ObjectivePostpartum depression (PPD) reportedly affects up to 20% of new mothers. While parental psychiatric history has been associated with an increased likelihood of neurodevelopmental conditions in the offspring, only a few studies of clinically diagnosed PPD exist exploring associated autism spectrum disorder (ASD) outcomes and no study to date has explored the contributions of paternal PPD with ASD risk or the combined influence.MethodsA nationwide prospective cohort of all live births in Sweden from 1997 through 2021, followed up through December 31, 2022. Associations between parental PPD and ASD were quantified by hazard ratios and two-sided 95% confidence intervals (CIs) from Cox regressions.ResultsAmong 1,781,349 live-births, ASD was diagnosed in 986 (4.6%) children of 21,461 born to mothers with PPD (574.3 per 100,000 person-years), 331 (5.3%) of 6,292 born to fathers with PPD (589.0 per 100,000 person-years), and 37 (8.8%) of 420 when both parents had PPD (1177.3 per 100,000 person-years). The hazard ratio of ASD when the mother was diagnosed with PPD was 2.56[CI:2.29-2.85], for fathers 2.59[CI:2.43-2.76] and both 5.54[CI:4.02-7.65]. Adjustment for possible confounders and depression history provided similar trends (mother 1.53[CI:1.36-1.71], fathers 1.71[CI:1.60-1.83] and both 2.19[CI:1.58-3.03]).ConclusionParental PPD was associated with an increased risk of ASD in the offspring, and this association was partially, though not fully, explained by depression history, antidepressant use, and other parental psychiatric factors. The magnitude of the association increased comparably when either parent was diagnosed with PPD and increased further when both parents were diagnosed, with a pattern indicative of shared genetic influences.

The music therapy internship represents the culmination of students’ clinical training. Currently, most music therapy internships are unpaid while other healthcare professions offer paid internship options or do not require an internship. The purpose of this position paper was to conduct a SWOT (strengths, weaknesses, opportunities, and threats) analysis and initiate dialogue regarding paid music therapy internships in the United States. Designed to initiate dialogue and conversation, this article is not a research paper. I conducted an initial SWOT analysis on paid music therapy internships. I then shared the analysis with music therapy students, internship directors, clinicians, business owners, and faculty and integrated their feedback. Although the SWOT analysis indicated that the current internship model can result in strong clinicians, there are weaknesses regarding workforce diversity, accessibility, and finances. There may be numerous opportunities for the profession to strengthen itself through paid internships. The profession’s mission and values regarding increased access to music therapy for service users, greater workforce diversity, and quality of care amid escalating tuition and cost of living expenses are consequential factors that may influence paid music therapy internships. Although paid internships may be beyond the control of clinical training directors and thus may not be feasible in all contexts, the large number of unpaid internships may hinder the music therapy profession from thriving and advancing toward its mission. The profession may have an opportunity to use its own agency by valuing itself through paid music therapy internships. Questions and considerations are provided to conclude the paper.

Despite evidence linking social connectedness (SC) and substance use disorders (SUD) treatment outcomes, there remains a gap in the literature about how people with SUD experience SC during music therapy. The purpose of this study was to understand how adults with SUD on an inpatient detoxification unit experienced SC during group-based songwriting. Participants were 12 adults with SUD who attended a single-group recovery-oriented songwriting session. After four sessions, we conducted individual semi-structured interviews with participants and used an inductive approach to thematic analysis to analyze interviews. Five themes emerged. The first two themes addressed how the songwriting session influenced SC: (1) songwriting facilitated participation and recognition of shared experiences with peers and (2) collaboratively creating a musical product was a positive experience that facilitated peer connections. Although not specific to the songwriting intervention, the final three themes described how social relationships, addiction, and recovery interacted and influenced each other more broadly: (3) addiction is associated with damaged relationships and isolation, (4) relationships and social support can aid or hinder recovery, and (5) reluctance to form relationships in treatment. Implications for clinical practice, limitations, and suggestions for future research are provided.

Objective The long-term consequences of the COVID-19 pandemic on college students' mental health remains unknown. The current study explored self-reported Obsessive-Compulsive symptomatology among college student cohorts from pre-, peak-, and later-pandemic time points. Participants Undergraduate college students (N = 524) who volunteered for course credit. Methods Self-report responses on the Dimensional Obsessive-Compulsive Scale (DOCS), which includes subscales for contamination, unacceptable thoughts, harm responsibility, and symmetry, were collected from November 29, 2016 through April 27, 2021 and assessed for differences between the pre-, peak-, and later-pandemic cohorts. Results Peak-pandemic responders reported higher symptomatology for contamination and unacceptable thoughts compared to pre-pandemic responders (and for pre- vs. later-pandemic for contamination), with no significant effects for symmetry or harm responsibility. Conclusions Although the longer-term consequences of the COVID-19 pandemic on students remains unknown, a greater shift in college mental health services from prevention to assessing and addressing more immediate challenges may be necessary.

Journal of Women's HealthVol. 31, No. 6 EditorialsFree AccessWhat Studying Postpartum Depression During the COVID-19 Pandemic Tells Us About Early Maternal NeedsMichael E. Silverman and Holly LoudonMichael E. SilvermanAddress correspondence to: Michael E. Silverman, PhD, Department of Psychiatry, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA E-mail Address: michael.silverman@mssm.eduhttps://orcid.org/0000-0002-1297-2865Department of Psychiatry, Gynecology and Reproductive Science, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Search for more papers by this author and Holly LoudonDepartment of Obstetrics, Gynecology and Reproductive Science, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Search for more papers by this authorPublished Online:14 Jun 2022https://doi.org/10.1089/jwh.2022.0138AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Postpartum depression (PPD) is characterized as a specifier of a major depressive episode conditional on childbirth. Even in the best environments, the period during pregnancy and immediately after the birth of a child represents a time of profound physiological, psychological, and socioenvironmental change. Indeed, most, if not all, new mothers find the postpartum period a time of unique stress and adjustment with upward of 80% of all postpartum women reporting some intermittent symptomatology associated with anxiety or the downregulation of mood.1 Although individualized treatments exist, finding effective and efficient ways to address the mood change that occurs in the postpartum period on a large scale has remained elusive. Because the impact of PPD extends beyond the mother, it represents a significant public health concern.On March 11, 2020, for the first time in a century, the World Health Organization declared a global pandemic ushering in global lockdowns and restrictions in the effort of interfering with the continued spread of the virus that causes the Coronavirus disease 2019 (COVID-19). While these measures significantly impacted normal aspects of everyday life, how heightened fears of infection or death, distress associated with diminished access to necessities, financial concerns, boredom, anger, confusion, and loneliness related to increased social isolation may have psychologically impacted the mental health of pregnant and postpartum women—during what is already known to be a vulnerable time—became of significant interest among obstetricians and mental health clinicians.Similarly, structural and interpersonal changes to the maternal care system during the early days of the pandemic, including the increased reliance on telehealth, modifications to visitor policies, and reduced routine or clustered care, further disrupted an otherwise normal maternal experience.In their article “Evaluating the Impact of the COVID-19 Pandemic on Postpartum Depression,” Waschmann et al.2 seek to explore the impact of the COVID-19 pandemic on postpartum women by comparing depression symptomatology in mothers seeking treatment in the Pacific Northwest of the United States who delivered a child from January 1 to June 1, 2020 with that of mothers delivering over the same period the year before the COVID-19 pandemic—an effort directed toward understanding the pandemic's impact on maternal mental health and aiding clinicians in expeditiously addressing early maternal wellness.Despite the fact that the Pacific Northwest of the United States was among the first and hardest hit regions in the early days of the pandemic, Waschmann et al. surprisingly did not observe an increase in symptomatology associated with PPD over this time. Specifically, postpartum women demonstrated no difference in anxiety or depressive symptomatology during the early days of the COVID-19 pandemic when compared with the year before the pandemic, despite an increase in underlying mood disorders in the former, a well understood predictor of PPD symptomatology.3 This finding similarly aligns with our study demonstrating that postpartum women in the Northeast United States reported no increase in depressive symptoms when comparing symptomatology before and during the pandemic.4Given that the COVID-19 pandemic represents a uniquely stressful time for most,5,6 and the overwhelming belief that the pandemic would significantly increase perinatal maternal mood dysregulation7 and possibly disrupt infant bonding,8 these findings appear strikingly counterintuitive. Waschmann et al. hypothesize that despite the increased emotional disruption attributable to the COVID-19 pandemic globally,9 social restrictions may have improved certain aspects of adjustment associated with the early maternal period. Indeed, an increasing body of work is beginning to reveal that those who stood to benefit most from an improved work–family–childcare balance also reported improved postpartum mood during the height of the pandemic restrictions10,11 as well as other aspects of health and wellness.12Beyond the alarming global spread of the disease itself, the COVID-19 pandemic has resulted in far-reaching consequences. That studies exploring symptomatology associated with PPD before and during the COVID-19 pandemic are finding stable or improved mood in an environment of what can only be described as a large-scale tragedy is nothing short of surprising and requires further attention. Similar to Waschmann et al., we believe there are a few possible explanations for these findings. First, although extended family arrangements are the most common around the globe, they are far less common in the United States. Consequences of the COVID-19 pandemic social restrictions seemingly created something of the equivalent of the extended family for many13 with other family members now available to assist in caring for the needs of the infant and home.Similarly, COVID-19 restrictions afforded something akin to an extended maternity leave for many who might not otherwise have been offered such accommodations, and in addition offered those new mothers who were initially shifted to working remotely an easier transition back to work. Indeed, it seems that the impact of the COVID-19 restrictions that resulted in the improved postpartum mental health of those at greatest risk for PPD provided a unique exploratory opportunity to observe how legislation geared toward protecting the basic needs of mothers in the postpartum period would assist them in growing their families and ameliorating the stress and uncertainty of having to navigate environments hostile to basic early maternal needs.The fact that early maternal depressive episodes result in the well-known attendant morbidity, including marked functional impairment, distress, and increased risk of suicide, putting a second individual, the newborn, at significant risk during a critical developmental period, underscores the importance of Waschmann et al.'s contribution. Diminished enrichment behaviors, shortened duration of breastfeeding, and lower-quality interactions between mothers and their infants have been shown to adversely affect physical growth and neurobehavioral development.The United States, with a culture of reliance on the nuclear family and limited support from extended family, is also one of only six countries without a nationally guaranteed paid parental leave.14 Maternal depression represents a significant public health concern that requires addressing on a national level; Waschmann et al. have begun to reveal how the COVID-19 pandemic restrictions have seemingly offered us clarity on how to begin addressing maternal support and easing the postpartum anxiety and depressive symptomatology associated with the profound adjustment of becoming a new mother.References1. Rezaie-Keikhaie K, Arbabshastan ME, Rafiemanesh H, Amirshahi M, Ostadkelayeh SM, Arbabisarjou A. Systematic review and meta-analysis of the prevalence of the maternity blues in the postpartum period. J Obstet Gynecol Neonatal Nurs 2020;49:127–136. Crossref, Medline, Google Scholar2. Waschmann M, Rosen K, Gievers L, Hildebrand A, Laird A, Khaki S. Evaluating the Impact of the COVID-19 Pandemic on Postpartum Depression. J Women's Health (Larchmt) 2022;31:772–778. Abstract, Google Scholar3. Silverman ME, Reichenberg A, Savitz DA, et al. The risk factors for postpartum depression: A population-based study. Depress Anxiety 2017;34:178–187. Crossref, Medline, Google Scholar4. Silverman ME, Burgos L, Rodriguez ZI, et al. Postpartum mood among universally screened high and low socioeconomic status patients during COVID-19 social restrictions in New York City. Sci Rep 2020;10:22380. Crossref, Medline, Google Scholar5. Otu A, Charles CH, Yaya S. Mental health and psychosocial well-being during the COVID-19 pandemic: The invisible elephant in the room. Int J Ment Health Syst 2020;14:38. Crossref, Medline, Google Scholar6. Twenge JM, Joiner TE. U.S. Census Bureau-assessed prevalence of anxiety and depressive symptoms in 2019 and during the 2020 COVID-19 pandemic. Depress Anxiety 2020;37:954–956. Crossref, Medline, Google Scholar7. Lakshmin P. Experts Fear Increase in Postpartum Mood and Anxiety Disorders: New and expecting moms are facing pandemic-related fears on top of social isolation. Available at: https://www.nytimes.com/2020/05/27/parenting/coronavirus-postpartum-depression-anxiety.html Accessed March 13, 2022. Google Scholar8. Liu CH, Hyun S, Mittal L, Erdei C. Psychological risks to mother-infant bonding during the COVID-19 pandemic. Pediatr Res 2021;10.1038/s41390-021-01751-9. Google Scholar9. Hopkins JS, Russell D. The mental health effects of Coronavirus are a “slow-motion disaster.” Mother Jones. Available at: https://www.motherjones.com/coronavirus-updates/2020/04/the-mental-health-effects-of-coronavirus-are-a-slow-motion-disaster Accessed March 13, 2022. Google Scholar10. Silverman ME, Medeiros C, Burgos L. Early pregnancy mood before and during COVID-19 community restrictions among women of low socioeconomic status in New York City: A preliminary study. Arch Womens Ment Health 2020;23:779–782. Crossref, Medline, Google Scholar11. Gijzen M, Shields-Zeeman L, Kleinjan M, et al. The bittersweet effects of COVID-19 on mental health: Results of an online survey among a sample of the Dutch population five weeks after relaxation of lockdown restrictions. Int J Environ Res Public Health 2020;17:90738d. Crossref, Google Scholar12. Nelson B. The positive effects of covid-19. BMJ 2020;369:m1785. Crossref, Medline, Google Scholar13. Engstrom M. Family processes in kinship care. In: Normal family processes: Growing diversity and complexity 4th ed. Guilford Press; 2012:196–221. Google Scholar14. World Policy Center. Available at: https://www.worldpolicycenter.org/data-tables/policy/is-paid-leave-available-for-mothers-of-infants Accessed March 20, 2022. Google ScholarFiguresReferencesRelatedDetails Volume 31Issue 6Jun 2022 InformationCopyright 2022, Mary Ann Liebert, Inc., publishersTo cite this article:Michael E. Silverman and Holly Loudon.What Studying Postpartum Depression During the COVID-19 Pandemic Tells Us About Early Maternal Needs.Journal of Women's Health.Jun 2022.753-754.http://doi.org/10.1089/jwh.2022.0138Published in Volume: 31 Issue 6: June 14, 2022Online Ahead of Print:May 17, 2022PDF download

Introduction: The differential impact of the coronavirus disease 2019 (COVID-19) pandemic across race, ethnicity, and socioeconomic status remains poorly understood. While recent explorations into birthrates during the pandemic have revealed significant declines, how birthrates may have differed between racial and socioeconomic subgroups during the pandemic remains to be detailed.Methods: Using electronic health records from a large hospital network in New York serving a racially and socioeconomically diverse population, we explored birthrates associated with conceptions that occurred during the COVID-19 pandemic lockdown for demographic and obstetric differences.Results: Two thousand five hundred twenty-three unique patient deliveries corresponded with conceptions that occurred during the COVID-19 pandemic lockdown in New York. Compared to the same period the previous year, there was a 22.85% decrease in births. Explorations into differences in birthrates by socioeconomic status revealed that much of the decline could be explained by fewer births among individuals living in higher socioeconomic status as opposed to individuals living in urban economic poverty [chi(2)(n = 5588) = 18.35, p < 0.01].Conclusion: On March 22, 2020, New York instituted a prohibition of all nonessential social gatherings and the closure of all nonessential businesses. Although the full impact of the COVID-19 pandemic on reproductive health and outcomes remains largely unknown, the decreased birthrate associated with the initial COVID-19 wave in New York was not entirely unexpected. While the mechanisms that drive health disparities are complex and multifactorial, most of the decrease occurred among those living in higher socioeconomic status. This finding has important implications for understanding health behaviors and disparities among minorities living in low socioeconomic status.

Journal of Women's HealthVol. 31, No. 12 EditorialFree AccessContradictory Health Legislation May Be Putting Vulnerable Women in Harm's WayHolly Loudon and Michael E. SilvermanHolly LoudonObstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Search for more papers by this author and Michael E. SilvermanAddress correspondence to: Michael E. Silverman, PhD, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA E-mail Address: michael.silverman@mssm.eduhttps://orcid.org/0000-0002-1297-2865Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Search for more papers by this authorPublished Online:13 Dec 2022https://doi.org/10.1089/jwh.2022.0450AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Several years ago, we set out to conduct the most extensive population-based study of severe postpartum depression in the United States. By linking various health and population databases collected in the State of New York, we had two objectives. First, determine who was most vulnerable to experiencing postpartum depression. Second, to explore the consequences of postpartum depression on the offspring. Because depressed parents have difficulty caring for their newborns, the second objective was designed to begin identifying any potential health consequences to the newborn associated with the gestational parent's depression diagnosis. For example, were these infants more likely to get injured or die from accidents, did they suffer increased incidental health issues such as ear or respiratory infections, or did they have growth and development problems?Because estimates suggest postpartum depression occurs in 3%–19% of the population, thereby potentially impacting up to 520,000 patients annually in the United States, the findings from such a large-scale exploration would be of considerable public health importance. Unfortunately, despite conducting this study in partnership with the United States National Institutes of Health, the State of New York would not provide us permission to link the gestational parent's health information with their offspring. Without this link, it would be impossible to determine which of the newborns were born to individuals who had been diagnosed with postpartum depression. It was not that this merging was impossible. Indeed, given what we had already accomplished, it would have been relatively easy. Instead, it was prohibited.To understand why, it is helpful to understand the importance of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA and its related privacy rules require medical providers to apply appropriate safeguards to protect the privacy of protected health information. Given the scope of the project and because the information we were working with had been de-identified, there was no ability to trace any specific piece of data to a particular individual, potentially compromising their right to privacy. However, in attempting to link the gestational parent's health information with their offspring's health data it might have been possible, although challenging, to identify the parent or child. For individuals with medical histories that if disclosed might expose them to physical, psychological, or economic harm, the State of New York rightly determined the merits and importance of our project did not outweigh the potential risks to participants, even if unlikely.More recently, with the implementation of the “Health Information Technology for Economic and Clinical Health Act,” health care delivery has undergone a digital evolution with the almost universal implementation of electronic medical records. Once maintained in paper charts by each individual practitioner, multiple doctors' notes can now be entered immediately into a single permanent electronic document specific to each patient. For example, in child delivery, when the gestational parent enters the hospital all their previous health information is immediately available to the attending medical providers and any new health information, and any care provided can be entered.Once the infant is born, a new medical health record specific to the infant is created. Along with specifics about the infant's health, this record is instantly autopopulated with a considerable amount of health data belonging to the gestational parent, including information such as syphilis, HIV, and hepatitis status, previous pregnancies, psychiatric history, and any current medical or pharmacological treatments that may cause complications, such as withdrawal, in the newborn. Notably, no private, previously undisclosed health information from the non-gestational parent is populated into the infant's medical record.The ProblemAmong the many facets of the recently established “21st Century Cures Act” is a provision to ensure an individual's access to their medical records. This federal legislation now makes it punishable for health care providers and institutions to impede patient access to their personal health care information or face significant and potentially catastrophic fines. The process of supplying this information is primarily managed through information technology applications that may be installed on the individual's electronic devices such as a mobile phone or accessed via the information distributor's webpage. In the case of a newborn, both parents are provided access to the newborn's medical record.At no time in a birthing individual's natural lifetime are they at greater physical and psychological risk than in the period during pregnancy and immediately after delivery. More so, at a time when reproductive and medical liberties appear to be systemically trampled, contradicting legislation may now be placing new mothers in additional harm's way by unintentionally disclosing private health information to a third party—the nongestational parent. This is neither insignificant nor is it hyperbole.The leading cause of death among pregnant and postpartum women in the United States is not diabetes, heart disease, or infection—it is murder, and stories such as Cicely Bolden, who was killed after her HIV status was disclosed to her sexual partner are not uncommon. Indeed, homicide rates are 16% higher for pregnant and postpartum women compared with their peers of similar reproductive age. Furthermore, the increased possibility of “honor killings,” which occurs with shocking regularity in certain parts of the Middle East and South Asia, should not be overlooked in respect to the systematic disclosure of the gestational parent's private health information.Health care institutions and individual providers are now caught between two important, but contradicting, pieces of legislation, one of which may place a vulnerable population at additional risk. Notably, the 21st Century Cures Act permits the “blocking” of health information on a “case-by-case basis” when doing so could prevent harm. However, in a large-scale medical center where thousands of deliveries occur annually, restricting specific information on a patient-by-patient basis is not practical. We propose that a larger scale workaround in the form of a legislative amendment is the only reasonable solution. However, for the time being, given that potentially private health information from the gestational parent is included in the newborns record, until this guidance is provided, access to a newborn's medical information should be universally restricted to the gestational parent and instead only made available to third parties on a case-by-case basis.FiguresReferencesRelatedDetails Volume 31Issue 12Dec 2022 InformationCopyright 2022, Mary Ann Liebert, Inc., publishersTo cite this article:Holly Loudon and Michael E. Silverman.Contradictory Health Legislation May Be Putting Vulnerable Women in Harm's Way.Journal of Women's Health.Dec 2022.1667-1668.http://doi.org/10.1089/jwh.2022.0450Published in Volume: 31 Issue 12: December 13, 2022PDF download

Although patient-preferred live music (PPLM) can be an effective music therapy intervention for addressing cancer-related fatigue (CRF) in adult oncology patients, there is a gap in the literature specific to patients’ experiences of how PPLM impacts CRF. The primary purpose of this interpretivist study was to understand the mechanisms by which PPLM impacts CRF from the patients’ perspectives. The secondary purpose was to gain insight into patients’ song choice rationales and their ensuing function within PPLM. We provided PPLM and conducted semi-structured interviews with adult oncology patients ( N = 5) on a blood and marrow transplant unit. We used an inductive approach to thematic analysis to analyze interview transcripts and achieved trustworthiness through independent analyses of transcripts as well as peer review of codes and themes. Participants described how PPLM provided CRF symptomatic relief by facilitating emotional release and being an aesthetically pleasing distraction. Participants noted they chose songs because of memorable experiences and for musical elements and components, while explaining that PPLM facilitated reminiscence, promoted relaxation and restful states, and encouraged reflection through the lyrics. Results provide an initial patient-centric understanding of how and why PPLM might impact CRF. Implications for clinical practice, limitations, and suggestions for future research are provided.

Objectives: Perceptions regarding the benefits of postpartum care among mothers and clinicians often differ. Clinicians generally perceive postpartum care as preventative, whereas pregnant and postpartum women often lack knowledge about its preventative benefits. As a result many women choose not to return for scheduled postpartum care visits. Methods: To examine if clinically relevant demographic and birth related factors are informative predictors for postpartum healthcare follow-up care, we conducted a population based cohort study of all women who delivered a child in 2012 – 2015 at the New York Mount Sinai Hospital Obstetrics and Gynecology Ambulatory Practice. Data was ascertained from electronic health records.Results: Of the 4,240 unique women who delivered between 2012-2015 at the Mount Sinai Hospital OB/GYN Ambulatory Practice, 1,685 (39.7%) did not return for their postpartum care follow-up appointment. The number of prenatal visits, maternal age, and parity were significantly associated with postpartum care follow-up. Conclusion for Practice: The purpose of this study was to determine identifiable factors associated with reduced postpartum healthcare follow-up utilization. Several clinically relevant variables were associated with the reduced likelihood for attending postpartum care visits. Because pregnant women represent a medically captured population, the results of this study point to the need to increase postpartum healthcare literacy during perinatal appointments especially among younger mothers, women who have had previous deliveries, and those with fewer prenatal visits.

The mental health effects of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the Coronavirus Disease 2019 (COVID-19) pandemic on postpartum women are of increasing concern among mental health practitioners. To date, only a handful of studies have explored the emotional impact of the pandemic surrounding pregnancy and none have investigated the consequence of pandemic-related social restrictions on the postpartum mood of those living among different socioeconomic status (SES). All postpartum patients appearing to the Mount Sinai Health System for their postpartum appointment between January 2, 2020 and June 30, 2020, corresponding to before and during pandemic imposed social restrictions, were screened for mood symptomatology using the Edinburgh Postnatal Depression Scale (EPDS). Each patient’s socioeconomic status (high/low) was determined by their location of clinical service. A total of 516 postpartum patients were screened. While no differences in EPDS scores were observed by SES prior to social restrictions (U = 7956.0, z = − 1.05, p = .293), a significant change in mood symptomatology was observed following COVID-19 restrictions (U = 4895.0, z = − 3.48, p < .001), with patients living in lower SES reporting significantly less depression symptomatology (U = 9209.0, z = − 4.56, p < .001). There was no change in symptomatology among patients of higher SES (U = 4045.5, z = − 1.06, p = .288). Postpartum depression, the most common complication of childbearing, is a prevalent, cross-cultural disorder with significant morbidity. The observed differences in postpartum mood between patients of different SES in the context of temporarily imposed COVID-19-related social restrictions present a unique opportunity to better understand the specific health and social support needs of postpartum patients living in urban economic poverty. Given that maternal mental illness has negative long-term developmental implications for the offspring and that poor mental health reinforces the poverty cycle, future health policy specifically directed towards supporting postpartum women living in low SES by ameliorating some of the early maternal burdens associated with balancing employment-family-childcare demands may assist in interrupting this cycle while simultaneously improving the long-term outcomes of their offspring.

Objective: Postpartum depression (PPD) is a prevalent disorder that can result in negative child developmental outcomes. While a maternal history of unipolar depression is understood to be the largest risk factor, how a history of unipolar depression with psychotic features modifies PPD risk remains unclear. Methods: In a prospective cohort of all women with single infant births in Sweden, 1997-2008, the study explored the relative risk (RR) of PPD for mothers with a depression history, both with and without psychotic features. Results: Of the 707,701 mothers observed, 4,397 received a PPD diagnosis (62 per 10,000). PPD incidence in women without a depression history was 48 per 10,000 compared to 1,154 per 10,000 for those with a depression history (RR = 27.0). The incidence of PPD in women with a depression history that included psychotic features was 2,360 per 10,000 (RR = 37.9). Conclusion: PPD risk is significantly elevated among women who had a history of depression with psychotic features compared to women with a history of depression without psychotic features.

To explore the mental health consequences of COVID-19-related social restrictions on pregnant women living in low socioeconomic status. Prenatal women appearing at the Mount Sinai Hospital Ambulatory Practice were screened for mood symptomatology from February 2, 2020, through June 12, 2020. An improvement in prenatal mood was observed following social restrictions compared to before the pandemic. The impact of COVID-19 remains largely unknown and may be useful towards understanding the needs of pregnant women living in poverty.

Postpartum depression (PPD) is characterized as a depressive episode conditional on childbirth. We examined whether the risk of depression is higher following childbirth than that at a randomly generated time unrelated to childbirth. In a prospective cohort of all women with live singleton births in Sweden, 1997–2008, we first calculated the relative risk (RR) of PPD for mothers with a history of depression compared to mothers without such a history. Next, we repeated the calculations, but now for depression following a computer-generated arbitrary “phantom delivery” date, unrelated to the true date of delivery. For this phantom delivery date, we used the average expected date of delivery for all women of the same age. For the analyses of each group, women were followed for a full calendar year. We fitted Poisson regression and calculated RR and two-sided 95% confidence intervals (CI). Among a total of 707,701 deliveries, there were 4397 PPD cases and 4687 control depression cases. The RR of PPD was 21.0 (CI 19.7–22.4). The RR of depression in the control group was 26.2 (CI 24.7–27.9). We provide evidence that the risk for PPD is no greater following childbirth than following a random date unrelated to childbirth. This finding suggests that the postpartum period may not necessarily represent a time of heightened vulnerability for clinically significant depression and that the well-established observation of depression covarying with childbirth does not necessarily equate to causation, but rather may be a secondary effect of postpartum women representing a medically captured population.

BACKGROUND:Postpartum depression (PPD) reportedly affects between 6.5-19% of all new mothers. Identifying those at greatest risk for PPD has implications for prevention, early detection and intervention. While the relationship between extremes of body mass index (BMI) and depression has been frequently studied, the association between BMI and PPD is less understood. METHODS:Prospective cohort of all women with live singleton births in Sweden 1997-2008. We calculated the relative risk (RR) for PPD in relation to each woman's BMI and depression history. PPD diagnosis was based on a clinical diagnosis of depression within the first postpartum year. RESULTS:First trimester BMI measurements were available for 611,506 women. Low BMI (< 18.5) RRadj = 1.52, [95% CI: 1.30-1.78] and high BMI (> 35) RRadj = 1.23, [95% CI: 1.04-1.45] were associated with increased PPD risk. Women with a depression history had an increased risk with low BMI (RRadj = 1.51, [95% CI: 1.17-1.95]). LIMITATIONS:Only first births were analyzed, potentially underestimating PPD incidence. Clinical data from health registries offers limited resolution regarding the specificity of diagnoses and incomplete sensitivity if women do not seek care. CONCLUSIONS:First trimester of pregnancy BMI is associated with PPD risk. This risk is further modified by depression history. While low BMI places all women at risk for PPD, being overweight increases risk of PPD only in women without a history of depression. Future research should explore potentially modifiable mechanisms involved in the relationship between PPD and BMI and should also examine interventional strategies for pregnant women at the extremes of BMI and/or with a depression history.

Depression and AnxietyVolume 34, Issue 2 p. 97-103 Issue InformationFree Access Depression and Anxiety Issue Information First published: 30 January 2017 https://doi.org/10.1002/da.22561AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume34, Issue2FOCUS ON RISK PREDICTION, WITH SPECIAL EMPHASIS ON MATERNAL-CHILD DYADSFebruary 2017Pages 97-103 RelatedInformation

BACKGROUND:Postpartum depression (PPD) can result in negative personal and child developmental outcomes. Only a few large population-based studies of PPD have used clinical diagnoses of depression and no study has examined how a maternal depression history interacts with known risk factors. The objective of this study was to examine the impact of a depression history on PPD and pre- and perinatal risk factors.METHODS:A nationwide prospective cohort study of all women with live singleton births in Sweden from 1997 through 2008 was conducted. Relative risk (RR) of clinical depression within the first year postpartum and two-sided 95% confidence intervals were estimated.RESULTS:The RR of PPD in women with a history of depression was estimated at 21.03 (confidence interval: 19.72-22.42), compared to those without. Among all women, PPD risk increased with advanced age (1.25 (1.13-1.37)) and gestational diabetes (1.70 (1.36-2.13)). Among women with a history of depression, pregestational diabetes (1.49 (1.01-2.21)) and mild preterm delivery also increased risk (1.20 (1.06-1.36)). Among women with no depression history, young age (2.14 (1.79-2.57)), undergoing instrument-assisted (1.23 (1.09-1.38)) or cesarean (1.64(1.07-2.50)) delivery, and moderate preterm delivery increased risk (1.36 (1.05-1.75)). Rates of PPD decreased considerably after the first postpartum month (RR = 0.27).CONCLUSION:In the largest population-based study to date, the risk of PPD was more than 20 times higher for women with a depression history, compared to women without. Gestational diabetes was independently associated with a modestly increased PPD risk. Maternal depression history also had a modifying effect on pre- and perinatal PPD risk factors.

A major barrier to the diagnosis of postpartum depression (PPD) includes symptom detection. The lack of awareness and understanding of PPD among new mothers, the variability in clinical presentation, and the various diagnostic strategies can increase this further. The purpose of this study was to test the feasibility of adding clinical decision support (CDS) to the electronic health record (EHR) as a means of implementing a universal standardized PPD screening program within a large, at high risk, population. All women returning to the Mount Sinai Hospital OB/GYN Ambulatory Practice for postpartum care between 2010 and 2013 were presented with the Edinburgh Postnatal Depression Scale (EPDS) in response to a CDS “hard stop” built into the EHR. Of the 2102 women who presented for postpartum care, 2092 women (99.5 %) were screened for PPD in response to a CDS hard stop module. Screens were missing on ten records (0.5 %) secondary to refusal, language barrier, or lack of clarity in the EHR. Technology is becoming increasingly important in addressing the challenges faced by health care providers. While the identification of PPD has become the recent focus of public health concerns secondary to the significant social burden, numerous barriers to screening still exist within the clinical setting. The utility of adding CDS in the form of a hard stop, requiring clinicians to enter a standardized PPD mood assessment score to the patient EHR, offers a sufficient way to address a primary barrier to PPD symptom identification at the practitioner level.

Objectives: To test whether dexamethasone (DEX) treatment in pregnancies at risk for congenital adrenal hyperplasia (CAH) impairs cognitive functioning in the offspring.Design: Observational follow-up of prenatally DEX-exposed offspring and controls.Methods: Study 1 included 140 children aged 5-12 years: 67 DEX-exposed (long-term: eight CAH girls) and 73 unexposed (with 15 CAH girls). Study 2 included 20 participants aged 11-24 years: seven DEX-exposed (long-term: one CAH woman) and 13 unexposed (with four CAH women). Neuropsychological testing was done in hospital settings or at patients' homes. Data analysis aimed at maximizing detection of the effects of DEX exposure.Results: The vast majority of group comparisons were not marginally or conventionally significant. The few significant findings on short-term prenatal DEX exposure suggested more positive than adverse outcomes. By contrast, few significant findings in females with CAH and long-term DEX exposure indicated slower mental processing than in controls on several neuropsychological variables, although partial correlations of DEX exposure duration with cognitive outcome did not corroborate this association.Conclusions: Although our studies do not replicate a previously reported adverse effect of short-term prenatal DEX exposure on working memory, our findings on cognitive function in CAH girls with long-term DEX exposure contribute to concerns about potentially adverse cognitive after effects of such exposure. Yet, our studies are not definitive, and replications in larger samples are required.