Prenatal depression effects on early development: A review

This review of recent research on prenatal depression suggests that it is a strong predictor of postpartum depression and is more common than postpartum depression. Prenatal depression has been associated with excessive activity and growth delays in the fetus as well as prematurity, low birthweight, disorganized sleep and less responsiveness to stimulation in the neonate. Infants of depressed mothers have difficult temperament, and later in development attentional, emotional and behavioral problems have been noted during childhood and adolescence, as well as chronic illnesses in adulthood. Several variables have confounded the effects of prenatal depression including comorbid anxiety and anger as well as stressful life events. Potential mediating variables are low prenatal maternal dopamine and serotonin levels and elevated cortisol and norepinephrine. The associated intrauterine artery resistance may limit blood flow, oxygen and nutrients to the fetus. Some studies also suggest the heritability of developmental problems for the children of prenatally depressed mothers, including ADHD and antisocial behavior. Multivariate, longitudinal research is needed to disentangle these confounding and mediating variables.     

Prenatal depression effects and interventions: A review

This review covers research on the negative effects of prenatal depression and cortisol on fetal growth, prematurity and low birthweight. Although prenatal depression and cortisol were typically measured at around 20 weeks gestation, other research suggests the stability of depression and cortisol levels across pregnancy. Women with Dysthymia as compared to Major Depression Disorder had higher cortisol levels, and their newborns had lower gestational age and birthweight. The cortisol effects in these studies were unfortunately confounded by low serotonin and low dopamine levels which in themselves could contribute to non-optimal pregnancy outcomes. The negative effects of depression and cortisol were also potentially confounded by comorbid anxiety, by demographic factors including younger age, less education and lower SES of the mothers and by the absence of a partner or a partner who was unhappy about the pregnancy or a partner who was depressed. Substance use (especially caffeine use) was still another risk factor. All of these problems including prenatal depression, elevated cortisol, prematurity and low birthweight and even postpartum depression have been reduced by prenatal massage therapy provided by the women's partners. Massage therapy combined with group interpersonal psychotherapy was also effective for reducing depression and cortisol levels. Several limitations of these studies were noted and suggestions for future research included exploring other predictor variables like progesterone/estriol ratios, immune factors and genetic determinants. Further research is needed both on the potential use of cortisol as a screening measure and the use of other therapies that might reduce prenatal depression and cortisol in the women and prematurity and low birthweight in their infants.     

Double Depression in Men: Does It Exist?

Differences between male veterans diagnosed with major depression alone and male veterans diagnosed with both major depression and dysthymia (double depression) were investigated. Assessment instruments included the Structured Clinical Interview for DSM-III-R, the Beck Depression Inventory (BDI), and the Symptom Checklist-90-R (SCL-90-R). Consistent with prior literature, it was hypothesized that male veterans diagnosed with both major depression and dysthymia display more severe depressive symptomatology and other forms of psychopathology than male veterans diagnosed with major depression alone. Results did not corroborate these hypotheses. Patients with double depression (n = 17) yielded BDI and SCL-90-R scores which did not differ significantly from those of patients with major depression alone (n = 14). Our results call into question the existence of double depression among men, a disorder whose existence has been demonstrated primarily among women.     

Prenatal maternal depression predicts neural maturation and negative emotion in infants

Despite widespread acceptance that prenatal symptoms of depression in mothers are detrimental to infants’ long-term emotional and cognitive development, little is known about the mechanisms that may integrate outcomes across these domains. Rooted in the integrative perspective that emotional development is grounded in developing cognitive processes, we hypothesized that prenatal symptoms of depression in mothers would be associated with delays in neural maturation that support sociocognitive function in infants, leading to more problematic behaviors. We used a prospective longitudinal study of mothers (N = 92) and their infants to test whether self-reported symptoms of depression in mothers during the second and third trimesters were associated with neural development and infant outcomes at 4 months of age. While controlling for postpartum symptoms of depression, more prenatal symptoms of depression in mothers predicted less neural maturation in the parietal region of 4-month-old infants. Less neural maturation, in turn, was associated with greater infant negativity, suggesting neural maturation as a putative mechanism linking maternal symptoms of depression with infant outcomes. Differences in neural regions and developmental timing are also discussed.     

Prenatal paternal depression

Prenatal depressive symptoms, anxiety, anger and daily hassles were investigated in 156 depressed and non-depressed pregnant women and their depressed and non-depressed partners (fathers-to-be). Depressed versus non-depressed fathers had higher depression, anxiety and daily hassles scores. Although the pregnant women in general had lower anxiety, anger and daily hassles scores than the men, the scores on the measures for depressed fathers and depressed mothers did not differ. Paternal depression appeared to have less effect than maternal depression on their partners’ scores. However, the similarity between the scores of depressed mothers and depressed fathers highlights the importance of screening for depression in fathers-to-be as well as mothers-to-be during pregnancy.     

Comparison of DSM-III-R chronic major depression and major depression superimposed on dysthymia (double depression): validity of the distinction

The nosology of chronic depression has become increasingly complex since the publication of the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987), but there are few data available to evaluate the validity of the distinctions between the subtypes of chronic depression. The validity of the distinction between DSM-III-R chronic major depression (CMD) and major depression superimposed on dysthymia (double depression, DD) was examined. Participants were 635 patients with chronic depression in a 12-week trial of antidepressant medications. Patients with CMD, DD, and a 3rd group with a chronic major depressive episode superimposed on dysthymia (DD/CMD) were compared on demographic and clinical characteristics, family history, and response to treatment. Few differences were evident, although the depression of patients with DD/CMD tended to be more severe.     

Automatic and effortful information processing in unipolar major depression

The present study investigated attentional dysfunction in patients with recurrent unipolar major depression in a visual search paradigm. The attentional aspects of automatic and effortful information processing were examined. The general hypothesis was that patients with unipolar major depression would have more problems with tasks that require effortful information processing than with tasks that require only automatic information processing. A task requiring effortful processing attracts attention, is more demanding, and is instruction-driven. A task that is automatically processed does not invoke attention, is less demanding, and is stimulus-driven. The results showed that the patient group needed significantly longer reaction times on the tasks requiring more effortful information processing than the control group, but there were no significant differences between groups on tasks requiring automatic information processing. Thus it seems as if the depressed patients show an impaired profile as a function of the degree of effort a task requires.     

Moderating effects of the valence of social interaction on the dysfunctional consequences of perseverative cognition: an ecological study in major depression and social anxiety disorder

Background and Objectives: Major depression disorder (MDD) and social anxiety disorder (SAD) are characterized by the use of perseverative cognition (PC) as a dysfunctional coping strategy. We sought to investigate the dysfunctional physiological and psychological consequences of PC and how the valence of social interactions moderates such consequences in these psychopathological conditions.

Design/Methods: The study combined 24-hour heart rate variability (HRV) and ecological momentary assessments in 48 individuals with MDD, SAD, and sex-matched controls.

Results: In all participants, PC was associated with mood worsening and reduced ability of the parasympathetic nervous system, mainly the vagus, to inhibit sympathetic arousal (i.e., reduced HRV). Individuals with SAD had the highest frequency of daily PC, while those with MDD reported that PC interfered more with their ongoing activities. In SAD, daily PC was associated with significantly lower HRV after negative social interactions. Individuals with MDD reported higher levels of sadness during PC irrespective of the valence of the preceding social interaction but higher levels of anxiety and efforts to inhibit PC following positive interactions.

Conclusions: Results highlight the need to account for important moderators like the valence of social interaction when looking at the physiological consequences of maladaptive emotion regulation strategies.     

Cognitive functioning and cortisol profiles in first episode major depression

Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the Hypothalamic Pituitary Adrenal (HPA) system, yielding high levels of cortisol, in addition to cognitive dysfunction. Previous studies have shown a relationship between cortisol profile and cognitive functioning in recurrent MDD in general. More specifically, the association between hypercortisolism and cognitive functioning, such as memory and Executive Functioning (EF), and also more recently cortisol suppression has been explored. However, no studies have investigated these relationships in patients diagnosed with first episode MDD. The aim of the present study was to examine the relationship between cortisol levels before and after the Dexamethasone suppression test (DST) and cognitive function in first episode MDD patients. Twenty‐one patients meeting the DSM‐IV criteria for a first episode of MDD diagnosis were included in the study. The control group was matched for age, gender and education level. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected 4 times during a 24 hours period over two consecutive days: at awakening, after 45 minutes, after 7 hours and at 11 pm. Dexamethasone (1.0 mg) was given orally on Day 1 at 11 pm. The neuropsychological test battery consisted of standardized tests measuring executive functioning (EF) and memory functioning. Cortisol levels did not differ significantly between patients and controls on Day 1, except for the last sample before Dexamethasone administration, where the control group showed higher levels. Both groups showed suppression after Dexamethasone. On Day 2 there was a significant difference between groups at the third sample, showing a significantly lower level in the control group, suggesting that the controls have a more effective suppression profile than the patients. There were no significant correlations between cortisol levels before or after Dexamethasone and cognitive measures. The results indicate impairment on HPA‐axis functioning in first episode MDD patients, with less suppression functioning compared to healthy controls, but no relationship between cortisol profile and cognitive functioning in EF or Memory.     

Prenatal exposure to methadone and buprenorphine: A review of the potential effects on cognitive development

The amount of opioid users receiving opioid maintenance therapy has increased significantly over the last few years. As a result, an increasing number of children are prenatally exposed to long-lasting opioids such as methadone and buprenorphine. This article reviews the literature on the cognitive development of children born to mothers in opioid maintenance therapy. Topics discussed are the effects of prenatal exposure on prematurity, somatic growth, brain volume, myelination, and the endocrine and neurotransmitter system. Social-environmental factors, including parental functioning, as well as genetic factors are also described. Areas requiring further research are identified.     

Prenatal depression effects on the fetus and newborn: a review

A review of research on prenatal depression effects on the fetus and newborn suggests that they experience prenatal, perinatal and postnatal complications. Fetal activity is elevated, prenatal growth is delayed, and prematurity and low birthweight occur more often. Newborns of depressed mothers then show a biochemical/physiological profile that mimics their mothers' prenatal biochemical/physiological profile including elevated cortisol, lower levels of dopamine and serotonin, greater relative right frontal EEG activation and lower vagal tone. Elevated prenatal maternal cortisol is the strongest predictor of these neonatal outcomes. Moderate pressure massage can alleviate these effects including reducing prematurity.     

Exposure to the Chinese famine in early life and depression in adulthood

We aimed to investigate whether exposure to the Chinese famine (1959–1961) in early life was associated with depression in adulthood. We included 17,505 participants from the China health and retirement longitudinal study (CHARLS). Participants were classified into indirect and direct exposure groups. And the directly exposure groups including prenatal, childhood, adolescence/adult exposure groups. Depression was diagnosed by Center for Epidemiological Studies Depression Scale-10 (CES-D) score. Multivariate logistic regression model was used to calculate the odd ratios (ORs) and 95% confidence intervals (CIs) of depression. In women, prenatal, childhood, adolescence/adult exposure groups had higher depression risk than indirect exposure group (OR = 1.46, 1.40, and 1.67, respectively). However, there was no significant association between famine exposure and depression among men. Exposure to famine during prenatal (OR: 1.48; 95% CI: 1.07–2.06), childhood (OR: 1.47; 95% CI: 1.13–1.91), and adolescence/adult (OR: 1.63; 95% CI: 1.24–2.15) period were associated with depression among subjects living in rural, but not those living in urban. Exposure to the Chinese famine in early life had sex and area-specific associations with depression.     

Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants

Although maternal attachment is an important predictor of infant attachment security and other developmental outcomes, little is known about the formation of maternal attachment in the first few months of the infant's life, particularly among ethnic minority mothers. The current study examined the predictors of postpartum maternal attachment in a sample of 217 Latina women enrolled in a perinatal depression prevention trial. Mothers’ attachment to their infants was measured at 6-8 weeks postpartum using the Maternal Postnatal Attachment Scale. A variety of predictors of early attachment were explored including: depressive symptoms during pregnancy, pregnancy intention, feelings about the pregnancy, and the quality of the partner relationship. The strongest predictor of lower maternal attachment was depressive symptoms late in pregnancy; pregnancy intention was marginally predictive of attachment, with lower scores being associated with unwanted pregnancies. The study fills a critical gap in our understanding of the role of depressive symptoms during pregnancy in shaping mothers’ early attachment to their infants.     

Internet administered guided self-help versus individualized e-mail therapy: A randomized trial of two versions of CBT for major depression

Internet-delivered psychological treatment of major depression has been investigated in several trials, but the role of personalized treatment is less investigated. Studies suggest that guidance is important and that automated computerized programmes without therapist support are less effective. Individualized e-mail therapy for depression has not been studied in a controlled trial. Eighty-eight individuals with major depression were randomized to two different forms of Internet-delivered cognitive behaviour therapy (CBT), or to a waiting-list control group. One form of Internet treatment consisted of guided self-help, with weekly modules and homework assignments. Standard CBT components were presented and brief support was provided during the treatment. The other group received e-mail therapy, which was tailored and did not use the self-help texts i.e., all e-mails were written for the unique patient. Both treatments lasted for 8 weeks. In the guided self-help 93% completed (27/29) and in the e-mail therapy 96% (29/30) completed the posttreatment assessment. Results showed significant symptom reductions in both treatment groups with moderate to large effect sizes. At posttreatment 34.5% of the guided self-help group and 30% of the e-mail therapy group reached the criteria of high-end-state functioning (Beck Depression Inventory score below 9). At six-month follow-up the corresponding figures were 47.4% and 43.3%. Overall, the difference between guided self-help and e-mail therapy was small, but in favour of the latter. These findings indicate that both guided self-help and individualized e-mail therapy can be effective.     

Transient versus enduring depression among alcoholics in inpatient treatment

The purposes of this study are (1) to determine the incidence of significant clinical depression among alcoholics at treatment intake at a Veterans Medical Center, (2) to subdivide alcoholics who show significant clinical depression into enduring and transient depressive subgroups, and (3) to identify demographic and psychometric variables useful in discriminating between these two subgroups. Results indicate that of the 60% of VA inpatient alcoholics who showed evidence of significant clinical depression at intake, approximately equal numbers met criteria for inclusion in transient and enduring depressive subgroups. Patients with enduring and transient depression, as defined in this study, were differentiated on the basis of age, drinking pattern, and selected scales from two psychometric instruments which measure depression, confused and disorganized thinking, and an avoidant personality style. These findings may be useful in assisting clinicians in differentiating between alcoholic patients with transitory depression associated with alcohol consumption and/or withdrawal and alcoholic patients with more serious and enduring depression, which may require additional pharmacologic and/or psychotherapeutic intervention.     

Anxiety and depression: toward overlapping and distinctive features

ABSTRACT

This Special Issue of Cognition and Emotion addresses one of the cardinal concerns of affective science, which is overlapping and distinctive features of anxiety and depression. A central finding in the study of anxiety and depression is that they are moderately highly correlated with each other. This leads us to the question: What is behind this co-occurrence? Possible explanations relate to poor discriminant validity of measures; both emotional states are associated with negative affect; stressful life events; impaired cognitive processes; they share a common biological/genetic diathesis. However, despite a set of common (nonspecific) features, anxiety and depression are clearly not identical emotional states. Differences between them might be best viewed, for example, through their heterogeneous and multi-layered nature, adaptive functions and relations with regulatory processes, positive affect, and motivation or complex cognitive processes. In this introduction we consider several approaches (e.g. functional approach; tripartite model and content-specificity hypothesis) to which most research in this Special Issue is relevant. In addition, we have asked contributors to this Special Issue to indicate how their own studies on comparisons between anxiety and depression and models on anxiety and depression move this area of research to more mature science with applicability.     

Evaluation of the effects of a childhood depression prevention program

The study aimed to design and evaluate a program for the prevention of childhood depression (“Pozik-Bizi” [in English, “Live-Happily”]), comparing its effects with a socio-emotional intervention program based on cooperative play. The sample comprised 420 students aged 7 to 10?years from the Basque Country, 51.9% were randomly assigned to the experimental condition (“Pozik-Bizi”) program and 48.1% to the control group (“Play program”). Using a pretest-posttest repeated measures experimental design, 7 evaluation instruments were administered. When comparing the two interventions, it was confirmed that those who participated in the “Pozik-Bizi” program significantly decreased their level of clinical maladjustment, school maladjustment, emotional, and behavioral problems, and they increased positive behaviors that inhibit depression. However, the cooperative play program improved self-concept and social skills significantly more than the “Pozik-Bizi” program. The effect size in all the variables was small. The discussion analyzes the effectiveness of specific programs of prevention of childhood depression versus global programs of social-emotional development. This work provides a program to prevent childhood depression that has been shown to be effective in the reduction of clinical variables. In addition, this study confirms the positive potential of programs of cooperative play, to increase self-concept and social skills.     

Information processing in patients with first episode major depression

Hammar, Å., Kildal, A. B. & Schmid, M. (2012). Information processing in patients with first episode major depression. Scandinavian Journal of Psychology 53, 445–449. Few studies have investigated cognitive functioning in a group of patients experiencing a first episode of depression. The aim of this study was to investigate how patients diagnosed with a first episode of depression perform in effortful and non‐effortful information processing compared to healthy controls. An experimental paradigm based on a visual search test was applied. Thirty‐one patients and thirty‐one healthy controls were included in the study. All patients experienced a severe level of symptom load at the time of testing. Results showed no significant differences between groups under any of the conditions. Findings in the present study indicate that patients with a first episode of depression perform equally to healthy controls in tasks requiring visual attention in both effortful and non‐effortful information processing.     

The beneficial and detrimental effects of major depression on intuitive decision-making

Intuitions play a central role in everyday life decision-making but little is known regarding this capacity during depression. Thus, in Study 1, N?=?39 depressed in-patients completed two well-established tasks, assessing intuitions of visual and semantic coherence. In the semantic coherence task, patients judged whether presented words triads were coherent (e.g. SALT DEEP FOAM, related to SEA) or not (e.g. DREAM BALL BOOK, no denominator). In the visual coherence task, patients judged whether blurred pictures depicted real-life objects (coherent) or not (incoherent). Results showed that higher depressive symptomatology was associated with impaired intuitions of semantic coherence but with enhanced intuitions of visual coherence. In Study 2, visual coherence intuitions of depressed patients (n?=?27) were compared to healthy control participants (n?=?30). Depressed patients outperformed the healthy control subjects in the visual coherence task. This pattern of findings shows both detrimental and beneficial decisional consequences of depression.