricians typically see new mothers 4–6 times per year at well baby visits. Therefore, our objective is to test the utility of screening women for postpartum depression at each well baby visit over the course of the first postpartum year as compared with controls derived from clinical practice and chart review. Method: Subjects for this prospective study were recruited at their first well baby visit at the UCSD Primary Care Pediatric Clinic and interviewed by telephone. Subjects then were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Beck Depression Inventory (BDI) at intervals consistent with the timing of well baby visits. If scores on the EPDS or the BDI exceeded the thresholds (EPDS ≥ 12 and BDI ≥ 10) then subjects were assessed further with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (SCID-DSM IV). If diagnosed with postpartum major depression, subjects were referred for appropriate treatment. Results: Out of 160 study packets distributed, only 7 women volunteered for the study, despite endorsement and presentation of the study by their pediatricians. Of those participants, five scored above threshold values at some point in the interval studied. Discussion: The difficulty in recruitment in this study highlights some of the problems encountered in clinical practice in terms of identifying and referring women with postpartum mental illnesses. We recommend further study be focused on how to attract potentially affected women while simultaneously addressing their fears of stigma. Since resistance also was encountered in other physicians, we recommend that educational efforts be aimed at increasing knowledge and awareness of postpartum mental illnesses in both the lay and professional spheres. Accepted July 26, 2002; Published online October 7, 2002 Acknowledgement This project was supported by a grant for the Eli Lilly Center for Women's Health. Correspondence: Leslie Westlund Tam, M.D., 591 Camino de la Reina, #821, San Diego, CA 92116, U.S.A. e-mail: ltam@ucsd.edu     

Prevalence of postpartum depression in a Moroccan sample

Summary The aim of the present study was to determine the prevalence and factors associated with post-partum depression among Moroccan mothers. The authors interviewed 144 mothers at 2 and 6 weeks, and at 6 and 9 months after delivery. They used the Mini International Neuropsychiatric Interview (M.I.N.I.) and the Arabic version of Edinburgh Postnatal Depression Scale (EPDS). Using the M.I.N.I., 18.7% met DSM-IV criteria for depressive disorder in the second week after childbirth. Using a cut-off score of 12, the EPDS indicated a sensitivity and specificity of 92% and 96% respectively. Depressive disorder was significantly associated with pregnancy complications, stressful life events during pregnancy, babys health problems, and poor marital relationship. The subsequent point prevalences were 6.9%, 11.8% and 5.6% respectively at 6 weeks, 6 and 9 months. Postnatal visits were effective in the identification of Moroccan depressed mothers.     

A history of personal violence and postpartum depression: is there a link?

Summary Background: A link between violence and depression has been shown, but not a link between violence and postpartum depression. This study sought to determine if there is an association between a history of abuse (physical, sexual, emotional as a child or adult) and postpartum depression (PPD). Method: 200 postpartum women were recruited from 6 hospitals. At 8–10 weeks postpartum, a telephone interviewer asked women about physical, emotional or sexual abuse as an adult or child and sociodemographic, obstetrical and personal medical history. PPD was assessed using the Edinburgh Postnatal Depression Scale (EPDS, score of ≥12). Abuse was determined by the Conflict Tactics Scale or the Abuse Assessment Screen. Chi-square and logistic regression were used to determine the relationship between violence and PPD. Results: 11% of women had EPDS scores of ≥12. Rates of childhood (6.5%), or adult (6.5%) physical abuse; and childhood (13%) or adult (14%) sexual abuse were reported by respondents. Emotional abuse in the current relationship (29.6%) exceeded that of childhood abuse (3.5%). Overall 43.2% of respondents had at least one form of abuse. Having a history of depression (OR = 3.3 (95% CI, 1.3–8.7)), panic attack during pregnancy (OR = 5.4 (1.6–19.0)), maternal complications (OR = 5.0 (1.7–15.1)), low social support (OR = 3.3 (1.3–8.7)) and emotional abuse (OR = 2.8 (1.1–7.4) were associated with PPD. Conclusion: Emotional abuse but not physical or sexual abuse was found to be associated with PPD. A possible explanation for this relationship may be that being in an abusive situation puts one at risk for depression and in turn, postpartum depression.     

Recruiting Latino women in the U.S. and women in Mexico in postpartum depression prevention research

The negative consequences of untreated depression on the health and well-being of women and their children are well-documented, underscoring the need to develop effective interventions to prevent the onset of major depression during the perinatal period. This article describes recruitment data from two randomized controlled trials of preventive interventions for postpartum depression: one conducted with immigrant Latinas in Washington, DC, United States, and the other with women in Mexico City, Mexico. In both countries, pregnant women met a priori eligibility criteria and were randomized into an 8-week theory-based group intervention. Two hundred and seventeen Latinas in the U.S. and 377 women born and raised in Mexico were enrolled in their respective countries. The recruitment rates (i.e., the number of participants who met eligibility criteria, consented, and randomized into the study) were 70% in the U.S. and in Mexico. Issues and recommendations related to recruiting Hispanic women into preventive intervention trials for postpartum depression are discussed.     

The relationship of deiodinase 1 genotype and thyroid function to lifetime history of major depression in three independent populations

Major depression (MD) is often associated with disturbances of the hypothalamic/pituitary/thyroid (HPT) axis. Unfortunately, whether this association is secondary to common underlying genetic variation or whether the MD‐associated disturbances in HPT function are chronic or state‐dependent is unknown. To examine these questions, we genotyped 12 single nucleotide polymorphisms identified in previous genome wide association analyses of thyroid function in DNA contributed by 1,555 subjects from three longitudinal ethnically diverse studies that are well‐characterized for lifetime MD and thyroid function. We then examined associations between genetic variants and key outcomes of thyroid stimulating hormone, free thyroxine (FT4) and depression. We confirmed prior findings that two variants in deiodinase 1 (DIO1), including a variant in the 3′UTR of DIO1 (rs11206244), were associated with altered FT4 levels in both White and African American subjects. We also found that rs11206244 genotype was associated with lifetime MD in White female subjects, in particular those from high‐risk cohorts. However, we found no association of current FT4 levels with lifetime MD in either ethnic group. We conclude that genetic variation influencing thyroid function is a risk factor for MD. Given the evidence from prior studies, further investigations of role of HPT variation in etiology and treatment of MD are indicated. © 2011 Wiley‐Liss, Inc.     

Secretion of growth hormone and thyroid-stimulating hormone in patients with dementia

We studied the growth hormone (GH) response to GH-releasing hormone (GHRH) and the thyroid-stimulating hormone (TSH) response to thyrotropin-releasing hormone (TRH) in four groups of patients with dementia and examined whether GH and TSH secretion is altered in patients with Alzheimer's disease. The four groups included those with Alzheimer's disease (n=28), parkinsonism with dementia (n=10), progressive supranuclear palsy with dementia (n=10), and dementia of vascular origin (n=28). The results showed no differences among the four groups in GH response to GHRH (12.2 ± 2, 10.7 ± 2, 8.9 ±1.1, and 9.9 ± 1.9 g/ml, respectively); there was no correlation between GH response to GHRH and sex, stage of the disease, or cerebral atrophy. The proportion of patients with exaggerated, normal, or lower GH response was similar in the four groups. There were also no differences among the groups in terms of TSH response to TRH (9.2 ±0.9, 11.1 ± 1, 11.1 ± 1, and 10.3 ± 1 mU/ml, respectively), nor was there a correlation between TSH response to TRH and sex, stage of the disease, cerebral atrophy, or GH response to GHRH. The proportion of those with exaggerated, normal, or lower TSH response was similar in the four groups. Cerebrospinal somatostatin levels were similar in Alzheimer's disease and vascular dementia patients. These findings indicate that neither GH response to GHRH nor TSH response to TRH provides a useful diagnostic adjunt in Alzheimer's disease patients.Abbreviations AD Alzheimer's disease - PD parkinsonism with dementia - PSP progressive supranuclear palsy - VD dementia of vascular origin - GH growth hormone - GHRH growth hormone releasing hormone - TRH thyrotropin releasing hormone - TSH thyroid stimulating hormone Correspondence to: J.M. Gomez     

Measurement issues in postpartum depression part 1: Anxiety as a feature of postpartum depression

Summary We investigated the contribution of anxiety symptoms to scores on the Edinburgh Postnatal Depression Scale (EPDS) between 36 weeks gestation and 16 weeks postpartum in 150 women. The 3-item anxiety subscale of the EPDS accounted for 47% of the total score in late pregnancy, and 38% of the total score in the postpartum period. Two categories of anxiety were common in the perinatal period: subsyndromal, situational anxiety (in particular during the last weeks of pregnancy); and clinically significant comorbid anxiety, which was experienced by nearly 50% of clinically depressed pregnant and postpartum women. The close relationship between anxiety and depression raises questions about whether symptoms of anxiety might be more common in the perinatal period than in other depressions. A strong role for anxiety symptoms in postpartum depression, and implications for its etiology and treatment, are discussed. Received June 26, 2002; accepted November 12, 2002 Published online January 17, 2003 Acknowledgements The authors wish to thank the women and their families who participated in this research. This work was funded in part by the Natural Sciences and Engineering Research Council of Canada, the Canadian Institutes of Health Research, the Women's College Hospital Foundation, the Ontario Women's Health Council, and the North American Society for Psychosocial Obstetrics and Gynecology. Dr. L.E. Ross is now Research Fellow, Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, Ontario; and Research Scientist, Women's Mental Health and Addiction Research Section, Centre for Addiction and Mental Health, Toronto, Ontario. Correspondence: Lori E. Ross, Ph.D., Women's Health Concerns Clinic, St. Joseph's Healthcare, Fontbonne Building, 6^th Floor, 50 Charlton Ave. E., Hamilton, Ontario, Canada L8N 4A6. e-mail: l.ross@utoronto.ca     

RGS4 polymorphism and response to electroconvulsive therapy in major depressive disorder

We studied the association between RGS4 (rs951436) polymorphism and treatment response in electroconvulsive therapy (ECT) as well as risk of treatment-resistant depression. The study sample consisted of 119 patients with major depressive disorder (MDD) and 384 healthy control subjects. RGS4 polymorphism was not associated with treatment response in ECT or risk of MDD. According to the present data, the impact of RGS4 genotype is not decisive in major depressive disorder. The results provide preliminary data on the impact of RGS4 polymorphism in treatment response in ECT.     

Sensitivity to cholecystokinin-tetrapeptide in major depression

Background: Sensitivity to the panicogenic effects of cholecystokinin-tetrapeptide (CCK-4) is enhanced in panic disorder patients relative to normal controls (NC). In the present study, we determined whether sensitivity to CCK-4 is enhanced in patients with major depressive disorder (MDD) with no history of panic attacks. We also determined whether CCK-4 would exacerbate depressive symptoms. Methods: The study used a double-blind, randomized, placebo-controlled design. Behavioral and cardiovascular response to a submaximal dose (20 μg) of CCK-4 was studied in seven patients with MDD and 12 NC subjects. Results: None of the subjects panicked with placebo, whereas 29% of MDD and 17% of NC subjects panicked with CCK-4. There was no significant difference between groups on the frequency of CCK-4-induced panic or the number and intensity of panic symptoms. No significant difference was detected for cardiovascular response to the CCK-4 challenge. CCK-4 did not worsen depressive symptoms in MDD patients. Limitations: Small number of study subjects. Conclusions: These data indicate that MDD patients show a response to CCK-4 that is comparable to NC. The lack of effect of CCK-4 on depressive symptoms suggest that central CCK receptors may not play an important role in the pathophysiology of MDD.     

Seasonality of symptoms in women with postpartum depression

Summary It is important to consider the potential contribution of seasonality to postpartum depression (PPD; Hiltunen et al, 2004). A possible link between seasonality and PPD may have implications for not only choice of treatment, but also in considering pregnancy planning. The objectives of this pilot study were to examine whether women with seasonal mood changes demonstrated greater incidence of PPD, and to determine if seasonality scores were predictive of PPD. The Seasonal Pattern Assessment Questionnaire (SPAQ; Rosenthal et al, 1987) was used to assess seasonality of mood. A logistic regression analysis was conducted to determine the association between clinical factors, SAD diagnosis, SPAQ global seasonality score (GSS) and season of SPAQ administration and PPD. In our sample, twice as many women in the PPD group were found to have SAD compared to the control group. The PPD group also had a higher group GSS mean (10.44) than did the control group (8.84). However, logistic regression analysis showed that higher seasonality scores in women with PPD were not necessarily predictive of PPD. While more women in the PPD group reported increased seasonal weight fluctuation and less sleep in the spring and summer, these items alone did not predict depression after childbirth.     

生长激素对慢性肾衰患者的免疫调节作用

生长激素(GH)是一种亲水性球蛋白,主要分泌于腺垂体.同时免疫器官,如胸腺、脾脏和外周血细胞,也可分泌GH,而GH受体在各种淋巴细胞中也有表达.GH除能够促进机体生长、代谢外,还具有一定的免疫调节作用.慢性肾衰患者存在着明显的免疫抑制,细胞免疫及体液免疫均受损,在长期血透患者中表现明显,如高感染性疾病并发率,注射疫苗后的反应性较差,恶性肿瘤发生率较正常人偏高.同时慢性肾衰患者也存在着生长激素抵抗现象,血液循环中生长激素水平正常甚至偏高,但生物活性偏低.慢性肾衰儿童生长较正常儿童迟缓,成人蛋白质分解代谢增强,合成代谢不足,而外源性生长激素在慢性.肾衰中的应用可起到一定的免疫调节作用.     

Lowering Cortisol enhances growth hormone response to growth hormone releasing hormone in healthy subjects

Cortisol is known to influence growth hormone release probably by modulating somatostatin tone. We examined the effect of metyrapone (the 1 β-hydroxylase inhibitor) treatment on growth hormone response to growth hormone releasing hormone (1 μg kg^-1 body wt). Six healthy male subjects were tested on two occasions 1 wk apart. On one occasion they received metyrapone followed by growth hormone releasing hormone and on the other placebo followed by growth hormone releasing hormone. In all subjects metyrapone produced a significant drop in Cortisol levels. Together with this drop there was a significant enhancement of growth hormone response to growth hormone releasing hormone. The GH response was negatively correlated with the Cortisol level. Growth hormone release in response to growth hormone releasing hormone challenge is thus seen to be heavily influenced by Cortisol levels.     

Localization of dopamine and its relation to the growth hormone producing cells in the central nervous system of the snail Lymnaea stagnalis

Summary The distribution of dopamine in the central nervous system of the pond snail Lymnaea stagnalis was investigated by using immunocytochemistry and HPLC measurements. With both methods it was demonstrated that dopamine is predominantly present in the cerebral and pedal ganglia. The dopamine-immunoreactivity was mainly observed in nerve-fibers in the neuropile of the ganglia. Relatively few dopamine-immunopositive cell bodies (diameters 10–30 m) were found. A large cell in the right pedal ganglion (the so-called RPeD1) stained positively with the dopamine antibody. It has previously been demonstrated that the growth hormone producing cells (GHCs) possess dopamine receptors on their cell bodies. However, dopamine-immunopositive fibers were observed only in the vicinity of the GHC nerve-endings and not close to the GHC cell bodies.     

Functioning and well-being at 24 weeks postpartum of women with postnatal depression

Summary Background: Postnatal depression, an episode of major depression occurring within six months postpartum, occurs in 10–15% of mothers. Previous research has focussed on prevalence, risk factors, treatment, and impact, with little emphasis on assessment of functioning and well-being in women with this depression. Our aim was to examine the effect of postnatal depression, age, and parity on eight indicators of functional status, using the SF-36 self-report questionnaire, at 24 weeks postpartum. Methods: The study used a prospective cohort design. 424 postpartum women, recruited from Nepean, Cowra, Dudley and Orange Hospitals (New South Wales, Australia) completed questionnaires assessing functioning and well-being (SF-36), and postnatal depression (EPDS). Results: Compared to age-appropriate Australian normative data, women with postnatal depression (n = 54, 12.7%) were impaired on five of eight SF-36 dimensions at twenty four weeks postpartum (i.e. Role Limitations due to Physical and Emotional Problems, Social Functioning, Mental Health, and Vitality), while women without this depression (n = 370) were impaired on two dimensions only (i.e. Role Limitations due to Emotional Problems and Vitality). Women with and without postnatal depression differed on six SF-36 dimensions (i.e. Role Limitations due to Physical and Emotional Problems, Social Functioning, Bodily Pain, Mental Health, and Vitality). Role Limitations due to Physical Problems were more impaired in depressed first-time than multiparous mothers, with no parity difference for women without postnatal depression. Conclusion: Some declines in functioning and well-being are associated with the postpartum period generally, but postnatal depression detrimentally effects other specific aspects of the postpartum women's functional status.     

The occurrence of panic and obsessive compulsive symptoms in women with postpartum dysphoria: a prospective study

Summary Objective: This study investigated the prevalence of panic and obsessive compulsive symptoms in a sample of postpartum women who endorsed high levels of dysphoria on a self-report depression measure. Method: A community-based sample of 788 postpartum women with self-reported depressive symptomatology completed an interview assessing major depression, panic disorder, and obsessive compulsive disorder. Results: An estimated 11% of the sample reported difficulties with panic attacks, 8% reported difficulties with obsessions, and 9% reported difficulties with compulsions. The most common panic symptoms included heart palpitations, sweating, trembling, and parasthesis. The most common content areas of obsessive compulsive symptoms were concerns about imminent disaster, compulsive cleaning behavior, and compulsive checking behavior, which were often related to fears concerning the newborn child. Comorbid depression and panic disorder was diagnosed in 1% of this sample, and comorbid depression and obsessive compulsive disorder was diagnosed in 2.4% of this sample. Conclusion: Postpartum panic and obsessive compulsive symptoms are common experiences that should be considered in treatment planning for women reporting dysphoria after they give birth.     

不同年龄抑郁症患者瞬目反射的研究

目的:探讨抑郁症与瞬目反射(BR)的关系。方法:对90例抑郁症(青年和老年各45例)患者及60例正常对照组(青年和老年各30例)进行BR检测。结果:与青年对照组和老年对照组比较,青年抑郁症患者和老年抑郁症患者BR的R2、R2′潜伏期分别显著延长(P<0.001),老年抑郁症患者的波幅与老年对照组、青年抑郁症患者的波幅相比显著升高,差异存在极显著意义(P<0.001)。结论:抑郁症患者存在BR的异常,提示抑郁症患者可能存在脑干功能障碍。     

A systematic review of home-based interventions to prevent and treat postpartum depression

This systematic review evaluated randomized controlled trials assessing home-based psychological interventions to prevent and treat postpartum depression (PPD). Six studies meeting inclusion criteria were identified, five assessing treatments for PPD and one assessing a preventive intervention for PPD. Interventions used cognitive behavioral, psychodynamic, and non-directive counseling approaches. Of the six studies reviewed, four reported statistically significant treatment effects on PPD following the intervention. Each of the three types of psychological interventions were shown to reduce levels of maternal depression. Recommendations for future development and evaluation of home-based psychological interventions for PPD are discussed. These include identification of mediators and moderators of intervention efficacy, exploring strategies for prevention of PPD, and targeting high-risk groups.