Emma Robertson Blackmore

Major depressive episodes and work stress: results from a national population survey.

OBJECTIVES We determined the proportion of workers meeting criteria for major depressive episodes in the past year and examined the association between psychosocial work-stress variables and these episodes. METHODS Data were derived from the Canadian Community Health Survey 1.2, a population-based survey of 24324 employed, community-dwelling individuals conducted in 2002. We assessed depressive episodes using the Composite International Diagnostic Interview. RESULTS Of the original sample, 4.6% (weighted n=745948) met criteria for major depressive episodes. High job strain was significantly associated with depression among men (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.29, 4.37), and lack of social support at work was significantly associated with depression in both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71, 3.29). Women with low levels of decision authority were more likely to have depression (OR=1.59; 95% CI=1.06, 2.39) than were women with high levels of authority. CONCLUSIONS A significant proportion of the workforce experienced major depressive episodes in the year preceding our study. Gender differences appear to affect work-stress factors that increase risk for depression. Prevention strategies need to be developed with employers and employee organizations to address work organization and to increase social support.

Interventions for the prevention and treatment of postpartum psychosis: a systematic review.

Postpartum psychosis is a serious disorder that can cause negative consequences for the mother, infant, and entire family. While reports of this condition date back for centuries, little is known about what interventions are most effective for this population. The purpose of this systematic review was to examine the research evidence on interventions for the prevention and treatment of postpartum psychosis. Studies were searched using CINAHL, EMBASE, MEDLINE, PsycINFO, and PubMed databases. All primary research studies published in English since 1970 that explored interventions for the prevention or treatment of postpartum psychosis were included. The search resulted in 26 studies on interventions for postpartum psychosis, with 10 focusing on prevention and 17 focusing on treatment. Studies on the prevention of postpartum psychosis have examined the effects of mood stabilizers, antipsychotics, and hormone therapy, while those examining treatment have included electroconvulsive therapy, mood stabilizers, antipsychotics, hormones, and the beta blocker propranolol. Only preliminary evidence suggests which interventions may be effective strategies to prevent (e.g., lithium) and treat (e.g., electroconvulsive therapy) postpartum psychosis. Due to methodological limitations in the studies reviewed, extensive evidence-based recommendations for the prevention and treatment of postpartum psychosis cannot be made. The known risk factors and negative consequences of postpartum psychosis point to the importance of preventative and acute treatment measures. Well-designed prospective studies are needed to determine the efficacy of prevention and treatment interventions for women who experience postpartum psychosis.

The role of depression and chronic pain conditions in absenteeism: results from a national epidemiologic survey.

Objective: This study examined whether depression is associated with absenteeism in a sample of individuals with chronic pain. Methods: Data were obtained from the Canadian Community Health Survey Cycle 1.2. Key variables were chronic pain, defined as fibromyalgia, arthritis/rheumatism, back problems, and migraine headaches, absenteeism, and depression. The sample comprised 9,238,154 individuals who reported at least one chronic pain condition and were absent from their job in the previous week because of illness or disability. Results: Nineteen percent of absent individuals met criteria for major depression versus 7.9% of non-absent individuals. The presence of major depression represented a three-fold risk of absenteeism. Other risk factors for absenteeism included younger age, higher income, and more education. Conclusions: Comorbid depression and chronic pain represents a significant source of disability in the workforce.

Psychosocial and clinical correlates of suicidal acts: results from a national population survey

BACKGROUND Clinical samples have identified a number of psychosocial risk factors for suicidal acts but it is unclear if these findings relate to the general population. AIMS To describe the prevalence of and psychosocial risk factors for suicidal acts in a general adult population. METHOD Data were obtained from a Canadian epidemiological survey of 36,984 respondents aged 15 years and older (weighted sample n=23,662,430). RESULTS Of these respondents, 0.6% (weighted n=130,143) endorsed a 12-month suicidal act. Female gender (OR=4.27, 95% CI 4.05-4.50), being separated (OR=37.88, 95% CI 33.92-42.31) or divorced (OR=7.79, 95% CI 7.22-8.41), being unemployed (OR=1.70, 95% CI 1.50-1.80), experiencing a chronic physical health condition (OR=1.70, 95% CI 1.67-1.86) and experiencing a major depressive episode in the same 12-month period as the act (OR=9.10, 95% CI 8.65-9.59) were significantly associated with a suicidal act. CONCLUSIONS The psychosocial correlates of suicidal acts in this sample are consistent with those previously reported in clinical and general population samples. These findings reinforce the importance of the determination of suicide risk and its prevention not only of psychiatric illness but of physical and psychosocial factors as well.

Differentiation and Clinical Implications of Postpartum Depression and Postpartum Psychosis

Postpartum depression and postpartum psychosis are serious mood disorders encountered by nurses working in a variety of settings. Postpartum depression refers to a nonpsychotic depressive episode, while postpartum psychosis refers to a manic or affective psychotic episode linked temporally with childbirth. The nursing profession plays a crucial role in the early identification and treatment of these postpartum mood disorders. This article explains the classification, clinical presentation, epidemiology, management, and long-term outcomes of postpartum depression and postpartum psychosis.

Diurnal cortisol patterns and psychiatric symptoms in pregnancy: short-term longitudinal study.

Alteration in the HPA axis is a robust biomarker of anxiety and depression in adults, but questions remain about this association in pregnancy. We examined the longitudinal links between diurnal cortisol and mood symptoms from self-report questionnaire and diagnostic interview in an ethnically diverse, psychosocially at-risk sample of 101 women at mid-pregnancy and early third trimester. There were modest but significant associations between depression and elevated cortisol, indexed by a decreased morning level and diminished diurnal decline; the effects were strongest for diagnostic data from clinical interview. These effects were independent of socio-demographic factors and sleep disturbance. Associations with anxiety and trauma were generally non-significant. These findings extend prior work by showing that significant mood symptoms in pregnancy are associated with altered diurnal cortisol in pregnancy, which may have implications for maternal and child health.

Support Needs of Mothers Who Experience Postpartum Psychosis and Their Partners

OBJECTIVES To explore the perceived support needs and preferences of women with postpartum psychosis and their partners. DESIGN A multisite, exploratory, qualitative descriptive design was used. SETTING AND PARTICIPANTS A purposive sample of nine mothers (Canada, n = 7, United States, n = 2) and eight fathers (Canada, n = 7, United States, n = 1) was obtained. METHODS Data were collected through one-on-one, in-depth, semistructured interviews. Inductive thematic analysis was used to explore the qualitative transcripts. RESULTS Couples who experienced postpartum psychosis looked to health professionals to provide reassurance and information on the illness, its management, and prognosis. The quality of support and interactions with staff varied, and participants reported difficulty identifying and obtaining professional support upon discharge. All participants felt that support groups for postpartum illnesses would help to normalize the experience and dissipate feelings of isolation. Participants reported that informal support networks provided practical help but were limited or hindered recovery and management due to lack of knowledge of the illness. Despite feeling overwhelmed and isolated, fathers were reluctant to identify their own support needs and struggled to ask for help from professionals and their informal support network. CONCLUSION These findings suggest that clinical interventions are needed to address the support needs and aid in the recovery of families affected by postpartum psychosis.

Depressive symptoms and proinflammatory cytokines across the perinatal period in African American women

Abstract Background: Comparatively few studies have examined the biological mechanisms that may underlie the reported racial disparities in antenatal and postpartum depression. Objective: To examine the associations among race, depressive symptoms and the proinflammatory cytokines interleukin (IL)-6 and tumor necrosis factor (TNF)-α across the perinatal period in a diverse sample of healthy pregnant women at elevated psychosocial risk. Methods: 171 subjects were enrolled. Women were interviewed and blood samples drawn at 18 and 32 weeks gestation and 6 weeks and 6 months postpartum. Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Serum levels of IL-6 and TNF-α were assayed using high sensitivity enzyme-linked immunosorbent assay kits. Results: Compared with non-African American (AA) women, AA women had significantly higher levels of IL-6 (est. diff = 0.521, p = 0.02, confidence interval (CI): 0.088–0.954) but not TNF-α across all time points (est. diff = −0.060, p = 0.80, CI: −0.517 to 0.397). IL-6 was not associated with depressive symptoms but differences in IL-6 were accounted for by greater Body Mass Index in AA women. Conclusions: Compared with non-AA women, AA women entered pregnancy with elevated inflammatory cytokine levels that persisted across the perinatal period. This group difference in inflammation did not suggest increased risk for depression, but suggests other implications for long-term health.

Pregnancy-related anxiety: Evidence of distinct clinical significance from a prospective longitudinal study.

BACKGROUND Pregnancy-related anxiety (PrA) has attracted considerable research attention, but questions remain about its distinctiveness from conventional constructs and measures. In a high psychosocial risk, ethnically diverse sample, we examine the degree to which PrA is distinct from continuous and diagnostic measures of anxiety and worry in terms of longitudinal course, associations with psychosocial and perinatal risk, and prediction of postnatal mood disturbance. METHODS 345 women oversampled for prenatal anxiety and depression were selected from an urban obstetrics clinic serving a predominantly low-income, ethnically diverse population. PrA was assessed at 20 and 32 weeks gestation; anxiety and depression symptoms were assessed from questionnaire and from clinical interview at 20 and 32 weeks gestation and again at 2 and 6 months postnatally. Data relevant to psychosocial and obstetric risks were ascertained from interview, medical exam, and chart review. RESULTS Two distinct factors of PrA were identified, indexing specific concerns about the childs health and about the birth; these two PrA factors showed distinct longitudinal patterns in the prenatal period, and modest associations with general measures of anxiety and depression from questionnaire and clinical interview. PrA was also distinguished from conventional symptom measures in its associated features and prediction of birth weight and postnatal mood. LIMITATIONS The sample was at high psychosocial risk and ethnically diverse; findings may not generalize to other samples. CONCLUSIONS PrA can be distinguished from general measures of anxiety in pregnancy in terms of longitudinal course, associated features, and prediction to postnatal mood disturbance, and may warrant specific clinical attention.

Work characteristics and social phobia in a nationally representative employed sample.

Objective: Social phobia is associated with long-term impairment and disability. Environmental and genetic influences may be important in etiology and persistence. This is the first study to examine the association of work characteristics with social phobia in a representative nationally employed population. Method: Self-reported work characteristics were linked to 12-month social phobia diagnosed by the World Mental Health Composite International Diagnostic Interview in 24 324 employed individuals from the Canadian Community Health Survey. Results: High job strain (OR = 1.62, 95%CI, 1.06 to 2.49) and job insecurity (OR = 2.47, 95%CI, 1.73 to 3.51) were associated with an increased risk of 12-month social phobia, adjusting for sociodemographic variables, prevalent depression, and other work characteristics. Conclusions: Work characteristics are associated with social phobia. Characteristics such as job insecurity may be a consequence of illness in employed populations, while high job strain may increase the risk of symptoms. More investigation is needed of the relation between work and social phobia to understand how to reduce occupational disability.