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Background: Peripartum depression is a common but potentially debilitating pregnancy complication. Mobile applications can be used to collect data throughout the pregnancy and postpartum period to improve understanding of early risk indicators. Aim: This study aimed to improve understanding of why women drop out of a peripartum depression mHealth study, and how we can improve the app design. Method: Participants who dropped out of the Mom2B study (n = 134) answered closed and open questions on their motives for dropping out of the study, suggestions for improvement, and preferred timeframe of the study. A mix of quantitative and qualitative strategies was used to analyze the responses. Results: The most common reasons for discontinuation were lack of time, problems with or loss of the pregnancy, the use of other pregnancy applications, surveys being too lengthy, the app draining too much battery, and participants incorrectly believing that their answers were irrelevant for the study. Participants suggested fewer survey moments, more reminders, and a need for more unique content compared to commercially available apps. Conclusions: Researcher who want to use mHealth designs in peripartum studies need to ensure that their study designs are as time-efficient as possible, remind participants about the study, manage expectations about the study and what is expected of participants throughout the study, design their apps to be attractive in a competitive market, and follow-up with participants who are excluded from the study due to pregnancy complications. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) and peripartum depression (PPD) are increasing global health issues with potentially long-lasting adverse outcomes. While limited studies suggest a bidirectional relationship between GDM and PPD, most research has been cross-sectional and focused on one direction of the relationship, primarily if GDM predicts postpartum depression. The interplay between antenatal depression and GDM is less explored, with a critical lack of prospective bidirectional studies. This longitudinal study aimed to investigate the bidirectional relationship between GDM and PPD in a total sample and according to different pre-pregnancy body mass index (BMI) categories. Specifically, we examined whether antenatal depression symptoms predict a subsequent GDM diagnosis and whether GDM predicts subsequent postpartum depression symptoms. Methods: A three-wave online longitudinal study included 360 women who were followed from the second trimester (20–28 weeks, T1) through the third trimester (32–42 weeks, T2), and into the postpartum period (6–20 weeks after birth, T3). Participants completed the General Data Questionnaire, one item about the diagnosis of GDM, and the Edinburgh Postnatal Depression Scale (EPDS). The sample was stratified according to pre-pregnancy BMI into normal-weight (N = 247) and overweight/obese (N = 113) subgroups. Women with type I and II diabetes, GDM at T1, and underweight BMI were excluded. Results: In the total sample, antenatal depression symptoms predicted GDM, whereas GDM did not predict postpartum depression symptoms. A bidirectional relationship was observed in normal-weight women, where antenatal depression symptoms predicted subsequent GDM diagnosis, and GDM diagnosis predicted postpartum depression symptoms. In contrast, no associations were found in either direction in the overweight/obese subgroup. Conclusions: This study provides evidence of a bidirectional relationship between GDM and PPD only in women with normal body weight before pregnancy. The results highlight the complexity of the relationship between peripartum mental and metabolic health, that is dependent on pre-pregnancy BMI. Clinicians should be aware that normal-weight women may have a unique sensitivity to the bidirectional interplay between GDM and PPD. Pregnant women should be closely monitored for both mental and metabolic health issues and targeted for prevention programs to reduce the risks and burdens associated with both conditions. [ABSTRACT FROM AUTHOR]

Background: The genetic determinants of peripartum depression (PPD) are not fully understood. Using a multi-polygenic score approach, we characterized the relationship between genome-wide information and the history of PPD in patients with mood disorders, with the hypothesis that multiple polygenic risk scores (PRSs) could potentially influence the development of PPD. Methods: We calculated 341 PRSs for 178 parous mood disorder inpatients affected by major depressive disorder (MDD) or bipolar disorder (BD) with (n = 62) and without (n = 116) a history of PPD. We used partial least squares regression in a novel machine learning pipeline to rank PRSs based on their contribution to the prediction of PPD, in the whole sample and separately in the two diagnostic groups. Results: The PLS linear regression in the whole sample defined a model explaining 27.12% of the variance in the presence of PPD history, 56.73% of variance among MDD, and 42.96% of variance in BD. Our findings highlight that multiple genetic factors related to circadian rhythms, inflammation, and psychiatric diagnoses are top contributors to the prediction of PPD. Specifically, in MDD, the top contributing PRS was monocyte count, while in BD, it was chronotype, with PRSs for inflammation and psychiatric diagnoses significantly contributing to both groups. Conclusions: These results confirm previous literature about the immune system dysregulation in postpartum mood disorders, and shed light on which genetic factors are involved in the pathophysiology of PPD. [ABSTRACT FROM AUTHOR]

Abstract Background As a biological marker for cellular senescence, telomere length (TL) has been linked to a variety of psychiatric disorders and adverse childhood experiences (ACE), though only preliminarily to peripartum depression (PPD). The present study sought to examine the association between TL and PPD, assessing the moderating role of ACE and genetic polymorphic variations related with the telomere machinery. Methods Adversity was self-reported, likewise were depressive symptoms evaluated at pregnancy week 17 and 32, as well as six-weeks and six-months postpartum. TL was assessed by use of qPCR in blood samples collected during delivery from females with antenatal depression resolving postpartum, females with depression persisting to postpartum, and healthy controls. Twenty haplotype-tagging Single Nucleotide Polymorphisms in the Telomerase Reverse Transcriptase (TERT) and three in the Telomerase RNA Component (TERC) genes were genotyped. Results TL was negatively correlated with severity of PPD symptoms at pregnancy week 32 and postpartum week 6. PPD was associated with shorter TL. Lastly, ACE, but not the TERT/TERC genotype, moderated the TL-trajectory association; with increasing ACE, individuals with persistent PPD symptoms had shorter TL, whereas the opposite pattern (longer TL) was observed in the controls. Conclusions The findings contribute to further understanding of PPD underpinnings, suggesting a negative relationship with TL.

Background: As a biological marker for cellular senescence, telomere length (TL) has been linked to a variety of psychiatric disorders and adverse childhood experiences (ACE), though only preliminarily to peripartum depression (PPD). The present study sought to examine the association between TL and PPD, assessing the moderating role of ACE and genetic polymorphic variations related with the telomere machinery. Methods: Adversity was self-reported, likewise were depressive symptoms evaluated at pregnancy week 17 and 32, as well as six-weeks and six-months postpartum. TL was assessed by use of qPCR in blood samples collected during delivery from females with antenatal depression resolving postpartum, females with depression persisting to postpartum, and healthy controls. Twenty haplotype-tagging Single Nucleotide Polymorphisms in the Telomerase Reverse Transcriptase (TERT) and three in the Telomerase RNA Component (TERC) genes were genotyped. Results: TL was negatively correlated with severity of PPD symptoms at pregnancy week 32 and postpartum week 6. PPD was associated with shorter TL. Lastly, ACE, but not the TERT/TERC genotype, moderated the TL-trajectory association; with increasing ACE, individuals with persistent PPD symptoms had shorter TL, whereas the opposite pattern (longer TL) was observed in the controls. Conclusions: The findings contribute to further understanding of PPD underpinnings, suggesting a negative relationship with TL. [ABSTRACT FROM AUTHOR]

Background: In many countries, midwives and nurses play a vital role in supporting effective perinatal mental health (PMH) care, including peripartum depression (PPD) management. In our study, we aimed to evaluate the effectiveness of PMH training in increasing certified midwives (CMs) and certified nurse–midwives (CNMs)’ knowledge about PPD management in primary care settings. The training was a part of postpartum depression (PPD) prevention programme implemented by Polish Ministry of Health. Additionally, we investigated the link between the CMs and CNMs perception of systemic difficulties, attitudes toward work with patients with mental health problems, and the adherence to PPD screening procedures. Method: A total of 379 CMs and CNMs from primary health centres and hospitals who participated in a PPD management training completed the Test of Antenatal and Postpartum Depression Knowledge before and after PMH training and the REASON scale after the training. Results: Before the training, only 17% (n = 66) of CMs and CNMs considered themselves to be educated for PPD management. The participants’ knowledge about PPD significantly increased after the training, by three points on average. The effect size was very strong, d = 0.84. However, the prevalence of perinatal mental disorders and the suicide rate among persons with PPD remained misestimated. We also found that age had a substantial influence in controlling the relationship between perceived educational preparation for PPD management, job tenure, and actual knowledge about PPD management. Self-reported higher levels of perceived systemic problems in the workplace and having more negative attitudes toward working with persons experiencing emotional difficulties were associated with declared lower frequency of measuring the severity of PPD, using screening tools, counselling, and making referrals to specialists. Discussion: Even though the training turned out to be effective, a tendency to underestimate the negative consequences of PPD was observed. The participants’ perception of systemic problems and personal attitudes were associated with an adherence to PPD screening procedures. The implementation of an obligatory PPD screening may not be enough to change the everyday practice of CMs and CNMs. Further training, taking into account personal attitudes of health care professionals, and systemic changes are required to ensure an optimal management for persons with PPD.

Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Postpartum depression affects about 10-15% of women, and it is a condition with negative consequences not only for the mother but also for the baby, the partner, and the entire family. There are many causes of postpartum depression: hormonal changes after childbirth, genetic predisposition, sleep deprivation, radical lifestyle changes, lack of emotional support, childbirth complications requiring a longer recovery, the birth of a child with health problems, and other emotional/social/economic factors influencing a mother's mental health. This paper features a particular and complex case of a 20-year-old woman diagnosed with postpartum depression who had numerous suicide attempts (ingesting several prescription drugs and a toxic substance) and psycho-cognitive damage. Intra-family conflicts aggravated the patient's symptomatology, separation from her newborn, and poor socioeconomic status, preventing her from continuing her treatment. This case provides a clear picture of the diversity and severity of symptoms occurring in postpartum depression and highlights the relevance of elaborating and implementing prevention measures. [ABSTRACT FROM AUTHOR]

Background: Peripartum depression (PPD) is the most common peripartum mental health problem. However, none of the available questionnaires evaluates depressive symptoms according to the latest DSM-5-TR (APA, 2022). Peripartum Depression Scale (PDS) is a new measure of PPD developed according to DSM-5-TR full criteria and postpartum-specific symptoms described in the literature. The aim of this study was to validate a new scale to assess depression in pregnancy and postpartum. Methods: In this online cross-sectional study, 513 pregnant women and 751 women within the 12 months postpartum completed a new PDS consisting of 43 items from Criterion A, rated on a four-point scale, and seven items on the remaining DSM-5-TR criteria. They also completed Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale (DASS), and General Data Questionnaire. Results: Confirmatory factor analysis confirmed that the one-factor model had a poor fit, but the 9-factor with a second-order factor in postpartum sample and 10-factor model with a second-order factor in pregnant sample, on the same 42-item version of scale, had a good fit to the data. The reliability of McDonald's ω of .96 was very high in both pregnant and postpartum women. Convergent and known-groups validity was demonstrated; however, correlations with stress were high. Limitations: Clinical interview was not administered. Conclusion: Peripartum Depression Scale is a 42-item instrument which is shown to be a valid and reliable measure to assess depression symptoms both during pregnancy and the full postpartum year according to DSM-5-TR criteria and current literature on peripartum-specific symptoms.

Background: Peripartum depression (PPD) is a major depression disorder (MDD) episode with onset during pregnancy or within four weeks after childbirth, as defined in DSM-5. However, research suggests that PPD may be a distinct diagnosis. The goal of this study was to summarize the similarities and differences between PPD and MDD by synthesizing the current research on PPD diagnosis concerning different clinical features and give directions for improving diagnosis of PPD in clinical practice. Methods: To lay the groundwork for this narrative review, several databases were searched using general search phrases on PPD and its components of clinical diagnosis. Results: When compared to MDD, peripartum depression exhibits several distinct characteristics. PPD manifests with a variety of symptoms, i.e., more anxiety, psychomotor symptoms, obsessive thoughts, impaired concentration, fatigue and loss of energy, but less sad mood and suicidal ideation, compared to MDD. Although PPD and MDD prevalence rates are comparable, there are greater cross-cultural variances for PPD. Additionally, PPD has some distinct risk factors and mechanisms such as distinct ovarian tissue expression, premenstrual syndrome, unintended pregnancy, and obstetric complications. Conclusion: There is a need for more in-depth research comparing MDD with depression during pregnancy and the entire postpartum year. The diagnostic criteria should be modified, particularly with (i) addition of specific symptoms (i.e., anxiety), (ii) onset specifier extending to the first year following childbirth, (iii) and change the peripartum onset specifier to either “pregnancy onset” or “postpartum onset”. Diagnostic criteria for PPD are further discussed.

Depression affects approximately 4 % of the global population and has huge social and economic implications. Social factors, including support, engagement, and stigma, play a crucial role in the development and severity of depression. We provide a synthesis of the consistency and magnitude of the association between measures of social connection and depression. We searched PubMed, PsycINFO, Cochrane Library, and EMBASE and 47 meta-analyses were included in the umbrella review. The strength of the associations was extracted and compared among different populations. The quality/certainty of evidence was assessed using AMSTAR-2 and GRADE tool. Results indicate that social support serves as a protective factor against depression, particularly in peripartum populations, while its impact is weaker in clinical populations. No association was found between social support and depression in post-disaster populations. Stigma and discrimination favour the development and maintenance of depressive symptoms in clinical populations, but have a weaker effect in ethnic minorities. The quality and certainty of evidence should be taken into account when interpreting our findings. Further research with more rigorous methodology and higher-quality evidence is needed to better understand the complex relationship between depression and social connection across various populations and contexts. Our findings confirm the role of social determinants in the emergence and severity of depression, particularly in the case of vulnerable populations. Efforts to counteract disconnection at the societal and individual levels and to reduce stigma should be central to an effective depression prevention agenda. • Social determinants play a significant role in influencing health. • Social connection represents a major protective/risk factors for depression. • Social support is protective against depression, especially in peripartum populations. • Stigma/discrimination represents risk factors for depression in clinical populations. • Social determinants should be central to an effective depression prevention agenda. [ABSTRACT FROM AUTHOR]

Background. Postpartum depression affects around 12% of mothers in developed countries, with consequences for the whole family. Many women with depressive symptoms remain undetected and untreated. The aim of this study was to investigate to what extent women with depressive symptoms at 6 weeks postpartum are identified by the healthcare system, the interventions they received, and remission rates at 6 months postpartum. Methods. Postpartum women scoring 12-30 on the Edinburgh Postnatal Depression Scale (EPDS) at 6 weeks after delivery (n = 697) were identified from the longitudinal cohort study "Biology, Affect, Stress, Imaging and Cognition" (BASIC) in Uppsala, Sweden. A total of 593 women were included. Background and remission information at 6 months was collected from the BASIC dataset. Medical records were examined to identify interventions received. Results. Most women (n = 349, 58.7%) were not identified by the healthcare system as having depressive symptoms and 89% lacked any record of interventions. Remission rates at 6 months postpartum were 69% in this group. Among women identified by the healthcare system, 90% received interventions and about 50% were in remission at 6 months postpartum. The EPDS reduction during the study period was largest in the group identified by the child health services (CHS, -5.15) compared to the non-identified (-4.24, p < 0.001). Conclusions. Despite screening guidelines, many women with depressive symptoms had no documentation of screening or interventions by the healthcare system. Furthermore, a significant proportion did not achieve remission despite interventions. Being identified by CHS was associated with the largest reduction of symptoms. Research is needed to understand gaps in the healthcare processes, to better identify peripartum depression. [ABSTRACT FROM AUTHOR]

Background: Early studies assessing peripartum mood disorders during the COVID-19 pandemic have conflicting results. Objective: The primary aim was to examine if postpartum depression (PPD) was more common or more severe during the COVID-19 pandemic compared to earlier periods, and to assess what individual factors may worsen the impact of the pandemic. Methods: Electronic health records at an academic pediatric practice in Michigan identified 242 biological mother-child dyads with delivery between 1/1/2017 and 12/31/2021. PPD was evaluated using the Edinburgh Postnatal Depression Scale (EPDS) during well-child visits. Participants were divided into three groups for analysis: Pre-Pandemic (n = 100), Early Pandemic (n = 93), and Later Pandemic (n = 49). Logistic regression analysis was used to predict PPD development, controlling for background factors. Results: After controlling for confounders, the three groups did not differ significantly. Preexisting mental health conditions was a significant (p<.001) moderator; PPD rates peaked early in the pandemic (60%), compared to late pandemic (42%) and pre-pandemic (36%). Women without a mental health diagnosis pre-pregnancy experienced the lowest levels of PPD during the pandemic. Conclusions: Rates of PPD were not significantly affected by the COVID-19 pandemic for most women. However, biological mothers with preexisting mental health conditions had significantly higher rates of PPD. [ABSTRACT FROM AUTHOR]

Background: Peripartum depression (PPD) is a prevalent, heterogeneous disorder with various underlying mechanisms and unwanted outcomes. Substantial uncertainty surrounding PPD aetiology exists. To comprehensively investigate PPD, research is adopting the biopsychosocial theoretical model highlighting the interplay between biological and psychosocial factors. This paper aims to provide an overview of risk factors and biopsychosocial models of PPD. Method: A literature search was conducted in databases to identify risk factors and biopsychosocial models of PPD. Results: The most robust biological and psychosocial risk factors of PPD and findings from integrative studies are outlined. Several biopsychosocial models are identified, explaining antepartum, postpartum or peripartum depression. Integrative models show promise but differ in conceptualisation and proposed aetiological pathways underlying PPD. Conclusion: Biopsychosocial principles should be applied throughout the perinatal research and healthcare provision as a necessary landmark towards guiding future theory, improving maternal mental health care and ensuring better outcomes for mothers and children.

Background: Peripartum depression (PPD) is a serious public health issue associated with severe and potentially long-term adverse maternal and child developmental outcomes. Suicide and overdose, for example, accounts for up to a third of maternal deaths. A current depression diagnosis with no active treatment is a common risk factor for maternal suicide. Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological treatment that has recently shown some promise as an effective treatment with limited side effects for PPD, but more research is required. This study aims to identify current barriers and potential facilitators for women with PPD accessing treatment in general, and rTMS specifically. Methods: This study will consist of two anonymous, self-administered surveys, focus groups, and interviews. A descriptive interpretative approach will be employed, and thematic analysis will be completed for the focus groups and interviews. Participants who are currently, or have previously experienced depressive symptoms, as well as health providers will be recruited. Our study will follow an equity, diversity, and inclusion (EDI) perspective on sex, gender, and ethnicity and the gender-based analysis plus (GBA+) analytic tool will be used. Both a qualitative and quantitative analysis of the data will be conducted. Discussion: We expect to find education and accessibility to be primary treatment barriers for persons with PPD. Identifying and addressing barriers is a critical first step towards the devolvement of initiatives that can work towards improving mental health in this population. [ABSTRACT FROM AUTHOR]

Copyright of Clinica y Salud is the property of Colegio Oficial de Psicologos de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The relationship between depression and reduced fibrinolytic activity reflects the role of tissue plasminogen activator and plasmin in brain remodeling underlying resilience, depression remission, and reward processing, rather than the dissolution of fibrin clots. Individuals who experience depression demonstrate hippocampal and prefrontal cortex atrophy, as well as impaired neuronal connectivity. Brain-derived neurotrophic factor (BDNF), synthesized as a precursor that is activated through cleavage by tissue plasminogen activator and plasmin, influences adult neurogenesis and neuronal plasticity in the hippocampus and prefrontal cortex. Depression is associated with decreased brain levels of BDNF, due to reduced activity of tissue plasminogen activator and plasmin. Tissue plasminogen activator and plasmin also mediate the release of dopamine, a neurotransmitter implicated in motivation and reward. Peripartum depression defines a depressive episode that occurs during pregnancy or in the first month after delivery, reinforcing the concept that postpartum depression may be a continuum of antenatal depression. This article describes the fibrinolytic status in the healthy brain, in stress and depression, emphasizing the links between biological markers of depression and defective fibrinolysis. It also discusses the association between hypofibrinolysis and risk factors for perinatal depression, including polycystic ovary syndrome, early miscarriage, preeclampsia, stressful life events, sedentariness, eating habits, gestational and type 2 diabetes, and antithyroid peroxidase antibodies. In addition, it reviews the evidence that antidepressant medications and interventions as diverse as placebo, psychotherapy, massage, video game playing, regular exercise, dietary modifications, omega 3 fatty acid supplementation, neurohormones, and cigarette smoking may reduce depression by restoring the fibrinolytic activity. Last, it suggests new directions for research. [ABSTRACT FROM AUTHOR]

BackgroundPeripartum major depression (MD) disables mothers and impairs emotional and neurocognitive development of offspring. We tested the hypothesis that critically-timed wake therapy (WT) relieves peripartum MD by altering melatonin and sleep timing, differentially, in antepartum vs. postpartum depressed patients (DP).MethodsIn a university clinical research center, we initially randomized 50 women - 26 antepartum (17 healthy comparison-HC, 9 DP) and 24 postpartum (8 HC, 16 DP) - to a cross-over trial of one night of early-night wake therapy (EWT: sleep 3:00-7:00 am) vs. late-night wake therapy (LWT: sleep 9:00 pm-01:00 am). Ultimately, we obtained mood, overnight plasma melatonin and polysomnography for: 15 antepartum women receiving EWT, 18 receiving LWT; 15 postpartum women receiving EWT, 14 receiving LWT.ResultsEWT improved mood more in antepartum vs. postpartum DP in conjunction with reduced (normalized) melatonin-sleep phase-angle differences (PADs) due to delayed melatonin onsets and advanced sleep onsets, and increased (from baseline) total sleep times (TST). LWT improved mood more in postpartum vs. antepartum DP in conjunction with increased TST.LimitationsSmall samples potentially rendered the study underpowered to detect group differences, making confirmation with larger samples essential. Sufficient follow-up data were not available in most women to document the duration of the mood response to wake therapy.ConclusionsEWT benefitted antepartum DP more by realigning melatonin and sleep timing, whereas LWT benefitted postpartum DP more by increasing TST. Thus, consistent with precision medicine aims, maximum mood benefits accrue from timing sleep/wake interventions to specific peripartum circadian pathophysiologies.

BackgroundPeripartum depression (PPD) is a serious public health issue associated with severe and potentially long-term adverse maternal and child developmental outcomes. Suicide and overdose, for example, accounts for up to a third of maternal deaths. A current depression diagnosis with no active treatment is a common risk factor for maternal suicide. Repetitive transcranial magnetic stimulation (rTMS) is a non-pharmacological treatment that has recently shown some promise as an effective treatment with limited side effects for PPD, but more research is required. This study aims to identify current barriers and potential facilitators for women with PPD accessing treatment in general, and rTMS specifically.MethodsThis study will consist of two anonymous, self-administered surveys, focus groups, and interviews. A descriptive interpretative approach will be employed, and thematic analysis will be completed for the focus groups and interviews. Participants who are currently, or have previously experienced depressive symptoms, as well as health providers will be recruited. Our study will follow an equity, diversity, and inclusion (EDI) perspective on sex, gender, and ethnicity and the gender-based analysis plus (GBA+) analytic tool will be used. Both a qualitative and quantitative analysis of the data will be conducted.DiscussionWe expect to find education and accessibility to be primary treatment barriers for persons with PPD. Identifying and addressing barriers is a critical first step towards the devolvement of initiatives that can work towards improving mental health in this population.

Testing the hypothesis that combined wake + light therapy improves mood in pregnant vs. postpartum depressed participants (DP) by differentially altering melatonin and sleep timing. Initially 89 women, 37 pregnant (21 normal controls-NC; 16 DP) and 52 postpartum (27 NCs; 25 DP), were randomized to a parallel trial of a phase-delay intervention (PDI): 1-night of early-night wake therapy (sleep 3-7 am) + 6-weeks of evening bright white light (Litebook Advantage) for 60 min starting 90 min before bedtime, vs. a Phase-advance intervention (PAI): 1-night of late-night wake therapy (sleep 9 pm-1 am) + 6-weeks of morning bright white light for 60 min within 30 min of wake time. Blinded clinicians assessed mood weekly by structured interview, and participants completed subjective ratings, a Morningness-Eveningness questionnaire, actigraphy, and collected 2 overnight urine samples for 6-sulphatoxy melatonin (6-SMT). In pregnant DP, mood improved more after the PDI vs. PAI (p =.016), whereas in postpartum DP, mood improved more after the PAI vs. PDI (p =.019). After wake therapy, 2 weeks of light treatment was as efficacious as 6 weeks (p >.05). In postpartum DP, PAI phase-advanced 6-SMT offset and acrophase (p <.05), which correlated positively with mood improvement magnitude (p =.003). Small N. Mood improved more after 2 weeks of the PDI in pregnant DP, but more after 2 weeks of PAI in postpartum DP in which improvement magnitude correlated with 6-SMT phase-advance. Thus, critically-timed Sleep + Light Interventions provide safe, efficacious, rapid-acting, well-tolerated, at-home, non-pharmaceutical treatments for peripartum DP. • Melatonin rhythms are phase-advanced in pregnancy depression; phase-delayed in postpartum depression • Sleep+light interventions that phase-delay rhythms improve mood in pregnancy depression • Sleep+light interventions that phase-advance rhythms improve mood in postpartum depression • Sleep+light interventions benefit mood within 2 weeks • Sleep+light interventions can be administered at home [ABSTRACT FROM AUTHOR]

Abstract Background Peripartum depression in and after pregnancy are common, reported by 11.9% of women worldwide, and the proportion was even higher during the outbreak of coronavirus disease 2019 (COVID-19). We aimed to investigate the prevalence and risk factors of peripartum depression under the influence of COVID-19 in China. Methods Using a cross-sectional design, 2026 pregnant and postpartum women residing in Beijing, Wuhan, and Lanzhou of China were recruited from February 28 to April 9, 2020. The Patient Health Questionnaire-9 was used to assess their depressive symptoms. The women were divided into four subgroups based on pregnancy stage, and a binary logistic regression analysis was conducted on each subgroup. Results Under the influence of COVID-19, the prevalence rate of peripartum depression among Chinese women was 9.7%. It was 13.6, 10.8, 7.9 and 7.3% in the first, second, third trimester and puerperium, respectively. Regression analysis showed that the influence of current pregnancy status on movement (Mild vs. No, aORs were 3.89, P

Objective: Postpartum depression (PPD), a major depressive episode with postpartum onset, develops in 15% of mothers. Although findings suggest sexual minority parents may be at risk for PPD, research among this population is scarce. We evaluated risk factors for PPD in a sample of sexual minority and heterosexual parents. Method: Four hundred and twenty seven heterosexual and one hundred and eleven sexual minority parents responded to a questionnaire distributed via social media that included demographics, the Edinburgh Postnatal Depression Scale, and the Multidimensional Scale of Perceived Social Support. Results: Sexual minority identity was not associated with increased risk for PPD. Pregnancy had no significant effect on the likelihood for PPD. Social support was negatively and significantly associated with probability for PPD. Conclusions: Our data suggest that sexual minority parents are not at increased risk for PPD, contrary to previous findings. The parental role, a psychosocial factor, is a more dominant risk factor than pregnancy itself, in the development of PPD. [ABSTRACT FROM AUTHOR]

Peripartum depression (PD) is a common mood disorder associated with negative outcomes for mother and child. PD is an understudied disorder in psychiatric genetics, and progress characterizing its genetic architecture has been limited by a lack of disorder-specific research, heterogeneous and evolving phenotypic definitions, inadequate representation of global populations, low-powered studies, and insufficient data amenable to large meta-analyses. The increasing availability of large-scale, population-level efforts, like biobanks, have the potential to accelerate scientific discovery and translational research by leveraging clinical, molecular, and self-report data from hundreds of thousands of individuals. Although these efforts will not fully equip researchers to confront every challenge posed by systemic issues in data collection, such as the reliance on minimal phenotyping strategies, the field is in a position to learn from other successful psychiatric genetic investigations. This review summarizes the current state of PD genetics research and highlights research challenges, including the impact of phenotype depth, measurement, and definition on the replicability and interpretability of genomic research. Recommendations for advancing health equity and improving the collection, analysis, discussion, and reporting of measures for PD research are provided. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression has a high prevalence in the United States (~13 %) and often goes undertreated/untreated. We conducted a multicenter, open-label, proof-of-concept trial to assess the Nēsos wearable, non-invasive, transcutaneous auricular vagus nerve stimulation (taVNS) system for the treatment of major depressive disorder with peripartum onset (PPD).Methods: Women (n = 25), ages 18 to 45, within 9 months postpartum, and diagnosed with PPD were enrolled at 3 sites. The study included 6 weeks open-label therapy and 2 weeks observation. Efficacy outcomes included change from baseline (CFB) in Hamilton Rating Scale for Depression (HAMD17) total scores, HAM-D17 response and remission, and patient and clinician global impression of change (PGIC, CGIC) scores. Analysis included descriptive statistics and mixed-effects models for repeated measures.Results: The most common AEs (≥5 %) were discomfort (n = 5), headache (n = 3), and dizziness (n = 2); all resolved without intervention. No serious AEs or deaths occurred. Baseline mean HAM-D17 score was 18.4. Week 6 least squares (LS) mean CFB in HAM-D17 score was -9.7; 74 % achieved response and 61 % achieved remission. At week 6, at least some improvement was reported by 21 of 22 (95 %) clinicians on CGIC and 22 of 23 (96 %) participants on PGIC.Limitations: This was a single-arm, open-label study, and enrollment was limited to participants with mild-to-moderate peripartum depression.Conclusion: Results from this proof-of-concept study suggest that the Nēsos taVNS system is well tolerated and may be an effective non-invasive, non-pharmacological treatment for major depressive disorder with peripartum onset. Further evaluation in larger sham-controlled studies is needed.Clinicaltrials: govNCT03972995. [ABSTRACT FROM AUTHOR]

Introduction: Dysphoric milk ejection reflex (D-MER) is a condition affecting lactating women, characterized by abrupt emotions of dysphoria that start shortly before or during milk let-down and progress for several minutes. Research on D-MER, especially with quantitative methodology, is minimal. This study aimed to validate an instrument for D-MER-related emotions, examine its prevalence and clinical features, and explore differences in maternal mental health and mother-infant bonding between mothers with and without D-MER. Methods: A total of 711 women up to 12 months postpartum participated in an online cross-sectional study. Participants fulfilled the D-MER Questionnaire (D-MERq), Edinburgh Postnatal Depression Scale, Depression, Anxiety, and Stress Scales, and the Postpartum Bonding Questionnaire. Results: The analysis showed that D-MERq had high reliability and good discriminant and divergent validity. The prevalence of D-MER was 5.9%. For the majority, D-MER manifested intensely, accompanied mostly by agitation- and anxiety-related emotions, and 45% of mothers discontinued breastfeeding due to D-MER. Mothers experiencing D-MER had higher levels of depression, anxiety, stress, previous psychiatric diagnoses, and more mother-infant bonding difficulties compared with mothers without D-MER. Conclusion: These findings demonstrate that D-MERq is a valuable tool with good psychometric properties and suitable for clinical and research use to facilitate early identification and better understanding of this phenomenon. D-MER affects a noteworthy number of women and is associated with impaired mental health, bonding difficulties, and breastfeeding discontinuation. This highlights the importance of health care providers recognizing D-MER to ensure better outcomes and a more positive breastfeeding experience.

Background/Aim: It is possible to find studies in the literature evaluating the relationship among self-reported bruxism, psychological factors, and myogenous temporomandibular disorder. In addition, the relationship between these issues has not yet been clarified. The objective of this study was to evaluate the association between peripartum depression, self-reported bruxism, and myogenous temporomandibular disorders among postpartum women in Turkey.

Peripartum depression (PD) is a common mood disorder associated with negative outcomes for mother and child. PD is an understudied disorder in psychiatric genetics, and progress characterizing its genetic architecture has been limited by a lack of disorder-specific research, heterogeneous and evolving phenotypic definitions, inadequate representation of global populations, low-powered studies, and insufficient data amenable to large meta-analyses. The increasing availability of large-scale, population-level efforts, like biobanks, have the potential to accelerate scientific discovery and translational research by leveraging clinical, molecular, and self-report data from hundreds of thousands of individuals. Although these efforts will not fully equip researchers to confront every challenge posed by systemic issues in data collection, such as the reliance on minimal phenotyping strategies, the field is in a position to learn from other successful psychiatric genetic investigations. This review summarizes the current state of PD genetics research and highlights research challenges, including the impact of phenotype depth, measurement, and definition on the replicability and interpretability of genomic research. Recommendations for advancing health equity and improving the collection, analysis, discussion, and reporting of measures for PD research are provided.

Background. Since the identification of Couvade syndrome in the late 1950s, little attention has been dedicated to the issue of depression in expecting fathers. Objective. To quantify the extent of depression in expecting fathers and find out if they match their pregnant partners' depression. Methods. We conducted a PubMed and ClinicalTrials.gov search using paternal depression and all its variants as terms. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement to include eligible studies. Results. We identified a grand total of 1443 articles, of which 204 were eligible. The total number of fathers/expecting fathers involved was 849,913. Longitudinal studies represented more than half of the included studies; more than three-quarters of the studies used the Edinburgh Postnatal Depression Scale (EPDS). The average occurrence of paternal depression was around 5%, which confers the entity some clinical dignity. Depression tends to occur more in expecting women and new mothers than in expecting partners or new fathers, while the co-occurrence in the same couple is quite low. Limitations. The methodological heterogeneity of the included studies prevents us from meta-analyzing the obtained data. The validity of the instruments used is another issue. Conclusions. Paternal depression is distinct from maternal depression and occurs at lower rates (about half). The very existence of a paternal depression clinical entity is beyond any doubt. Future research should address methodological heterogeneity. [ABSTRACT FROM AUTHOR]

Untreated peripartum depression (PD) affects one in seven women and is associated with negative maternal outcomes. This retrospective observational study used health record data from an integrated health system in Texas to assess the extent to which time to access reproductive psychiatry influences the mental health of peripartum women. Women with at least one screening for depression symptoms conducted in obstetric or pediatric settings between May 2014 and October 2019 and subsequently seen by the reproductive psychiatry clinic (n= 490) were included. Descriptive and inferential statistics were used to assess timing and factors related to psychiatry follow-up. Findings from this study demonstrated that the average time between a positive screen and a psychiatry assessment was 5 weeks. At psychiatry referral appointments, 85% of women continued to screen positive for PD symptoms. Depression symptom scores at the psychiatry appointment were significantly higher than scores precipitating the referral (p = 0.002). Wait time between initial positive screen and referral appointment was positively correlated with clinically meaningful increases in depression symptom scores (p < 0.001). Each week spent waiting for an appointment produced a 13% increase in odds of clinically meaningful worsening of PD scores and 9% increase in odds of developing new self-harm ideation. Given the findings that a longer period between primary care referral and subspecialty appointment has a negative impact on the mental health of women, this study supports the need for earlier psychiatric assessment to minimize decompensation. Expansion of reproductive psychiatry services are needed to support peripartum women and improve maternal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Suicides are a leading cause of maternal deaths. Depression, the commonest mental illness during pregnancy, amidst its numerous morbidities, can precipitate suicides. So, early detection and treatment of maternal depression and suicidal thoughts are important for reducing maternal morbidity and mortality. Pregnant women's help-seeking patterns play a crucial role in this. Limited availability and accessibility of potential sources, poor knowledge, and perceptions of the condition and the help-seeking process itself ,would act as barriers for help-seeking, especially in resource-constrained settings. This study explores the help-seeking intention, preferred sources, and factors influencing help-seeking for depression and suicidal thoughts among pregnant women in rural Sri Lanka. Methods: A cross-sectional study was conducted among pregnant women attending antenatal clinics in Anuradhapura, Sri Lanka. A multistage cluster sampling technique with probability proportionate to size was used. A self-completed, vignette-based questionnaire was developed, validated and pretested for the study. The vignette described the experience of a postpartum mother with symptoms of peripartum depression without suicidal ideation (part A) and the same mother developing suicidal ideation (part B). Results: Out of 624 participants, 202 (33.8%, 95%CI 30.0-37.7%) and 206 (36.7%, 95%CI 32.7-40.8%) reported they would seek help soon if they experienced symptoms of depression and suicidal ideations, respectively, while 181 (30.3%, 95%CI 26.6-34.1%) and 161 (28.6%, 95%CI 24.9-32.6%) said they would so if symptoms or suicidal thoughts did not resolve with time. Women were most likely to seek help from their husbands for symptoms of depression (n=445, 72.6%) and for suicidal thoughts (n=406, 71.1%). A public health midwife (n=346, 57.9%) was preferred over other formal or semiformal sources. If they were to seek help, 467 (49.2%) would contact a doctor or midwife specifically. The majority did not perceive that the described emotions could be symptoms of an illness (n=300, 50.1%) or that having suicidal ideation can be a threat to the life of the affected person (n=308, 52.1%) or that there was a probability for them to develop a mental illness during a current pregnancy (n=379, 65%). The majority perceived that positive responses were likely to be received, and negative responses were less likely to be received, if they were to seek help from their husband, another family member and midwife. Conclusion: Using a vignette approach allowed an exploration of how the 'at risk population' would construct meaning to symptoms of depression and suicidal ideation during pregnancy and the postpartum period, and what their actions would likely be if they were in a similar situation. It was observed that symptoms of depression and suicidal thoughts were regarded as normal by the pregnant women in this rural community, and they also perceived a low threat of getting a similar condition. This is a crucial point to intervene at for improving help-seeking. Informal and semiformal sources of help preferred by these women, especially husbands and public health midwives, should be empowered to respond effectively and facilitate further help-seeking from mental health professionals.

Introduction: Suicides are a leading cause of maternal deaths. Depression, the commonest mental illness during pregnancy, amidst its numerous morbidities, can precipitate suicides. So, early detection and treatment of maternal depression and suicidal thoughts are important for reducing maternal morbidity and mortality. Pregnant women's help-seeking patterns play a crucial role in this. Limited availability and accessibility of potential sources, poor knowledge, and perceptions of the condition and the help-seeking process itself,would act as barriers for helpseeking, especially in resource-constrained settings. This study explores the help-seeking intention, preferred sources, and factors influencing help-seeking for depression and suicidal thoughts among pregnant women in rural Sri Lanka. Methods: A cross-sectional study was conducted among pregnant women attending antenatal clinics in Anuradhapura, Sri Lanka. A multistage cluster sampling technique with probability proportionate to size was used. A self-completed, vignette-based questionnaire was developed, validated and pretested for the study. The vignette described the experience of a postpartum mother with symptoms of peripartum depression without suicidal ideation (part A) and the same mother developing suicidal ideation (part B). Results: Out of 624 participants, 202 (33.8%, 95%CI 30.0-37.7%) and 206 (36.7%, 95%CI 32.7-40.8%) reported they would seek help soon if they experienced symptoms of depression and suicidal ideations, respectively, while 181 (30.3%, 95%CI 26.6-34.1%) and 161 (28.6%, 95%CI 24.9-32.6%) said they would so if symptoms or suicidal thoughts did not resolve with time. Women were most likely to seek help from their husbands for symptoms of depression (n=445, 72.6%) and for suicidal thoughts (n=406, 71.1%). A public health midwife (n=346, 57.9%) was preferred over other formal or semiformal sources. If they were to seek help, 467 (49.2%) would contact a doctor or midwife specifically. The majority did not perceive that the described emotions could be symptoms of an illness (n=300, 50.1%) or that having suicidal ideation can be a threat to the life of the affected person (n=308, 52.1%) or that there was a probability for them to develop a mental illness during a current pregnancy (n=379, 65%). The majority perceived that positive responses were likely to be received, and negative responses were less likely to be received, if they were to seek help from their husband, another family member and midwife. Conclusion: Using a vignette approach allowed an exploration of how the 'at risk population' would construct meaning to symptoms of depression and suicidal ideation during pregnancy and the postpartum period, and what their actions would likely be if they were in a similar situation. It was observed that symptoms of depression and suicidal thoughts were regarded as normal by the pregnant women in this rural community, and they also perceived a low threat of getting a similar condition. This is a crucial point to intervene at for improving help-seeking. Informal and semiformal sources of help preferred by these women, especially husbands and public health midwives, should be empowered to respond effectively and facilitate further help-seeking from mental health professionals. [ABSTRACT FROM AUTHOR]

Purpose: The psychosocial health of mother is crucial for healthy prenatal period and early childhood. We investigated the prevalence and risk factors of maternal depression during pregnancy and postpartum among women who participated in a home visitation program in Seoul, South Korea (Seoul Healthy First Step Project, SHFSP). Methods: We analyzed 80,116 women who participated in the SHFSP, which was launched by Seoul metropolitan government in 2013, and defined peripartum depression as a score ≥ 10 on the Korean version of the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic factors and psychosocial health status were evaluated through a standardized questionnaire completed by participants upon program registration. We calculated the prevalence of women at risk for peripartum depression and evaluated associated factors by multivariable logistic regression analysis. Results: Prevalence of women at risk for peripartum depression was 17.7% (prepartum depression: 14.2%, postpartum depression: 24.3%). Younger maternal age, low income (OR 2.40, 95% CI 2.03–2.84), disability (2.61, 1.96–3.47), single parenthood (3.27, 2.69–3.99), and smoking (2.02, 1.44–2.83) increased the peripartum depression risk. Furthermore, experience of stress, change, or loss over the past 12 months (3.36, 3.22–3.50), history of treatment for emotional issues (2.47, 2.27–2.70), experience of child abuse (1.91, 1.74–2.11), and domestic violence (2.25, 1.81–2.80) increased the risk for peripartum depression, whereas having helpers for the baby (0.62, 0.58–0.67), having someone to talk with (0.31, 0.27–0.35), and considering oneself confident (0.30, 0.29–0.31) decreased the risk. Conclusions: Policies to reduce and manage peripartum depression should be strengthened, with a focus on high-risk pregnant and puerperal women. [ABSTRACT FROM AUTHOR]

Abstract Background Peripartum depression is a common disorder with very high potential hazards for both the patients and their babies. The typical treatment options include antidepressants and electroconvulsive therapy. However, these treatments do not ensure the safety of the fetus. Recently, repetitive transcranial magnetic stimulation has emerged as a promising treatment for neuropathies as well as depression. Nevertheless, many studies excluded pregnant women. This systematic review was conducted to confirm whether repetitive transcranial magnetic stimulation was a suitable treatment option for peripartum depression. Methods We performed a systematic review that followed the PRISMA guidelines. We searched for studies in the MEDLINE, PsycINFO, EMBASE, and Cochrane library databases published until the end of September 2020. Eleven studies were selected for the systematic review, and five studies were selected for quantitative synthesis. Data analysis was conducted using Comprehensive Meta-Analysis 3 software. The effect size was analyzed using the standardized mean difference, and the 95% confidence interval (CI) was determined by the generic inverse variance estimation method. Results The therapeutic effect size of repetitive transcranial magnetic stimulation for peripartum depression was 1.394 (95% CI: 0.944–1.843), and the sensitivity analysis effect size was 1.074 (95% CI: 0.689–1.459), indicating a significant effect. The side effect size of repetitive transcranial magnetic stimulation for peripartum depression was 0.346 (95% CI: 0.214–0.506), a meaningful result. There were no severe side effects to the mothers or fetuses. Conclusions From various perspectives, repetitive transcranial magnetic stimulation can be considered an alternative treatment to treat peripartum depression to avoid exposure of fetuses to drugs and the severe side effects of electroconvulsive therapy. Further research is required to increase confidence in the results.

Background: Depressive symptoms, postpartum and peripartum, can affect mothers' ability to nurture their children, and may have adverse impacts on social, cognitive, language, and self-concept development. Currently, postpartum and peripartum depression are treated through psychotherapy, electroconvulsive therapy (ECT), and pharmacotherapy. These treatments are moderately effective and may induce side effects that can negatively impact the mother-child relationship. Repetitive transcranial magnetic stimulation (rTMS) is a new treatment option with promise as an effective and safe treatment for postpartum and peripartum depression.Objective: We conducted a systematic review to assess the effectiveness and safety of rTMS as a treatment option for postpartum and peripartum depression. Design: MEDLINE, PsycINFO, EMBASE, CINAHL, Scopus, The Cochrane Library, Theses and Dissertations Global database were searched. We included randomized and non-randomized studies that used rTMS as the primary treatment option for women with postpartum or peripartum depression as defined by the DSM or ICD. This review abides by the PRISMA 2009 guidelines.Results: A total of 537 articles were identified by the search, and seven articles met the inclusion criteria of the review accounting for a total of 110 participants. Four of the studies assessed rTMS as a treatment for postpartum depression, and three studies assessed rTMS as a treatment for depression during pregnancy. All seven articles suggest that rTMS is a promising treatment option, however, the two existing randomized controlled trials did not observe any statistically significant results. Conclusions and implications: RTMS appears to be a safe treatment with limited side effects and low dropout rates. However, the existing research on rTMS as a treatment for postpartum and peripartum depression is limited and underpowered. More randomized controlled trials with larger sample sizes are needed to better assess the efficacy of rTMS as a treatment option for postpartum and peripartum depression.

Background: Postpartum depression (PPD) is a depressive disorder that occurs after childbirth and can last until a year after delivery. The global prevalence of PPD among mothers is between 0.5% and 63.3%. The aim of the study is to determine the prevalence of postpartum depression within a year after birth among mothers in Semey (Kazakhstan) and identify the factors associated with it. Methods: A cross-sectional study covering 251 women within one year after delivery was conducted in five Primary Healthcare Centers in Semey. The Edinburgh Postnatal Depression Scale (EPDS) for assessing PPD was used. Data was analysed using the Statistical Package for Social Sciences (SPSS), version 25. The statistical significance and magnitude of the relationships between dependent and independent variables were conducted using chi-square and bivariate and multivariate logistic regression analyses. A p-value of less than 0.05 was considered to be significant. Results: The prevalence of PPD within a year after delivery was estimated as 59.4%. Factors including accommodation type (p = 0.021), satisfaction with living conditions (p = 0.001), relationship with mother-in-law (p = 0.013), the interest of the patronage service about the psychological state of a woman after childbirth (p = 0.001) and husband employment status (p = 0.04) showed significant positive association with PPD. Conclusion: The high prevalence rate of PPD and associated risk factors imply the need for strengthening and improving of postpartum care program in country. Further research on the experiences and the level of antenatal depression among women will be needed to understand and prevent any possible depressions in prenatal and postpartum periods.

Introduction The peripartum is a period at high risk for the onset of depressive symptoms. The prevalence of peripartum depression (PD) ranges from 6 to 20% and is burdened with high adverse birth outcomes, poor mother-infant bonding, and a high risk for suicidal ideation and attempts. However, PD is underrecognized and consequently undertreated. Objectives We aimed at screening depressive symptoms in women during pregnancy and postpartum, and evaluating the socio-demographic and clinical characteristics associated with depressive symptoms. Methods 199 women, 55 during pregnancy and 144 in the postpartum period, consecutively admitted to the Perinatal Mental Health Service of Ancona (Italy) were administered a socio-demographic and clinical questionnaire together with the Edinburgh Postnatal Depression Scale (EPDS). Women scoring ≥ 12 at the EPDS were considered screening positive. Results Twenty women (10%) were screening-positive. These women were more often foreigners (R2=0,032; β=0,178; p=0,012), single (R2=0,026; β=0,163; p=0,022), with a positive psychiatric family history (R2=0,114; β=-0,337; p=0,001) and more frequently affected by physical comorbidities unrelated to pregnancy (R2=0,03; β=0-0,174; p=0,014). These women also had more gestational comorbidities such as gestational hypertension (R2=0,02; β=-0,154; p=0,030), shortening of uterus neck (R2=0,05; β=-0,234; p=0,001), and miscarriage threats/placental abruption (R2=0,004; β=-0,067; p=0,001). Conclusions Our study highlighted the association between depressive symptoms and potentially dangerous gestational comorbidities. Our results further stress the need to screen all women in the peripartum for the presence of depression, in order to identify those at-risk and eventually put in place strategies to prevent further complications to mothers and children. Disclosure No significant relationships.

Introduction Postpartum and peripartum depression are debilitating disorders that impact the mother and their ability to care for their children’s emotional, social, and physical needs. Current treatments include psychotherapy, pharmacotherapy, and electroconvulsive therapy. These treatments are moderately effective or come with side effects that can negatively impact mother and child. As a result, many mothers view some treatments as unacceptable while pregnant or breastfeeding. Over the last decade, repetitive transcranial magnetic stimulation (rTMS) has shown promise as an effective and safe treatment option for postpartum and peripartum depression. However, little is known regarding people’s knowledge and attitudes towards this emerging technology, with no research assessing this in Canada. Objectives We aim to identify gaps in knowledge and to assess attitudes toward rTMS as a treatment for postpartum and peripartum depression in mental health professionals, patients, and the general public living in Canada. Methods A mixed methods study design will be employed. The qualitative portion will consist of individual semi-structured interviews. An inductive thematic analysis will be completed. The quantitative portion will consist of an anonymous, self-administered survey shared through REDCap. Focus groups with rTMS experts will be conducted to inform survey creation. Results No resulst at this time. Conclusions Understanding gaps in knowledge and attitudes toward rTMS is the first step toward ensuring that everyone is well informed and able to access safe and effective treatments. With limited treatment options available to a postpartum and/or peripartum depression patients being well informed on all treatments is crucial towards accessing treatments that best suit their needs. Disclosure No significant relationships.

Introduction Peripartum depression (PPD) impacts around 12% of women globally and is a leading cause of maternal mortality. However, there are currently no accurate methods in use to identify women at high risk for depressive symptoms on an individual level. An initial study was done to assess the value of deep learning models to predict perinatal depression from women at six weeks postpartum. Clinical, demographic, and psychometric questionnaire data was obtained from the “Biology, Affect, Stress, Imaging and Cognition during Pregnancy and the Puerperium” (BASIC) cohort, collected from 2009-2018 in Uppsala, Sweden. An ensemble of artificial neural networks and decision trees-based classifiers with majority voting gave the best and balanced results, with nearly 75% accuracy. Predictive variables identified in this study were used to inform the development of the ongoing Swedish Mom2B study. Objectives The aim of the Mom2be study is to use digital phenotyping data collected via the Mom2B mobile app to evaluate predictive models of the risk of perinatal depression. Methods In the Mom2B app, clinical, sociodemographic and psychometric information is collected through questionnaires, including the Edinburgh Postnatal Depression Scale (EPDS). Audio recordings are recurrently obtained upon prompts, and passive data from smartphone sensors and activity logs, reflecting social-media activity and mobility patterns. Subsequently, we will implement and evaluate advanced machine learning and deep learning models to predict the risk of PPD in the third pregnancy trimester, as well as during the early and late postpartum period, and identify variables with the strongest predictive value. Results Analyses are ongoing. Conclusions Pending results. Disclosure No significant relationships.

Objective: This study aimed to explore transcranial electrical stimulation (tES) to relieve peripartum anxiety and depressive symptoms in women undergoing cesarean section with combined spinal–epidural anesthesia. Methods: This double-blind, randomized, sham-controlled trial was conducted in the Affiliated Hospital of Xuzhou Medical University from March 2021 and May 2021. One hundred and forty-eight full-term parturients giving birth by elective cesarean section were selected, and 126 were included in the intent-to-treat analysis. Parturients were provided standardized anesthesia and randomized to the active-tES (a-tES) group and sham-tES group. Parturients and outcome assessors were blinded to treatment allocation. The primary outcome was the changes in peripartum mental health disorders, including anxiety, assessed by the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2). Secondary outcomes included peripartum depressive symptoms, assessed by the Edinburgh Postnatal Depression Scale (EPDS), maternal satisfaction, fatigue level, sleep quality index, and pain score during and after operation. Data were collected before entering the operating room (T0), between post-anesthesia and pre-surgery (T1), before leaving the operating room (T2), and at 24 h post-surgery (T3). Results: One hundred and twenty-six eligible parturients were enrolled in the two groups: a-tES group (N = 62) and sham-tES group (N = 64). Treatment with tES resulted in significantly lower scores of anxiety compared with sham-tES (T2: P < 0.001; T3: P = 0.001). Moreover, the a-tES groups showed a significant reduction in depression scores (T2: P = 0.003; T3: P = 0.032). Conclusion: In this randomized pilot study, tES treatment is efficacious in alleviating peripartum anxiety and depressive symptoms in women undergoing cesarean section and has been demonstrated to be a novel strategy for improving peripartum mental health disorders. Clinical Trial Registration: [www.chictr.org.cn], identifier [ChiCTR2000040963]. [ABSTRACT FROM AUTHOR]

Abstract Background During pregnancy, about 10 to 20% of women experience depressive symptoms. Subclinical depression increases the risk of peripartum depression, maternal neuro-endocrine dysregulations, and adverse birth and infant outcomes. Current treatments often comprise face-to-face psychological or pharmacological treatments that may be too intensive for women with subclinical depression leading to drop-out and moderate effectiveness. Therefore, easily accessible, resilience enhancing and less stigmatizing interventions are needed to prevent the development of clinical depression. This paper describes the protocol of a prospective cohort study with an embedded randomized controlled trial (RCT) that aims to improve mental resilience in a sample of pregnant women through a self-help program based on the principles of Acceptance and Commitment Therapy (ACT). Maternal and offspring correlates of the trajectories of peripartum depressive symptoms will also be studied. Methods Pregnant women (≥ 18 years) receiving care in Dutch midwifery practices will participate in a prospective cohort study (n ~ 3500). Between 12 and 18 weeks of pregnancy, all women will be screened for depression with the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score ≥ 11 will be evaluated with a structured clinical interview. Participants with subclinical depression (n = 290) will be randomized to a 9-week guided self-help ACT-training or to care as usual (CAU). Primary outcomes (depressive symptoms and resilience) and secondary outcomes (e.g. anxiety and PTSD, bonding, infant development) will be collected via online questionnaires at four prospective assessments around 20 weeks and 30 weeks gestation and at 6 weeks and 4 months postpartum. Maternal hair cortisol concentrations will be assessed in a subsample of women with a range of depressive symptoms (n = 300). The intervention’s feasibility will be assessed through qualitative interviews in a subsample of participants (n = 20). Discussion This is the first study to assess the effectiveness of an easy to administer intervention strategy to prevent adverse mental health effects through enhancing resilience in pregnant women with antepartum depressive symptomatology. This longitudinal study will provide insights into trajectories of peripartum depressive symptoms in relation to resilience, maternal cortisol, psychological outcomes, and infant developmental milestones. Trial registration Netherlands Trial Register (NTR), NL7499 . Registered 5 February 2019.

Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating evidence suggests that these disorders may be due to changes in immune responses. During pregnancy complications such as the prolongation of cervical ripening or descent, placental abruption, premature labor, and preeclampsia increase the risk of postpartum psychiatric disorders. Women may exhibit depression and postpartum psychosis following either normal birth or caesarean section. Since psychiatric disorders like schizophrenia, major depression, and bipolar disorder are associated with both alterations in the immune response and changes in immune cell subpopulations, in this study we have chosen to examine whether the psychiatric disorders in women during labor or postpartum also lead to aberrant immune responses.