24 January 2022: Working Group 2 “Assessment Approaches and Methods in PPD”
The workshop that was organized by the Working Group 2 “Assessment Approaches and Methods in PPD”, focused on the assessment for peripartum depression in clinical and research settings. The Workshop took place online, on the 24th of January 2022.
In the morning session, the discussion was focused on the biopsychological and neuropsychological underpinnings of perinatal depression and how we can investigate them in research settings. Alkistis Skalkidou noted that sex-steroid hormone profile differences may underlie the difference in the prevalence of depression between women and men, most prominent during the reproductive years. As highlighted, pregnancy is a period with immense hormonal fluctuations, with several hormones, such as estradiol, reaching their peak at the end of the pregnancy and decreasing afterward. Several hormonal systems were discussed in relation to the risk for perinatal depression (PPD), such as the immune system, the sex-steroid system, neurotransmitters, but also genetic and epigenetic differences. Hypothalamus-pituitary-adrenal axis (HPA) function in the perinatal period and implication in PPD was discussed by Ana Conde. One of the mentioned findings was that parents with higher depressive and anxiety symptoms seem to have lower levels of cortisol, signifying an overall hypo-activation of the HPA axis. Results of the systematic review of WG2 on inflammatory markers of PPD were also presented. Further, brain imaging studies were presented by Anna-Lisa Schuler. Several ways to conduct brain imaging studies were presented, such as fMRI, structural MRI, and PET. Regarding the meta-analysis that is conducted on the neurological correlates of postpartum depression (PPD), the preliminary analysis pinpointed two important clusters, namely the anterior cingulate cortex (ACC) and dorsolateral medial prefrontal cortex (dmPFC). Finally, Sara Cruz gave a presentation on the neuropsychological assessment of children. One of the WG2s systematic reviews examined the neural and physiological markers related to socio-emotional and cognitive development in infants of mothers who had experienced PPD. Studies on EED/ERP, fMRI, and the vagal response showed that alteration in infants; neurophysiology is actually related to developmental problems.
In the afternoon session, the discussion was focused on how to assess perinatal depression in clinical settings. Claire Zefara shared with the group her experience as a midwife in Malta. Midwives in Malta play a crucial role in mothers’ perinatal health, they ask women about their mental health and refer when needed, visit women at home until 8 weeks after pregnancy and they offer consultation on breastfeeding to new mothers. Home visits enable the midwives to detect signs of PPD or relapse of symptoms, and teach new mothers coping skills. Also, midwives help by teaching the extended family further skills. This is important, since in Malta's culture, the relationship with the extended family is strong, and thus relatives may help the new mother; nevertheless, a possible overinvolvement could be problematic. Ylva-Li Lindahl discussed the screening process of perinatal mental health problems in Sweden. She mentioned that midwives first administer the two Whooley questions (for depression identification) and two questions from the Generalized Anxiety Disorder scale (GAD-2) during pregnancy and postpartum. Those who respond positively in any of the two Whooley questions and/or report feelings of anxiety, worry, or nervousness more than half the time on GAD-2 are administered the Edinburgh Postnatal Depression Scale (EPDS). Women are referred, when needed, to specialized professionals. Also, fear of childbirth is assessed within this routine screening protocol. Barbara Figueiredo highlighted that screening should be done during the 1st trimester of pregnancy because maternal mental health in this trimester predicts her mental health during the pregnancy and postpartum; the 1st trimester has a higher impact on fetus development and the prevalence of perinatal mental health disorders is in its peak. Also, after childbirth, she suggested that screening should be done as soon as possible. Finally, screening should not be limited to the mother but professionals should assess the partner and the child since maternal mental health is impacted by them. Finally, Magdalena Chrzan-Dętkoś and Tamara Walczak-Kozłowska shared their experience from the screening program implemented in Poland. They mentioned that when women completed the EPDS with direct contact with the professionals, the reported prevalence was significantly lower than when they completed it online. Another important point was that many women in this program, even though had the option to attend a psychological consultation when screened positive for PPD, did not actually attend it. This was explained in terms of the stigma associated with PPD.
In the morning session, the discussion was focused on the biopsychological and neuropsychological underpinnings of perinatal depression and how we can investigate them in research settings. Alkistis Skalkidou noted that sex-steroid hormone profile differences may underlie the difference in the prevalence of depression between women and men, most prominent during the reproductive years. As highlighted, pregnancy is a period with immense hormonal fluctuations, with several hormones, such as estradiol, reaching their peak at the end of the pregnancy and decreasing afterward. Several hormonal systems were discussed in relation to the risk for perinatal depression (PPD), such as the immune system, the sex-steroid system, neurotransmitters, but also genetic and epigenetic differences. Hypothalamus-pituitary-adrenal axis (HPA) function in the perinatal period and implication in PPD was discussed by Ana Conde. One of the mentioned findings was that parents with higher depressive and anxiety symptoms seem to have lower levels of cortisol, signifying an overall hypo-activation of the HPA axis. Results of the systematic review of WG2 on inflammatory markers of PPD were also presented. Further, brain imaging studies were presented by Anna-Lisa Schuler. Several ways to conduct brain imaging studies were presented, such as fMRI, structural MRI, and PET. Regarding the meta-analysis that is conducted on the neurological correlates of postpartum depression (PPD), the preliminary analysis pinpointed two important clusters, namely the anterior cingulate cortex (ACC) and dorsolateral medial prefrontal cortex (dmPFC). Finally, Sara Cruz gave a presentation on the neuropsychological assessment of children. One of the WG2s systematic reviews examined the neural and physiological markers related to socio-emotional and cognitive development in infants of mothers who had experienced PPD. Studies on EED/ERP, fMRI, and the vagal response showed that alteration in infants; neurophysiology is actually related to developmental problems.
In the afternoon session, the discussion was focused on how to assess perinatal depression in clinical settings. Claire Zefara shared with the group her experience as a midwife in Malta. Midwives in Malta play a crucial role in mothers’ perinatal health, they ask women about their mental health and refer when needed, visit women at home until 8 weeks after pregnancy and they offer consultation on breastfeeding to new mothers. Home visits enable the midwives to detect signs of PPD or relapse of symptoms, and teach new mothers coping skills. Also, midwives help by teaching the extended family further skills. This is important, since in Malta's culture, the relationship with the extended family is strong, and thus relatives may help the new mother; nevertheless, a possible overinvolvement could be problematic. Ylva-Li Lindahl discussed the screening process of perinatal mental health problems in Sweden. She mentioned that midwives first administer the two Whooley questions (for depression identification) and two questions from the Generalized Anxiety Disorder scale (GAD-2) during pregnancy and postpartum. Those who respond positively in any of the two Whooley questions and/or report feelings of anxiety, worry, or nervousness more than half the time on GAD-2 are administered the Edinburgh Postnatal Depression Scale (EPDS). Women are referred, when needed, to specialized professionals. Also, fear of childbirth is assessed within this routine screening protocol. Barbara Figueiredo highlighted that screening should be done during the 1st trimester of pregnancy because maternal mental health in this trimester predicts her mental health during the pregnancy and postpartum; the 1st trimester has a higher impact on fetus development and the prevalence of perinatal mental health disorders is in its peak. Also, after childbirth, she suggested that screening should be done as soon as possible. Finally, screening should not be limited to the mother but professionals should assess the partner and the child since maternal mental health is impacted by them. Finally, Magdalena Chrzan-Dętkoś and Tamara Walczak-Kozłowska shared their experience from the screening program implemented in Poland. They mentioned that when women completed the EPDS with direct contact with the professionals, the reported prevalence was significantly lower than when they completed it online. Another important point was that many women in this program, even though had the option to attend a psychological consultation when screened positive for PPD, did not actually attend it. This was explained in terms of the stigma associated with PPD.
