Social support mediates the influence of cerebellum functional connectivity strength on postpartum depression and postpartum depression with anxiety

Abstract

Post-Partum Depression (PPD) is the most common health issue impacting emotional well being in women and is often comorbid with anxiety (PPD-A). Previous studies have shown that adequate social support can protect against PPD and PPD-A. However, how the brain connectome is disrupted in PPD and PPD-A and the neural basis underlying the role of social support in PPD and PPD-A remains unclear. The present study aims to explore these issues in patients with PPD and PPD-A. Well-established questionnaires and resting-state functional Magnetic Resonance Imaging (rsfMRI) were performed in 45 PPD, 31 PDD-A patients and 62 Healthy Postnatal Women (HPW). Brain functional integration was measured by analysis of Functional Connectivity Strength (FCS). Association and mediation analyses were performed to investigate relationships between FCS, PPD and PPD-A symptoms and social support. PPD patients showed specifically higher FCS in right parahippocampus, whereas PPD-A patients showed specifically higher FCS in left ventrolateral prefrontal cortex. In all postpartum women, depression symptoms positively correlated with FCS in left paracentral lobule; depression and anxiety symptoms were negatively correlated with FCS in right cerebellem posterior lobe (CPL), a brain region implicated in supporting social cognition and regulation of emotion. Subsequent mediation analysis revealed that perceived social support mediated the association between right CPL FCS and PPD and PPD-A symptoms. Measurement of FCS in disorder-specific neural circuits offers a potential biomarker to study and measure the efficacy of social support for PPD and PPD-A.

Fig. 1. Functional Connectivity Strength (FCS) differences among HPW, PPD, and PPD-A.

A One-way analysis of variance (ANOVA) of functional connectivity strength (FCS) maps revealed significant differences in right parahippocampus (ParaHipp) and left ventrolateral prefrontal cortex (vlPFC) between postpartum depression (PPD) and PPD with anxiety (PPD-A) and healthy postnatal women (HPW). B Post-hoc two-sample t tests showed that FCS in ParaHipp was higher in PPD patients compared to PPD-A patients and HPW, and FCS was higher in vlPFC in PPD-A patients compared to both PPD patients and HPW.

Fig. 2. Whole brain voxel-wise correlation analyses were used to identify the associations between FCS and Edinburgh Postnatal Depression Scale (EPDS) and Beck’s Anxiety Inventory (BAI) scores.

A There is a significant positive correlation between FCS in paracentral lobule (ParaCL), and significant negative correlation between FCS in right cerebellem posterior lobe (CPL), and EPDS, respectively. B There is also a significant negative correlation between FCS in right CPL and BAI. C Post-hoc two sample t-tests showed that FCS was significantly lower in right CPL in both PPD and PPD-A patients compared to HPW. There was no significant difference in FCS between PPD and PPD-A patients in these or in any other brain regions.

Fig. 3. Mediation analysis revealed that FCS of right cerebellem posterior lobe (CPL) affects postpartum depression and anxiety through social support.

In particular, social support as measured by the PSQ questionnaire mediates the effect of right CPL on Edinburgh Postnatal Depression Scale (EPDS) and Beck’s Anxiety Inventory (BAI) scores.