Giuliana Grossi

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A new cohort study conducted at an academic medical center shed light on the disparities in perinatal depression screening rates and scores between women with sexual minority status and heterosexual cisgender women.

The research, published in the Journal of Obstetrics and Gynecology, revealed that those in a sexual minority are not only at higher risk of postpartum depression (PPD) but also face challenges with their sexual orientation being adequately documented in medical records.

The study conducted was conducted by a team of investigators led by Leiszle Lapping-Carr, PhD, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, from January - December 2019, included a total of 18,234 female-identified individuals who gave birth at the academic medical center. Among this cohort, only 1.5% identified as having sexual minority status, highlighting a potential underrepresentation of sexual minority individuals in medical records.

The results found those with sexual minority status were significantly more likely to attend prenatal care visits (20%) when compared with heterosexual women (13.7%), and postpartum care visits (18.6% vs. 12.8%, respectively).

However, the most significant disparities were observed in depression screening rates. Women in the sexual minority were more likely to be screened for depression during postpartum care (OR, 1.77).

Similarly, a higher percentage of women in the sexual minority attended at least 1 postpartum care visit compared with heterosexual women (18.6% vs. 12.8%, respectively). These results suggested women in the sexual minority are more engaged in obstetric care.

"These findings suggest that sexual minority women are not only at higher risk of postpartum depression but are also more likely to experience barriers in accessing adequate depression screening," investigators wrote. "Moreover, their sexual orientation is often undocumented in medical records, potentially leading to further disparities in care."

Investigators further expressed the need for healthcare providers to implement strategies for measuring sexual orientation reliably during the perinatal period. Specifically, medical record review alone may not be sufficient to capture the sexual identities of patients.

A significant gap in the literature exists regarding perinatal depression screening rates and symptom endorsement among sexual minority women, despite a substantial number of births in the US being to sexual minority individuals, the study cited. Factors such as intimate partner violence and a history of mental illness further compound the disparities in perinatal depression risk among sexual minority individuals.

The importance of healthcare providers being mindful of the distinct requirements and obstacles that sexual minority women encounter throughout pregnancy and the postpartum phase was emphasized. Depression screening rates and the accurate documentation of sexual orientation need to increase, which could result in more precise and efficient interventions for individuals at risk.

The study's limitations included its retrospective design and data from a single academic medical center. However, the findings provided valuable insights into the disparities in perinatal depression screening and the need for inclusive and comprehensive care for sexual minority women.

Future research and interventions should focus on enhancing the cultural competency of healthcare providers, creating inclusive environments, and developing standardized approaches for assessing and documenting sexual orientation in medical records. The study speculated that by addressing these challenges, healthcare systems can work towards providing equitable and supportive care for all women during the perinatal period, regardless of their sexual orientation.

Lapping-Carr L, Dennard A, Wisner KL, Tandon SD. Perinatal Depression Screening Among Sexual Minority Women. 

 Published online August 02, 2023. doi:10.1001/jamapsychiatry.2023.2619

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The results found those with sexual minority status were significantly more likely to attend prenatal care visits (20%) when compared with heterosexual women.

Women with Sexual Minority Status Show Higher Risk of Postpartum Depression 

Credit: American Society for Metabolic and Bariatric Surgery

New research provided valuable insight into the potential benefits of telephone-based cognitive behavioral therapy (tele-CBT) as a post-bariatric surgery intervention. While tele-CBT did not lead to significant changes in short-term weight outcomes, it was effective in improving disordered eating behaviors and reducing psychological distress.

Bariatric surgery has been an effective intervention for individuals struggling with obesity, leading to significant weight loss and improvement in various obesity-related medical comorbidities. However, the study acknowledged that weight regain after bariatric surgery remains a concern, necessitating the development of psychosocial interventions to support long-term success and overall mental health.

Sanjeev Sockalingam, MD, MHPE, Bariatric Surgery Program, University Health Network, and a team of investigators conducted the randomized clinical trial to investigate the effectiveness of a tele-CBT intervention in improving weight loss, disordered eating, and psychological distress among individuals one year after undergoing bariatric surgery.

The multisite trial involved 306 adult participants who had undergone bariatric surgery 1 year prior to the study. The participants were recruited between February 2018 - December 2021 from 3 hospital-based bariatric surgery programs.

To be eligible, participants needed to be fluent in English and have access to both a telephone and the internet. Those with active suicidal ideation or poorly controlled severe psychiatric illness were excluded from the study.

The tele-CBT intervention consisted of 6 weekly 1-hour sessions, with an additional booster session 1 month later. The control group received standard postoperative bariatric care. Primary outcome measures included postoperative percentage total weight loss, while secondary outcomes were assessed through the Binge Eating Scale (BES), Emotional Eating Scale (EES), Patient Health Questionnaire-9 item scale (PHQ-9), and Generalized Anxiety Disorder-7 item scale (GAD-7).

Data were collected at baseline (1 year after surgery), after the intervention (approximately 15 months after surgery), and at the 3-month follow-up (approximately 18 months after surgery).

Investigators did not find a significant difference in weight outcomes between the tele-CBT group and the control group. However, the results showed promising outcomes in terms of disordered eating and psychological distress.

Individuals who received tele-CBT reported significant reductions in binge eating, emotional eating, depression, and anxiety symptoms compared with the control group.

Specifically, the group that underwent tele-CBT displayed significant interactions for mean BES, EES total, PHQ-9, and GAD-7 scores across all times compared with the control group.

Investigators noted tele-CBT could play a crucial role in supporting individuals' mental health and overall well-being following bariatric surgery. Further research continues to explore the impact of these psychosocial improvements on long-term weight outcomes as part of an ongoing longitudinal multisite randomized clinical trial.

As obesity rates continue to rise, the integration of effective psychosocial interventions like tele-CBT becomes increasingly essential to enhance the success and sustainability of bariatric surgery outcomes, the study stated.

Investigators acknowledged the relatively small sample size and focus on short-term outcomes were possible limitations of the study. Future investigations with larger and more diverse populations, as well as longer follow-up periods, were recommended to fully understand the potential benefits of tele-CBT in the context of bariatric surgery.

Overall the findings of this study highlighted the promising role of tele-CBT in improving mental health and eating behaviors for individuals who have undergone bariatric surgery. As investigators continue to delve deeper into the subject, tele-CBT has potential to become a crucial component of post-bariatric surgery care, ultimately contributing to better long-term outcomes and improved quality of life for those affected by obesity.

Sockalingam S, Leung SE, Ma C, et al. Efficacy of Telephone-Based Cognitive Behavioral Therapy for Weight Loss, Disordered Eating, and Psychological Distress After Bariatric Surgery: A Randomized Clinical Trial. 

 2023;6(8):e2327099. doi:10.1001/jamanetworkopen.2023.27099

While tele-CBT did not lead to significant changes in short-term weight outcomes, it was effective in improving disordered eating behaviors and reducing psychological distress.

Tele-CBT Improves Psychological Distress After Bariatric Surgery

Recent research conducted by Gemma Hammerton, PhD, at the Population Health Sciences, Bristol Medical School, University of Bristol, suggested alcohol dependence during adolescence may increase the risk of 

However, the data showed alcohol consumption alone does not seem to have a significant impact on depression risk, indicating it is the presence of alcohol dependence that plays a more substantial role in predicting depression later in life. 

Hammerton further explained the details of the investigation and her findings in a written interview with 

Can you explain the main objective of your study and what prompted you to investigate the link between alcohol dependence during adolescence and the risk of depression in young adulthood?

 The main objective of our study was to investigate whether alcohol dependence, but not high frequency or quantity of consumption, during adolescence was associated with depression in young adulthood. 

We wanted to examine the relationship between alcohol dependence during adolescence and depression in young adulthood because, if there is evidence that this relationship is causal, there would be important public health implications.

Depression causes a large public health burden, and alcohol-related behavior is a potentially modifiable risk factor. Given the rich data we had available, we felt we could make an important contribution to the current evidence base.

The study used the Avon Longitudinal Study of Parents and Children data. What were the key factors that led you to select this particular cohort for your research?

Using the Avon Longitudinal Study of Parents and Children (ALSPAC) allowed us to examine our research questions using a large contemporary sample. Most of the previous research in this area has been conducted using data from the USA or New Zealand, so we felt it was important to examine if the findings generalized to a UK-based sample. 

Additionally, ALSPAC has rich data available on potential confounders (including sex, sociodemographic factors, parental mental health and alcohol use, child behavioral problems, being bullied, substance use, and depression symptoms), prospective repeated measures of both alcohol consumption and dependence across adolescence and depression diagnosis in early adulthood. 

These data allowed us to robustly examine the effects of alcohol dependence and consumption at different time points during adolescence, and the rate by which they increase depression in young adulthood.

Your findings indicated a positive link between alcohol dependence at age 18 and depression at age 24. Could you discuss the potential mechanisms behind this association and what implications it may have for addressing mental health concerns in young adults?

Alcohol dependence is associated with a wide range of physical, psychological, interpersonal, social, educational, and economic consequences that could lead to depression. Two potential mechanisms for the association between alcohol dependence and depression could include antisocial behavior and cannabis use; however, there are many other possible explanations, and these are important to examine in future research.

Our findings suggest that preventing alcohol dependence during adolescence, or potentially treating it early, could reduce the risk of future depression in young adults. We did not find an association between high frequency and quantity of alcohol consumption and depression; however, heavy alcohol consumption is likely to precede dependence. 

Therefore, high frequency and quantity of alcohol consumption are still important to prevent or reduce during adolescence, especially given its associations with other harms, such as injury and antisocial behavior. Public health interventions to prevent depression among young people could target subthreshold levels of alcohol dependence, which are likely to involve high frequency and quantity of consumption. 

Additionally, public health messages to prevent depression that are aimed at young people could emphasize dependent aspects of drinking that are harmful.

Can you elaborate on the contrasting findings which showed no significant association between the rate of change in alcohol dependence and depression?

We found no evidence that a faster increase in levels of dependence across adolescence was associated with depression in young adulthood and only small variability in the rate of change over time. 

This finding suggests the magnitude of the association between dependence and depression is fairly constant over adolescence and that the time point for considering levels of alcohol dependence (between ages 16 and 23 years) might not be particularly important.

Do you have any future plans in your research agenda regarding alcohol dependence, depression, and their interplay in young adulthood? Are there any specific areas you believe need further investigation to build on the current knowledge?

It would be useful to examine this same research question in other contexts, particularly outside of high-income countries, where the majority of research has been conducted to date. 

We would like to take these findings forward and examine potential mechanisms of the association between alcohol dependence and later depression, for example, whether the relationship is explained by antisocial behavior or cannabis use, and examine the role of neuroticism (as suggested in a commentary based on the article in Lancet Psychiatry). ALSPAC has data available that could be used to address these questions.

Grossi, G. Targeting Adolescent Alcohol Dependence May Prevent Depression in Young Adults. HCPLive. July 19, 2023. 

https://www.hcplive.com/view/targeting-adolescent-alcohol-dependence-prevent-depression-young-adults

"Depression causes a large public health burden, and alcohol-related behavior is a potentially modifiable risk factor," Dr. Gemma Hammerton writes.

Gemma Hammerton, PhD: Adolescent Alcohol Dependence and Adult Depression 

Suicidality among young individuals is a pressing public health concern, warranting immediate attention and research efforts. In a new study, investigators aimed to develop a comprehensive research registry focusing on youth with 

 and/or suicidal tendencies within the state of Texas called the Texas Youth Depression and Suicide Research Network (TX-YDSRN), established in 2020.

The investigation sheds light on the baseline clinical and demographic characteristics of the first 1000 participants in the TX-YDSRN, with a specific emphasis on suicidal thoughts and behaviors.

Beth D. Kennard, PsyD, The Peter O'Donnell Jr. Brain Institute and the Department of Psychiatry, University of Texas Southwestern Medical Center, and a team of investigators used the TX-YDSRN, encompassing individuals aged 8 - 20 years who are either undergoing treatment for depression or have screened positive for depression and/or suicidal ideation/behavior. Baseline data collected included participants' diagnosis, severity of depression and anxiety, history of suicidal ideation/behavior, experiences with trauma, and assessments of resilience.

Suicidality among young individuals is a pressing public health concern, warranting immediate attention and research efforts. In a new study investigators aimed to develop a comprehensive research registry focusing on youth with depression and/or suicidal tendencies within the state of Texas called the Texas Youth Depression and Suicide Research Network (TX-YDSRN), established in 2020.

Beth D. Kennard, PsyD, and  team of investigators used the TX-YDSRN, encompassing individuals aged 8 - 20 years who are either undergoing treatment for depression or have screened positive for depression and/or suicidal ideation/behavior. Baseline data collected included participants' diagnosis, severity of depression and anxiety, history of suicidal ideation/behavior, experiences with trauma, and assessments of resilience.

The baseline data for the initial 1000 participants recruited into the TX-YDSRN show a significant majority (79.6%) were diagnosed with a primary depressive disorder.

The severity of depression, as measured by the Patient Health Questionnaire for Adolescents (PHQ-A), was found to be at a moderate to severe level with a mean score of 12.9 ± 6.4. Similarly, anxiety levels were also relatively high, with a mean Generalized Anxiety Disorder (GAD-7) score of 11.3 ± 5.9.

Notably, almost half of the participants reported having at least one lifetime suicide attempt, indicating a concerning prevalence of suicidal behavior. Furthermore, a staggering 90% of the participants reported either lifetime or current suicidal ideation, underscoring the severity of the issue.

Comparing participants with past/current suicidality to those without such tendencies, the former group exhibited higher levels of illness severity in terms of depression, anxiety, and suicidal thoughts/behaviors. Additionally, these individuals demonstrated lower levels of resilience and higher rates of exposure to traumatic experiences.

Based on the data of the first 1000 participants, the study stated it is evident that the cohort of youth in Texas faces substantial challenges related to mental health, particularly in terms of depression, anxiety, and suicidality.

The findings indicated moderate to severe levels of depression and anxiety, coupled with alarming rates of lifetime suicide attempts and current suicidal ideation. Participants with a history of suicidality showed greater illness severity, reduced resilience, and higher rates of exposure to trauma, highlighting the need for comprehensive interventions, investigators stated.

These findings serve as a foundation for further investigations within the TX-YDSRN. Future research will delve into the trajectories of outcomes and identify predictors, moderators, and social determinants influencing these outcomes. Investigators reported the ultimate goal is to utilize these findings to develop targeted and effective strategies to address suicidality in youth and promote their mental well-being and resilience.

“There is an urgent need for prevention and intervention strategies for suicidal ideation and behavior in youth. These findings highlight important demographic and clinical correlates, which can inform future efforts for more targeted treatments,” the team wrote. “Additionally, it is important to develop strategies for reaching youth who may not have access to evidence-based interventions, even when youth are established in a system of clinical care.”

Kennard, B. D., Hughes, J. L., Minhajuddin, A., Slater, H., Blader, J. C., Mayes, T. L., Kirk, C., Wakefield, S. M., & Trivedi, M. H. (2023). Suicidal thoughts and behaviors in youth seeking mental health treatment in Texas: Youth Depression and Suicide Network research registry. 

The baseline data for the initial 1000 participants recruited into the TX-YDSRN show 79.6% were diagnosed with a primary depressive disorder.