While stress in the environment alters sperm function and fertility, the underlying biology is not understood. Our prior studies showed that current stress could significantly change the composition and levels of sperm small noncoding (sncRNA) and impact sperm motility in men. However, the additional influence of adversity experienced earlier in life, designated as adverse childhood experiences (ACE), on sperm sncRNA dynamics remains unclear. To expand our understanding of the important relationship between ACE and stress, we recruited a longitudinal human cohort and modeled differential sncRNA and co-expression networks associated with perceived stress and ACE. Utilizing a repeated measures design, we were able to identify significant time-dependent interactions between ACE and perceived stress that resulted in differential sncRNA expression. Furthermore, network analyses revealed ACE and perceived stress coordinated sncRNA across subtypes, including miRNA that target genes important for offspring development. As these changes were identified widely across sncRNA subtypes, our findings reflect a novel and exciting synchronization strategy by which current and past experiences can impact the next generation. Evolutionarily, this coordination would preserve sncRNA modules essential for species survival while allowing refinement around developmental pathways important for intergenerational fitness.

Lebanese Americans, the largest Arab ethnic group in the United States, remain underrepresented in mental health research despite collective exposure to conflict, displacement, and immigration. This study examined intergenerational associations of parental childhood war exposure (CWE) during the Lebanese Civil War (1975–1990) on the mental health of second-generation Lebanese American young adults (G1) and characterized G1 clinical symptoms and service use. Using community-partnered recruitment, 92 G1 (mean age 28.1 years, SD 4.5) participants reported on their own adverse childhood experiences (ACEs), psychiatric symptoms, past mental health service use, and duration of CWE in their 184 immigrant parents (G0; mean maternal and paternal ages 54.6 and 58.7 years, respectively). G1s showed high levels of clinical range psychopathology: 48.9

OBJECTIVE:The developmental timing of childhood adversity is a critical risk factor for negative health outcomes. Specifically, whether adverse events occurred before or after puberty is relevant to health outcomes due to the different developmental landscapes between these periods. Furthermore, women have unique health risks due to sex differences in pubertal timing, hormones, and types of adverse childhood experiences (ACEs) relative to males. However, a prospective determination of childhood adversity's impact on adult health outcomes is difficult because of the decades between exposure and onset of disease. Therefore, we sought to determine the test-retest reliability of retrospectively recalled ACEs and the timing of such events in relation to menarche (prepubertal vs. postpubertal), among women in their 50s and 60s. METHOD:The ACE Questionnaire was administered to participants (N = 106) in the Penn Ovarian Aging Study, first by phone and second during a home interview approximately 1 year later. Age of menarche and age at onset of ACEs were documented at each assessment. RESULTS:Kappa values for individual ACEs indicated strong test-retest reliability of the ACE Questionnaire between the two assessments. There were no significant differences between either the mean ACE total scores or prepubertal ACE scores between the two assessments. Overall, women demonstrated consistency in their retrospective reporting of early childhood adversity in total and with respect to onset of experiences in relation to menarche. CONCLUSIONS:These data suggest that investigators can rely on retrospective reports when studying the relationship between childhood adversity and adult health outcomes for midlife women. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Research on ovarian hormones reveals an increasingly important role in brain function. This includes reward processing, the umbrella phrase for functions that promote motivation for, response to, and learning about rewards. This paper seeks to provide a concise overview of how ovarian hormones influence reward function, with a specific focus surrounding the ovarian hormone derivatives found in hormonal contraception. Despite the complexity of findings, the research suggests a general pattern in which estradiol may promote multiple reward functions and progesterone often appears to play an inhibitory role. Allopregnanolone's effects on reward functions appear to be concentration dependent and follow an inverted-U. Limited research on hormonal contraception suggests that these agents may interfere with reward neurobiology, potentially contributing to deficits in sexual desire and positive mood, though some individuals may be more susceptible than others. Effects of ovarian hormones and their derivatives on reward processing have multiple clinical implications. These are discussed as it relates to hormonal therapy in menopause, avoiding side effects with hormonal contraception, and ongoing research on the use of progesterone in substance use disorders.

Background Polycystic ovarian syndrome (PCOS) is a chronic multi-system condition, affecting up to 5 million reproductive aged females in the United States. Research points to significant cardiovascular (CV) risk burden among people with PCOS, even after controlling for body composition. This study sought to evaluate modifiable CV risk factors for a community sample of non-treatment seeking females with and without PCOS. Methods Participants completed validated surveys measuring depression, anxiety, sleep (insomnia, sleepiness, obstructive sleep apnea risk), and physical activity. PCOS status and body mass index (BMI) were self-reported. Data were summarized with descriptive statistics; linear regressions were used to assess differences between groups stratified by PCOS status and BMI category (above or below 25). Results Among 1,574 participants (95% identified as female, 72.7% White, 7% Black/African American, 7% Asian, mean age 30.6), 24% of participants with PCOS (N = 881) had a BMI < 25, while 51% of non-PCOS participants’ BMI was normal or underweight. Independent of BMI, participants with self-reported PCOS indicated greater depression, anxiety, insomnia, and worse quality of life, compared to participants without PCOS. While PCOS status in those with BMI > 25 was associated with higher sleep apnea risk, most PCOSxBMI interactions were nonsignificant, indicating no difference between BMI groups in the effect of PCOS on outcomes. Conclusions Regardless of BMI, people with PCOS report greater rates of modifiable psychosocial and behavioral CV risk factors. Given the multifactorial risk of PCOS for CV diseases, screening and treatment is essential for CV prevention in people with PCOS.

Development, implementation, and outcomes are described for the Psychiatry Research Methods and Scholarship (PReMS) curriculum targeting research literacy and scholarship during second year post graduate (PGY-2) residency training. PReMS development at the University of Colorado Department of Psychiatry (UC-DOP) incorporated expertise from residency leadership, pedagogy, and biostatistics and was fine-tuned during 5 years of implementation. Content addressed Accreditation Council for Graduate Medical Education core competencies in research literacy and scholarship. Faculty-authored publications from UC-DOP highlighted research aspects including different study designs, methods, populations, sources of bias, and statistical analyses. Residents chose a paper and led its discussion; lecture materials supported the concepts addressed. Faculty authors were invited to sessions when their papers were presented to meet residents, answer questions, and stimulate discussion. The course director developed an assessment for administration before and after PReMS. Across five resident cohorts (n = 66), an increasing number and proportion of invited faculty authors attended sessions discussing their papers (93

Approximately half of the global population will live to experience the menopausal transition, which is associated with significant quality of life concerns and economic costs. Due to research and funding inequities, there exist significant gaps in knowledge about the menopausal transition and how to improve health outcomes. One tool that is needed to push women’s health research forward is the ability to prospectively and accurately identify reproductive stage throughout the female lifespan. In the current paper we review the current criteria for reproductive staging and historical research methods of determining stage, including retrospective and prospective approaches. We discuss important considerations surrounding recall intervals, limitations of the 2011 Stages of Reproductive Aging Workshop + 10 (STRAW+10) criteria, and data privacy concerns. We provide recommendations for the design and execution of future studies, including digital data processing algorithms that can clearly implement operational definitions of STRAW+10 reproductive stages. Standardizing STRAW+10 terminology and validating methods to collect, process, and analyze prospectively tracked vaginal bleeding data will facilitate more precise and reliable reproductive staging that are critically needed to increase our understanding of how perimenopause increases risk for adverse health outcomes and develop novel interventions to increase quality of life during reproductive aging.

Recent research indicates that sociostructural factors affect mental health and care across racial and ethnic groups differently. The mental health and care access of refugee and asylum-seeking youth has been studied in various populations and host countries. Yet, despite the increasing numbers of such children, their poor outcomes, and underuse of care, little is known about racial, ethnic, and context-based disparities in these outcomes. To our knowledge, this is the first systematic review to identify the progress and shortcomings in the research of such disparities among refugee and asylee youth, emphasizing ecological dimensions affecting health and care. Using rigorous search and inclusion criteria across the MEDLINE, APA PsycInfo, CINAHL, and Web of Science databases and following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we evaluated the findings and limitations of 63 included studies. These studies compared children or adolescents of distinct racial or ethnic refugee or asylum-seeking populations to each other or to other populations across 30 countries, investigating child and adolescent mental health outcomes (including disorders, symptoms, and mental health care access-related outcomes). We identify specific disparities in outcomes based on racial, ethnic, and contextual differences, with results organized by ecological systems theory dimensions and timescales. Our review highlights that generally, Middle Eastern youth may experience worse outcomes across contexts, that there is a gap in research inclusive of youth from the Americas, and that the mechanisms of sex differences, acculturative stress, and intergenerational transmission may vary by population. We propose actionable steps for research on disparities and interventions in migrant child and adolescent populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BackgroundMental health treatment is hindered by the limited number of mental health care providers and the infrequency of care. Digital mental health technology can help supplement treatment by remotely monitoring patient symptoms and predicting mental health crises in between clinical visits. However, the feasibility of digital mental health technologies has not yet been sufficiently explored. Rhythms, from the company Health Rhythms, is a smartphone platform that uses passively acquired smartphone data with artificial intelligence and predictive analytics to alert patients and providers to an emerging mental health crisis. ObjectiveThe objective of this study was to test the feasibility and acceptability of Rhythms among patients attending an academic psychiatric outpatient clinic. MethodsOur group embedded Rhythms into the electronic health record of a large health system. Patients with a diagnosis of major depressive disorder, bipolar disorder, or other mood disorder were contacted online and enrolled for a 6-week trial of Rhythms. Participants provided data by completing electronic surveys as well as by active and passive use of Rhythms. Emergent and urgent alerts were monitored and managed according to passively collected data and patient self-ratings. A purposively sampled group of participants also participated in qualitative interviews about their experience with Rhythms at the end of the study. ResultsOf the 104 participants, 89 (85.6%) completed 6 weeks of monitoring. The majority of the participants were women (72/104, 69.2%), White (84/104, 80.8%), and non-Hispanic (100/104, 96.2%) and had a diagnosis of major depressive disorder (71/104, 68.3%). Two emergent alerts and 19 urgent alerts were received and managed according to protocol over 16 weeks. More than two-thirds (63/87, 72%) of those participating continued to use Rhythms after study completion. Comments from participants indicated appreciation for greater self-awareness and provider connection, while providers reported that Rhythms provided a more nuanced understanding of patient experience between clinical visits. ConclusionsRhythms is a user-friendly, electronic health record–adaptable, smartphone-based tool that provides patients and providers with a greater understanding of patient mental health status. Integration of Rhythms into health systems has the potential to facilitate mental health care and improve the experience of both patients and providers.

People exposed to childhood maltreatment (CM) are thought to emerge as "resilient" or "non-resilient" in adulthood, with the implication that resilient adults eluded the negative consequences of CM. However, adults with CM who are classified as "resilient" may still face negative outcomes in areas of life not captured by resilience criteria. To test this hypothesis, the present study examined whether higher levels of CM were associated with worse psychological, social, and physical health outcomes even in "resilient" adults. Using data at all three survey waves spanning two decades from the Midlife in the United States (MIDUS) longitudinal study, resilience was defined as healthy functioning across seven domains: psychiatric disorders, substance use, education, employment, homelessness, crime, and social isolation. Results showed that in both the "resilient" and "non-resilient" groups, higher CM exposure was significantly associated with worse outcomes on measures of stress reactivity, perceived stress, number of chronic conditions, self-esteem, life satisfaction, relationship quality with friends and family, and positive relations with others (measured at wave 3; all p-values <.033). These findings suggest that CM has enduring and overlooked psychological, social, and physical health consequences not captured by comprehensive resilience criteria, highlighting the need for intervention even in seemingly resilient adults.

This themed issue examines the impact of ovarian hormone fluctuations on women's mental health across the lifespan, including puberty, the menstrual cycle, pregnancy, postpartum and menopause. It highlights critical gaps and calls for sex-specific approaches in reproductive psychiatry and hormone-informed mental care.

Importance:Recent changes in the legal landscape in the United States have affected access to abortion, and this restricted access has profound effects on both physical and mental health of reproductive-aged women and their families. Observations:Denial of abortion care has substantial consequences for the mental health of pregnant individuals and their children. We review rates of mental health symptoms and disorders in abortion-seeking individuals, those who are denied care, and those who are subject to laws restricting care. We also cover how these effects are experienced by those in marginalized communities, including rural populations and those of limited financial resources, and how resulting distress affects children born to those denied abortions. Finally, we review the current and shifting legal landscape and how it affects clinicians aiming to care for those experiencing mental health sequelae from the denial of abortion care. Conclusions and Relevance:There is an urgent need for research on strategies to manage psychiatric disorders associated with restricted reproductive health services. The health of the mother is a critical element in fetal and infant well-being. Individuals who are forced to continue an unwanted pregnancy deserve the social and resource support required to deliver healthy infants who can be raised in an environment that allows the family to thrive.

IntroductionWith nicotine dependence being a significant healthcare issue worldwide there is a growing interest in developing novel therapies and diagnostic aids to assist in treating nicotine addiction. Glutamate (Glu) plays an important role in cognitive function regulation in a wide range of conditions including traumatic brain injury, aging, and addiction. Chemical exchange saturation transfer (CEST) imaging via ultra-high field MRI can image the exchange of certain saturated labile protons with the surrounding bulk water pool, making the technique a novel tool to investigate glutamate in the context of addiction. The aim of this work was to apply glutamate weighted CEST (GluCEST) imaging to study the dorsal anterior cingulate cortex (dACC) in a small population of smokers and non-smokers to determine its effectiveness as a biomarker of nicotine use.Methods2D GluCEST images were acquired on 20 healthy participants: 10 smokers (ages 29-50) and 10 non-smokers (ages 25-69), using a 7T MRI system. T1-weighted images were used to segment the GluCEST images into white and gray matter tissue and further into seven gray matter regions. Wilcoxon rank-sum tests were performed, comparing mean GluCEST contrast between smokers and non-smokers across brain regions.ResultsGluCEST levels were similar between smokers and non-smokers; however, there was a moderate negative age dependence (R2 = 0.531) in smokers within the cingulate gyrus.ConclusionFeasibility of GluCEST imaging was demonstrated for in vivo investigation of smokers and non-smokers to assess glutamate contrast differences as a potential biomarker with a moderate negative age correlation in the cingulate gyrus suggesting reward network involvement.

Semen quality and fertility has declined over the last 50 years, corresponding to ever-increasing environmental stressors. However, the cellular mechanisms involved and their impact on sperm functions remain unknown. In a repeated sampling human cohort study, we identify a significant effect of prior perceived stress to increase sperm motility 2-3 months following stress, timing that expands upon our previous studies revealing significant stress-associated changes in sperm RNA important for fertility. We mechanistically examine this post-stress timing in mice using an in vitro stress model in the epididymal epithelial cells responsible for sperm maturation and find 7282 differentially H3K27me3 bound DNA regions involving genes critical for mitochondrial and metabolic pathways. Further, prior stress exposure significantly changes the composition and size of epithelial cell-secreted extracellular vesicles that when incubated with mouse sperm, increase mitochondrial respiration and sperm motility, adding to our prior work showing impacts on embryo development. Together, these studies identify a time-dependent, translational signaling pathway that communicates stress experience to sperm, ultimately affecting reproductive functions.

BackgroundAdverse childhood experiences (ACEs) increase risk for mental illness in women and their children, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis may play a role. The impact of ACEs on the HPA axis may be strongest when ACEs occur prepubertally and in those exposed to abuse ACEs.MethodsTo test this, we measured salivary cortisol in 96 mother-infant dyads while mothers were separated from their infant experiencing a laboratory stressor. Mothers completed the ACE questionnaire, ACEs occurring prepubertally (pACEs) were measured, and mother-infant dyads were grouped based on maternal pACE history: no pACEs, 1+ pACEs with abuse, or 1+ pACEs but no abuse.ResultsMothers with 1+ pACEs exhibited decreases in cortisol (relative to pre-infant stressor), which differed significantly from the cortisol increase mothers with no pACEs experienced, regardless of abuse presence (p=.001) or absence (p=.002). These 1+ pACE groups did not differ from one another (p=.929). Significant sex differences in infant cortisol were observed in infants of mothers with 1+ pACEs (regardless of abuse) but not in infants of mothers with no pACEs. When mothers had 1+ pACEs, males showed decreases in cortisol in response to a stressor whereas females demonstrated increases, and males and females differed significantly when their mothers had 1+ pACEs with (p=0.025) and without (p=0.032) abuse.ConclusionsRegardless of maternal exposure to childhood abuse, in response to a stressor, prepubertal ACEs were associated with lower cortisol response in mothers and sex differences in six-month-old infants, with males showing a lower cortisol response than females.

Back to table of contents Next article From the Guest EditorNo AccessReproductive Psychiatry: Postpartum Depression is Only the Tip of the IcebergC. Neill Epperson, M.D., Sarah Nagle-Yang, M.D., Andrew M. Novick, M.D., Ph.D.C. Neill EppersonSearch for more papers by this author, M.D., Sarah Nagle-YangSearch for more papers by this author, M.D., Andrew M. NovickSearch for more papers by this author, M.D., Ph.D.Published Online:16 Jan 2024https://doi.org/10.1176/appi.focus.20230029AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article"Reproductive Psychiatry: Postpartum Depression is Only the Tip of the Iceberg." FOCUS, 22(1), pp. 1–2 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Register for access Purchase Save for later Item saved, go to cart PPV Articles - Focus $35.00 Add to cart PPV Articles - Focus Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 22Issue 1 Winter 2024Pages 1-2 Reproductive Psychiatry: Postpartum Depression is Only the Tip of the Iceberg KeywordsPregnancyPostpartum PsychosisBipolar DisorderTraumaInfertilityPCOSPDF download