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Perinatal Anxiety 101: An Introduction

Authors: Brynn Stagg, MSc Student, University of British Columbia; Claudia Cargnelli, MSc Student, University of British Columbia; Nichole Fairbrother, Ph.D., RPsych, Clinical Associate Professor & MSFHR Health Professional-Investigator, University of British Columbia | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators)

Published: February 24th, 2023

Are you pregnant, recently given birth, or know someone who has? If so, chances are you or someone you know has experienced anxiety during or after their pregnancy.

Anxiety is a normal human experience.

We all feel anxious, worried, or afraid some of the time. Often, anxiety serves a useful purpose. For example, when heights make us anxious, this feeling serves as a warning to be careful in this potentially dangerous situation. Because of this fear, we take precautions to protect ourselves.

When does anxiety become a problem?

Sometimes, however, we become fearful of something that is not dangerous, or more fearful than we need to be. If anxiety becomes severe enough to cause significant distress or interference in a person’s life, it may have developed into an anxiety or anxiety-related disorder (AD).

There are several different ADs, including panic disorder, generalized anxiety disorder, social anxiety disorder, and anxiety-related disorders like obsessive-compulsive disorder and posttraumatic stress disorder. Given the diversity of ADs, it is no surprise that these are important to diagnose – especially when you add in the everyday stress that comes with parenting!

What about anxiety during pregnancy and the postpartum?

Anxiety is especially common (and normal) among pregnant and postpartum people. Often, the anxiety experienced during this time is related to one’s pregnancy (will my baby be healthy?), the childbirth (will childbirth be painful?), and one’s newborn (what if something happens to my baby?).

Although anxiety during the perinatal period is common, and in many cases, a normal and healthy part of becoming a parent, sometimes perinatal anxiety becomes a problem. If you are experiencing substantial anxiety and fear, and these feelings are making you upset or affecting your ability to parent and live your life, you may be experiencing symptoms that meet criteria for an AD.

Most importantly, we want you to know that you are not alone! There are things you can do (like talking to your healthcare providers, for starters).

Why does perinatal anxiety matter?

Over one in five (21%) pregnant and postpartum people suffer from at least one AD during the perinatal period. Believe it or not, this number is more than postpartum depression – which, at most, 10-16% of birthing people experience.

ADs, when they occur during pregnancy, have been associated with adverse obstetrical and neonatal outcomes, such as increased risks for pre-eclampsia, preterm birth, and low birth weight. These can have consequences for the infant and developing child.

What can be done?

It’s important to ask for help. You are not alone. Some treatments really work, including self-help materials, group or individualized therapy, and/or medication.

Cognitive Behavioural Therapy (CBT) is the recommended first-line treatment for most ADs. It is the talk therapy for anxiety with the most scientific support. It’s safe, effective, and is often the treatment of choice for pregnant or postpartum parents as it works as well or better than medication does.

CBT works to reframe thinking patterns and behaviour. In other words, CBT focuses on how you are thinking (cognitive), what you do about those thoughts (behavioural), and then works on changing these to help your feelings. Lots of research has been done on the effectiveness of CBT in general populations, and we hope to see even more studies focused on perinatal people in the future!

If talk therapy is not helping, individuals may benefit from medication instead of, or in combination with, talk therapy. Selective serotonin and selective norepinephrine reuptake inhibitors (SSRIs and SNRIs), also known as antidepressants, are used to treat anxiety. While many are hesitant and fearful of using medications while pregnant or breastfeeding, not treating more severe perinatal anxiety greatly overshadows the risks associated with using medication, so it’s important to weigh the pros and cons.

If you think your anxiety has become a problem, you may want to speak to your primary healthcare provider. You can also seek the services of a psychologist.

What’s next for this area?

The team at the Perinatal Anxiety Research Lab hopes that by spreading knowledge of anxiety during pregnancy and the postpartum, we can work to make sure that perinatal anxiety becomes easily recognized so everyone can get the support they need during such a stressful time.

Coming up, we will teach you about some important steps that are crucial in making sure parents are getting the support and resources they need. Stay tuned for our next feature on Screening for Perinatal Anxiety Disorders.

Reflecting & Resources

If you are pregnant or have been pregnant, what has your experience been like? Did you know anxiety is this common during the perinatal period? Is there someone that could benefit from this knowledge?

Let us know your thoughts, questions, or ideas for future posts in our Perinatal Anxiety 101 feature at womenshealth.blog@ubc.ca.

Click here for resources and additional support!

Responses to Anxiety and Depression During Pregnancy Require Funding Say Care Providers

Author: Julia Santana Parrilla, MSc Population & Public Health at the University of British Columbia | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators)

Published: April 23rd, 2021

Perinatal mental health is considered a global public health issue. [17] So, why don’t we talk about it more?

In the Global North, pregnancy care and interventions developed exponentially throughout the twentieth century. [2] The medicalization of pregnancy and childbirth has led to significant innovations in care. It has also problematized the experience in ways that privilege medical expertise and suppress pregnant people’s agency. In the early 1900s, reproduction was commodified as pregnancy supplied the labour force for industrializing societies. [2] Given how babies are produced from our bodies, it is unsurprising that pregnancy was reduced to gestation. Over a century later, these foundations persist in our social imaginations and shape healthcare priority-setting. From research to funding, education to practice, and recommendations to policy, mental health has yet to be integrated in pregnancy care.

Mood and anxiety disorders are the most common types of mental ill-being locally and globally. [6] But, anxiety and depression occur more frequently among women than in men. [6,9,16] This lifetime prevalence is seen across cultures and most often manifests during reproductive years, particularly in times of dramatic hormonal fluctuations, such as during pregnancy and after birth. [10,16] Approximately ⅓ women may experience anxiety symptoms during pregnancy. [19] In British Columbia (BC), up to ⅕ will experience significant depression associated with pregnancy and childbirth. [4]

I dedicated my thesis research to understanding how anxiety and depression are addressed with pregnant people. In BC, people can choose to be cared for throughout pregnancy by a family physician (FP), obstetrician-gynecologist (ObGyn), and/or registered midwife (RM). I interviewed five FPs, four RMs, and three ObGyns practicing in the Lower Mainland to understand their attitudes and perspectives regarding anxiety and depression during pregnancy, those who experience them, and how to address them (identification and management). I perceived providers on the frontlines of pregnancy care to have the power to shape families’ health outcomes and the initiatives and policies that impact them. [13,20] Understanding provider perspectives is the first step in improving our healthcare system’s responsiveness to families’ needs.

Participants reported seeing anxiety and/or depression regularly. Some even expressed expecting to see them given how the journey toward parenthood is a “big change” [RM,7] full of unknowns that can cause much distress and call for psychosocial adjustments. [21,22] As this FP put it:

“[..] the antenatal period is very hard to come to terms with […] there’s just so many changes going on, mentally, physically, emotionally. It’s hard for people to even A: recognize that there is an issue, and B: sort of come to terms or accept that there might be an issue.” [FP,5]

Feeling “[…] sad of the life you left behind, and being anxious of what’s going to happen, being afraid of giving birth […]” [RM,6] was considered natural by most. However, the aggravation of fears by perceived social pressures was a common frustration. As this ObGyn explained:

“[there] is a lot of pressure on women to do everything perfectly during pregnancy and the reality is it can be a lot harder than expected and that the expectation that are created are unrealistic.” [ObGyn,10]

Most participants found that messaging about how to be during pregnancy undermined the capacity for self-compassion essential to cope with unexpected emotions/moods. This requires disruption. As asserted by this FP:

“[…] when society and this culture is telling you so many things about how you have to be as a mom and like there’s so many outside pressures […] what would help? Like, changing that!” [FP,4]

The confluence of this “big life transition” [RM,8] with the stigma that befalls those who are experiencing anything other than the “ideal pregnancy” predicts and worsens anxiety and/or depression. [23] In response, providers centered the normalization of anxiety and depression in encouraging disclosures and supporting management. Often, this involved letting pregnant people know “[…] it’s common” [FP,3], and that they’ll “[…] figure it out together.” [RM,8]

Most participants favoured this approach over-relying on standardized screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS) integrated into their antenatal care forms. [5] This is consistent with previous investigations. [3,7,8,13,14] Many expressed skepticism about the EPDS’ reliability. As an ObGyn with 16 years experience said:

“All of our patients were supposed to be filling it out, but it didn’t seem to be identifying things particularly well for us.” [ObGyn,10]

Some participants reported refraining from using the EPDS due to perceived harms. They expressed worry about isolating people, giving them a stigmatizing label (i.e. mentally ill), and/or triggering the very issues they are trying to identify, prevent, and manage. One RM referred to screening tools as “systems of triggers” [RM,6] adding, “I feel like it is quite isolating, and I feel like it is quite stigmatizing.”[RM,6]

Discussing mental health openly was considered less alienating than using a screening tool. Participants explained how dialogue feels innocuous (safe) whereas tools feel official (intimidating). They considered identification an important first step toward management and supporting healthy pregnancy outcomes. Unfortunately, the stigmatization and complexity of mental health presents challenges in communication. As this RM said:

“one of the things [providers] find challenging is that […] there’s different ways that you can check in with people and people respond very differently to different types of communication.” [RM,8]

Negative perceptions of mental health and reluctance to talk about it mean that there is “[a] fine line between trying to help and offending people” [RM,7]

This is cause for concern given how anxiety and depression during pregnancy often manifest in avoidance of care, poor adherence to recommendations and poor health habits relating to sleep and nutrition. [11,15,18] All exacerbate mental health conditions and risks of poor health outcomes. [4] Providers expressed concern about keeping clients engaged.

Additionally, feeling underprepared and overburdened in supporting pregnant people experiencing anxiety and/or depression was commonplace. All wished they received the systemic support to “make it easier!”[RM,8] beginning with their training. As this RM said:

“[…] perinatal depression is the number one, uh, issue in pregnancy. Not, you know, preeclampsia, and not, you know, whatever, it’s perinatal depression […] and we’re so not educated in it […]” [RM,6]

Even though some may think of mental health as within the scope of their care responsibilities, it is not perceived to be facilitated. Most reported:

“[…] I feel like I try to do my best.” [RM,8] but when “[…] people, resources, money and resources that are… scarce.” [RM,7], “[…] healthcare providers take on a lot of responsibility and a lot of worry.” [FP,1]

Generally, there is a sense of insecurity in the quality of care provided given the lack of mental health integration.

When discussing what would be advantageous to their efforts, many echoed this RM in needing a “multi-pronged approach” [RM,9] that allocates resources to provider capacity, specialist availability, and resource accessibility (affordability and relevance). They emphasized this is our systems’ responsibility and insisted that funding translates to care priority. In this RM’s words:

“[…] the government decides how they’re going to fund us and what they’re going to pay for […] if they don’t put funding into programs to support mental health and wellness, then… then just the programs don’t exist for us to refer people to.” [RM,8]

Simply, we need “[to] build a government that supports mental health care” [FP,1]

To create demand for existing structures to change in favour of integrating mental health, we need to think about who has the power to stimulate adaptations by the healthcare system. While I entered this project assuming primary care providers had this power, participants identified that the changes need to happen upstream where the money comes from. It is with sincere alignment with participants that I assert the need to fund perinatal mental health research, training, and care. When perinatal mental health is not represented in priority-setting and decision-making documents and spaces, it minimizes the urgency of the issue, trivializes avoidable adverse health outcomes, and erases the people (and families; communities) experiencing them.

The World Health Organization and the United Nations Population Fund have jointly decreed there can be “no health without mental health”. Perinatal Services British Columbia recognizes that early detection of mental health challenges before, during and after pregnancy offers opportunities to improve health outcomes for parents and families. [5] Mental health promotion, prevention and early intervention show positive investment on returns. [12] Our Ministry and health authorities are responsible for making mental health services available and accessible, from prevention to management. [24]

Far more than producers of the next generation/s, pregnant people’s care should not be exclusive to physiology and babies’ gestation. To care for populations equitably, we must recognize how the erasure of complexity in people’s experiences perpetuate health and social inequities. We must make room for the experiences that are silenced, erased, and stigmatized to be demystified and supported.

Disclaimer: To meaningfully address perinatal mental health disparities, all pregnancy experiences within our colonial, cisgender, ableist, hetero-patriarchy must be accounted for.

Bibliography

Santana Parrilla, J. (2020). Addressing anxiety and depression during pregnancy: primary antenatal care provider perspectives. University of British Columbia. http://hdl.handle.net/2429/74143

Al-Gailani, S., & Davis, A. (2014). Introduction to “Transforming pregnancy since 1900.” Studies in History and Philosophy of Biological and Biomedical Sciences, 47(Pt B), 229–232. https://doi.org/10.1016/j.shpsc.2014.07.001

Bayrampour, H., Hapsari, A. P., & Pavlovic, J. (2018). Barriers to addressing perinatal mental health issues in midwifery settings. Midwifery, 59, 47–58. https://doi.org/10.1016/j.midw.2017.12.020

BC Reproductive Mental Health Program. (2006). Addressing Perinatal Depression: A Framework for BC’s Health Authorities (Framework) [Framework]. BC Reproductive Mental Health Program: BC Women’s Hospital & Health Centre, an Agency of the Provincial Health Services Authority. http://www.health.gov.bc.ca/library/publications/year/2006/MHA_PerinatalDepression.pdf

BC Reproductive Mental Health Program, & Perinatal Services BC. (2014). Best Practice Guidelines for Mental Health Disorders in the Perinatal Period. http://www.perinatalservicesbc.ca/Documents/Guidelines-Standards/Maternal/MentalHealthDisordersGuideline.pdf

Canada, P. H. A. of. (2016, May 27). Report from the Canadian Chronic Disease Surveillance System: Mood and Anxiety Disorders in Canada, 2016 [Research]. Aem. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-canadian-chronic-disease-surveillance-system-mood-anxiety-disorders-canada-2016.html

Coburn, S. S., Luecken, L. J., Rystad, I. A., Lin, B., Crnic, K. A., & Gonzales, N. A. (2018). Prenatal Maternal Depressive Symptoms Predict Early Infant Health Concerns. Maternal and Child Health Journal, 22(6), 786–793. https://doi.org/10.1007/s10995-018-2448-7

Fairbrother, N., Corbyn, B., Thordarson, D. S., Ma, A., & Surm, D. (2019). Screening for perinatal anxiety disorders: Room to grow. Journal of Affective Disorders, 250, 363–370. https://doi.org/10.1016/j.jad.2019.03.052

Gobinath, A. R., Mahmoud, R., & Galea, L. A. M. (2015). Influence of sex and stress exposure across the lifespan on endophenotypes of depression: Focus on behavior, glucocorticoids, and hippocampus. Frontiers in Neuroscience, 8. https://doi.org/10.3389/fnins.2014.00420

Hendrick, V., Altshuler, L. L., & Suri, R. (1998). Hormonal Changes in the Postpartum and Implications for Postpartum Depression. Psychosomatics, 39(2), 93–101. https://doi.org/10.1016/S0033-3182(98)71355-6

Kruper, A., & Wichman, C. (2017). Integrated Perinatal Mental Health Care. Psychiatric Annals, 47(7), 368–373. https://doi.org/10.3928/00485713-20170531-01

Mental Health Commission of Canada. (2014). Why investing in mental health will contribute to Canada’s economic prosperity and to the sustainability of our healthcare system (p. 5). Mental Health Commission of Canada. https://www.mentalhealthcommission.ca/English/media/3104

Price, S. K., Corder-Mabe, J., & Austin, K. (2012). Perinatal Depression Screening and Intervention: Enhancing Health Provider Involvement. Journal of Women’s Health, 21(4), 447–455. https://doi.org/10.1089/jwh.2011.3172

Psaros, C., Geller, P. A., Sciscione, A. C., & Bonacquisti, A. (2010). Screening Practices for Postpartum Depression Among Various Health Care Providers. The Journal of Reproductive Medicine, 55, 477–484.

Stewart, D. E. (2011). Depression during Pregnancy. New England Journal of Medicine, 365(17), 1605–1611. https://doi.org/10.1056/NEJMcp1102730

Weissman, M. M., & Olfson, M. (1995). Depression in Women: Implications for Health Care Research. Science, 269(5225), 799–801. JSTOR. http://www.jstor.org/stable/2888484

WHO | Maternal mental health. (n.d.). WHO. Retrieved July 7, 2019, from https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/

World Health Organization. (2008). Improving Maternal Mental Health [Millennium Development Goal 5 – improving maternal Health]. https://www.who.int/mental_health/prevention/suicide/Perinatal_depression_mmh_final.pdf?ua

Lee, A. M., Lam, S. K., Sze Mun Lau, S. M., Chong, C. S. Y., Chui, H. W., & Fong, D. Y. T. (2007). Prevalence, Course, and Risk Factors for Antenatal Anxiety and Depression: Obstetrics & Gynecology, 110(5), 1102–1112. https://doi.org/10.1097/01.AOG.0000287065.59491.70

Selix, N., Henshaw, E., Barrera, A., Botcheva, L., Huie, E., & Kaufman, G. (2017). Interdisciplinary Collaboration in Maternal Mental Health. MCN, The American Journal of Maternal/Child Nursing, 42(4), 226–231. https://doi.org/10.1097/NMC.0000000000000343

Deave, T., Johnson, D., & Ingram, J. (2008). Transition to parenthood: The needs of parents in pregnancy and early parenthood. BMC Pregnancy and Childbirth, 8(1), 30. https://doi.org/10.1186/1471-2393-8-30

George, A., Luz, R. F., De Tychey, C., Thilly, N., & Spitz, E. (2013). Anxiety symptoms and coping strategies in the perinatal period. BMC Pregnancy and Childbirth, 13(1), 233. https://doi.org/10.1186/1471-2393-13-233

Public Health Agency of Canada. (2012). Depression in Pregnancy. http://www.phac-aspc.gc.ca/mh-sm/preg_dep-eng.php

Auditor General of British Columbia. (2016). Access to Adult Tertiary Mental Health and Substance Use Services. https://www.bcauditor.com/sites/default/files/publications/reports/OAGBC_Mental_Health_Substance_Use_FINAL.pdf

Photo by Janko Ferlič on Unsplash

Mental Health Awareness Beyond Anxiety and Depression: Shedding Light on the Body Image Problem

Author: Kaylee Misener, Clinical Psychology PhD student at University of British Columbia Okanagan | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators)

Published: January 28th, 2021

In a 2003 New York Times interview, Dr. Susie Orbach, a sociologist at the London School of Economics and Political Science, said “we’re still not fully recognizing that the body-image problem is a public health emergency”. Unfortunately, this statement still rings true today.

As a graduate student in clinical psychology and the president of the Mental Health Awareness and Advocacy Club at the University of British Columbia Okanagan (UBCO), addressing mental health stigma and promoting positive mental health is a particular passion of mine. However, throughout my education and work in mental health, I find the same themes continue to receive most of the focus during events like Bell Let’s Talk Day. Events that promote awareness have made profound shifts in our cultural landscape regarding mental health in recent years, particularly for mental health challenges related to depression and anxiety.

This year, I would like to draw attention to the mental health challenges related to body image and disordered eating. Despite their pervasive and serious nature, as noted by Dr. Orbach, these challenges are massively underrepresented in the broader discussions on mental health awareness. As a body image researcher and advocate, I have seen how these issues are often trivialized, dismissed, and underfunded.

Why does body image matter?

Body image is a broad term pertaining to thoughts and feelings about one’s body. It also includes body-related behaviours one engages in.[1] Negative thoughts and feelings about one’s body are associated with a myriad of negative psychosocial outcomes including depression, low self-esteem, unsafe sex practices, smoking, increased anxiety, and school avoidance. Negative body image also predicts lower levels of physical activity and disordered eating behaviours, and is associated with increased dieting and weight gain.[7,8]

Notably, negative body image is also one of the strongest predictors of eating disorders.[9] While less attention is directed towards their study, eating disorders are associated with the highest mortality rate across mental health disorders, outside of substance use disorders.[10] Despite these concerns, negative body image is so pervasive, particularly among women, that it is commonly referred to as “normative discontent,” indicating how normal it is to be unsatisfied in one’s relationship with their body and how much work we have left to do in this area.

What is positive body image?

While the findings noted above underscore the prevalence and severity of body image concerns, we also know that positive body image can significantly benefit overall health and well-being. For example, positive body image predicts favourable health outcomes such as increased physical activity, and decreased dieting, smoking and alcohol use.[11] Positive body image is also associated with lower rates of depression, higher self-esteem, and even greater use of sun protection.[12]

Positive body image is commonly misunderstood as simply loving one’s appearance. However, this misconception misses the true essence of positive body image. Rather, it encompasses respecting the body by attending to its needs, accepting the body despite its perceived flaws, appreciating the body for its functionality, and working to protect ourselves from harmful outside influences such as those included in the media or physical harms.[13]

How can we move toward positive body image?

Given the significant concerns associated with negative body image and the notable benefits associated with positive body image, it is tempting to wish we could wave a magic wand and create universal positive changes in body image overnight. While we may not have that magic wand, there are evidence-based strategies that can be used to improve one’s relationship with their body.

Positive People: Surround yourself with body positive people and minimize the time you spend engaging with dieting friends and diet culture.
Focus on Values: List the things you like about yourself and others that have nothing to do with physical appearance.
Be Critical: Be a critical consumer of the media and messages from the diet industry. Consider who profits from you feeling like you need to change.
What Will You Give Up: Consider what you give up to pursue idealized body shapes. Would you rather spend that time with friends, pursuing your dreams, or enjoying your life?
Enjoy Movement: Engage in types of physical activity that you enjoy. Consider movement in the context of taking care of your body instead of punishing it.
Focus on Functionality: Celebrate all the things your body does for you. Make a list of everything and reflect on why those functions are important to you.
Hit Unfollow: Unfollow anyone on social media that makes you feel bad about yourself. Use social media to your benefit by following accounts which make you feel good.
Self-compassion: Try responding to yourself as you would a dear friend. Try self-compassion meditations or a workbook.
Mindfulness: Stay in the present moment and meet it without judgement. That includes your body.

The above suggestions are just the tip of the body image iceberg. Often, the first step is simply starting the discussion on body image issues, particularly in the context of mental health. Everyone has a body and everyone has a relationship with their body. It is only through increased awareness and stigma reduction that societal-level shifts can be made to promote positive body image. By starting on the individual level and starting small, we can be part of this necessary wave of change.

References

Cash, T. F. (2004). Body image: Past, present, and future. Body Image, 1, 1-5. doi:10.1016/S1740-1445(03)00011-1
Paxton, S. J., Neumark-Sztainer, D., Hannan, P. J., & Eisenberg, M. E. (2006). Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of Clinical Child & Adolescent Psychology, 35, 539–549. doi:10.1207/s15374424jccp3504_5
Schooler, D. (2013). Early adolescent body image predicts subsequent condom use behavior among girls. Sexuality Research and Social Policy, 10, 52-61. doi:10.1007/s13178-012-0099-9
Howe, L. J., Trela-Larsen, L., Taylor, M., Heron, J., Munafò, M. R., & Taylor, A. E. (2017). Body mass index, body dissatisfaction and adolescent smoking initiation. Drug and Alcohol Dependence, 178, 143–149. doi:10.1016/J.DRUGALCDEP.2017.04.008
Vannucci, A., & Ohannessian, C. M. (2018). Body image dissatisfaction and anxiety trajectories during adolescence. Journal of Clinical Child and Adolescent Psychology, 47, 785–795. doi:10.1080/15374416.2017.1390755
Neumark-Sztainer, D., Paxton, S. J., Hannan, P. J., Haines, J., & Story, M. (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244-251. doi:10.1016/j.jadohealth.2005.12.001
Hayden-Wade, H. A., Stein, R. I., Ghaderi, A., Saelens, B. E., Zabinski, M. F., & Wilfley, D. E. (2005). Prevalence, characteristics, and correlates of teasing experiences among overweight children vs. non-overweight peers. Obesity Research, 13, 1381–1392. doi:10.1038/oby.2005.167
Sonneville, K. R., Calzo, J. P., Horton, N. J., Haines, J., Austin, S. B., & Field, A. E. (2012). Body satisfaction, weight gain and binge eating among overweight adolescent girls. International Journal of Obesity, 36, 944–949. doi:10.1038/ijo.2012.68
Rosenvinge, J. H., & Pettersen, G. (2014). Epidemiology of eating disorders part II: An update with a special reference to the DSM-5. Advances in Eating Disorders, 3, 198-220. doi:10.1080/21662630.2014.940549
Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13, 153-160. doi:10.1002/wps.20128
Andrew, R., Tiggemann, M., & Clark, L. (2016). Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study. Developmental Psychology, 52, 463–474. doi:10.1037/dev0000095
Gillen, M. M. (2015). Associations between positive body image and indicators of men’s and women’s mental and physical health. Body Image, 13, 67-74. doi:10.1016/j.bodyim.2015.01.002
Tylka, T.L. (2011) ‘Positive psychology perspectives on body image’, in T.F. Cash and L. Smolak (Eds) Body image: A handbook of science, practice and prevention, 2nd edition (pp. 56–67), New York: Guilford.
Neighbors, L. A., & Sobal, J. (2007). Prevalence and magnitude of body weight and shape dissatisfaction among university students. Eating Behaviors, 8, 429-439. doi:10.1016/j.eatbeh.2007.03.003
Stice, E., & Shaw, H. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53, 985-993. doi:10.1016/S0022-3999(02)00488-9
Duenwald, M. (2003, June 22). Body Image: One size definitely does not fit all. The New York Times. https://www.nytimes.com/2003/06/22/health/body-and-image-one-size-definitely-does-not-fit-all.html

Women’s Brain Health Series: Symposium 2 Summary

Author: Alex Lukey (@AlexandraLukey) – Registered Nurse, Master of Science in Nursing (UBC) and Women’s Health Blog Co-Coordinator | Editor: Arrthy Thayaparan, Women’s Health Blog Co-Coordinator

Published: December 14th, 2020

This past year has been a time of unprecedented change and constant adjustments. For the Women’s Health Research Cluster (WHRC) a lot of our work has shifted online to better serve our cluster members. In particular, the WHRC’s annual women’s health conference went from a single-day event to a series of 10 monthly sessions.

Originally meant to be held in May 2020, this year’s conference focused on women’s brain health. The purpose of the conference was to highlight how women have unique health needs and are more susceptible to specific brain diseases. The fourth session of the Women’s Brain Health Virtual Conference Series was held on December 4th and welcomed experts to discuss the intersection between women’s health and mental health. A variety of ideas were considered during the session, which our blog coordinator, Alex Lukey, has summarized for our esteemed readers:

Dr. Shau-Ming Wei, NIH/NIMH

Mood disorders during Reproductive Transitions: Circuit and Cellular Substrates of Risk

Many women experience Pre-Menstrual Syndrom (PMS) but for some women, the mood shifts can be so severe that they damage work and family relationships. When this happens what they may be experiencing is known as Premenstrual Dysphoria Disorder (PMDD); a far more severe form of PMS.

Dr. Wei presented research that shows that there may be differences at both the brain and cellular response to hormones in women with PMDD. This early research is exciting because it is evidence that the extreme psychological symptoms that some women experience have a biological basis. This also means that PMDD may be treatable.

The research showed that there were differences in blood flow to an area of the brain (subgenual cingulate) indicated in major depression disorder when exposed to high levels of estrogen and progesterone compared to women without PMDD. This means that the brains of women with PMDD respond differently to the normal fluctuations of hormones than women without PMDD. Early evidence from Dr. Wei also showed that when estrogen was suppressed in women with PMDD that there was as much as a 70% reduction in symptoms.

To treat a disorder we must first understand the biological reasons for the illness. That’s why this research is critical for us to better understand how to treat women with PMDD.

Dr. Cindy Lee Dennis, University of Toronto

Mental Health across the Perinatal Period starting Preconception

Perinatal mental health pertains to the period of time immediately before and after mother’s give birth. Research in this area is still in it’s early stages of conception – having only been addressed in the last 30 years. Dr. Dennis presented research that is critical to the effective treatment of perinatal anxiety and depression.

Due to public health efforts, there is an increased awareness of post-natal depression, commonly known as “baby blues.” What is less known is that depression and anxiety often start during pregnancy and can last several years after if not treated. According to Dr Dennis, at least a ⅓ of women had symptoms DURING and another ⅓ before pregnancy. Further one of the strongest risk factors for perinatal depression is a previous major depressive episode. Yet, screening and interventions are usually not completed until after the baby is born. Dr. Dennis advocated that screening and interventions must be aimed much earlier for better outcomes.

Anxiety is also not commonly addressed in women both during and after pregnancy. About 1/4 of women reported a major anxiety episode into their pregnancy. There were factors that reduced anxiety and depression according to Dr Davis. Two factors which reduced anxiety and depression in women were partner support and self-efficacy in breastfeeding. Both of these factors can be targeted for intervention.

Partner support is an important component to focus on as well because men also experience increased anxiety and depression. Dr. Dennis highlighted the importance of studying the effects and experiences of men with anxiety and depression during the perinatal period. Risk factors for paternal perinatal mental health issues varied from emotional abuse, financial instability, paternal ADHD, and obesity. Yet there is much less research and support for partners of women.

The main take-away message from this conversation? Perinatal mental health is not exclusive to mothers, but is a family affair. Thus, the imporatance to initiate interventions before pregnancy becomes even more vital. It really is never too early to address perinatal mental health. Especially considering that the first contact with antenatal care is usually too late to target major risk factors.

Dr. Benicio Frey, McMaster University

Mood Disorders and Reproductive Live Events: Translating Research into Clinical Practice

Dr. Frey started his talk with three clear objectives for the audience to understand:

There are major links between mood disorders getting worse and premenstrual, postpartum and menopausal disorders
The link between mood and premenstrual disorders is associated with worse clinical outcomes. In extreme cases even increased suicide rates
Hormonal treatments may be one option to help improve symptoms and clinical outcomes

What do these conclusions mean? For women with serious mood disorders such as bipolar disorder, major hormonal changes such as pregnancy are risky. This could mean a relapse or worsening of their condition. Research also shows that with treatment this risk is significantly reduced. Unfortunately, according to Dr. Frey, hormonal changes as a risk factor for psychiatric emergencies is not widely taught to mental health professionals.

Dr Frey also discussed the connection between PMDD (Prementrual Dysphoric Disorder) and bipolar disorder. A staggaring meta-analysis of 32 papers showed a 26% increase in suicide deaths at menstruation. This is further evidence that the effects of hormones are serious for women with mood disorders.

Dr Liisa Galea asked a follow up question for the women in the audience: What should a woman do if she thinks that she might have PMDD? Dr Frey suggested that women track their symptoms for two cycles using either an app or paper tracker. It is much harder for healthcare providers to dismiss symptoms when presented with a numerical measurement.

Alex’s main takeaways:

The talks although different in focus and topic had a clear message: We have a lot of work to do to understand the causes of mental health challenges in women. The hopeful message is that there are biological mechanisms specific to women that treatments can be aimed at. The talks by Dr Wei, Dr Dennis and Dr Frey are evidence of the immense progress being made in this field. Hopefully in the years to come, these essential conversations will bring to fruition results that will drive change in our understanding and treatment of women’s mental health.