Nicoletta Giacchetti

Magnetic Resonance Imaging Studies of Postpartum Depression: An Overview

Postpartum depression is a frequent and disabling condition whose pathophysiology is still unclear. In recent years, the study of the neural correlates of mental disorders has been increasingly approached using magnetic resonance techniques. In this review we synthesize the results from studies on postpartum depression in the context of structural, functional, and spectroscopic magnetic resonance studies of major depression as a whole. Compared to the relative wealth of data available for major depression, magnetic resonance studies of postpartum depression are limited in number and design. A systematic literature search yielded only eleven studies conducted on about one hundred mothers with postpartum depression overall. Brain magnetic resonance findings in postpartum depression appear to replicate those obtained in major depression, with minor deviations that are not sufficient to delineate a distinct neurobiological profile for this condition, due to the small samples used and the lack of direct comparisons with subjects with major depression. However, it seems reasonable to expect that studies conducted in larger populations, and using a larger variety of brain magnetic resonance techniques than has been done so far, might allow for the identification of neuroimaging signatures for postpartum depression.

MMPI-2: Cluster Analysis of Personality Profiles in Perinatal Depression—Preliminary Evidence

Background. To assess personality characteristics of women who develop perinatal depression. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, to which was administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Minnesota Multiphasic Personality Inventory 2 (MMPI-2). A clinical group of subjects with perinatal depression (PND, 55 subjects) was selected; clinical and validity scales of MMPI-2 were used as predictors in hierarchical cluster analysis carried out. Results. The analysis identified three clusters of personality profile: two “clinical” clusters (1 and 3) and an “apparently common” one (cluster 2). The first cluster (39.5%) collects structures of personality with prevalent obsessive or dependent functioning tending to develop a “psychasthenic” depression; the third cluster (13.95%) includes women with prevalent borderline functioning tending to develop “dysphoric” depression; the second cluster (46.5%) shows a normal profile with a “defensive” attitude, probably due to the presence of defense mechanisms or to the fear of stigma. Conclusion. Characteristics of personality have a key role in clinical manifestations of perinatal depression; it is important to detect them to identify mothers at risk and to plan targeted therapeutic interventions.

Perinatal Depression and Patterns of Attachment: A Critical Risk Factor?

Background. This study aims to verify if the presence and severity of perinatal depression are related to any particular pattern of attachment. Methods. The study started with a screening of a sample of 453 women in their third trimester of pregnancy, who were administered a survey data form, the Edinburgh Postnatal Depression Scale (EPDS) and the Experience in Close Relationship (ECR). A clinical group of subjects with perinatal depression (PND, 89 subjects) was selected and compared with a control group (C), regarding psychopathological variables and attachment patterns. Results. The ECR showed a prevalence of “Fearful-Avoidant” attachment style in PND group (29.2% versus 1.1%, p < 0.001); additionally, the EPDS average score increases with the increasing of ECR dimensions (Avoidance and Anxiety). Conclusion. The severity of depression increases proportionally to attachment disorganization; therefore, we consider attachment as both an important risk factor as well as a focus for early psychotherapeutic intervention.

Modelli di attaccamento e personalità nella depressione post partum

AIMS This study investigates the prevalence of post partum depression (PPD) in a sample of Roman women, and the role of socio-demographic variables, personality structure and maternal attachment patterns, in order to identify primary and secondary prevention strategies. METHODS Data were collected in two phases. During the third trimester of pregnancy, a sample of 453 women completed a socio-demographic data sheet and the Edinburgh Postnatal Depression Scale (EPDS). Among the patients scoring 12 or more at EPDS, 15 entered the second phase of the study and completed SCID-II and Adult Attachment Interview. PPD diagnosis was confirmed by the SCID-I. The study group was compared with a control group. RESULTS Among the 453 women who were evaluated, 92 (20.3%) scored ≥12 at EPDS, 39 has been enrolled and 15 entered the study. Presence of depressive symptoms was associated with: complications in pregnancy, previous psychiatric disorders, family and marital conflicts. 66.6% of depressed mothers showed more than one diagnosis on Axis II (particularly avoidant/dependent + borderline or histrionic + dependent). The AAI showed a prevalence of insecure (33.3%) and unresolved/disorganized (46.6%) attachment pattern in the clinical group. DISCUSSION AND CONCLUSIONS Our results suggest that psychological factors such as personality structure and attachment patterns are not only involved in post natal affective disorders, but have a key role in the onset and development of PPD.

The Influence of Mother’s Personality on the Decision about the Elective Cesarean Section: A Pilot Study with a Sample of 16 New Mothers

Objective: To investigate the psychological profile of a sample of new mothers, who requested an elective caesarean section (CS), compared with a group of women who had a CS in emergency. Furthermore, the study examined psychiatric, environmental, medical and obstetrical risk factors related to the mother’s choice of an elective CS, in order to develop specific intervention strategies. Methods: A sample of 16 mothers aged 34.88 ± 8.53 years were enrolled and assessed using a semi-structured face-to-face interview, the Minnesota Personality Inventory Test-2 (MMPI-2) and the Edinburgh Postnatal Depression Scale (EPDS). The sample was divided in two groups: cases (8 women who had an elective CS) and controls (8 women who had a CS in emergency). Results: The analysis identified a statistical significance among the two groups with a higher prevalence in cases’s group of: previous mood disorders (100% of the cases group), maternal comorbidities (100% of the cases group), neuroticism (MMPI-2’s scale ‘NEGE’: p=0.013), ‘defensive’ attitude (MMPI-2’s scale ‘K’: p=0.013), hypochondria (MMPI-2’ scale ‘Hs’: p=0.046), health concerns (MMPI-2’s scale ‘Hea’: p=0.013) and depression (MMPI-2’s scales ‘D’: p=0.012 and ‘Dep’: p=0.023; EPDS’s scores: p=0.007), with a general tendency to have higher scores of psychopathology (p=0.033). No statistical significance was found concerning socio-demographic information and obstetrical risk factors. Conclusion: Women who chose CS without medical indications showed more somatic anxiety levels, expressed with a hypochondriac rumination and an obsessive way to control their body. This seems associated with more neuroticism and more symptoms of depression which may lead to a higher risk of develop postnatal depression. Gynaecologists should pay attention to the reasons behind the mother’s choice of an election CS by ensuring a detailed psychological counselling and try to mitigate levels of anxiety and fears related to the childbirth.

Early attachement relationships and epigenetic customization

Recently, new findings in epigenetic science switched the focus from the observation of physiological intragenomic dynamics to the idea of an environmental co-construction of phenotypic expression. In psichodynamic field, objectual relations and attachement theoreticians emphasized the interpersonal dimension of individual development, focusing the attention on the relational matrix of self organization. The construction of stable affective-behavioral traits throughout different parenting styles has actually found a coincidence in ethological studies, which have explored the epigenetic processes underlying the relationship between caregiving and HPA stress responsiveness. An adequate parenting style seems to support affective regulation throughout psychobiological hidden moderators, which would tend to rebalance the physiological systems homeostasis; an unconfident attachment style would promote, on the other hand, the allostatic load rise. Sites of longlife epigenetic susceptibility have also been identified in humans; although associated with risk of maladaptive developing in adverse environmental conditions, they seem to confer protection under favorable conditions. This persisting possibility of reorganization of stable traits throughout lifetime, which seems to be activated by a relevant environmental input, grant to significant relationships, and to therapeutical one as well, an implicit reconditioning potential which could result into the configuration of new stable affective-behavioral styles.

La depressione post-partum: inquadramento del problema.

In questo articolo gli Autori presentano i risultati preliminari relativi a 20 pazienti con diagnosi di depressione post-partum. Di recente infatti, e stato avviato dalla UOS di Igiene Mentale delle Relazioni Affettive e del post-partum del Policlinico Umberto I di Roma, un progetto intervento sui disturbi dell’umore nel puerperio. I dati raccolti finora indicano la prevalenza di un disturbo di personalita del cluster B e che la depressione post-partum si configura come una difficolta nel processo di separazione-individuazione madre-bambino che appare isomorfa a una indifferenziazione dei partner dalla propria famiglia di origine. Sia a livello individuale materno che della coppia, l’evento nascita, in quanto riedizione di vissuti di antiche separazioni, viene sperimentata come fonte di angosce e di pericolo.