The hypothalamic-pituitary-adrenal axis in the perinatal period: Its relationship with major depressive disorder and early life adversity.

Objectives: Effects of major depressive disorder and early life adversity (ELA) on the maternal HPA axis in the perinatal period were examined.Methods: Four groups of women (n = 127) were recruited, with the perinatal groups being compared during pregnancy (Preg) and at two months postpartum (PP) - [1] Depressed during pregnancy (Depressed-Preg/PP), [2] Prior history of depression but euthymic during pregnancy (History-Preg/PP), [3] Healthy pregnant women (Control-Preg/PP), and [4] Healthy non-pregnant women (Non-pregnant Control). Serial saliva samples were collected over the course of a day and waking and evening cortisol, total cortisol output and the cortisol awakening response were examined.Results: There were no HPA axis differences among the three groups during pregnancy. A history of ELA, regardless of comorbid depression, was associated with higher evening cortisol levels during pregnancy (p = 0.015). Women in the Depressed-PP group had had higher evening cortisol levels compared to the History-PP group (p < 0.017).Conclusions: Evening cortisol measures are a potential marker for both ELA and depression, with higher levels during pregnancy being associated with ELA and higher levels postpartum being associated with antenatal depression.

Service user perspectives of a psychoeducation group for individuals with a diagnosis of bipolar disorder: a qualitative study.

Group psychoeducation, incorporating cognitive-behavioral techniques, is increasingly used as part of the treatment package for bipolar disorder. The aim of this study was to explore service-users' perspectives of a psychoeducation group which was run in the context of a community mental health service. Semi-structured interviews were conducted with 11 participants who had completed a psychoeducation group for individuals with a diagnosis of bipolar disorder. The verbatim transcripts of those interviews were analyzed using IPA. Three superordinate themes emerged from the data, including the treatment of bipolar disorder, perception of others, and learning from the group. From the perspectives of the service-users, positive working alliances with mental health professionals and the need for a treatment strategy that matches the individual's own approach to their illness were highlighted as benefits of participation in the group.