The peripartum period involvement in the development of post-partum depression. A prospective cohort study.

PURPOSE: This study explores postpartum depression (PPD) in women who screened negative in mid-pregnancy to assess the impact of the peripartum period on the development of depressive symptoms. METHODS: A prospective cohort study was carried out in two facilities in Argentina. The Edinburgh postnatal depression scale (EPDS) scale was applied to pregnant women between weeks 20-24 gestation, and those screening negative (<10) were included in the cohort. Participants were followed up until the 4th week postpartum, when the EPDS was repeated. If positive, a semi-structured clinical interview was applied (MINI) to define the diagnosis. RESULTS: A total of 112 pregnant women were eligible for the follow-up. At the 4th week postpartum, 14 women (12.5%, CI 95% 7.0; 20.1) screened positive using a cutoff point of 10 or more in the EPDS. Of those screened positive in the EPDS, two participants (1.8%, CI 95% 0.2-6.3) had a Major Depressive Disorder. Newborn admission to the Intensive Care Unit, hospitalization of the newborn after discharge, abuse during childbirth, and lack of company during labor were identified as peripartum risk factors. CONCLUSIONS: This study reinforces the relevance of women and newborn mental health care during the hospitalization process surrounding peripartum. The women and newborn hospitalization process should be better explored to understand the contribution to PPD and design and test strategies to alleviate the impact of maternal depression.

Factors associated with depression during pregnancy in women from a low socioeconomic level: A hierarchical model approach.

The objectives of this cross-sectional study were to estimate the prevalence of depressive symptoms and affective disorders during pregnancy in a maternity hospital in Argentina and to explore potential risk factors. Symptoms of depression were measured with the Edinburgh Postnatal Depression Scale (EPDS), and the Mini International Neuropsychiatric Interview (MINI) for diagnosis at mid-pregnancy. 50.7%, 95% CI: 43.7; 57.8 screened positive using a score ≥ 10 and 23% of pregnant women were diagnosed with affective disorders, 11% unipolar, and 12% bipolar. Personal and family depression history were main risk factors. It is advised to routinely screen for depression during pregnancy.

Polyunsaturated fatty acids as predictors of future suicide attempt.

Polyunsaturated fatty acids (PUFAs) and cholesterol are lipids implicated in suicide risk. We prospectively studied plasma glycerophospholipid PUFAs and cholesterol as putative predictors of suicide attempts. In a multicenter cohort study, we enrolled 123 patients admitted to the emergency department (ED) for suicidal ideation or suicide attempt. Clinical assessments were performed, with follow-up telephone evaluations 6, 12, 18, and 24 months later. Blood samples were obtained in the ED and assayed for PUFAs. Using survival analysis, suicide events were not predicted by eicosapentaenoic acid (EPA, HR: -0.83, 95%CI: 0.39-1.76, p = 0.621) or docosahexaenoic acid (DHA, HR: -0.60, 95%CI: 0.19-1.86, p = 0.371). However, higher arachidonic acid (AA) was a trend for a protective factor (HR=0.30, 95%CI: 0.08-1.08, p = 0.065) in the entire trans-diagnostic sample. This protective effect was significant in all participants with a prior suicide attempt history (n = 85; HR=0.16, 95%CI: 0.04-0.67, p = 0.012), and in the subgroup of attempters with major depressive disorder (MDD; n = 55, HR=0.15, 95%CI:0.03-0.76, p = 0.002). Total LDL- and HDL-cholesterol did not predict subsequent suicide events. AA, but not DHA or EPA, positively correlated with baseline depression severity in MDD patients (r = 0.3, p = 0.006). Contrary to our hypothesis that low n-3 PUFA levels would create risk, we found that while higher AA was associated with greater depression severity at baseline, low AA unexpectedly predicted subsequent suicide attempts, the more so in higher-risk patients. Although surprising, this result agrees with a minority of reports concerning n-6 PUFAs and may represent complex interactions with sample characteristics.

Differential Impact of Child Sexual Abuse and Family History of Suicidal Behavior in High-Risk Suicidal Patients.

The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than family history of suicidal behavior.

Interaction between prospective risk factors in the prediction of suicide risk.

BACKGROUND: To meet the goal of preventing suicide the most important thing is to know the risk factors of suicidal behavior and understand their interaction. AIMS: The current study aims to evaluate prospective predictors and the interaction between factors for suicide and suicide re-attempts in high-risk, suicidal patients during a 24 month prospective follow-up period. METHODS: A multicenter prospective cohort study was designed to compare data obtained from 324 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Participants were clinically evaluated at baseline and follow-up every 6 months to assess any unfavorable events (suicide or a suicide attempt). To estimate the rate of unfavorable events, the Kaplan-Meier method was used and Cox Proportional Hazards Regression Model was employed to examine predictors of suicide and suicide reattempt. RESULTS: The incidence of a new suicide attempt was 26,000 events/100,000 persons-years. The incidence of death by suicide was 1110 events/100,000 person-year. The most reliable predictors of unfavorable events were being women, previous suicide attempts, younger age, and childhood sexual abuse. Findings revealed an interaction between childhood sexual abuse and low psychosocial functioning that increased the risk of an unfavorable event. CONCLUSION: The risk of suicide re-attempts and suicide in the current 2-year follow-up was high. There was an interaction between low psychosocial functioning and childhood sexual abuse. This evidence should be taken into account for the evaluation and planning of preventive strategies.

Lethality of Previous Suicidal Behavior among Patients Hospitalized for Suicide Risk Predicts Lethality of Future Suicide Attempts.

OBJECTIVE: A suicide attempt is an established risk factor for subsequent suicide attempts and suicide. Nonetheless, the prediction of future suicidal behavior is poor. The lethality of previous suicidal behavior may be informative to better understand future suicide risk among patients hospitalized for suicidal thoughts and behavior. The current study examined whether the lethality of patients' index (most recent suicidal episode at hospitalization), first, and worst suicidal episode predicts the lethality of one's most lethal suicide attempt during a 2-year follow-up period. METHOD: A total of 98 patients hospitalized at an emergency department for high suicide risk (i.e., acute suicidal ideation or a suicide attempt) were included in the study. RESULTS: Results indicated that the lethality of the index suicidal episode predicted the lethality of the worst suicide attempt during a 2-year follow-up period. CONCLUSIONS: These findings extend a growing literature examining risk factors that influence the progression toward high lethality suicidal behavior.

Serotonin transporter gene polymorphism as a predictor of short-term risk of suicide reattempts.

OBJECTIVE: The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship. METHODS: A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months. RESULTS: At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p =  0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0-7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity. CONCLUSION: The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.

Depresion durante el período perinatal en dos maternidades de Argentina / Depression during the perinatal period in two maternity hospitals in Argentina

INTRODUCCIÓN La depresión es uno de los trastornos mentales más frecuente en todo el mundo; según la Organización Mundial de la Salud (OMS) afecta a unos 350 millones de personas. Durante el período perinatal los valores de depresión son aún más elevados, transformando a la misma en un objetivo prioritario en salud pública debido a las consecuencias que origina sobre la salud materna y del recién nacido. Hasta el momento todos los trabajos de depresión perinatal en Argentina se han focalizado en la depresión postparto y no se ha explorado la depresión durante el embarazo. OBJETIVOS Estimar la prevalencia de síntomas de depresión perinatal usando la Escala de Depresión Postparto de Edimburgo (Edinburgh Pospartum Depression Scale, EPDS) y la prevalencia de Trastornos Afectivos realizando para esto una evaluación con una entrevista diagnóstica semiestructurada (Entrevista Neuropsiquiátrica Internacional MINI, MINI International Neuropsychiatric Interview) en mujeres de dos maternidades de Argentina. Asimismo se espera poder describir los factores de riesgo asociados a los síntomas depresivos durante el embarazo. Por último, se evaluará la relación entre los síntomas depresivos durante el embarazo, la frecuencia de complicaciones perinatales y los síntomas depresivos durante el puerperio. MATERIALES Y MÉTODOS Se realizó un estudio de cohorte en dos maternidades de Argentina, una pública en Tucumán y otra privada de la Ciudad de Buenos Aires. RESULTADOS Se tamizaron un total de 1212 mujeres entre la semana 20 y 24 de gestación, 891 en Tucumán y 321 en CEMIC. De estas mujeres fueron elegibles 208 (23.3%) y se evaluaron 205 en Tucumán y en CEMIC fueron elegibles y se evaluaron 186 (57.9%). En Tucumán, del total de 205 mujeres, 104 (50.7%) fueron tamizadas positivas en la Escala de Edimburgo usando un punto de corte de 10 o más. En CEMIC, del total de 186 mujeres, un total de 30 mujeres (16.1%) fueron tamizadas positivas en la Escala de Edimburgo usando un punto de corte de 10 o más. En Tucumán encontramos que las mujeres con síntomas de depresión tuvieron mayores complicaciones perinatales entre ellas sufrimiento fetal 9.77 (0.98 a 96.95), amenaza de aborto 2.38 (0.51 a 11.14) y muerte fetal 3.2 (0.43 a 23.56), mientras que en CEMIC no se encontraron diferencias

Determinants of mental and physical health-related quality of life among patients hospitalized for suicidal behavior.

The current study was interested in exploring the clinical factors related to mental and physical health-related quality of life among patients hospitalized for suicidal behavior. A multicenter cross-sectional study was designed to compare data obtained form 246 patients hospitalized for suicide behavior. Results suggest that mental health-related quality of life was negatively associated with hopelessness while physical health-related quality of life was negatively associated with age, medical disease and the number of previous suicide attempts and positively associated with employment. Findings are discussed in the context of theoretical evidence and clinical implications.

The independent effects of child sexual abuse and impulsivity on lifetime suicide attempts among female patients.

Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (ß=.18, p<.05) and impulsivity (ß=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (ß=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior.

Vasoconstrictor effects of 8-iso-prostaglandin E2 and 8-iso-prostaglandin F(2alpha) on human umbilical vein.

The present study was undertaken to determine whether 8-iso-prostaglandin E2 and 8-iso-prostaglandin F(2alpha) posses contractile action on human umbilical vein and to evaluate the possible involvement of prostanoid TP receptors in this effect. Human umbilical vein rings were mounted in organ baths and concentration-response curves to 8-iso-prostaglandin E2 or 8-iso-prostaglandin F(2alpha) were constructed. Both isoprostanes evoked concentration-dependent contraction. 8-iso-prostaglandin E2 (pEC50=6.90+/-0.03) was significantly more potent than 8-iso-prostaglandin F(2alpha) (pEC50=6.10+/-0.04). However, both isoprostanes were equieffective. The prostanoid TP receptor antagonists, ICI-192,605 (4-(Z)-6-(2-o-Chlorophenyl-4-o-hydroxyphenyl-1,3-dioxan-cis-5-yl)hexenoic acid) and SQ-29548 (7-[3-[[2-[(phenylamino)carbonyl]hydrazino]methyl]-7-oxabicyclo[2.2.1]hept-2-yl]-[1S(1alpha,2alpha(Z),3alpha,4alpha)]-5-Heptenoic acid) produced a competitive rightward shift of 8-iso-prostaglandin E2 concentration-response curves with pKB values of 8.91+/-0.04 and 8.07+/-0.07, respectively. When ICI-192,605 (1 nM) and SQ-29548 (10 nM) were evaluated against 8-iso-prostaglandin F(2alpha) they produced a parallel rightward displacement of 8-iso-prostaglandin F(2alpha) concentration-response curves without affecting the maximum responses giving pA2 values of 9.02+/-0.12 and 8.26+/-0.13, respectively. In conclusion, the present study describes for the first time the vasoconstrictor action of 8-iso-prostaglandin E2 and 8-iso-prostaglandin F(2alpha) in human umbilical vein. Furthermore, the affinity values obtained with ICI-192,605 and SQ-29548 provide strong pharmacological evidence of prostanoid TP receptors involvement in this effect.

Pharmacological characterization of prostanoid receptors mediating vasoconstriction in human umbilical vein.

1. This study was undertaken to characterize pharmacologically the prostanoid receptor subtypes mediating contraction in human umbilical vein (HUV). 2. HUV rings were mounted in organ baths and concentration-response curves to U-46619 (TXA(2) mimetic) were constructed in the absence or presence of SQ-29548 or ICI-192,605 (TP receptor antagonists). U-46619 was a potent constrictor (pEC(50): 8.03). SQ-29548 and ICI-192,605 competitively antagonized responses to U-46619 with pK(B) values of 7.96 and 9.07, respectively. 3. Concentration-response curves to EP receptor agonists: PGE(2), misoprostol and 17-phenyl-trinor-PGE(2) gave pEC(50) values of 5.06, 5.25 and 5.32, respectively. Neither pEC(50) nor maximum of PGE(2) and 17-phenyl-trinor-PGE(2) concentration-response curves were modified by the DP/EP(1)/EP(2) receptor antagonist AH 6809 (1 micro M). However, ICI-192,605 produced a concentration-dependent antagonism of the responses to all the EP receptor agonists. The pA(2) estimated for ICI-192,605 against PGE(2) or misoprostol were 8.91 and 9.22, respectively. 4. Concentration-response curves to FP receptor agonists: PGF(2)(alpha) and fluprostenol gave pEC(50) values of 6.20 and 5.82, respectively. ICI-192,605 (100 nM) was completely ineffective against PGF(2)(alpha) or fluprostenol. In addition, lack of antagonistic effect of AH 6809 (1 micro M) against PGF(2)(alpha) was observed. 5. In conclusion, the findings obtained with TP-selective agonist and antagonists provide strong evidence of the involvement of TP receptors promoting vasoconstriction in HUV. Furthermore, the action of the natural and synthetic EP receptor agonists appears to be mediated via TP receptors. On the other hand, the results employing FP receptor agonists and antagonists of different prostanoid receptors suggest the presence of FP receptors mediating vasoconstriction in this vessel.