Occurrence of postpartum manic or mixed episodes in women with bipolar I disorder: A systematic review and meta-analysis.

OBJECTIVE: Accurate information on the frequency and prevalence of manic or mixed episodes is important for therapeutic, prognostic, and safety concerns. We aimed to estimate the risk of relapse of manic and mixed episodes after delivery in women with bipolar I disorder or schizoaffective disorder-bipolar type. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search in PubMed, PsycINFO, Embase, and Cochrane databases was carried out on November 17, 2022, using the terms ((bipolar disorder) OR (manic depressive illness)) AND (mania)) AND (postpartum)) AND (recurrence)) AND (relapse). The search was updated on March 29, 2023. Case studies and qualitative analyses were excluded. Twelve studies reporting on 3595 deliveries in 2183 women were included in the quantitative analysis. RESULTS: The overall pooled estimate of postpartum relapse risk was 39% (95% CI = 29, 49; Q(11) = 211.08, p < 0.001; I2 = 96.31%). Among those who had a relapse, the pooled estimate of risk for manic and mixed episodes was 38% (95% CI = 28, 50; Q(11) = 101.17, p < 0.001; I2 = 91.06%). Using data from the nine studies that reported the percentage of medication use during pregnancy, we estimated a meta-regression model with the percent medication use as a continuous explanatory variable. The estimated prevalence of relapse was 58.1% (95% CI, 9.6 to 39.3 to 76.8) for studies with no medication use and 25.9% (95% CI, 10.5-41.3) for studies with 100% medication use. The difference between the two prevalence estimates was statistically significant, z = -2.099, p = 0.0359. CONCLUSIONS: Our findings suggest an overall pooled estimate of postpartum relapse risk of 39%, while the pooled estimate of risk for manic and mixed episodes was 38%. These findings highlight the need to educate patients with bipolar I disorder, and their healthcare professionals about the high risk of relapse of manic or mixed episodes after delivery.

Careful considerations for the treatment of posttraumatic stress disorder during and following pregnancy.

INTRODUCTION: The focus on perinatal mental health has expanded recently, though there is less research on post-traumatic stress disorder (PTSD). Therefore, a review of the literature was undertaken and coupled with expert clinical insights to discuss current clinical practice recommendations for PTSD in the perinatal period. AREAS COVERED: This review covers considerations for the assessment, prevention, and treatment of PTSD during the perinatal period. Within these sections, evidence-based and promising practices are outlined. Extra attention is afforded to treatment, which includes considerations from both psychotherapeutic and psychopharmacological perspectives. This review closes with coverage of three important and related areas of consideration, including bereavement, intimate partner violence, and childhood sexual abuse. EXPERT OPINION: Psychotherapeutic interventions for PTSD during pregnancy are limited, and no strong recommendations can be supported at this time while evidence points toward the effectiveness of cognitive behavioral therapies and eye movement desensitization therapy as first-line treatments postpartum though research evidence is also limited. Research on psychopharmacological interventions is similarly scarce, though selective serotonin reuptake inhibitors may be beneficial. Clinicians should also be mindful of additional considerations that may be needed for the treatment of PTSD in the context of bereavement, intimate partner violence, and history of sexual violence.

Development and Initial Validation of the Transportation Support Scale.

IMPORTANCE: Driving cessation affects older drivers and, possibly, also care partners (most of whom tend to be women). Although tools exist to assess the effects on family and friends of providing informal care to someone who needs assistance, no tool is available to clinicians that specifically focuses on the effects of driving cessation. OBJECTIVE: To develop the Transportation Support Scale (TSS) to measure care partners' responses-both negative and positive-to driving cessation and assuming transportation responsibilities. DESIGN: We developed a list of 98 items to capture the impact on care partners of providing transportation to older adults who have stopped driving. In Phase 1, we pretested the items qualitatively with a small sample of care partners. In Phase 2, we reduced the number of items and examined several psychometric properties of the TSS with a larger sample. SETTING: Community. PARTICIPANTS: Two convenience samples of care partners who provide transportation (Phase 1, n = 11; Phase 2, n = 66). RESULTS: The initial pool of items was reduced from 98 to 22. The final TSS has an internal consistency of .88 (Cronbach's α). Thirty-five percent of care partners' scores fell above the middle possible score; these care partners were likely experiencing a high negative impact related to providing transportation after driving cessation. CONCLUSIONS AND RELEVANCE: The TSS demonstrated adequate preliminary psychometric properties. We need additional research to further evaluate the psychometric properties of the TSS (e.g., test-retest reliability). A fully validated TSS may be useful to clinicians and researchers. What This Article Adds: The TSS has the potential to help clarify the perspective of care partners as well as inform the development and evaluation of services for care partners who are providing transportation to former drivers.

Preventing recurrence of postpartum depression by regulating sleep.

INTRODUCTION: Women are at a high risk of recurrence of depression in the postpartum period. Given the circumscribed duration of the risk period and knowledge of its triggers, postpartum depression should be easily preventable. However, prophylactic drug studies have reported contradictory findings partly due to the heterogeneity of the disorder. Currently, there are no studies on the efficacy of psychotherapy in the prevention of postpartum depression in women with major depressive or bipolar disorder. AREAS COVERED: This review evaluates the results of controlled medication and psychotherapeutic studies in the prevention of depression in women with major depressive disorder or bipolar disorder; it further suggests that the management of sleep loss/insomnia may be an effective strategy in the prevention of postpartum depression. EXPERT OPINION: A thorough understanding of the clinical course of the antecedent mood disorder and historical treatment response is necessary before the implementation of strategies for the prevention of postpartum depression. Targeting disturbed and/or insufficient sleep - a common and early transdiagnostic symptom of peripartum psychiatric disorders - may be a more effective intervention for the prevention of postpartum depression and psychiatric comorbidities in some individuals than the traditional approach of antidepressant use.

Technology-Facilitated Sexual Harassment Against Women and Psychological Dysfunction: A Test of Objectification Theory.

Objectification theory was tested to examine the potential mediating role of self-objectification in the relationship between technology-facilitated sexual harassment (TFSH) and psychological functioning in a sample of women (N = 481). The results indicated that TFSH was associated with eating pathology, alcohol use, and sexual functioning. Furthermore, partial support for the objectification theory was achieved, with self-objectification potentially explaining the relationships between TFSH and eating pathology, and TFSH and alcohol use. This research may shed light on the role of objectification processes in the context of TFSH in women, as well as inform mental health interventions for women victims of TFSH.

Motives to engage with or refrain from gambling and loot box content: an exploratory qualitative investigation.

This study examined motives to engage or refrain from engaging with gambling and loot boxes (i.e., in-game "boxes" that can be won within a game or purchased with in-game currency or real money, and which contain a random selection of prizes or objects). University students (n = 321) and community members (n = 279) completed an online questionnaire that included open-ended motives questions. Qualitative inductive content analysis was used to identify a number of overlapping motives to engage with or refrain from gambling and loot box content. Themes associated with motives to gamble included enjoyment, the chance to win, boredom, and charitable intentions. Self-reported reasons to engage with loot boxes included enjoyment, the chance to win, game progression, and passive engagement. In contrast, themes associated with refraining from gambling included negative consequences (e.g., addiction), uncertain outcomes, disinterest, finances, and accessibility. Similarly, reasons to refrain from loot boxes included negative consequences, gambling concerns, disinterest, finances, and accessibility. Overall, these findings, and particularly the overlapping themes between gambling and loot boxes engagement, provide further context and insight into the burgeoning research on loot boxes and assist in delineating their relation to gambling.Motives to engage with or refrain from gambling and loot box content: An exploratory qualitative investigation.

Relationship of Premenstrual Dysphoric Disorder With Bipolar Disorder: A Systematic Review.

Objective: Since depression represents the most predominant mood polarity in bipolar disorder (BD), the prevalence rates of a diagnosis of premenstrual dysphoric disorder (PMDD) in women with BD and those of a diagnosis of BD in women with PMDD deserve systematic review.Data Sources: A systematic search of PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Reviews databases was carried out on November 19, 2021, using the terms [late luteal phase disorder OR premenstrual dysphoric disorder] AND comorbidity AND bipolar disorder. Articles from 1987-2021 were searched. Case studies, intervention studies, reviews, and systematic analyses were excluded.Study Selection: All studies that included a diagnosis of PMDD and BD were included.Data Extraction: The selected articles were reviewed to extract data using a data extraction form developed for this study.Results: A total of 5 studies were included in the review. Extant literature, although limited, suggests that PMDD is more common among women with BD than in the general population. Similarly, BD is more common among women with PMDD than in the general population. The proportion of people with PMDD and diagnosed with BD ranged from 10% to 15%. Conversely, the proportion of people with BD who received a diagnosis of PMDD ranged from 27% to 76%.Conclusions: Only a small number of relevant studies were available, and the findings from these were limited by the failure to employ prospective monitoring of symptoms-perhaps the most important feature necessary for confirming PMDD and differentiating it from premenstrual exacerbation of BD. Given the important clinical and heuristic implications, prospective studies are needed to clarify the relationship between the two disorders in order to improve their detection, diagnosis, and treatment.

Are we overlooking obsessive-compulsive disorder during and after pregnancy? Some arguments for a peripartum onset specifier.

The peripartum period appears to be a potent trigger of obsessive-compulsive disorder in women; however, due to the lack of awareness and routine screening, women with obsessive-compulsive disorder may be at risk of under- or misdiagnosis. Unfortunately, the missed diagnosis or misdiagnosis can have serious consequences including symptom persistence, compromised ability to care for the newborn, poor quality of life and unnecessary reporting of the mother to child protective services. It is argued that future iterations of the DSM consider expanding the scope of the peripartum onset specifier to include obsessive-compulsive disorder to increase its detection, diagnosis and management.

Development and Initial Evaluation of the Patterns of Activity Measure-Pain Short Form.

OBJECTIVES: There has been growing interest in examining pain-related activity patterns and their relationships to psychosocial functioning. The Patterns of Activity Measure-Pain (POAM-P) is frequently used to measure 3 pain-related activity patterns: avoidance, overdoing, and pacing. Although the POAM-P possesses excellent psychometric properties, its length may limit its utility where multiple measures of functioning are required or the time available for assessment is limited. The present studies describe the development and evaluation of a short-form version of this measure. MATERIALS AND METHODS: In Study 1, 775 individuals with ongoing pain completed the original POAM-P at the start of a treatment program. Item analyses were conducted to construct a short-form of the POAM-P. In Study 2, a separate sample of 171 individuals completed the original and short-form of the POAM-P, and measures of psychosocial functioning. Correlations between the short-form and original, and between the short-form and measures of psychosocial functioning were examined to evaluate the reliability and validity of the short-form. RESULTS: The 3 scales of the short-form were found to have excellent internal consistency and correlated well with corresponding scales on the original POAM-P. Correlations between scales on the short-form and measures of psychosocial functioning supported the construct validity of the measure. DISCUSSION: The short-form of the POAM-P possesses good psychometric properties and correlates well with the long-form of the measure. It appears to be a promising addition to existing measures of pain-related activity. It may be useful as an addition to questionnaire batteries that comprehensively assess the psychosocial functioning of individuals with ongoing pain.

Patterns of pain-related activity: replicability, treatment-related changes, and relationship to functioning.

Changes in activity patterns frequently accompany the experience of chronic pain. Two activity patterns, avoidance and overdoing, are hypothesized to contribute to the development of ongoing pain and pain-related disability, while activity pacing is frequently introduced to enhance pain management and functioning. Two studies were conducted to assess whether reliable subgroups with differing activity patterns could be identified in different pain populations and to evaluate changes in these subgroups after a group format, pain management program. In study 1, individuals with ongoing pain being assessed for treatment at 2 different tertiary care pain centres completed a measure of pain-related activity. Separate cluster analyses of these samples produced highly similar cluster solutions. For each sample, a 2-cluster solution was obtained with clusters corresponding to the activity patterns described by the avoidance-endurance model of pain. In study 2, a subset of individuals completing a 12-session, group format, pain management program completed measures of pain-related activity, pain intensity, and physical and psychological functioning at the beginning and end of the program. At the conclusion of the program, 4 clusters of pain-related activity were identified. Individuals who used high levels of activity pacing and low levels of avoidance consistently reported significantly better functioning relative to all other individuals. Observed changes in activity patterns from pre-treatment to post-treatment suggested that decreasing the association between activity pacing and avoidance was associated with better functioning. These results have implications for both the assessment of activity pacing and for its use as an intervention in the management of ongoing pain.

The hormonal sensitivity hypothesis: A review and new findings.

Previous women's health practitioners and researchers have postulated that some women are particularly sensitive to hormonal changes occurring during reproductive events. We hypothesize that some women are particularly sensitive to hormonal changes occurring across their reproductive lifespan. To evaluate this hypothesis, we reviewed findings from the existing literature and findings from our own lab. Taken together, the evidence we present shows a recurring pattern of hormonal sensitivity at predictable but different times across the lifespan of some women (i.e., menarche, the premenstrual phase, hormonal contraceptive use, pregnancy, the postpartum period, and menopause). These findings provide support for the hypothesis that there is a subgroup of women who are more susceptible to physical, psychological, and sexual symptoms related to hormonal shifts or abrupt hormonal fluctuations that occur throughout the reproductive lifespan. We propose that this pattern reflects a Hormonal Sensitivity Syndrome.

Breastfeeding and Postpartum Depression: An Overview and Methodological Recommendations for Future Research.

Emerging research suggests that a relationship exists between breastfeeding and postpartum depression; however, the direction and precise nature of this relationship are not yet clear. The purpose of this paper is to provide an overview of the relationship between breastfeeding and postpartum depression as it has been examined in the empirical literature. Also, the potential mechanisms of action that have been implicated in this relationship are also explored. PubMed and PsycINFO were searched using the keywords: breastfeeding with postpartum depression, perinatal depression, postnatal depression. Results of this search showed that researchers have examined this relationship in diverse ways using diverse methodology. In particular, researchers have examined the relationships between postpartum depression and breastfeeding intention, initiation, duration, and dose. Due to a number of methodological differences among past studies we make some recommendations for future research that will better facilitate an integration of findings. Future research should (1) use standardized assessment protocols; (2) confirm diagnosis through established clinical interview when possible; (3) provide a clear operationalized definition for breastfeeding variables; (4) clearly define the postpartum period interval assessed and time frame for onset of symptoms; (5) be prospective or longitudinal in nature; and (6) take into consideration other potential risk factors identified in the empirical literature.

Breastfeeding and postpartum depression: Assessing the influence of breastfeeding intention and other risk factors.

BACKGROUND: Risk and protective factors for postpartum depression have been extensively studied, and in recent studies an association between breastfeeding and maternal mood has been reported. The present retrospective, cross-sectional study was conducted to evaluate the association between breastfeeding-related variables and postpartum depression (based on Edinburgh Postnatal Depression Scale threshold criteria) within the context of other known risk factors. METHOD: Breastfeeding information, demographic information, and scores on the Edinburgh Postnatal Depression Scale were examined from the Canadian Maternity Experience Survey. This survey contains data collected from 6421 Canadian mothers between October 2006 and January 2007, and 2848 women between five and seven months postpartum were included in the current analyses. RESULTS: In contrast to previous research, logistic regression analyses revealed that when considered within the context of other risk factors, breastfeeding attempt and duration were not associated with postpartum depression at five to seven months postpartum. Although a relationship between the prenatal intention to combination feed and postpartum depression was observed, these variables were no longer related once other potential risk factors were controlled for. Factors that were associated with postpartum depression included lower income, higher perceived stress, lower perceived social support, no history of depression, or no recent history of abuse. LIMITATIONS: A clinical diagnostic instrument was not used and variable selection was restricted to data collected as part of this survey. CONCLUSION: These findings suggest that the association between breastfeeding and postpartum depression reported by previous researchers may in fact be due to alternative risk factors.

Obstacles to activity pacing: assessment, relationship to activity and functioning.

Activity pacing is frequently included among the strategies provided to individuals with chronic pain to manage pain and improve functioning. Individuals with chronic pain may, however, limit their use of activity pacing because they perceive significant obstacles to its use. This study describes the development of a measure to assess obstacles to activity pacing and examines the relationship of this measure to activity patterns and functioning. A sample of 637 individuals with chronic pain completed items describing potential obstacles to activity pacing as part of their pretreatment assessment. Item analyses were used to construct a 14-item measure of obstacles to activity pacing. A subset of these individuals completed the measure again after completion of a group treatment program. The resulting measure demonstrated excellent internal consistency and was minimally affected by social desirability. Correlations with measures of activity and psychosocial functioning provided initial construct validity for the measure. Sex differences were found with women initially identifying more obstacles to activity pacing. Fewer obstacles were identified by both men and women after treatment, and these changes were related to modest changes in activity patterns and functioning. The present results identify a number of obstacles that may limit the use of activity pacing by individuals with chronic pain. Treatment may result in a decrease in the number of obstacles identified, and this change is related to changes in the individual's activity pattern and psychosocial functioning.

A meta-analysis of the worldwide prevalence of pica during pregnancy and the postpartum period.

BACKGROUND: Although pica has long been associated with pregnancy, the exact prevalence in this population remains unknown. OBJECTIVES: To estimate the prevalence of pica during pregnancy and the postpartum period, and to explain variations in prevalence estimates by examining potential moderating variables. SEARCH STRATEGY: PsycARTICLES, PsycINFO, PubMed, and Google Scholar were searched from inception to February 2014 using the keywords pica, prevalence, and epidemiology. SELECTION CRITERIA: Articles estimating pica prevalence during pregnancy and/or the postpartum period using a self-report questionnaire or interview were included. DATA COLLECTION AND ANALYSIS: Study characteristics, pica prevalence, and eight potential moderating variables were recorded (parity, anemia, duration of pregnancy, mean maternal age, education, sampling method employed, region, and publication date). Random-effects models were employed. MAIN RESULTS: In total, 70 studies were included, producing an aggregate prevalence estimate of 27.8% (95% confidence interval 22.8-33.3). In light of substantial heterogeneity within the study model, the primary focus was identifying moderator variables. Pica prevalence was higher in Africa compared with elsewhere in the world, increased as the prevalence of anemia increased, and decreased as educational attainment increased. CONCLUSIONS: Geographical region, anemia, and education were found to moderate pica prevalence, partially explaining the heterogeneity in prevalence estimates across the literature.