Suicide Attempts during Pregnancy and Postpartum: A Systematic Review and Meta-Analysis.

PURPOSE: Suicide attempts (SA) during perinatal period have the potential to adversely affect a woman's health and her developing infant. To date, little is known about perinatal SA and their risk factors. This study aimed to synthetize the evidence on risk factors of SA in pregnant and postpartum women. METHODS: We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, and CINAHL, following the PRISMA guidelines for reporting. A meta-analysis was conducted only for risk factors examined in at least three distinct samples. RESULTS: A total of ten studies were eligible for inclusion. All the studies found significant associations in regression models between perinatal SA and other variables (sociodemographic, clinical factors obstetric, neonatal, and psychosocial). The meta-analysis showed that unmarried women (pooled OR = 1.87, 95% CI = 1.26-2.78), with no higher education (pooled OR = 1.89, 95% CI = 1.31-2.74) and affected by a mood disorder (pooled OR = 11.43, 95% CI = 1.56-83.87) have a higher risk of postpartum SA; women who smoke during pregnancy (pooled OR = 3.87, 95% CI = 1.35-11.11) have a higher risk of SA in pregnancy; and women with previous suicidal behavior(pooled OR = 38.04, 95% CI = 3.36-431.17) have a higher risk of perinatal SA, whether during pregnancy or in the postpartum period. The type of sample, whether community or clinical, is a relevant moderating factor. CONCLUSION: Our study extends prior reviews about suicidal behaviors in women by studying perinatal suicide attempts independently, as well as it synthesized data on some sociodemographic, clinical, and obstetric/neonatal risk factors. Further studies about specific risk factors for perinatal SA are needed in order to improve early detection and intervention of women at risk.

SIGNIFICANCE: Suicide attempts during pregnancy and the postpartum period pose a severe risk to the health of women and the development of their infants. Despite their importance, little is known about specific risk factors for these attempts during the perinatal period. This study is the first meta-analysis to synthesize risk factors associated with suicide attempts in pregnant and postpartum women. We found that unmarried women, those without higher education, and those with mood disorders are at higher risk for postpartum suicide attempts; women who smoke during pregnancy are at higher risk for suicide attempts during pregnancy; and those with previous suicidal behavior are at higher risk for perinatal suicide attempts. Our study extends prior reviews by independently examining perinatal suicide attempts and synthesizing data on sociodemographic, clinical, and obstetric/neonatal risk factors. Further studies on specific risk factors for perinatal suicide attempts are needed to improve early detection and intervention for women at risk.

Delineating apathy profiles in Huntington's disease with the short-Lille Apathy Rating Scale.

INTRODUCTION: Apathy, a prevalent feature in neurological disorders including Huntington's disease (HD), is characterized by a reduction in goal-directed behavior across cognitive, auto-activation (i.e., self-activating thoughts/behavior), and emotional domains. Nonetheless, current diagnostic criteria are incapable of distinguishing multidimensional apathy profiles. Meanwhile, the short-Lille Apathy Rating Scale (LARS-s) bears potential as an operative diagnostic tool to disentangle apathy dimensions in clinical practice. The present study thereby examines the psychometric properties and factor structure of the LARS-s to tap into apathy profiles and their underlying neural correlates in HD. METHODS: Forty HD individuals were scanned and evaluated for apathy using the LARS-s, assessed for reliability and validity in HD, and the short-Problem Behavior Assessment (PBA-s). To study the dimensional structure of apathy, principal component analysis (PCA) of the LARS-s was implemented. Resulting factors were associated with gray matter volume through whole-brain voxel-based morphometry. RESULTS: The LARS-s demonstrated satisfactory psychometric properties, sharing convergent validity with PBA-s apathy and discriminant validity against depression. PCA resulted in three factors representative of apathy profiles across cognitive, auto-activation, and emotional domains. Anatomically, global apathy was significantly related with large-scale motor, cognitive, and limbic networks. Exploratory analyses of apathy profiles revealed correspondence between each factor and distinct cortical and subcortical nodes. CONCLUSION: The LARS-s is capable of capturing the multidimensional spectrum of apathy. At the same time, apathy profiles in HD are underpinned by functionally diverse neural networks. Such findings promote the continued study of apathy domains to pinpoint personalized therapeutic targets in neurologic disorders in addition to HD.

Acceptability and participation predictors for a pragmatic randomized controlled trial to test a smoking cessation intervention after discharge from mental health wards.

BACKGROUND AND AIM: Hospitalization is an ideal time to promote smoking cessation, but interventions are limited for supporting cessation maintenance after discharge. This study aimed to evaluate the acceptability of participating in a trial that tested the efficacy of an intensive telephone-based intervention for smokers after discharge. METHODS: Adult smokers admitted to mental health wards of six hospitals were invited to participate in the trial. We studied the study acceptance/decline rates by analyzing the characteristics of participants (e.g., sex, age, psychiatric disorder, smoking pattern) and hospitals (e.g., size, tobacco control implementation). We calculated adjusted odds ratios (aOR) to assess predictors of non-participation. RESULTS: Of 530 smokers that met the study inclusion criteria, 55.5% (n = 294) agreed to participate. Participant and non-participants were not different in sex, age, or psychiatric diagnosis. Compared to non-participants, participants had made more attempts to quit in the past year (66.1% vs 33.9%; p < 0.001) and reported higher abstinence rates during the hospital stay (66.7% vs. 33.3%; p = 0.05). Participation rates by hospital varied from 30.9% to 82.0% (p < 0.001). Predictors of non-participation were not having attempted to quit in the last year (aOR=2.42; 95%CI: 1.66-3.53) and low level of tobacco control in the hospital (aOR range: 1.79-6.39, p < 0.05). CONCLUSIONS: A telephone-based intervention to promote smoking cessation after discharge was accepted by half of the smokers with mental health disorders. Smokers that had attempted to quit previously and those that stayed in hospitals with a strong tobacco control policy were more likely to participate in the trial.

Personality traits as a risk factor for postpartum depression: A systematic review and meta-analysis.

BACKGROUND: Certain personality traits increase vulnerability to depression, but the evidence linking personality and postpartum depression (PPD) is less robust. This systematic review aimed to identify personality traits that increase the risk of PPD. METHODS: We systematically reviewed studies retrieved from PubMed/Medline, PsycINFO, Scopus, CINAHL, and Cochrane, following the PRISMA guidelines for reporting. We carried out a meta-analysis on the association between neuroticism and PPD. RESULTS: A total of 34 studies were analyzed. Of these, 31 considered at least one trait associated with PPD; 10 studies considered at least one trait not associated with PPD. The meta-analysis included 13 studies, concluding that neuroticism was associated with PPD (OR: 1.37; 95%CI: 1.22-1.53; p<0.001). LIMITATIONS: Study design and approach to personality assessment influence results. Prospective longitudinal studies of persons with no prior history of mood disorder would provide stronger evidence about whether particular personality traits predict PPD. Most studies reviewed used self-report measures to assess personality. Study design and approach to personality assessment influence results, and indications of publication bias were found. CONCLUSIONS: Neuroticism is the personality trait most widely studied in relation to PPD. Our meta-analysis found this trait is strongly related with PPD. Moreover, vulnerable personality style and trait anxiety are also associated with PPD. Screening for these traits might help identify women at risk, improving prevention, early detection, and possibly treatment.

Gray Matter Vulnerabilities Predict Longitudinal Development of Apathy in Huntington's Disease.

BACKGROUND: Apathy, a common neuropsychiatric disturbance in Huntington's disease (HD), is subserved by a complex neurobiological network. However, no study has yet employed a whole-brain approach to examine underlying regional vulnerabilities that may precipitate apathy changes over time. OBJECTIVES: To identify whole-brain gray matter volume (GMV) vulnerabilities that may predict longitudinal apathy development in HD. METHODS: Forty-five HD individuals (31 female) were scanned and evaluated for apathy and other neuropsychiatric features using the short-Problem Behavior Assessment for a maximum total of six longitudinal visits (including baseline). In order to identify regions where changes in GMV may describe changes in apathy, we performed longitudinal voxel-based morphometry (VBM) on those 33 participants with a magnetic resonance imaging (MRI) scan on their second visit at 18 ± 6 months follow-up (78 MRI datasets). We next employed a generalized linear mixed-effects model (N = 45) to elucidate whether initial and specific GMV may predict apathy development over time. RESULTS: Utilizing longitudinal VBM, we revealed a relationship between increases in apathy and specific GMV atrophy in the right middle cingulate cortex (MCC). Furthermore, vulnerability in the right MCC volume at baseline successfully predicted the severity and progression of apathy over time. CONCLUSIONS: This study highlights that individual differences in apathy in HD may be explained by variability in atrophy and initial vulnerabilities in the right MCC, a region implicated in action-initiation. These findings thus serve to facilitate the prediction of an apathetic profile, permitting targeted, time-sensitive interventions in neurodegenerative disease with potential implications in otherwise healthy populations. © 2021 International Parkinson and Movement Disorder Society.

White matter cortico-striatal tracts predict apathy subtypes in Huntington's disease.

BACKGROUND: Apathy is the neuropsychiatric syndrome that correlates most highly with Huntington's disease progression, and, like early patterns of neurodegeneration, is associated with lesions to cortico-striatal connections. However, due to its multidimensional nature and elusive etiology, treatment options are limited. OBJECTIVES: To disentangle underlying white matter microstructural correlates across the apathy spectrum in Huntington's disease. METHODS: Forty-six Huntington's disease individuals (premanifest (N = 22) and manifest (N = 24)) and 35 healthy controls were scanned at 3-tesla and underwent apathy evaluation using the short-Problem Behavior Assessment and short-Lille Apathy Rating Scale, with the latter being characterized into three apathy domains, namely emotional, cognitive, and auto-activation deficit. Diffusion tensor imaging was used to study whether individual differences in specific cortico-striatal tracts predicted global apathy and its subdomains. RESULTS: We elucidate that apathy profiles may develop along differential timelines, with the auto-activation deficit domain manifesting prior to motor onset. Furthermore, diffusion tensor imaging revealed that inter-individual variability in the disruption of discrete cortico-striatal tracts might explain the heterogeneous severity of apathy profiles. Specifically, higher levels of auto-activation deficit symptoms significantly correlated with increased mean diffusivity in the right uncinate fasciculus. Conversely, those with severe cognitive apathy demonstrated increased mean diffusivity in the right frontostriatal tract and left dorsolateral prefrontal cortex to caudate nucleus tract. CONCLUSIONS: The current study provides evidence that white matter correlates associated with emotional, cognitive, and auto-activation subtypes may elucidate the heterogeneous nature of apathy in Huntington's disease, as such opening a door for individualized pharmacological management of apathy as a multidimensional syndrome in other neurodegenerative disorders.

Specific patterns of brain alterations underlie distinct clinical profiles in Huntington's disease.

Huntington's disease (HD) is a genetic neurodegenerative disease which involves a triad of motor, cognitive and psychiatric disturbances. However, there is great variability in the prominence of each type of symptom across individuals. The neurobiological basis of such variability remains poorly understood but would be crucial for better tailored treatments. Multivariate multimodal neuroimaging approaches have been successful in disentangling these profiles in other disorders. Thus we applied for the first time such approach to HD. We studied the relationship between HD symptom domains and multimodal measures sensitive to grey and white matter structural alterations. Forty-three HD gene carriers (23 manifest and 20 premanifest individuals) were scanned and underwent behavioural assessments evaluating motor, cognitive and psychiatric domains. We conducted a multimodal analysis integrating different structural neuroimaging modalities measuring grey matter volume, cortical thickness and white matter diffusion indices - fractional anisotropy and radial diffusivity. All neuroimaging measures were entered into a linked independent component analysis in order to obtain multimodal components reflecting common inter-subject variation across imaging modalities. The relationship between multimodal neuroimaging independent components and behavioural measures was analysed using multiple linear regression. We found that cognitive and motor symptoms shared a common neurobiological basis, whereas the psychiatric domain presented a differentiated neural signature. Behavioural measures of different symptom domains correlated with different neuroimaging components, both the brain regions involved and the neuroimaging modalities most prominently associated with each type of symptom showing differences. More severe cognitive and motor signs together were associated with a multimodal component consisting in a pattern of reduced grey matter, cortical thickness and white matter integrity in cognitive and motor related networks. In contrast, depressive symptoms were associated with a component mainly characterised by reduced cortical thickness pattern in limbic and paralimbic regions. In conclusion, using a multivariate multimodal approach we were able to disentangle the neurobiological substrates of two distinct symptom profiles in HD: one characterised by cognitive and motor features dissociated from a psychiatric profile. These results open a new view on a disease classically considered as a uniform entity and initiates a new avenue for further research considering these qualitative individual differences.

Course of a major postpartum depressive episode: A prospective 2 years naturalistic follow-up study.

BACKGROUND: Survival methodology has not already been used in studies about postpartum depression (PPD) course. The aims of the present study were to estimate the duration of a Major Postpartum Depressive Episode (MPDE) during 2 years, as well as to explore factors associated with the course. METHOD: This was a prospective, naturalistic, longitudinal study with a cohort of 165 women with a MPDE (DSM-IV criteria). Potential predictors of prognosis were recorded at baseline. Follow-up was conducted using the Longitudinal Interval Follow-up Evaluation (LIFE). RESULTS: Of the total sample, 110 (66.7%) completed the 2 years follow-up. The mean time to full remission was 49.4 weeks (95% CI: 44.0-59.8). The probability of recovering was 30.2% (95% CI: 22.1%-37.4%) at 6 months of follow-up, 66.3% (95% CI: 57.4%-73.4%) at 12 months of follow-up, and 90.3% (95% CI: 79.8%-95.4%) at 24 months of follow-up. Mothers with financial difficulties, onset of depressive episode previous to birth, and those with prior treated depressive episodes took longer in achieving full remission. LIMITATIONS: Results are only generalizable to mothers with PPD treated in a psychiatric outpatient setting. Psychopharmacological treatment was uncontrolled and personality was not assessed. CONCLUSIONS: Our findings suggest that PPD could become a chronic disorder, particularly in mothers with an onset of the episode previous to birth, with a history of depression or with financial problems. Knowledge of these factors may help to improve the guidelines of depression management and treatment during the perinatal period.

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial.

BACKGROUND: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. METHODS: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, ß = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. DISCUSSION: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03230955 . Registered on 24 July 2017.

An active cognitive lifestyle as a potential neuroprotective factor in Huntington's disease.

A cognitive stimulating lifestyle has been observed to confer cognitive benefits in multiple neurodegenerative diseases. However, the underlying neurobiological basis of this phenomenon remains unclear. Huntington's disease can provide a suitable model to study the effects and neural mechanisms of cognitive engagement in neurodegeneration. In this study, we investigate the effect of lifestyle factors such as education, occupation and engagement in cognitive activities in Huntington's disease gene carriers on cognitive performance and age of onset as well as the underlying neural changes sustaining these effects, measured by magnetic resonance imaging. Specifically, we analyzed both gray matter volume and the strength of connectivity of the executive control resting-state network. High levels of cognitive engagement were significantly associated with more preserved executive functions, a delay in the appearance of symptoms, reduced volume loss of the left precuneus and the bilateral caudate and a modulation of connectivity strength of anterior cingulate cortex and left angular gyrus with the executive control network. These findings suggest that a cognitively stimulating lifestyle may promote brain maintenance by modulating the executive control resting-state network and conferring protection against neurodegeneration, which results in a delayed onset of symptoms and improved performance in executive functions.

Reduced striato-cortical and inhibitory transcallosal connectivity in the motor circuit of Huntington's disease patients.

Huntington's disease (HD) is a neurodegenerative disorder which is primarily associated with striatal degeneration. However, the alterations in connectivity of this structure in HD have been underinvestigated. In this study, we analyzed the functional and structural connectivity of the left putamen, while participants performed a finger-tapping task. Using fMRI and DW-MRI, 30 HD gene expansion carriers (HDGEC) and 29 healthy participants were scanned. Psychophysiological interaction analysis and DTI-based tractography were employed to examine functional and structural connectivity, respectively. Manifest HDGEC exhibited a reduced functional connectivity of the left putamen with the left and the right primary sensorimotor areas (SM1). Based on this result, the inhibitory functional connectivity between the left SM1 and the right SM1 was explored, appearing to be also decreased. In addition, the tract connecting these areas (motor corpus callosum), and the tract connecting the left putamen with the left SM1 appeared disrupted in HDGEC compared to controls. Significant correlations were found between measures of functional and structural connectivity of the motor corpus callosum, showing a coupling of both types of alterations in this tract. The observed reduction of functional and structural connectivity was associated with worse motor scores, which highlights the clinical relevance of these results. Hum Brain Mapp 39:54-71, 2018. © 2017 Wiley Periodicals, Inc.

Assessment of psychometric properties of the Postpartum Bonding Questionnaire (PBQ) in Spanish mothers.

The Postpartum Bonding Questionnaire (PBQ) was developed to assess mother-infant bonding disturbances in the postpartum period. The aim of this study was to examine the psychometric properties of the Spanish version of the PBQ in a sample of Spanish postpartum women. Eight hundred forty mothers were recruited in the postpartum visit (4-6 weeks after delivery): 513 from a gynecology unit (forming the general population sample) and 327 mothers from a perinatal psychiatry program (forming the clinical sample). All women were assessed by means of the Edinburgh Postnatal Depression Scale (EPDS) and the PBQ. Neither the original four-factor structure nor alternative structures (Reck et al. 2006; Wittkowski et al. 2010) were replicated by the confirmatory factor analyses. An exploratory factor analysis showed a four-factor solution. The Schmid-Leiman transformation found a general factor that accounted for 61% of the variance of the PBQ. Bonding impairment showed higher associations with depressive symptomatology in both samples. The Spanish version of the PBQ showed adequate psychometric properties for use with clinical and general populations of Spanish postpartum women. The results suggest that the PBQ could be summarized by a general factor and confirm the utility of the use of the total score for detecting bonding impairment.

Facial emotion processing in patients with social anxiety disorder and Williams-Beuren syndrome: an fMRI study.

BACKGROUND: Social anxiety disorder (SAD) and Williams-Beuren syndrome (WBS) are 2 conditions with major differences in terms of genetics, development and cognitive profiles. Both conditions are associated with compromised abilities in overlapping areas, including social approach, processing of social emotional cues and gaze behaviour, and to some extent they are associated with opposite behaviours in these domains. We examined common and distinct patterns of brain activation during a facial emotion processing paradigm in patients with SAD and WBS. METHODS: We examined patients with SAD and WBS and healthy controls matched by age and laterality using functional MRI during the processing of happy, fearful and angry faces. RESULTS: We included 20 patients with SAD and 20 with WBS as well as 20 matched controls in our study. Patients with SAD and WBS did not differ in the pattern of limbic activation. We observed differences in early visual areas of the face processing network in patients with WBS and differences in the cortical prefrontal regions involved in the top-down regulation of anxiety and in the fusiform gyrus for patients with SAD. Compared with those in the SAD and control groups, participants in the WBS group did not activate the right lateral inferior occipital cortex. In addition, compared with controls, patients with WBS hypoactivated the posterior primary visual cortex and showed significantly less deactivation in the right temporal operculum. Participants in the SAD group showed decreased prefrontal activation compared with those in the WBS and control groups. In addition, compared with controls, participants with SAD showed decreased fusiform activation. Participants with SAD and WBS also differed in the pattern of activation in the superior temporal gyrus, a region that has been linked to gaze processing. LIMITATIONS: The results observed in the WBS group are limited by the IQ of the WBS sample; however, the specificity of findings suggests that the pattern of brain activation observed for WBS is more likely to reflect a neurobiological substrate rather than intellectual impairment per se. CONCLUSION: Patients with SAD and WBS showed common and specific patterns of brain activation. Our results highlight the role of cortical regions during facial emotion processing in individuals with SAD and WBS.

Hostility and childhood sexual abuse as predictors of suicidal behaviour in Borderline Personality Disorder.

Impulsivity is a multidimensional construct and has been previously associated with suicidal behaviour in borderline personality disorder (BPD). This study examined the associations between suicidal behaviour and impulsivity-related personality traits, as well as history of childhood sexual abuse, in 76 patients diagnosed with BPD using both the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders III (DSM-III) Axis-II diagnoses and the self-personality questionnaire. Impulsivity-related traits were measured using the Barratt Impulsiveness Scale-11 (BIS-11), the Buss-Durkee Hostility Inventory (BDHI) and the Temperament and Character Inventory-Revised (TCI-R). We found that hostility and childhood sexual abuse, but not impulsivity or other temperament traits, significantly predicted the presence, number and severity of previous suicide attempts. Hostility traits and childhood sexual abuse showed an impact on suicide attempts in BPD. Our results support previous findings indicating that high levels of hostility and having suffered sexual abuse during childhood lead to an increased risk for suicidal behaviour in BPD.

Decision-making and impulsivity in eating disorder patients.

Impairment in decision-making can be related to some pathological behaviors in eating disorders. This ability was assessed in 71 eating disorder patients (27 restricting type patients and 44 binge/purging type patients) and compared with 38 healthy controls using the Iowa Gambling Task. This task simulates real-life decision-making by assessing the ability to sacrifice immediate rewards in favor of long term gains. Furthermore, some studies have demonstrated a relationship between impulsivity and decision-making, so in our study the Barratt Impulsiveness Scale was also used. Eating disorder patients, both the restricting and the binge/purging groups, performed poorly in the Iowa Gambling Task compared to controls, confirming a deficit in decision-making in these patients. The restricting group showed poorer IGT performance than the binge/purging group. Interestingly, impulsivity was negatively correlated with decision-making, but only in the binge/purging group. In conclusion, our results confirm a specific deficit in eating disorder patients which may be related to their pathological eating behavior, and suggest that this impairment might be explained by different mechanisms in restricting and binge/purging disorders.

Social anxiety and negative early life events in university students.

INTRODUCTION: There is substantial evidence regarding the impact of negative life events during childhood on the aetiology of psychiatric disorders. We examined the association between negative early life events and social anxiety in a sample of 571 Spanish University students. METHODS: In a cross-sectional survey conducted in 2007, we collected data through a semistructured questionnaire of sociodemographic variables, personal and family psychiatric history, and substance abuse. We assessed the five early negative life events: (i) the loss of someone close, (ii) emotional abuse, (iii) physical abuse, (iv) family violence, and (v) sexual abuse. All participants completed the Liebowitz Social Anxiety Scale. RESULTS: Mean (SD) age was 21 (4.5), 75% female, LSAS score was 40 (DP = 22), 14.2% had a psychiatric family history and 50.6% had negative life events during childhood. Linear regression analyses, after controlling for age, gender, and family psychiatric history, showed a positive association between family violence and social score (p = 0.03). None of the remaining stressors produced a significant increase in LSAS score (p > 0.05). CONCLUSION: University students with high levels of social anxiety presented higher prevalence of negative early life events. Thus, childhood family violence could be a risk factor for social anxiety in such a population.

Social anxiety and negative early life events in university students / Eventos negativos na infância e ansiedade social em estudantes universitários

INTRODUCTION: There is substantial evidence regarding the impact of negative life events during childhood on the aetiology of psychiatric disorders. We examined the association between negative early life events and social anxiety in a sample of 571 Spanish University students. METHODS: In a cross-sectional survey conducted in 2007, we collected data through a semistructured questionnaire of sociodemographic variables, personal and family psychiatric history, and substance abuse. We assessed the five early negative life events: (i) the loss of someone close, (ii) emotional abuse, (iii) physical abuse, (iv) family violence, and (v) sexual abuse. All participants completed the Liebowitz Social Anxiety Scale. RESULTS: Mean (SD) age was 21 (4.5), 75% female, LSAS score was 40 (DP = 22), 14.2% had a psychiatric family history and 50.6% had negative life events during childhood. Linear regression analyses, after controlling for age, gender, and family psychiatric history, showed a positive association between family violence and social score (p = 0.03). None of the remaining stressors produced a significant increase in LSAS score (p > 0.05). CONCLUSION: University students with high levels of social anxiety presented higher prevalence of negative early life events. Thus, childhood family violence could be a risk factor for social anxiety in such a population.

INTRODUÇÃO: Existem evidências substanciais sobre o impacto de eventos negativos da vida durante a infância na etiologia dos transtornos psiquiátricos. Examinamos a associação entre os eventos negativos ocorridos na infância e a ansiedade social em uma amostra de 571 estudantes universitários espanhóis. MÉTODOS: Em um estudo transversal realizado em 2007, foram coletados os dados de variáveis sociodemográficas, história psiquiátrica pessoal e familiar e abuso de substâncias por meio de um questionário semiestruturado e avaliamos cinco eventos negativos ocorridos na infância: (i) a perda de alguém próximo, (ii) abuso emocional, (iii) abuso físico, (iv) violência familiar e (v) abuso sexual. Todos os participantes preencheram a escala de Liebowitz para ansiedade social. RESULTADOS: A média (DP) de idade foi de 21 anos (4,5); 75% eram do sexo feminino; o escore na LSAS foi 40 (DP = 22); 14,2% tinham história psiquiátrica familiar e 50,6% tiveram eventos negativos durante a infância. A análise de regressão linear, após o controle para idade, sexo e história psiquiátrica familiar, mostraram associação positiva entre violência familiar e escore de ansiedade social (p = 0,03). Nenhum dos fatores estressores restantes produziu aumento significativo no escore da LSAS (p > 0,05). CONCLUSÃO: Os estudantes universitários com altos níveis de ansiedade social apresentaram prevalência maior de eventos negativos precoces. Portanto, a violência familiar na infância pode ser um fator de risco para ansiedade social em tal população.

Perfectionism dimensions in major postpartum depression.

BACKGROUND: Although perfectionism from a multidimensional perspective has generally been associated with depressive illness, there are not many studies on its role in major depression in the postnatal period. The aim of the present study was to explore the relationship between perfectionism dimensions using the Frost Multidimensional Perfectionism Scale (FMPS) and major postpartum depression. METHODS: One-hundred-twenty-two women with major postpartum depression (SCID-I; DSM-IV) and 115 healthy postpartum women were evaluated using the FMPS, an instrument for the assessment of six perfectionism dimensions: concern over mistakes, personal standards, parental expectations, parental criticism, doubt about actions and organisation. Other variables were also considered: neuroticism, psychiatric history, social support, life events and genotype combinations according to serotonin transporter expression (5-HTTLPR and Stin2 VNTR polymorphisms). RESULTS: The prevalence of high-perfectionism was higher in major postpartum depression group than in control group (34% vs. 11%; p<0.001). Multivariate models confirmed high-perfectionism as an independent factor associated with major postpartum depression. Specifically, the high-concern over mistakes dimension increased over four-fold the odds of major depression in postpartum period. (OR=4.14; 95% CI=1.24-13.81) Neuroticism, personal psychiatric history and 5-HTT low-expressing genotypes at one of the loci were also identified as independent factors. CONCLUSIONS: High-perfectionism, and particularly high-concern over mistakes is a personality dimension associated with major postpartum depression. The inclusion of perfectionism assessment, together with others factors, may be considered in order to improve the detection of women at risk of postpartum depression, in whom early intervention may be of benefit.

Psychometric properties of the Spanish version of the frost multidimensional perfectionism scale in women / Propiedades psicométricas de la versión española de la Escala Multidimensional de Perfeccionismo de Frost en mujeres

This instrumental study was designed to analyze the psychometric properties of the Spanish version of the Frost Multidimensional Perfectionism Scale (FMPS). The total sample was made up of 582 female college students, with a mean age of 21.68 (SD= 4.45). The results of confirmatory factor analysis identified the six-factor solution proposed by the original authors as the best factor structure, with acceptable fit indices. Cronbach’s alpha coefficient was .93 for the FMPS total score and ranged from .74 to .91 for the subscales. Test-retest reliability suggested a good temporal stability of the FMPS total score [ICC= .89 (95% CI= .80-.94)] and its subscales. Results showed moderate to high associations between the Spanish version of the FMPS and other measures of perfectionism. The Spanish version of FMPS has shown satisfactory psychometric properties to be used in women. Future research should replicate these findings in broader samples, in clinical populations, and use longitudinal designs to determine whether perfectionism is a risk factor for psychopathology in women (AU)

Este estudio instrumental se diseñó para estudiar las propiedades psicométricas de la versión española de la Escala Multidimensional de Perfeccionismo de Frost (FMPS). La muestra total fue de 582 mujeres, estudiantes universitarias, con una edad media de 21,68 años (DT= 4,45). Los resultados del análisis factorial confirmatorio identificaron los seis factores propuestos por Frost et al. (1990) como la mejor estructura factorial, con índices de ajuste aceptables. El coeficiente alfa de Cronbach fue de ,93 para la puntuación total del FMPS, y entre ,71 y ,91 para las diferentes subescalas. La fiabilidad test-retest sugirió una buena estabilidad temporal de la puntuación total del FMPS [CCI= 0.89 (95% IC= ,80-,94)] y de sus subescalas. Se observaron asociaciones de moderadas a fuertes entre la versión española del FMPS y otras medidas de perfeccionismo. La versión española del FMPS ha mostrado buenas propiedades psicométricas para ser aplicada en mujeres. Futuras investigaciones deberían replicar estos hallazgos en muestras más amplias, en población clínica y utilizar diseños longitudinales para determinar si el perfeccionismo es un factor de riesgo para la psicopatología en las mujeres (AU)

Psychometric properties of the Spanish version of the Frost Multidimensional Perfectionism Scale in women.

This instrumental study was designed to analyze the psychometric properties of the Spanish version of the Frost Multidimensional Perfectionism Scale (FMPS). The total sample was made up of 582 female college students, with a mean age of 21.68 (SD= 4.45). The results of confirmatory factor analysis identified the six-factor solution proposed by the original authors as the best factor structure, with acceptable fit indices. Cronbach's alpha coefficient was .93 for the FMPS total score and ranged from .74 to .91 for the subscales. Test-retest reliability suggested a good temporal stability of the FMPS total score [ICC= .89 (95% CI= .80-.94)] and its subscales. Results showed moderate to high associations between the Spanish version of the FMPS and other measures of perfectionism. The Spanish version of FMPS has shown satisfactory psychometric properties to be used in women. Future research should replicate these findings in broader samples, in clinical populations, and use longitudinal designs to determine whether perfectionism is a risk factor for psychopathology in women.