747 Suicidal Ideation Associated with Cognitive Hyperarousal, Rumination and Insomnia in Depressed Perinatal Women

Abstract Introduction This prospective study explored associations among clinical insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with mild-to-moderate depression. Methods From late pregnancy through early postpartum, 39 women with depression completed 17 weekly surveys assessing insomnia, depression, suicidal ideation, perceived stress, and three cognitive arousal indices. Results Women with nocturnal cognitive hyperarousal at baseline, relative to those with low nocturnal cognitive arousal, were at greater risk for developing new onset SI in late pregnancy or early postpartum (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR=5.66, p=.037) or perinatal-focused rumination (OR=11.63, p=.018). Daytime perseverative thinking was not uniquely associated with SI. Conclusion Cognitive hyperarousal and perinatal-focused rumination at night are uniquely associated with SI among perinatal women with depression. Moreover, insomnia augments the suicidogenicity of nighttime cognitive activity. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression. Support (if any) This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach). Dr. Cheng’s effort was supported by the National Heart, Lung, and Blood Institute (K23-HL13866, PI: Cheng).

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Peripartum cardiomyopathy

BMJ ◽

10.1136/bmj.k5287 ◽

2019 ◽

pp. k5287 ◽

Cited By ~ 21

Author(s):

Michael C Honigberg ◽

Michael M Givertz

Keyword(s):

Systolic Function ◽

Systolic Dysfunction ◽

Specific Treatment ◽

Late Pregnancy ◽

Peripartum Cardiomyopathy ◽

Future Research ◽

Multiple Gestation ◽

Reduced Ejection Fraction ◽

Early Postpartum ◽

Future Research Directions

AbstractPeripartum cardiomyopathy (PPCM) is a rare, often dilated, cardiomyopathy with systolic dysfunction that presents in late pregnancy or, more commonly, the early postpartum period. Although the condition is prevalent worldwide, women with black ancestry seem to be at greatest risk, and the condition has a particularly high incidence in Nigeria and Haiti. Other risk factors include pre-eclampsia, advanced maternal age, and multiple gestation pregnancy. Although the complete pathophysiology of peripartum cardiomyopathy remains unclear, research over the past decade suggests the importance of vasculo-hormonal pathways in women with underlying susceptibility. At least some women with the condition harbor an underlying sarcomere gene mutation. More than half of affected women recover systolic function, although some are left with a chronic cardiomyopathy, and a minority requires mechanical support or cardiac transplantation (or both). Other potential complications include thromboembolism and arrhythmia. Currently, management entails standard treatments for heart failure with reduced ejection fraction, with attention to minimizing potential adverse effects on the fetus in women who are still pregnant. Bromocriptine is one potential disease specific treatment under investigation. In this review, we summarize the current literature on peripartum cardiomyopathy, as well as gaps in the understanding of this condition and future research directions.

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Portfolio analysis on preeclampsia and pregnancy-associated hypertension research funded by the National Heart, Lung, and Blood Institute

Physiological Genomics ◽

10.1152/physiolgenomics.00093.2018 ◽

2018 ◽

Vol 50 (11) ◽

pp. 982-987

Author(s):

Christine Maric-Bilkan

Keyword(s):

Science Research ◽

Cardiovascular Complications ◽

Portfolio Analysis ◽

Future Research ◽

Chronic Hypertension ◽

Blood Institute ◽

National Heart ◽

National Heart Lung ◽

Future Research Directions ◽

Funding Research

Chronic hypertension and preeclampsia are the most common complications of pregnancy. To clarify the contributions of the National Heart, Lung, and Blood Institute (NHLBI) to the field and identify potential research gaps, we performed portfolio analysis of awards related to preeclampsia and pregnancy-associated hypertension. A list of National Institutes of Health (NIH)-funded awards between fiscal years 2008-present was obtained through an NIH RePORTER search using the following terms: “preeclampsia” and “pregnancy-associated hypertension.” More in-depth analyses were performed on currently active awards supported by the NHLBI. The NHLBI is the lead institute at the NIH in funding research related to pregnancy-associated hypertension and second leading in funding research related to preeclampsia. The NHLBI currently supports 38 awards related to preeclampsia and six awards related to pregnancy-associated hypertension, with a combined total dollar investment of $21 million. Of the currently active, NHLBI-supported awards on preeclampsia and pregnancy-associated hypertension combined, 47% are related to basic science research, 30% to clinical, 14% to clinical trials, and 9% to early translational research. The focus of NHLBI-funded awards is primarily on vascular mechanisms and short and long-term cardiovascular complications of preeclampsia and pregnancy-associated hypertension. Despite steady funding for research on preeclampsia and pregnancy-associated hypertension, several gaps in knowledge exist. NHLBI held a workshop entitled Predicting, Preventing and Treating Preeclampsia to address some of these gaps and inform future research directions for the institute.

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740 Insomnia, cognitive arousal, and perinatal-focused rumination fuel perinatal depression

SLEEP ◽

10.1093/sleep/zsab072.737 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A289-A289

Author(s):

Andrea Cuamatzi Castelan ◽

David Kalmbach ◽

Philip Cheng ◽

Christopher Drake

Keyword(s):

Perinatal Depression ◽

Perinatal Complications ◽

Prospective Data ◽

Ample Opportunity ◽

Cognitive Arousal ◽

Gestational Week ◽

Perseverative Thinking ◽

Perinatal Women ◽

Insomnia Symptoms ◽

Prospective Analyses

Abstract Introduction Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in non-perinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship. Methods Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25–30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. Results Women were at elevated risk of screening positive for depression when experiencing high levels of insomnia (OR=2.36, 95%CI=1.28, 4.35), nocturnal cognitive arousal (OR=3.05, 95%CI=1.60, 5.79), perinatal-focused rumination (OR=2.05, 95%CI=1.11, 3.79), and perseverative thinking (OR=7.48, 95%CI=3.90, 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23–43% of the effect of insomnia on depression. Insomnia mediated 12–18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia. Conclusion Perseverating at night, particularly on perinatal concerns, fuels insomnia. In turn, lying awake at night provides ample opportunity for perseverating. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night. Support (if any):

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Adapting to the Pandemic: Experiences of Latin American Restaurants During COVID-19 and Potential Implications for Community Health and Food Environments

Current Developments in Nutrition ◽

10.1093/cdn/nzab029_026 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 225-225

Author(s):

Elise Harrison ◽

Michelle Rodriguez ◽

Diana Veliz ◽

Rosa Abreu-Runkel ◽

Melissa Fuster

Keyword(s):

Community Health ◽

Latin American ◽

High Energy ◽

Future Research ◽

Food Environments ◽

Structured Interviews ◽

Future Health ◽

Blood Institute ◽

Funding Sources ◽

National Heart Lung

Abstract Objectives Assess how Latin American restaurants (LAR) have been adapting in response to COVID-19, and the potential implications of those changes for community food environments. Methods Qualitative study design using semi-structured interviews with LAR owners and staff (n = 12). Interviews were conducted via Zoom, lasting between 30 and 90 minutes. Verbatim transcripts were analyzed by two independent coders using Dedoose following an iterative approach for organizing results using emergent themes. Results COVID-19 led to initial closures, decrease in clientele and interrupted food supply. LAR adjusted by switching to outdoor dining and/or delivery/takeout, reducing hours and staff, increasing social media presence, and making changes to the menus. Menus were reduced, decreasing items not well-suited for takeout/delivery, (notably salads), while keeping customer favorites, such as high-energy “comfort foods.” Menu changes were more prevalent in full-service restaurants, compared with fast casual LAR. The results also include experiences with delivery companies and government assistance during COVID-19. Conclusions The pandemic has forced drastic changes in LARs, with potential implications for future health promoting interventions. The results from this study contribute to informing how restaurants are adapting in response to COVID-19 and the potential implications on community health and nutrition, as well as what restaurants can do to prepare for future crises. This will need to be considered for the survival of the industry and the communities that they serve. Future research is needed to examine long-term effect of changes in community food environments and customers’ diets. Funding Sources NIH - National Heart, Lung, and Blood Institute

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A pathogenic cycle between insomnia and cognitive arousal fuels perinatal depression: exploring the roles of nocturnal cognitive arousal and perinatal-focused rumination

SLEEP ◽

10.1093/sleep/zsab028 ◽

2021 ◽

Cited By ~ 1

Author(s):

David A Kalmbach ◽

Philip Cheng ◽

Christopher L Drake

Keyword(s):

Perinatal Depression ◽

Mixed Effects Models ◽

Perinatal Complications ◽

Prospective Data ◽

Cognitive Arousal ◽

Gestational Week ◽

Perseverative Thinking ◽

Perinatal Women ◽

Insomnia Symptoms ◽

Prospective Analyses

Abstract Study Objectives Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in nonperinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship. Methods Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25 and 30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, and perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. Results Women were at risk for depression when experiencing insomnia (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.28 to 4.35), nocturnal cognitive arousal (OR = 3.05, 95% CI = 1.60 to 5.79), perinatal-focused rumination (OR = 2.05, 95% CI = 1.11 to 3.79), and perseverative thinking (OR = 7.48, 95% CI = 3.90 to 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23–43% of the effect of insomnia on depression. Insomnia mediated 12%–18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia. Conclusion Nocturnal cognitive arousal, including ruminating on perinatal concerns while trying to fall asleep, fuels insomnia. In turn, lying awake at night provides an opportunity for nocturnal cognitive arousal. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.

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Attachment Organization in Suicide Prevention Research

Crisis ◽

10.1027/0227-5910/a000231 ◽

2014 ◽

Vol 35 (1) ◽

pp. 60-66 ◽

Cited By ~ 10

Author(s):

Amanda Venta ◽

Carla Sharp

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Interpersonal Relationships ◽

Suicide Ideation ◽

Suicide Attempts ◽

Critical Role ◽

Self Report ◽

Future Research ◽

Self Harm

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.

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