Weekly Roundup for MARCH 1, 2019: Recent Publications in Women’s Mental Health

This week there are a series of articles related to the recommendations issued by the US Preventive Services Task Force (USPSTF) several weeks ago, stating that all pregnant and postpartum women should be evaluated in order to determine risk for depressive illness and recommends that women at increased risk for perinatal depression should be referred for counseling.

The second editorial from Dr. Lyndsay Avalos and colleagues looks at the USPSTF recommendations from a pediatric perspective, emphasizing that improving maternal mental health is an important step in improving the health and well-being of children and that we need to overcome barriers to the implementation of screening and preventive interventions for perinatal depression. Dr. Jennifer Felder discusses some of the challenges in terms of implementing these recommendations.

Further down on the list is an interesting article from Park and Choi looking at the impact of breastfeeding on risk for perimenopausal depression. These researchers found that breastfeeding for longer periods of time led to a significant reduction in risk. How exactly this happens is not so clear, but it is certainly an interesting finding.

Ruta Nonacs, MD PhD

Attention to Prevention-Can We Stop Perinatal Depression Before it Starts?

Wisner KL, Miller ES, Tandon D. JAMA Psychiatry. 2019 Feb 12.

Preventing Perinatal Depression to Improve Maternal and Child Health-a Health Care Imperative.

Avalos LA, Flanagan T, Li DK. JAMA Pediatr. 2019 Feb 12.

Implementing the USPSTF Recommendations on Prevention of Perinatal Depression-Opportunities and Challenges.

Felder JN. JAMA Intern Med. 2019 Feb 12.

Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice.

Earls MF, Yogman MW, Mattson G, Rafferty J; COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH. Pediatrics. 2019 Jan;143(1).

See also Vaccination nation

Recurrence of depression in the perinatal period: Clinical features and associated vulnerability markers in an observational cohort.

Molenaar NM, Brouwer ME, Kamperman AM, Burger H, Williams AD, Hoogendijk WJG, Bockting CLH, Lambregtse-van den Berg MP. PLoS One. 2019 Feb 22. Free Article

85 pregnant women with a history of depression treated with SSRI or SNRI antidepressants at the start of the study were included. During follow-up, 12 women (14.1%) completely discontinued their medication and four (4.7%) intended to taper medication, but did not completely discontinue during follow-up. Eight women (9.4%) experienced a recurrence of depression; two during pregnancy and six in the first 12 weeks postpartum. Three of the 8 women had discontinued antidepressant. Of the women discontinuing, 25% experienced recurrence compared to 7% of the women continuing.

Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms.

Fisher SD, Sit DK, Yang A, Ciolino JD, Gollan JK, Wisner KL. Depress Anxiety. 2019 Jan 15.

In this research study, researchers identified three distinct trajectories of depressive symptoms: (1) gradual remission (50.4%), (2) partial improvement (41.8%), and (3) chronic severe (7.8%). Factors which were predictive of the chronic severe trajectory (versus gradual remission and partial improvement) included parity, education, and baseline global functioning and depression severity.

Comorbid anxiety and depression: a community-based study examining symptomology and correlates during the postpartum period.

Ramakrishna S, Cooklin AR, Leach LS. J Reprod Infant Psychol. 2019 Feb 20:1-12.

Comorbid anxiety and depression symptomology was common (13.4%), and was associated with greater symptom severity. Women in the ‘comorbid’ group more often experienced financial hardship, cessation of breastfeeding, infants with difficult temperaments, inadequate social support, and stressful adverse life events than mothers with no symptoms.