Maternal anxiety, depression and posttraumatic stress disorder (PTSD) after natural disasters: a systematic review.

OBJECTIVE: To measure the prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) in those exposed to natural disasters. METHODS: A literature search of the PubMed database and www.clinicaltrials.gov from January 1990 through June 2020 was conducted. A PRISMA review of the available literature regarding the incidence and prevalence of maternal anxiety, depression and posttraumatic stress disorder (PTSD) following natural disasters was performed. A natural disaster was defined as one of the following: pandemic, hurricane, earthquake and post-political conflict/displacement of people. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcome was the prevalence of maternal anxiety, depression and PTSD in the post-disaster setting. Two independent extractors (I.F. & H.G.) assessed study quality using an adapted version of the Effective Public Health Practice Project Quality Assessment tool. Given the small number of studies that met inclusion criteria, all 22 studies were included, regardless of rating. Data were extracted and aggregate rates of depression, anxiety, and PTSD were calculated to provide synthesized rates of maternal mental health conditions among participants. RESULTS: Twenty-two studies met the inclusion criteria. A total of 8357 pregnant or birthing persons in the antepartum and postpartum periods were studied. The prevalence of post-pandemic anxiety, depression and PTSD were calculated to be 48.2%, 27.3%, and 22.9%. Post-earthquake depression and PTSD rates were 38.8% and 22.4%. The prevalence of post-hurricane anxiety, depression and PTSD were 17.4%, 22.5%, and 8.2%. The rates of post-political conflict anxiety, depression and PTSD were 48.8%, 31.6% and 18.5%. CONCLUSION: Given the high rates of anxiety, depression and PTSD among pregnant and birthing persons living through the challenges of natural disasters, obstetrician-gynecologists must be able to recognize this group of patients, and provide a greater degree of psychosocial support.

Impact of Leishmania mexicana infection on dendritic cell signaling and functions.

Leishmania parasites have the ability to modify macrophage signaling pathways in order to survive and multiply within its mammalian host. They are also known to invade other cells including neutrophils, fibroblasts and dendritic cells (DCs). DCs have an important role in immunity as the link between innate and adaptive immunity, necessary for the development of an effective response; however, the impact of Leishmania mexicana infection on DCs has been poorly studied. Herein, we report that Leishmania infection rapidly induced DC protein tyrosine phosphatases activity, leading to MAP kinases inactivation. In line with this, L. mexicana was found to decrease the nuclear translocation of transcription factors such as AP-1 and NF-κB. Concomitantly, L. mexicana-infected DCs showed reduced expression of several surface antigen-presenting and co-stimulatory molecules upon LPS stimulation. Leishmania-induced interference on DC maturation was further reflected by their reduced capacity to present OVA antigen to OVA-specific T cells, as shown by abrogation of IL-2 production by the T cells. Collectively, our data revealed that DC infection by L. mexicana appears to affect the cellular and immunological mechanisms necessary for the development of an effective and protective immune response, therefore favouring the survival and propagation of the parasite within its host.