Tag Archive for: mental health

Behind the Science: Identifying Predictive Biomarkers in Bipolar Disorder and Related Suicidality to Improve Disease Outcomes

Interviewee: Dr. Sara Afjeh, Postdoctoral fellow, Centre for Addiction and Mental Health (CAMH) | Authors/Editors: Romina Garcia de leon, Janielle Richards (Blog Co-coordinators)

Can you tell us a little bit about your research?

Genes serve as the blueprint for how our bodies and minds function. My research seeks to decode this genetic blueprint to understand how psychiatric disorders manifest differently in women. The primary goals are to identify predictive genetic markers for mental disorders like bipolar disorder and related suicidality, as well as biomarkers to assess medication responses. I use machine learning to develop predictive models that can anticipate disorder progression and treatment outcomes. These advancements push us closer to personalized mental health care, where each individual’s unique combination of genetics, environmental, and societal factors are considered. By uncovering these genetic markers, we can bring greater precision to mental health care, ultimately improving outcomes for those most affected.

 

How did you get into this field of research? 

I first became interested in genetics because it plays such a critical role in our understanding of health and disease. As I delved deeper into the field, I discovered how genetic research could transform our approach to complex conditions like mental disorders. Over time, I became particularly drawn to studying gender differences in mental health, as emerging research showed that men and women often experience mental disorders in unique ways. Unfortunately, many diagnostic tools and treatments overlook these distinctions. By focusing on the genetics of mental health in women, I hope to bridge this gap and develop more accurate diagnostic and treatment options that account for women’s specific biological and societal factors, especially during life stages where mental health can be most vulnerable.

 

Can you elaborate on the impact of gender differences in mental health research?

Gender differences play a crucial role in how mental health issues manifest, especially for women. Hormonal, biological, and societal factors, such as stigma, unique stressors, and trauma, all contribute to how women experience mental disorders. These influences shift throughout a woman’s life, impacting mental health in complex ways that are often overlooked. Ignoring these factors can lead to misdiagnosis or less effective treatments, underscoring the importance of research that addresses gender-specific needs in mental health care.

 

Are there any findings that you can share with us? 

During my PhD, I identified a genetic variant associated with bipolar disorder, suicidality, and response to lithium treatment in individuals diagnosed with bipolar disorder. When examining gender differences within this population, I discovered that this variant had a stronger effect in women than in men, which inspired me to continue my research with a specific focus on women. Additionally, I found that an ADCY variant was associated with bipolar disorder in women, which was further supported by findings from genome-wide association studies. These insights emphasize the importance of examining genetic markers in a gender-specific context, especially for complex mental health disorders.

 

What are your long term goals for your research?

My long-term goal is to contribute to a future where mental health care is personalized, especially for women. I aim to achieve this by integrating genetic insights into our understanding of mental disorders, which would help create diagnostic tools that identify these conditions earlier and more accurately for women. Early detection could help women avoid years of undiagnosed suffering. I also hope my research will lead to improved pharmacotherapy, addressing the unique needs of women with mental health challenges. Many medications currently have side effects that can lead to treatment discontinuation or relapse. Through my work, I aspire to support the development of treatments that are more effective, come with fewer side effects, and ultimately enhance the quality of life for women facing mental health issues.

 

Where to learn more about Sara’s work?

Linkedin Profile: www.linkedin.com/in/sara-afjeh-365847b8

Publication: Predictive Biomarkers of Bipolar Disorder

More publications: Google scholar

 

Personality and Sex Differences in Depressive Symptomatology

Authors: Jessica Stewart, PhD Candidate, Health Psychology, University of British Columbia | Editors:  Romina Garcia de leon and Shayda Swann

Published: January 19, 2024

It’s not hard to believe that people with tendencies toward anger or aggression will end up with more health problems than those who have a positive outlook. Many studies have shown that personality traits are associated with physical health and mortality.

Personality traits can be identified as patterns of feelings, thoughts, and behaviours that take shape in one’s childhood and become consistent throughout one’s life.

The Five-Factor Model of personality is a common method of describing personality traits and separates the traits into agreeableness, conscientiousness, extraversion, neuroticism and openness to experience.

Hostility, which is an attribute of neuroticism, is associated with coronary heart disease and mortality, while conscientiousness predicts longevity.

Depressive symptoms, which approximately 350 million people around the world currently experience, have been linked to personality traits. A 2023 study showed that all five dimensions of personality were linked to changes in depressive symptoms but neuroticism has the strongest association with depressive symptoms, with people who are high in neuroticism being more likely to experience depressive symptoms.

Personality traits may also be a cause of the considerable sex difference in depressive disorders that exists between males and females across sociocultural contexts. This difference exists across the lifespan, with females around twice as likely as men to experience depressive disorders from adolescence to late adulthood.

Neuroticism and depression in women

In a 2022 study, neuroticism was correlated with the prevalence of probable major depressive episodes for both men and women. Still, the effect of neuroticism in the incidence and persistence-recurrence of probable major depressive episodes was only found in females. In other words, the study found a neuroticism-related vulnerability in women for the incidence or persistence-recurrence of a major depressive episode.

Past research has suggested one neural mechanism between neuroticism and depression found only in women. It has been described as a correlation between neuroticism and resting-state regional cerebral blood flow in the hippocampus and midbrain, and neuroticism predicted depressive symptoms through greater activity of these regions, which are used in emotional processing and regulation.

Conscientiousness and depression in women

Conscientiousness affects men and women differently as well. In the same 2022 study, the interaction found between gender and conscientiousness for the incidence of depressive symptomatology demonstrated a larger protective effect of conscientiousness for men compared to women. In other words, being high in conscientiousness helps men prevent depressive symptoms more than it does for women.

Considering the impact of personality traits and gender on depressive symptoms, researchers recommend including personality and gender-specific strategies in mental health and depression intervention or prevention programs.

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!

 

Sex Differences and the Brain-heart Connection

Author: Emilie Théberge, MSc. Medical Genetics, Clinical Research Coordinator (University of British Columbia/Vancouver General Hospital)   Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators).

Published: December 30th, 2022.

Note: Biological sex (i.e. female, male) is not the same as gender (i.e. woman, man, nonbinary, Two-Spirit, etc.), which is a social construct. Throughout this blog post, the cited literature considers the term “women” to equate to cisgender females, and the term “men” to cisgender males. This post’s cited conclusions of sex differences are under researched in reference to transgender and non-binary individuals, as well as those with non-conforming gender identities.  Read more 

When does stress overwhelm the body to the point that it causes a state of mental and/or physical illness with an accelerating feedback loop? If the cause of stress is unremovable, how can we adapt and find hope?

A large-scale wildfire may cause short-term (acute) stress to someone nearby, but there is also a defined endpoint when the fire is put out and no longer a threat. However, there can be long-term (chronic) consequences to one’s lungs and the local environmental ecosystem This wildfire metaphor may be translated to the acute and chronic mental and physiological adaptations caused by stressful events. Everyone has different thresholds of stress tolerance based on their lived experiences and  biological (genetic) susceptibility to how their bodies manifest this stress.  

 Despite being half of the world’s population, I am shocked at how little research in psychiatric and neuroscience is dedicated to studying sex differences and women’s health. Approximately one in four Canadians were estimated to have depression in 2021 – and across borders, depression rates are consistently reported twice as high in women (20%) than in men (10%). How much of this is attributed to biological sex differences? Do the physical manifestations of mental stress and depression differ between the sexes? I decided to explore these ideas in my thesis. 

This recently published article on the “immunometabolic theory of depression” piqued my interest. Most literature on depression focuses on dysfunction within the brain, ignoring the context of its link to the cardiovascular and metabolic systems. Recent genetics literature on depression has pointed towards genes and molecular pathways that implicate the immune system, specifically chronic-low-grade inflammation, as a key driver of depression. The brain controls the perception of stress, and the heart reacts to it. Chronic low-grade inflammation is a result of this system staying “on” too long after the perceived threat has passed. 

Depression is a systemic and  whole-body concern that can affect our cardiovascular system. I developed a keen interest in exploring these connections when working with patients who believed that stress triggered their cardiovascular disease onset. Heart disease does not occur overnight. Chest pain to the point of a heart attack comes from a complex interaction of metabolic and immune factors that build up over time from imbalances in the body (i.e. from stress). This can manifest as plaque in the large blood vessels with coronary artery disease or dysfunction of the smallest blood vessels with microvascular dysfunction. Traditional risk factors such as high cholesterol, diabetes, high blood pressure, smoking, and obesity, may also have different effects between men and women. 

In my thesis, I studied a sample of over 16,000 people from the Canadian Longitudinal Study on Aging (CLSA) cohort of 50,000 people and found sex differences in the genetic and cardiometabolic risk factors associated with depression. Women with a history of clinical depression were at higher odds of having comorbid histories of heart disease, diabetes, hypothyroidism (which results in slower metabolism), and a higher “genetic risk score” for depression. However, men with depression did not show significant relationships with these conditions, in comparison to men without depression. Among men, high blood pressure was a significant risk factor, while high genetic risk was not. Younger age and lower annual income contributed the most to my statistical models for both sexes. 

Depression is not just in the head, it’s a whole-body dysfunction to cope with stress. In consultation with your primary health care provider, you can make a habit of checking on your body through regular health examinations and seeking support for your mental health. Mental and physical health are interconnected, and gradual mental and physical decline in our youth have the potential to snowball into early life-threatening heart disease. It is imperative that we talk about the individual and collective actions that we can take to treat depression, especially in this post-COVID era. This can take place in our friend groups, families, and workplaces – as we think about long-term solutions instead of “quick fixes.”

 

Behind the Science: Promoting Women’s Mental HealthThrough Social Interventions

Authors: Romina Garicia de leon and Negin Nia, Women’s Health Blog Coordinators | Interviewee: Dr. Saima Hirani, Ph.D., University of British Columbia

Published: September 9th, 2022 

Can you please tell us a bit about your career trajectory as a registered nurse, and now Assistant Professor of Nursing?

I’m an internationally educated nurse. I completed my Bachelors of Science and Master of Science in Nursing from The Aga Khan University in Pakistan. I began  my nursing career as an intensive care unit and cardiac intensive care unit nurse in Pakistan, which involved a lot of technical, high tech, critical care.

I then came to Canada and completed my PhD in Nursing with a focus on mental health at the University of Alberta. After PhD, I went back to Pakistan and worked as an Assistant Professor in the Aga Khan University. In 2019, I joined University of British Columbia (UBC) as a postdoctoral research fellow and currently, I am Assistant Professor,  at UBC,  School of Nursing.

What got you interested in Mental health Nursing? 

After I started working in the ICU, I got some experience with mental health nursing and I got to work with a variety of women, some of whom were incarcerated, survivors of sexual assault or domestic violence. This got me interested in mental health, and many of my teachers recommended me to enter the field.  In 2007, I joined a multidisciplinary research project as a co-investigator that aimed to promote mental health and empowerment in women. My master’s thesis was also part of that larger project. By the time I came to Canada for my PhD, it was very clear that I wanted to focus on women’s health and mental health specifically. My PhD focused on development and testing of social support intervention for women’s resilience and quality of life. My program of research mainly focuses on mental health promotion of individuals including women who live in socioeconomic disadvantaged settings. 

You recently published a paper on COVID-19 and its effects on mental health. Can you elaborate on that study? 

So that was a team that I was working with during my postdoctoral work. Dr. Emily Jenkins led this work which was about the impact of COVID-19 on Canadian Mental Health. The first findings that we published showed  an anticipated change in mental health issues among the population, and especially women experienced more mental health issues than men, globally. COVID-19 has affected women badly, as we all know there are some social issues at play. For example, many working women were also taking care of kids at home so there is a double burden. Sex differences were also observed for employment losses i.e. women’s employment has been affected more than men.There’s actually a layer of complexity into women’s well being and in turn the well being of the families and the children. 

You touched a bit on this, but why is women’s health important to you?

Women’s Health has been very close to me for a long time. This passion started when I was a master’s student 15 years ago. I actually joined a multidisciplinary research team back in Pakistan, and it was made up of nurses, psychologists, and psychiatrists. The team’s goal was to develop and test economic skill building and life skill interventions for women, and that’s where my masters thesis came from. So I actually developed and tested that lifestyle building intervention and tested it for feasibility. Intervention development is not an easy task, I went through a lot  of literature, and interviewed several women who were living in some more vulnerable conditions, and some low socio economic communities. I would go to the urban slum areas of Karachi, Pakistan to work with these women. I learnt a lot from these women, it was a life changing experience for me. That was what laid the foundation for my work. After 15 years, I’m still very passionate about that work. 

And the way I think about it is, there are the two main reasons women’s health is important. The first and foremost is, women’s health is directly linked with the children and families health, which is the cornerstone of a family’s overall health. Working in different contexts  of Pakistan and Canada, I learnt that  in general women and mothers play the same roles across countries. There are some universal gender roles attached to women, therefore, women’s mental health is directly associated with their children’s wellbeing.  To pay attention to women’s health and well being is to make children’s lives better and create healthier families. 

And the second reason to focus on women’s health is the high prevalence and high risk of developing certain health challenges among women, as women experience unique healthcare issues more than men. Such as reproductive health issues, violence and abuse, depression and anxiety. These issues are more prevalent globally, and not only in low and middle income women. Moreover, women don’t just experience higher prevalence to diseases but more barriers in accessing  health care than men. Some women may lack economic independence in certain countries, meaning no or lack of education opportunities, or unemployment. If women don’t have the freedom to decide for themselves, this creates a large barrier to reach out for help and support.  Mostly, I’ve seen these issues come up in Pakistan, when women get married. A lot  of attention goes to their families and children, leading them to overlook their own health. So I think this realization and awareness drove the focus of my research, and to empower women, and help them prioritize their health. 

Where can people go to learn more about the work that you do? 

I have  twitter @HiraniSaima and people can look at my Google Scholar or PubMed. 

 

Behind the Science: The Intersection of Social and Health Psychology


Authors: Negin Nia and Arrthy Thayaparan (Blog Coordinators) || Interviewing: Frances Chen, Associate Professor of Psychology, University of British Columbia

Published: November 26th, 2021

COVID-19 has made our social interactions even more isolated and reliant on technology. This month on Behind the Science, we speak to Frances Chen, Associate Professor of Psychology at University of British Columbia, exploring the intersection of social and health psychology linking our social lives (especially online), mental health and physical health. 

Could you describe what you are pursuing in your research? 

I’m interested in how we develop and manage our social relationships and how our social lives influence our health. This includes both good effects and bad effects. Good effects include when we’re able to receive social support from our loved ones, or when we feel a sense of belonging in our communities. Bad effects could include when we have a conflict with somebody that we care about, or when we feel lonely, socially isolated, or experience social rejection. In my lab, we try to advance scientific understanding of these phenomena.

It is also important to mention that women and men can experience different kinds of challenges when navigating social relationships. Sociocultural norms can play into those different challenges that women and men face, but also biological factors such as how our hormones influence our social behaviour or emotional reactions.

What got you interested in pursuing this research? 

There’s a saying, “all research is ME-search.” I would say that’s true of me. For as long as I can remember, I’ve always cared deeply about social connection. I believe it’s a very powerful part of what it means to be a human being. When you have experiences and relationships where you feel seen, accepted, loved, and appreciated, those are incredibly powerful experiences. On the other hand, if you are going through a relationship conflict or a breakup with a romantic partner, if you’re feeling socially isolated, or you don’t have social support and a strong social network to lean on, it can feel emotionally devastating. I’ve personally observed how strongly social connections influence my own health and well-being, and I’ve also observed that in so many other people’s lives. 

What sparked your interest in women’s health?

The more I look at these questions that I’m pursuing, the more I see that there are both social and cultural factors, and also potentially biological factors, that play into some differences in how women and men experience social relationships. I think it’s important to consider those potential differences because if our ultimate goal is to improve the mental health and physical health of people of different sexes and genders, then we need to be aware of these kinds of nuances.

In one line of work in my lab, we are investigating why depression and anxiety tend to be more common experiences for women than men. To investigate this, we are currently running a large-scale prospective study where we’re tracking the emotions and social functioning of young women during their teenage years. We’re collecting a bunch of different metrics, including data on their changing hormones and social experiences, to help us understand some of these questions around women’s mental health better.

What impact do you hope your research will have on today’s world and also in the future?

I think that loneliness and social isolation are increasingly common experiences. This may be in part a side effect of globalization. People move around a lot more than they did in the past, which might cause them to uproot themselves from a social community and have to make new connections. 

Another factor might be how we increasingly seem to be replacing our in-person face-to-face interactions with interactions on our smartphones and computers. Although technological advances have created opportunities for connections that didn’t exist for past generations, they are also a double-edged sword. The COVID-19 pandemic has made many of us realize that these computer-mediated ways of connecting aren’t a perfect replacement for our in-person interactions. In today’s world and into the future, it’ll be increasingly important to ask and seek answers to these questions around how we can kind of manage to stay socially connected, despite these new challenges that we’re facing.

 

The Gut-Brain Connection: Why Biological Sex May Matter

Author: Avril Metcalfe-Roach, PhD student, University of British Columbia | Editors: Negin Nia and Arrthy Thayaparan (Blog Coordinators) 

Published: November 12th, 2021

If you had to build your own house from scratch, what supplies would you bring to the job? High-quality building materials would certainly make the house much more durable, and having a diverse array of tools on hand will make construction much easier. 

Joe, on the other hand, brought just four zip ties and a wrench and is probably in for a tough time. If you live in a hot climate, you might consider installing air conditioning; in cold climates, good insulation and a heater will help you avoid freezing during the winter. In any case, putting love and effort into the home helps ensure that it keeps you comfortable for many years.

Similarly, the food we eat directly impacts every facet of our health. The links between diet, obesity, and cardiovascular disease are well known. However, more research indicates that dietary habits also directly impact issues like cancer, mental health, and even neurodegenerative diseases, including Alzheimer’s and Parkinson’s disease. Healthy eating can also indirectly reduce disease burden by ensuring that your body has the tools it needs to heal and combat infection.

So, how do different foods actually exert these effects? 

Each food, of course, has a different nutritional profile and will provide your body with different tools. We can anticipate what tools we will need and provide them before problems arise. For example, people who menstruate require more iron in their diets, and oral contraceptive use can lower the absorption of multiple vitamins and minerals. 

Humans also have a little problem: we’re more complex than our genetics allow. While our bodies directly absorb and create many nutrients, a lot of essential nutrients are created solely by the 100 trillion bacteria living in our intestines. In exchange for some energy and a warm place to call home, these beneficial bacteria help to prevent other harmful bacteria from infecting the gut. This keeps our gut tissue working properly, and produces vitamins and other compounds that can leave the gut and promote health throughout the body. For example, certain types of fiber are broken down by bacteria into molecules that enter the bloodstream and help to reduce inflammation.

Even the ‘happy’ chemical, serotonin, is mostly produced in the gut. Like us, each type of bacteria has its own nutritional requirements that mostly revolve around fiber-rich foods such as fruits and whole grains. By eating a variety of nutrient-dense foods, we foster a gut environment full of healthy, anti-inflammatory bacteria that in turn keep us healthy. 

What type of diets are sustainable and have health benefits?

Dietary research is progressing at a staggering rate, and it can be overwhelming to stay up to date. When the research is clarified, however, certain dietary patterns emerge that are consistently linked with specific health outcomes. 

The Mediterranean diet, which promotes plant-based foods, fish, and healthy oils, while limiting red meat and other animal products, is perhaps the best-studied healthy diet in the world. It has been associated with lower rates of cardiovascular disease, obesity, glucose sensitivity and diabetes, and overall mortality.

More recently, a few studies have suggested that the Mediterranean diet may improve brain health. Neurodegenerative diseases are not yet well understood, and there are very few known factors that help to prevent them. Recognizing this, Dr. Martha Clare Morris unveiled the MIND diet in 2015, which optimizes the Mediterranean diet against cognitive decline.

What is the MIND diet and how does it benefit us?

Most food groups are conserved between the two diets; crucially, however, the MIND diet also promotes brain-healthy berries and leafy greens, while restricting pro-inflammatory sugary, fried, and processed food. These latter foods are becoming increasingly common, especially in North America; some research suggests that their overconsumption can even negate some of the health benefits normally associated with the Mediterranean diet. 

As a result, the MIND diet has since been associated with significantly reduced rates of many neurodegenerative diseases, including Alzheimer’s, cognitive decline, and general motor decline; what’s more, the strength of these associations seems to exceed those of the Mediterranean diet.

We recently investigated the MIND diet in a group of individuals with Parkinson’s disease, where we assessed their normal dietary intake and assigned a score based on how closely their intake resembled the MIND diet. Female participants had higher scores on average, indicating closer MIND diet resemblance. Participants with high scores developed Parkinson’s disease significantly later than those with low scores; unexpectedly, this association was especially strong in the female participants, where dietary habits accounted for up to 17 years’ difference in disease onset. Interestingly, the MIND diet accounted for only 10 years in men, and the Mediterranean diet accounted for 10 years with no apparent sex differences.

How do these diets work exactly?

While the complexity of these diets means that it is difficult to know exactly how they work, a sizable amount of research has zeroed in on our microscopic friends as a key factor. Brain-healthy diets help anti-inflammatory bacteria to thrive, which may help to limit inflammation in the brain. Regulation of the immune system is known to be partially sex-specific – for example, women are more prone to autoimmune disease, where the immune system attacks healthy body tissue – and these differences might impact how effective the diets are against neurodegeneration. Indeed, women make up only 1/3 of all Parkinson’s disease cases. 

While our findings here are only correlational, they highlight the importance of including sex as a factor in further research. With a strong enough framework, everyone can design a house that will keep them happy and healthy for a lifetime.

 

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. 

  1. Positive People: Surround yourself with body positive people and minimize the time you spend engaging with dieting friends and diet culture. 
  2. Focus on Values: List the things you like about yourself and others that have nothing to do with physical appearance. 
  3. 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. 
  4. 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?
  5. 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. 
  6. 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. 
  7. 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. 
  8. Self-compassion: Try responding to yourself as you would a dear friend. Try self-compassion meditations or a workbook. 
  9. 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
  1. Cash, T. F. (2004). Body image: Past, present, and future. Body Image, 1, 1-5. doi:10.1016/S1740-1445(03)00011-1
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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.
  14. 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
  15. 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
  16. 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:

  1. There are major links between mood disorders getting worse and premenstrual, postpartum and menopausal disorders
  2. The link between mood and premenstrual disorders is associated with worse clinical outcomes. In extreme cases even increased suicide rates
  3. 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.