Depression across pregnancy and the postpartum, antidepressant use and the association with female sexual function
- Authors: Galbally, Megan , Watson, Stuart , Permezel, Michael , Lewis, Andrew
- Date: 2019
- Type: Text , Journal article
- Relation: Psychological Medcine Vol. 49, no. 9 (2019), p. 1490-1499
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- Description: There is an established relationship between depression and sexual functioning in women. However, there is limited research examining the relationship between perinatal depression and sexual functioning. This study draws on the Mercy Pregnancy and Emotional Wellbeing Study and reports on 211 women recruited in early pregnancy and followed to 12 months postpartum. Women were assessed for depression using the Structured Clinical Interview for the DSM-IV, repeated measurement of depressive symptoms using the Edinburgh Postnatal Depression Scale and sexual functioning using the Female Sexual Functioning Inventory. Data were also collected on antidepressant use, mode of delivery, history of childhood trauma, breastfeeding and partner support. Women showed a decline in sexual functioning over pregnancy and the first 6 months postpartum, which recovered by 12 months. For women with depression, sexual functioning was lower throughout pregnancy and continued to be lower at 6 months postpartum than those without depression. Ongoing depressive symptoms at 12 months were also associated with lower sexual functioning. Sexual functioning was not predicted by mode of delivery, antidepressant use or childhood trauma. Breastfeeding predicted lower sexual functioning only at 6 months. Higher partner support predicted higher female sexual functioning. Pregnancy and the postpartum are a time of reduced sexual functioning for women however, women with depression are more likely to have lower levels of sexual functioning and this was not predicted by antidepressant use. In women with perinatal depression, consideration of the impact on sexual functioning should be an integral part of care.
The role of trauma and partner support in perinatal depression and parenting stress: An Australian pregnancy cohort study
- Authors: Galbally, Megan , Watson, Stuart , Boyce, Philip , Lewis, Andrew
- Date: 2019
- Type: Text , Journal article
- Relation: International Journal of Social Psychiatry Vol. 65, no. 3 (2019), p. 225-234
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- Description: Background: Improving our understanding of the relationship between maternal depression and parenting stress is likely to lie in the range of additional factors that are associated with vulnerability to depression and also to parenting stress. Objectives: To examine the role of trauma and partner support, in understanding the relationship between perinatal depression and parenting stress. Methods: This study utilises data from 246 women in a pregnancy cohort study that followed women from early pregnancy until their infant was 12 months. Included were both women with a diagnosis of depression and those without depression. The measures included Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Edinburgh Postnatal Depression Scale, Childhood Trauma Questionnaire, Social Support Effectiveness Questionnaire and the Parenting Stress Index. Results: We found women with depression were more likely to report a history of childhood trauma. Depressive symptoms were positively associated with parenting stress while partner support was negatively associated with parenting stress. The protective role of partner support for parenting distress was observed in those with no history of childhood abuse and low depressive symptoms, but not in those with a trauma history and high depressive symptoms. Conclusions: These findings highlight the importance of early trauma in understanding the protective role of support on the relationship between parenting and depression. These findings can inform future studies and the refinement of future interventions aimed at both perinatal depression and parenting.
Maternal psychosocial predictors of pacifier use in a mother-infant interaction task: An observational study from the MPEWS pregnancy cohort
- Authors: MacMillan, Kelli , Lewis, Andrew , Watson, Stuart , Power, Josephine , Galbally, Megan
- Date: 2020
- Type: Text , Journal article
- Relation: Infant behavior & development Vol. 61, no. (2020), p. 101505
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- Description: •Lower emotional availability at 6 months is associated with mothers more likely using a pacifier.•Women with depression were no more likely to use a pacifier during the interaction.•Women with childhood trauma history were no more likely to use a pacifier during the interaction. The prevalence of pacifier use is high but when it occurs outside of the recommended sleep context, it becomes more controversial. Using 211 mother-infant dyads recorded as part of the Mercy Pregnancy and Emotional Wellbeing Study, we examined the maternal psychosocial predictors of pacifier use within an interaction task (i.e., ten minutes face-to-face followed by 30-minutes unstructured play). Predictors included maternal emotional availability measured with the Emotional Availability Scales depression measured by the Structured Clinical Interview for the DSM-IV-TR Clinician Version and maternal history of childhood trauma measured by the Childhood Trauma Questionnaire. An unadjusted odds ratio demonstrated that women classified as non-emotionally available to their infants were three-and-a-half-times more likely to use a pacifier. Multivariate logistic regression including all maternal psychosocial predictors demonstrated that even when adjusting for cessation of breastfeeding, maternal emotional availability remained the only significant predictor of pacifier use. This is the first time that predictors of pacifier use have been examined with a sample of clinically depressed women, as well as women with childhood trauma history. The results provide preliminary evidence that women who are not emotionally available might be more likely to rely on a pacifier during mother-infant interaction.
Emotional availability in women with bipolar disorder and major depression: A longitudinal pregnancy cohort study
- Authors: Aran, Pavitra , Lewis, Andrew , Watson, Stuart , Nguyen, Thinh , Galbally, Megan
- Date: 2021
- Type: Text , Journal article
- Relation: Australian and New Zealand Journal of Psychiatry Vol. 55, no. 11 (2021), p. 1079-1088
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- Description: Objective: Poorer mother–infant interaction quality has been identified among women with major depression however, there is a dearth of research examining the impact of bipolar disorder. This study sought to compare mother–infant emotional availability at 6 months postpartum among women with perinatal major depressive disorder, bipolar disorder and no disorder (control). Methods: Data were obtained for 127 mother–infant dyads from an Australian pregnancy cohort. The Structured Clinical Interview for the DSM-5 was used to diagnose major depressive disorder (n = 60) and bipolar disorder (n = 12) in early pregnancy (less than 20 weeks) and review diagnosis at 6 months postpartum. Prenatal and postnatal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, along with self-report psychotropic medication use. Mother and infant’s interaction quality was measured using the Emotional Availability Scales when infants reached 6 months of age. Multivariate analyses of covariance examining the effects of major depressive disorder and bipolar disorder on maternal emotional availability (sensitivity, structuring, non-intrusiveness, non-hostility) and child emotional availability (responsiveness, involvement) were conducted. Results: After controlling for maternal age and postpartum depressive symptoms, perinatal disorder (major depressive disorder, bipolar disorder) accounted for 17% of the variance in maternal and child emotional availability combined. Compared to women with major depressive disorder and their infants, women with bipolar disorder and their infants displayed lower ratings across all maternal and child emotional availability qualities, with the greatest mean difference seen in non-intrusiveness scores. Conclusions: Findings suggest that perinatal bipolar disorder may be associated with additional risk, beyond major depressive disorder alone, to a mother and her offspring’s emotional availability at 6 months postpartum, particularly in maternal intrusiveness.
Maternal social support, depression and emotional availability in early mother-infant interaction: Findings from a pregnancy cohort
- Authors: MacMillan, Kelli , Lewis, Andrew , Watson, Stuart , Bourke, Declan , Galbally, Megan
- Date: 2021
- Type: Text , Journal article
- Relation: Journal of affective disorders Vol. 292, no. (2021), p. 757-765
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- Description: •Maternal depression in pregnancy was not predictive of postpartum maternal emotional availability (EA).•Maternal depression in pregnancy was not associated with perceived social support.•Depressive symptoms negatively predict maternal EA when partner support is low.•Depressive symptoms negatively predict maternal EA when family support is low.•Support from friends is not a moderator between depressive symptoms and maternal EA. Social support theory suggests that parental social support may influence the nature of early parenting behaviours and specifically the mother-infant relationship. This study examines whether support from a partner, friends or family is associated with differences in quality of mother-infant interactions in the context of maternal depression. 210 women were followed from early pregnancy to six months postpartum within Australian pregnancy cohort, the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS). Mother-infant interactions within a standardised observation at six months postpartum were measured by the Emotional Availability (EA) Scales using total scores of the parental scales. In early and late pregnancy and at six months postpartum, mothers rated perceived maternal social support from a partner, family and friends using subscales of the Multidimensional Scale of Perceived Social Support. Depression was measured in early pregnancy and at six months postpartum using the Structured Clinical Interview for the DSM-IV-TR, with repeated measurement of depressive symptoms by the Edinburgh Postnatal Depression Scale (EPDS). Data was analysed using structural equation models. There were significant interactions between depressive symptoms in early pregnancy and perceived maternal support from a partner (B = .18, 95% CI = 03, .31) and separately from family (B = .12, 95% CI = .03, .32) in predicting maternal emotional availability. No such interaction was found for support from friends. While partner and family support moderated the association between early depressive symptoms and emotional availability, there were no direct associations between maternal depressive disorder in early pregnancy and perceived support, and further, maternal depression was not a significant predictor of emotional availability. Future studies should consider extending measurement of the mother-infant relationship beyond the EA Scales, inclusion of a measure of maternal childhood trauma, and replicating our findings. Maternal perception of partner and family support in the postpartum is a predictor of the association between early pregnancy depressive symptoms and maternal emotional availability.
The relationship between oxytocin blood concentrations and antidepressants over pregnancy and the postpartum
- Authors: Galbally, Megan , Watson, Stuart , Keelan, Jeffrey , Spigset, Olav , Lewis, Andrew
- Date: 2021
- Type: Text , Journal article
- Relation: Progress in Neuro-Psychopharmacology and Biological Psychiatry Vol. 109, no. (2021), p. 110218-110218
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- Description: Antidepressant treatment of perinatal depression is increasingly common and accepted in clinical guidelines. It has been suggested that serotonergic antidepressants may effect changes in the oxytocinergic system, including oxytocin levels, and that this may be one of the beneficial mechanisms of action for these drugs. Furthermore, oxytocin has been associated with the quality of the parent-child relationship, which may be important in treatment of perinatal depression. This study will explore if there is a relationship between antidepressant use over the perinatal period and oxytocin levels. Data from a pregnancy cohort study are used from 279 women across three groups: women taking antidepressants in pregnancy (n = 48), women with untreated depression (n = 31) and healthy control women (n = 200). Data included antidepressant use, maternal depression and oxytocin plasma concentrations in pregnancy and up to 12 months postpartum. We found that concurrent oxytocin blood concentrations were not associated with perinatal antidepressant use. However, oxytocin blood concentrations increased more steeply in those on antidepressants across the perinatal period compared to control women. A steeper increase for Selective Serotonergic Reuptake Inhibitors was observed, however, this effect was on the boarder of statistical significance. In conclusion, although antidepressant use and oxytocin was not associated at any time point, women taking antidepressants during pregnancy had larger increases in oxytocin over the perinatal period. Future research could examine specific agents and class of antidepressant and the relationship to parenting. •Animal studies have suggested that SSRI antidepressants may be associated with increased oxytocin levels•Oxytocin levels increased for women from early pregnancy to 12 months postpartum•Differences in cross-sectional perinatal oxytocin blood concentrations were not associated with antidepressant use•Antidepressant blood concentrations and oxytocin blood concentrations were not associated•Antidepressants across pregnancy and the postpartum were assocaited with a steeper increase in levels of oxytocin