Primary care screening and risk factors for postnatal depression in Zimbabwe: A scoping review of literature

Postnatal depression (PND) exerts a significant burden on the global public health system, globally affecting approximately 10 to 20% of women. Despite the recently reported high prevalence of PND in Zimbabwe, it is rarely diagnosed or appropriately managed in primary care settings. This review scopes evidence on PND from studies on screening for PND and the associated risk factors conducted in Zimbabwe over the past 20 years. We searched electronic databases for published articles and checked reference lists of studies relating to depression among women in Zimbabwe. We used the following key words: postnatal, depression, women, screening, risk-factors, and Zimbabwe. A total of 14 studies were retrieved as follows: postnatal depression (4), postnatal mental disorders (1), mental disorders among pregnant women (1), and depression and women in general (8). Reported prevalence of PND ranged from 16% to 34.2%. Studies on PND enrolled women from urban and peri-urban settings. Significant risk factors for PND identified among women in Zimbabwe included multi parity, having a spouse who was older than 35years, poorer relations with spouses or partners, having had experienced an adverse event, being unemployed, and having had experienced intimate partner violence. Psychosocial factors are implicated in PND occurrence among Zimbabwean women. There is need to explore the burden of PND among rural communities.     

Prenatal diagnosis for "minor" genetic abnormalities is ethical

Is it justified to detect minor genetic aberrations before birth and terminate pregnancies based upon such information? We present the case of a woman who wanted Prenatal Diagnosis (PND) to detect whether her female fetus was a Haemophilia mutation carrier. Such carriers are usually healthy. She wished to eradicate the Haemophilia mutation from her family to avoid future generations being affected and to protect her children from having to go through PND themselves. We explore existing guidelines, public attitudes and possible objections to providing PND for minor abnormalities. We argue that in a society where couples have considerable autonomy relating to decisions about the fetus at least until viability, the routine restriction of PND for minor genetic abnormalities would be an unjust infringement of individual liberty.     

The conditional power of randomization tests for single-case effect sizes in designs with randomized treatment order: A Monte Carlo simulation study

The conditional power (CP) of the randomization test (RT) was investigated in a simulation study in which three different single-case effect size (ES) measures were used as the test statistics: the mean difference (MD), the percentage of nonoverlapping data (PND), and the nonoverlap of all pairs (NAP). Furthermore, we studied the effect of the experimental design on the RT’s CP for three different single-case designs with rapid treatment alternation: the completely randomized design (CRD), the randomized block design (RBD), and the restricted randomized alternation design (RRAD). As a third goal, we evaluated the CP of the RT for three types of simulated data: data generated from a standard normal distribution, data generated from a uniform distribution, and data generated from a first-order autoregressive Gaussian process. The results showed that the MD and NAP perform very similarly in terms of CP, whereas the PND performs substantially worse. Furthermore, the RRAD yielded marginally higher power in the RT, followed by the CRD and then the RBD. Finally, the power of the RT was almost unaffected by the type of the simulated data. On the basis of the results of the simulation study, we recommend at least 20 measurement occasions for single-case designs with a randomized treatment order that are to be evaluated with an RT using a 5% significance level. Furthermore, we do not recommend use of the PND, because of its low power in the RT.     

围生期双酚A暴露对不同性别子代小鼠行为的影响

探讨围生期母体双酚A(bisphenol A, BPA)暴露对幼年期(生后21~30天, postnatal day 21~30, PND 21~30)和青年期(生后56~63天, PND 56~63)不同性别子代小鼠行为的影响。母鼠从妊娠第7天至断乳前(产后21天)进行BPA(0.05、0.5、5、50 mg/kg/day)灌胃染毒, 同时设对照组。每个剂量组分别在PND 21和PND 56开始测试雌雄子代小鼠各项行为。以旷场行为检测小鼠的自发活动及探究行为, 以高架十字迷宫检测小鼠的焦虑行为, 以水迷宫检测小鼠的空间学习记忆能力, 以跳台检测小鼠的被动回避记忆行为。结果表明, BPA使PND 21雌雄子鼠和PND 56雄性子鼠自发活动减少(p<0.05或p<0.01), 理毛和站立行为发生性别分化(p<0.05或p<0.01); PND 21子鼠的3分钟跑动格数有明显的剂量效应关系, 其中5~50 mg/kg/day组特别显著。BPA显著增加PND 21雌雄子鼠和PND56雌性子鼠在高架十字迷宫中进入开放臂次数和停留时间(p<0.05或p<0.01)并减少封闭臂的进入时间, 但没有明显的剂量效应关系; BPA减少PND 56雄性子鼠开放臂的进入并增加其封闭臂的进入, 干扰了幼年期和青年期小鼠焦虑行为的性别分化。BPA剂量依赖性地延长PND 21和PND 56雄性子鼠在水迷宫搜索平台的平均距离, 其中5~50 mg/kg/day剂量组具有差异显著性(p<0.05或p<0.01), 但对雌性子鼠空间学习记忆行为没有影响。此外, 5~50 mg/kg/day BPA增加PND 21雄性子鼠在跳台实验中的错误次数并缩短其跳下平台潜伏期, PND 56雌雄子鼠的被动回避记忆仅被50 mg/kg/day BPA减弱。以上结果提示, 围生期BPA暴露可影响子代小鼠幼年期和青年期的多种行为及行为的性别差异, 不同行为对BPA的敏感程度不同, 其中以自发活动和探究行为最敏感。     

The development and content of an interpersonal psychotherapy group for postnatal depression

Postnatal depression (PND) usually causes distressing symptoms for sufferers and significant impairments in relationships. Group Interpersonal Psychotherapy (IPT-G) provides the experienced therapist with a brief, focused, and manualized approach to helping women recover from the debilitating effects of PND. This paper describes the background and development of IPT-G for PND. The evidence for the effectiveness of individual and group IPT formats with this population is summarized. The triad of theories underpinning IPT are discussed with an emphasis on the important role of attachment styles during the transition to parenthood. Its strengths, which include its unique package of targets, tactics, and techniques, are highlighted. The benefits and challenges of IPT-G are also explored, and the results of a randomized controlled trial are summarized. Finally, a case study illustrates how IPT-G specifically addresses the social role transitions, conflicts, losses, and social isolation that mothers commonly experience.     

The Role of Women's Relationships With Their Partners in Their Adjustment Following Prenatal Genetic Testing1

This study explored how aspects of the couple relationship contributed to the adjustment of 95 women who underwent prenatal diagnostic (PND) testing because of advanced maternal age (AMA). Participants completed self‐report measures prior to genetic counseling (T1), during the waiting period for PND test results (T2), and after normal results were received (T3). At T2, distress was predicted by the degree to which women approached the PND decision jointly with their partners, and marital adjustment was predicted by women's satisfaction with the support received from their partners. Marital adjustment at T3 was predicted by earlier levels of partner agreement about PND‐related issues. Results suggest that the couple relationship has the potential to facilitate or hinder women's experience of PND testing.     

Neonatal ventral hippocampus lesions disrupt extra-dimensional shift and alter dendritic spine density in the medial prefrontal cortex of juvenile rats

Recent data showed that neonatal ventral hippocampus (VH) lesions, an approach used to model schizophrenia symptoms in rodents, produce premature deficits of working memory believed to be associated with early medial prefrontal cortex (mPFC) maldevelopment. This experiment expands the investigation of mPFC integrity in juvenile rats with neonatal VH lesions by assessing behavioral flexibility and dendritic spine density. Sixteen Sprague-Dawley male pups received bilateral microinjections of ibotenic acid in the VH or SHAM surgery on postnatal day (PND) 6. On PND 29 and 30, rats were subjected to a spatial shift task in a cross-maze; an attentional set-shifting task was then administered on two consecutive days, between PND 33 and PND 35. Rats were sacrificed at PND 36 and dendritic spine density in the mPFC was assessed using Golgi-Cox staining procedure. Results revealed impaired extra-dimensional shift in VH-lesioned rats and inconsistent reversal discrimination outcomes. Although lesioned animals displayed intact performance in the spatial shift, rates of perseverative responses were higher than normal in this task. Neonatal VH damage resulted in lower dendritic spine density in the mPFC than measured in control brains; however, no significant correlation was found between this outcome and behavioral data. Juvenile morphological and cognitive perturbations are consistent with the early emergence of mPFC anomalies following neonatal VH lesions. Results are discussed in relation with potential common mechanisms linking pre- and post-pubertal onsets of behavioral dysfunction.     

What lies behind postnatal depression: is it only a mood disorder?

Postnatal depression (PND) is a common condition that has been extensively researched specifically because of its negative impact on the mother-infant relationship. Psychiatric research has looked at comorbidity of major depressive disorder and found it to be strongly associated with Axis II disorders. This study's principal aim was to investigate whether there is a greater incidence of personality disorder (PD) among a PND population than among a non-PND population at 3 months postpartum. A secondary aim was to define the different types of PD. Depression was assessed with the Montgomery and Asberg Depression Rating Scale (MADRS), and PD was assessed with the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) in 109 women with their 12-week-old infants. Twice as many depressed mothers had PD. The PND group presented a greater number of severe clinical symptoms than the nondepressed group (p < .002). Further research is necessary to reexamine the heterogeneity of PND and reassess its impact on infant development.     

“Make things as simple as possible, but no simpler.” A rejoinder to Scruggs and Mastropieri

Scruggs and Mastropieri (Behaviour Research and Therapy, 32, 879–883, 1994) take issue with criticisms of their PND (Percent of Nonoverlapping Data) statistic that we offered in our recent article (Allison & German, Behaviour Research and Therapy, 31, 621–631, 1993), which advocated a regressionbased method for obtaining effect sizes in single-subject studies. They contend that their PND approach has several advantages over our approach because: (1) they believe that, unlike ours, it can take advantage of the small number of observations that are typically available in single-case studies; (2) it is simple to compute; (3) it frees researchers from traditional regression assumptions of normality, homogeneity of variance, and independence of observations and residuals; and (4) it correlates with visual judgements made by experts. As we shall argue, these claims are built upon very questionable assumptions and they are very difficult to substantiate. In addition, we show that the expected value of the PND is so strongly related to sample size as to be rendered meaningless.     

The utility of the PND statistic: A reply to Allison and Gorman

Quantitative synthesis (“meta-analysis”) of single-subject research has rarely been conducted, partly because of a lack of agreement on how study outcomes are to be quantified. This article provides a response to Allison and German (Behaviour Research and Therapy, 31, 621–631, 1993), who listed some problematic characteristics of use of the PND (percent of non-overlapping data) statistic for computing single-subject study outcomes, and recommended a regression-based solution to computation of effect sizes from single-subject research reports. Although Allison and Gorman are generally accurate in pointing out some limitations of the use of the PND statistic, they have been less thorough in identifying its relative strengths. Among these strengths is the fact that the PND statistic and its variations (a) have been shown to be strongly related to qualitative, “expert” ratings, (b) have been successfully employed in at least seven separate integrative reviews, and (c) have produced results which are complementary to more qualitative reviews of the same literature. In contrast, Allison and Gorman did not report results of applications of their procedure and, although their procedure has apparent theoretical support, it may be less useful in synthesizing existing single-subject literature.     

Prenatal Diagnosis for Inherited Deafness—What is the Potential Demand?

Genetic testing for inherited deafness is now available within some genetics centres. This study used a structured questionnaire to assess the potential uptake of prenatal diagnosis (PND) for inherited deafness, and document the opinions of deaf and hearing individuals toward PND and termination of pregnancy (TOP) for hearing status. Participants were self-selected from the whole of the UK, of whom 644 were deaf, 143 were hard of hearing or deafened, and 527 were hearing individuals who had either a deaf parent or child. The results showed that 21% of deaf, 39% of hard of hearing and deafened, and 49% of hearing participants said they would consider PND for deafness. Six percent of deaf, 11% of hard of hearing and deafened, and 16% of hearing participants said they would consider a TOP if the fetus was found to be deaf. Two percent of deaf participants said they would prefer to have deaf children and would consider a TOP if the fetus was found to be hearing.     

Evaluation of publication bias in response interruption and redirection: A meta-analysis

Publication bias is the disproportionate representation of studies with large effects and statistically significant findings in the published research literature. If publication bias occurs in single-case research design studies on applied behavior-analytic (ABA) interventions, it can result in inflated estimates of ABA intervention effects. We conducted an empirical evaluation of publication bias on an evidence-based ABA intervention for children diagnosed with autism spectrum disorder, response interruption and redirection (RIRD). We determined effect size estimates for published and unpublished studies using 3 metrics, percentage of nonoverlapping data (PND), Hedges' g, and log response ratios (LRR). Omnibus effect size estimates across all 3 metrics were positive, supporting that RIRD is an effective treatment for reducing problem behavior maintained by nonsocial consequences. We observed larger PND for published compared to unpublished studies, small and nonsignificant differences in LRR for published compared to unpublished studies, and significant differences in Hedges' g for published compared to unpublished studies, with published studies showing slightly larger effect. We found little, if any, difference in methodological quality between published and unpublished studies. While RIRD appears to be an effective intervention for challenging behavior maintained by nonsocial consequences, our results reflect some degree of publication bias present in the RIRD research literature.     

早期剥夺所致大鼠抑郁样行为与海马BDNF mRNA表达变化

为探讨早期剥夺对大鼠行为与海马脑源性神经营养因子(BDNF)mRNA表达的影响,将新生的SD大鼠随机分为正常对照组与早期剥夺组,早期剥夺组在出生后1～14d每天孤养4h。监测体重,在出生后36?64天进行液体消耗试验,每周一次。12w龄时,进行穿梭箱试验,酶联免疫法检测海马BDNF含量,原位杂交法观察海马BDNF mRNA的表达。早期剥夺组大鼠体重显著低于正常对照组(p0.01),糖水摄入量与糖水偏爱显著低于正常对照组(p0.05或p0.01)。穿梭箱试验中,早期剥夺组大鼠在训练时的穿梭反应次数显著少于正常对照组(p0.05),在测试时,两组大鼠的被动逃避行为、主动逃避行为与逃避错误次数无显著差异。早期剥夺组大鼠海马BDNF含量、CA1区和CA3区BDNF mRNA表达显著低于正常对照组(p=0.05或p0.05)。提示早期剥夺可导致大鼠生长减慢,表现出快感缺失的抑郁样行为,但未诱导成年大鼠表现出明显的习得性无助倾向,早期剥夺能下调成年大鼠海马BDNFmRNA的表达。     

Effects of motherless rearing on basal and stress-induced corticosterone secretion in rat pups

Rearing of rat pups without a mother, artificial rearing (AR), produces substantial changes in the pups' behavior in later life. These changes are similar to those produced by the stress of repeated mother-pup separations. The predominant interpretation is that the long-term effects of disruptions to the mother-pup relationship are mediated by exposure to elevated levels of corticosterone which affect the development of neurobiological systems underlying cognition and behavior. Indeed, repeated separation of pups from the mother sensitizes the pups' corticosterone response to stress. This study examined basal and stress-induced corticosterone release in AR pups. Corticosterone levels were increased immediately following implantation of feeding cannulae. One day after the start of AR, circulating concentrations of corticosterone were not increased unless AR pups were challenged with an additional stressor (injection). Corticosterone levels were lowest when cannulation and AR started on postnatal day (PND) 5 compared with earlier PNDs. On PND 12, there was no evidence of increased corticosterone levels in AR pups at baseline or in response to stress, indicating that AR did not result in persistent sensitization of corticosterone release. The long-term effects of motherless rearing on rat behavior are mediated by mechanisms that are independent of sustained early corticosterone exposure.     

Effects of Early Maternal Separation on Subsequent Reproductive and Behavioral Outcomes in Male Rats

To investigate effects of maternal separation on reproductive and behavioral outcomes, male Wistar rats were separated from their mothers daily for 3 hr (maternal separation; MS) or 0 hr (control) from postnatal day (PND) 1 to 14. Timing of puberty, reproductive parameters, hormone levels, and aggressive behaviors in juvenile and adult rats were examined. Contrary to expectations, there was no effect of maternal separation on any measure of aggression. However, maternal separation altered peripubertal testosterone secretion and increased mean day of preputial separation. In addition, adult MS males demonstrated less total sexual behavior. There was no difference in sperm counts or testosterone levels at necropsy on PND 56 or in adulthood, but seminal vesicle weights were increased in adult MS rats. These results suggest that early life stress may influence hypothalamic-pituitary-gonadal axis development in males, at least during peripuberty.     

生命早期双酚A暴露对子代成年小鼠焦虑和抑郁行为的影响及其神经机制

双酚A (bisphenol A, BPA)对脑和行为发育的影响已引起关注, 本研究探讨围生期不同发育阶段母体BPA暴露对仔鼠成年后焦虑和抑郁行为的影响。分别在妊娠期(妊娠第7天~出生)和哺乳期(出生第1~14天) 将母鼠暴露于BPA (0.4、4 mg/kg/day), 以旷场、明暗箱、镜子迷宫、高架十字迷宫等多种模型检测生后56天(postnatal day 56)仔鼠的焦虑行为, 以强迫游泳模型检测其抑郁行为。结果显示, 妊娠期BPA暴露的成年雌性仔鼠在所有4种模型中均检测到促焦虑作用, 而哺乳期BPA暴露的雌鼠、妊娠期或哺乳期BPA暴露的雄鼠仅在2种模型中检测到促焦虑作用。妊娠期BPA暴露显著加重雌雄仔鼠的抑郁行为, 而哺乳期仅高剂量BPA加重仔鼠的抑郁行为。进一步的Western blot分析显示, 妊娠期或哺乳期BPA暴露显著下调成年后雌雄仔鼠海马和杏仁核AMPA受体GluR1亚基的表达, 但对NMDA受体NR1亚基的影响不一致。以上结果提示, 妊娠期或哺乳期BPA暴露对成年雌雄仔鼠均有不同程度的促焦虑和抑郁作用, 其中妊娠期暴露对雌鼠的作用最显著, 海马和杏仁核AMPA受体活动的减弱可能与围生期BPA暴露加重仔鼠成年后的焦虑和抑郁行为有关。     

The effects of prenatal stress on motivation in the rat pup

Exposure to prenatal stress (PNS) has been shown to induce a set of psychological and behavioral changes in developing offspring. We used the rodent model to investigate whether PNS produces changes in the ability of the pup to express social motivation. We used a set of behavioral tasks including monitoring ultrasonic vocalizations after isolation, a conditioned place preference, and a novel and familiar odor approach test. Pregnant Long-Evans rats were exposed to an unpredictable, variable stressor twice daily during the third week of gestation. Isolation vocalizations were assessed on postnatal day (PND) 10. Pup affinity for the dam was evaluated on PND 15. Typically, pups display a selective preference for an odor-paired environment only after the odor has been associated with the dam. This previous association produces a positive conditioned stimulus (CS). Normally, pups exposed to a neutral CS (odor paired with cotton balls) do not form this place preference. Results indicate that PNS exposed pups had significantly increased distress vocalizations and an equal preference for the positive and neutral conditioned stimuli. This type of alteration in forming early preferences could be detrimental because of decreases in the specificity of social learning and an impaired responsiveness in social relationships.     

Reproductive Decision-Making in MMR Mutation Carriers After Results Disclosure: Impact of Psychological Status in Childbearing Options

Reproductive techniques such as prenatal diagnosis (PND) or preimplantation genetic diagnosis (PGD), although debated, are legally forbidden in France in case of Lynch syndrome. The preference of mutation carriers about their reproductive options is not systematically considered in France. We aimed to prospectively assess the reproductive preferences of mismatch repair mutation carriers consulting in our institution (2003–2010, n?=?100). We also considered the short- and long-term post-disclosure psychological impact using the Impact of Events Scale-Revised questionnaire to measure the prevalence of posttraumatic stress disorder (PTSD) in those patients. Complete data were obtained for 34 respondents (17 males, 17 females, median age of 33.5 years [22–59]). Seventeen respondents (57 %) preferred spontaneous natural conception versus 28 % and 35 % choosing PND and PGD, respectively. At results disclosure, respondents mainly explained their distress by fear of premature death (43 %) and transmitting mutated genes (42 %). One year later, this last fear remained predominant in 55 % of subjects. None of the main socio-demographical, psychological or medical variables (including fear of transmitting mutations) was significantly associated with the reproductive preferences. Results disclosure had a real and time-decreasing psychological impact on mutation carriers. Reproductive techniques, expected to decrease the hereditary risk, were not significantly preferred to natural conception.     

Effects of Early Hippocampal Lesions on Trace, Delay, and Long-Delay Eyeblink Conditioning in Developing Rats

The effects of bilateral hippocampal aspiration lesions on later acquisition of eyeblink conditioning were examined in developing Long-Evans rat pups. Lesions on postnatal day (PND) 10 were followed by evaluation of trace eyeblink conditioning (Experiment 1) and delay eyeblink conditioning (Experiment 2) on PND 25. Pairings of a tone conditioned stimulus (CS) and periocular shock unconditioned stimulus (US, 100 ms) were presented in one of three conditioning paradigms: trace (380 ms CS, 500 ms trace interval, 880 ms interstimulus interval [ISI]), standard delay (380 ms CS, 280 ms ISI), or long delay (980 ms CS, 880 ms ISI). The results of two experiments indicated that hippocampal lesions impaired trace eyeblink conditioning more than either type of delay conditioning. In light of our previous work on the ontogeny of trace, delay, and long-delay eyeblink conditioning (Ivkovich, Paczkowski, & Stanton, 2000) showing that trace and long-delay eyeblink conditioning had similar ontogenetic profiles, the current data suggest that during ontogeny hippocampal maturation may be more important for the short-term memory component than for the long-ISI component of trace eyeblink conditioning. The late development of conditioning over long ISIs may depend on a separate process such as protracted development of cerebellar cortex.     

Short- and long-term effects of juvenile stressor exposure on the expression of GABAA receptor subunits in rats

During the juvenile period rodents are particularly sensitive to stressors. Aversive events encountered during this period may have enduring effects that are not evident among animals initially stressed as adults. Interestingly, experiencing stressor during juvenile period was found to elicit a biphasic behavioral pattern over the course of development. During the juvenile period, the expression of several GABAA receptor subunits is subject to elevated plasticity, rendering the GABAergic system sensitive to stressors. In the present investigation, animals were exposed to a juvenile variable stressor regimen (JUV-S) at 27-29 postnatal days (PND): 27 PND-acute swim stress (10 min), 28 PND-elevated platform stress (3 sessions×30 min each), and 29 PND-restraint (2 h). One hour following the last exposure to stressor or in adulthood (60 PND), anxiety-related behaviors were assessed in a 5-min elevated plus maze test. The western blotting technique was used to evaluate whether the juvenile stress induced behavioral pattern will be accompanied by respective changes in GABAA α1, α2, and α3 protein expression in male rats. Our findings further established that juvenile stressor elicits hyper-reactivity when rats were tested as juveniles, whereas rats exhibited reduced activity and increased anxiety when tested as adults. Additionally, the effects of juvenile stressor on α1, α2, and α3 were more pronounced among juvenile stressed rats that were challenged as adults compared with rats that were only challenged as juveniles. Interestingly, the stress-induced modulation of the subunits was particularly evident in the amygdala, a brain region closely associated with anxiety. Thus, age- and region-specific alterations of the α subunits may contribute to the age-specific behavioral alterations observed following juvenile stress exposure.