Abstracts from the COST Action Riseup-PPD Second International Conference Knowledge and implementation gaps in peripartum depression: innovation and future directions

Peripartum depression (PPD) has been the focus of many studies, clinical interventions and policymaking over the past decades, yet more work is needed in order to mitigate this disorder and its negative consequences. This symposium offers an examination, through various review techniques, of five emerging understudied topics related to PPD diagnosis, treatment and policy implications. Through a scoping review, the first presentation considers how economic evaluation can inform the development of mental health policy strategies and guidelines and identify implications for preventive, screening and treatment strategies for PPD. The second presentation increases understanding of PPD disorder diagnosis through a synthesis of current literature on issues regarding PPD diagnosis in different aspects. The third presentation focuses on Paternal PPD (P-PPD) and presents a consensus report on emerging issues and questions on the prevention, diagnosis and treatment of P-PPD The fourth presentation presents, through an umbrella review of systematic reviews and meta-analyses, an overarching synthesis of the literature regarding complementary and alternative therapies (CATs) to treat PPD, while assessing the extent to which CATs are associated with depressive symptoms reduction during pregnancy or after childbirth. The fifth presentation focuses, through a systematic review, on the effectiveness of Third Wave cognitive behavioral psychological interventions in treating peripartum depression. All five presenters will discuss the major findings of their work as well as potential implications for research, clinical practice and policy. Collectively, this set of papers advances the understanding of PPD diagnosis, prevention and treatment and of implications for clinical practice, research and policy.

Peripartum depression (PPD) has been the focus of many studies, clinical interventions and policymaking over the past decades, yet more work is needed in order to mitigate this disorder and its negative consequences.This symposium offers an examination, through various review techniques, of five emerging understudied topics related to PPD diagnosis, treatment and policy implications.Through a scoping review, the first presentation considers how economic evaluation can inform the development of mental health policy strategies and guidelines and identify implications for preventive, screening and treatment strategies for PPD.The second presentation increases understanding of PPD disorder diagnosis through a synthesis of current literature on issues regarding PPD diagnosis in different aspects.The third presentation focuses on Paternal PPD (P-PPD) and presents a consensus report on emerging issues and questions on the prevention, diagnosis and treatment of P-PPD The fourth presentation presents, through an umbrella review of systematic reviews and meta-analyses, an overarching synthesis of the literature regarding complementary and alternative therapies (CATs) to treat PPD, while assessing the extent to which CATs are associated with depressive symptoms reduction during pregnancy or after childbirth.The fifth presentation focuses, through a systematic review, on the effectiveness of Third Wave cognitive behavioral psychological interventions in treating peripartum depression.All five presenters will discuss the major findings of their work as well as potential implications for research, clinical practice and policy.Collectively, this set of papers advances the understanding of PPD diagnosis, prevention and treatment and of implications for clinical practice, research and policy.

Presentation 1: Scoping review of cost-effectiveness evidence for interventions in peripartum depression
Presentation 4: Complementary and alternative therapies to treat peripartum depression in pregnant or postpartum women: an umbrella review of systematic reviews and meta-analyses which has had devastating consequences for pregnant and postpartum women.Within the Riseup-PPD COST Action (CA18138) Task Force "Perinatal Mental Health and COVID-19 Pandemic", an international prospective cohort study was conducted to fill the gaps in research on the impact of the COVID-19 pandemic on perinatal mental health (Riseup-PPD-COVID-19).This symposium presents the main results reached so far.Presentations will provide an overview of current research efforts, including snapshots of ongoing research and future research directions.The first presentation will offer an overview of the prevalence of perinatal depression and anxiety during the pandemic.The second presentation will address the unmet needs in perinatal mental healthcare in the context of the COVID-19 pandemic.The proportion of women with clinically significant symptoms of perinatal mental health problems receiving mental healthcare and its associated factors will be presented.The third presentation will discuss the impact of self-reported and country-specific factors on breastfeeding rates during the COVID-19 pandemic.Finally, the fourth presentation will discuss about the changes in women's childbirth plans during the COVID-19 pandemic and their association with posttraumatic stress symptoms.
Presentation 1: Overview of the main results on the impact of COVID-19 pandemic on perinatal mental health: Riseup-PPD-COVID-19 international cross-sectional study E. Motrico a , R. Costa b , V. Mateus c , A. Osorio d , R. Bina e , S. Dom� ınguez-Salas a , Y. Contreras-Garc� ıa f , M. Carrasco-Portiño f , E. Ajaz g , A. Christoforou h , P. Dikmen-Yildiz i , E. Felice j , C. Hancheva k , E. Vousoura l , C. A. Wilson m , R. Buhagiar j , C. Diaz-Louzao n , F. Gude n , E. Hadjigeorgiou o , D. Levy d , M. F. Rodriguez-Muñoz p , S. Saldivia f , M. F. Gonz� alez q , M. Mattioli r , A. Ganho Presenting Author: Ana Mesquita Background: A considerable number of women giving birth during the COVID-19 pandemic reported concerns about changes to their childbirth plans and experiences due to imposed restrictions.Research prior to the pandemic suggests that women may be more at risk of post-traumatic stress symptoms (PTSS) due to unmet expectations of their childbirth plans.
Objectives: Therefore, this study aimed to examine if the mismatch between women's planned birth and actual birth experiences during COVID-19 was associated with women's postpartum PTSS.Methods: Women in the postpartum period (up to 6 months after birth) across 11 countries reported on childbirth experiences, mental health, COVID-19-related factors and PTSS (PTSD checklist DSM-V version) using self-report questionnaires.Results: More than half (64%) of the 3532 postpartum women included in the analysis reported changes to their childbirth plans.All changes were significantly associated with PTSS scores.Participants with one change and two changes to their childbirth plans had a 12% and 38% increase, respectively, in PTSS scores compared to those with no changes.Additionally, the effect of having one change in the childbirth plan on PTSS scores was stronger in primigravida than in multigravida.Discussion: Changes to women's childbirth plans during the COVID-19 pandemic were common and associated with women's postpartum PTSS scores.Developing health policies that protect women from the negative consequences of unexpected or unintended birth experiences is important for perinatal mental health.The symposium aims to shed light on the complexity of motherhood and the multifactorial nature of peripartum depression (PPD).
The first presentation will discuss recent evidence on the "mommy brain" and on neuropsychological functioning during the perinatal period.The presentation will also shed light on the results of a systematic review aimed at characterizing the association between depressive/anxiety symptoms and cognitive functioning in motherhood.
The second presentation will provide evidence on the potential role of microbiome in assessing environmental, health behavior, and host factors related to perinatal mental health.The study utilized fecal samples analyzed with whole genome metagenomics from pregnant individuals, as well as the Edinburgh Postnatal Depression Scale (EPDS) and its subsets.The results suggest that EPDS may not be consistent in self-reporting of symptoms across different cohorts, but the microbial communities of the two groups based on higher or lower EPDS scores differed significantly.
The third presentation will show findings from the ongoing Mom2B study, which is a mobile application-based cohort study of pregnant women aimed at recruiting 10,000 Swedish participants between 2020 and 2024.The study will replicate earlier findings on subgroups of PPD, both relating to the onset and nature of symptoms.The study will also use exploratory clustering methods to further understand the heterogeneity of PPD.
Overall, the symposium will provide a comprehensive overview of the latest research on PPD and motherhood and highlight potential avenues for future research including multimodal studies of motherhood, which may inform the development of individualized prevention and treatment options for perinatal mental health.Objectives: This study aimed to investigate the association between perinatal mental health and the gut microbiome in pregnant individuals from the United States and Sweden.Methods: Pregnant individuals, at two timepoints in pregnancy, filled out the Edinburgh Postnatal Depression Scale (EPDS) and provided fecal samples analyzed with whole genome metagenomics.Total EPDS scores were assessed in addition to subsets of questions reflecting anxiety, depression, and anhedonia.Results: The total number of samples analyzed from both timepoints included 657 from Sweden and 144 from the U.S. 13.7% had higher depressive symptoms in both cohorts (EPDS >11); 17.3% in Sweden and 9.9% from the U.S. Total EPDS score at each timepoint was associated with lower individual microbial community diversity, alpha diversity; driven by the evenness of different types of microbes (p ¼ .03,p ¼ .02)and the anxiety subscale (p ¼ .0099,p ¼ .0099).For beta diversity, the depressed group differed from those with lower EPDs scores, only when considering both timepoints (p ¼ .008).Discussion: The EPDS may not be consistent in self-report of symptoms across two U.S. and Swedish cohorts.The microbial communities of two groups based on higher or lower EPDS score differed significantly, although this was driven by the Swedish cohort given its size.Anxiety was found to be important to study further.Presenting Author: Alkistis Skalkidou Background: Peripartum depression (PPD) is a prevalent disorder with often devastating consequences for those suffering, as well as their families.The etiology seems to be highly multifactorial.Earlier studies have suggested heterogeneity in PPD, both in relation to the onset of symptoms, the nature of prevailing symptoms and many associated variables.Some findings suggest that different subgroups have divergent characteristics, which could be used to develop individualized prevention and treatment options.Objectives: This study aims to explore the heterogeneity, onset and nature of PPD.

Methods:
The Swedish Mom2B study is a national ongoing mobile application-based cohort of pregnant women, anticipated to recruit 10,000 Swedish women between 2020 and 2024 (n > 6800 participants have already entered the study).Participants are followed up from early pregnancy to one year postpartum through self-reports and digital phenotyping measures.The dataset is going to be used to replicate earlier findings on subgroups of PPD, both relating to the onset and nature of symptoms; more explorative clustering methods are also going to be implemented.Results: Preliminary results are going to be presented.Discussion: The contributions of this study to the field will be presented.Management, sharing and analysis of large amounts of data, especially when conducting international collaboration studies, has generated concern and proved to be a challenge regarding ethical and FAIR principles -Findability, Accessibility, Interoperability, and Reusability.OECD and the European Union have already defined some guidelines and suggested further development of the management of large amounts of data, for example through the FAIR principles and a more careful observation of ethical issues at the various stages of the data cycle.Artificial Intelligence (AI) and machine learning is now present in various areas of society such as medicine, education, or science, thus creating a potential to learn from large amounts of data that might include details of private lives in common applications, personal health data that can now be more easily inferred from points outside the medical context.This communication aims to contribute to the full cycle of management, sharing and analysis of data, with a focus on statistical learning methods for prediction applied to the area of mental health research.Being able to store large amounts of data uninterruptedly thus proves to be more advantageous when compared to the learning capacity of the human being.The large amount of data collected, includes details of private lives in common applications and personal health data that can now be more easily inferred from points outside the medical context.This new ability to create health data from online content, outside the medical context, has been referred to as "emerging medical data".It often occurs without the knowledge or consent of users, and has been generating concern and proved to be a challenge.Objectives: This communication aims to present the results of the work developed on the issues of ethics in research using AI, particularly in the area of mental health research.Methods: For this purpose, a literature review was conducted covering the period between 2016 and 2023.Results: Overall, a generalized concern with ethical issues was identified, which can hardly keep up with the technological pace.Discussion: In order to address these ethical concerns, the OECD and the European Union have already defined some guidelines and suggested further development on the management of large amounts of data, for example through the FAIR principles -Findability, Accessibility, Interoperability, and Reusability -and a more careful observation of ethical issues at the various stages of the data cycle.Presenting Author: Daniel Faria Background: The European research landscape is dominated by seemingly irreconcilable demands when it comes to research involving human data.On the one hand, funders demand Data Management Plans (DMPs) and compliance with the FAIR data principles.On the other hand, the GDPR, state laws and ethical regulations stand in the way of data sharing.Faced by these apparent contradictions, researchers are quick to dismiss the FAIR data principles as not applicable to them when they are handling human data, and equally quick to fill-in a DMP that merely justifies that dismissal.Objectives: In this communication, we will discuss the applicability and merits of research data management, the FAIR data principles and DMPs, as well as the available resources to facilitate their uptake.Methods: Key resources for supporting research data management activities, namely the RDMkit, the FAIR cookbook, and the Data Stewardship Wizard (DSW) were developed and interconnected through community efforts coordinated by ELIXIR, the European research infrastructure for data in the life sciences.Results: These key resources are now freely available to the research community to assist researchers in their data management activities.Discussion: FAIR does not imply open sharing, and there are many advantages to adopting good research data management practices, employing DMPs and complying with the FAIR principles regardless of whether data can be shared.Objectives: As inspiration, the presentation will outline how to conduct similar studies including the following steps: A study protocol is a necessary first step where collaborators outline the aim of the study and share relevant details regarding study aims, guidelines for dataset creation and analyses plans.Methods: All study sites will perform analyses independently, i.e. each site is blind to the results from other sites.Results: Results from each site will be meta-analyzed, if appropriate.Site-specific prevalence/incidence rates and effect estimates can then be pooled using random-effects meta-analytic models.Discussion: In situations where data sharing is prevented due to legal reasons, it is still possible to conduct large scale collaborations across research groups and across countries.During this symposium, we will delve into the latest breakthroughs and applications of NIBS treatment for peripartum depression as well as imaging-based insights on its mechanisms.

Presentation 1: The challenge of ethics in the use of artificial intelligence in mental health research
First, we will discuss how tasks used for neuroimaging and cognitive assessment are designed and how they could potentially be biased.Then we will explore meta-analytical data that provides multimodal imaging results on NIBS stimulation targets in peripartum depression.Afterwards, we will discuss how these targets could show sex-specific differences in terms of response to NIBS.Next, we will discuss the efficacy of tDCS combined with psychotherapy.Finally, we will discuss the feasibility, safety, and patient acceptance of home-based transcranial Direct Current Stimulation (tDCS) during the peripartum period.
Through this symposium, we aim to demonstrate the potential of NIBS and imaging-guided personalization in effectively understanding and treating depressive symptoms during the peripartum period.Presenting Author: Anna-Lisa Schuler Background: This presentation focuses on the utilization of imaging-guided approaches for noninvasive brain stimulation (NIBS) in the treatment peripartum depression.Previous studies on major depressive disorder (MDD) have shown that these approaches, particularly those based on the connectivity between the anterior cingulate cortex (ACC) and dorsolateral prefrontal cortex (DLPFC) using resting-state fMRI data, yield better treatment outcomes.Objectives: In this meta-analytical study, we aimed to investigate three key aspects.Firstly, we wanted to determine if the same brain pattern observed in MDD populations applies to a specific group of patients: those experiencing depressive symptoms during the peripartum period.Secondly, we aimed to explore whether there are alternative brain regions to be targeted that could be effective in treating these patients.Lastly, we sought to assess if connectivity patterns hold true under multimodal imaging conditions, incorporating various techniques such as task-based and resting-state fMRI, tractography, cortical thickness analysis, and PET imaging.Methods: To accomplish this, we conducted a systematic literature search encompassing the aforementioned imaging modalities.We then performed a meta-analysis using activation likelihood estimation to synthesize the findings.Results: Although we found large overlaps between MDD and PPD there were some brain patterns distinct for PPD indicating different treatment options for this specific condition.Discussion: The objective of this presentation is to discuss targeting strategies for NIBS treatment in patients during the peripartum period, with the aim of improving treatment response.The integration of TMS with fMRI, known as interleaved TMS/fMRI, holds immense potential in enhancing the personalization of TMS treatment.Stand-alone TMS has gained FDA approval as a treatment for treatment-resistant depression, primarily targeting the left dorsolateral prefrontal cortex (DLPFC).Despite its efficacy, the significant variability observed among patients has spurred the need for stronger personalization strategies.Interleaved TMS/fMRI offers a valuable approach to estimating effective stimulation doses and understanding changes in the whole brain network during depression treatment.Sex-related variability has been identified as a major source of variation in TMS outcomes.Objectives: This talk focuses on potential disparities in TMS responses over the DLPFC between male and female participants, in terms of the BOLD response during stimulation.Methods: We have reanalyzed an interleaved TMS-fMRI dataset investigating the effect of TMS over DLPFC with respect to changes in BOLD response.Results: There were clear differences in TMS response between male and female participants, especially in terms of cortical excitability.Discussion: Adjusting TMS parameters based on interleaved TMS/fMRI findings holds the potential to provide valuable insights into enhancing the treatment of female patients with depressive symptoms related to pregnancy and childbirth.Investigating sex differences in TMS responses and considering hormonal influences during pregnancy and breastfeeding in this respect are crucial for optimizing treatment efficacy during this period.

M. Vanderhasselt
GHEPLab, Ghent University, Ghent, Belgium Presenting Author: Marie-Anne Vanderhasselt Background: Dual active treatment, combining transcranial Direct Current Stimulation (tDCS) with psychological interventions, holds promise as a non-pharmacological approach to improve mental health outcomes in clinical populations.However, recent literature reveals considerable variability in reported efficacy, suggesting that a mere combination of these interventions may not always be the optimal solution.Objectives: To maximize the clinical efficacy of dual active treatment for mental health disorders, it is crucial to gain a deeper understanding of the underlying mechanisms that drive potential synergistic neuroplastic effects.Methods: In this presentation, I will discuss recent research that delves into the state-of-the-art investigation of dual active treatment and explore the lessons learned thus far, as well as future perspectives.Results: Specifically, I will highlight the utility of cognitive neuroscience in mental healthcare and underscore its importance in defining neurocognitive endophenotypes that can enhance the efficacy of dual active treatment.Discussion: By shedding light on these mechanisms, this research not only contributes to fundamental neuroimaging studies in Peripartum Depression but also holds the potential to inform and optimize clinical practice within this challenging-to-treat patient population.Presenting Author: Ana Ganho-� Avila Background: Whereas Transcranial Direct Current Stimulation (tDCS) is a promising treatment for PPD, but its efficacy is still being investigated, the effectiveness of cognitive-behavioral therapy in treating PPD is well-established.The FLOW solution (developed by FLOW NEUROSCIENCE AB) combines home-based tDCS with computerized behavioral therapy.Objectives: In our project, we aimed to understand the perspectives of women and healthcare professionals (HPs) regarding the FLOW solution for Perinatal Depression.Methods: We utilized a cross-sectional, qualitative design and employed Focus Groups methodology (five groups of women with lived experience of PPD, and three groups of HPs).We conducted qualitative content analysis concurrently with data collection, following a systematic, sequential, and consequential approach.The coding process was based on template analysis, for a deeper exploration of the phenomenological and experiential aspects of the data.
Results: Overall, FLOW is seen as a suitable alternative for many women and should be included in the range of available treatment options.While there is some resistance to computerized behavioral therapy among both women and HPs, tDCS treatments, are considered feasible and acceptable in PPD if integrated properly into the mental health system.However, adjustments are necessary for the app to better meet the needs of the target population and those in the perinatal period.Discussion: Involving patients' experiences in the development of health interventions promotes early identification of issues and allows for prompt intervention improvements.This approach fosters the development of innovative strategies to support patients, enabling them to actively participate in their own care.

A. Skalkidou
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden The symposium will be realized thanks to the contribution of experts, clinicians and researchers who participated in the Working Group 2 (WG2) of the RISEUP PPD COST Action.The WG2 on "Evaluation approaches and methods in Perinatal Depression (PPD)" was in fact characterized by a multi-professional and multidisciplinary approach to PPD assessment, which saw gynecologists, psychiatrists, psychologists working together.Original and yet unpublished results will be presented on: (1) the association between inflammatory biomarkers and PPD; (2) the tools and methods used to assess maternal interpersonal functioning in the context of PPD; (3) screening procedures for PPD in use in countries participating in the COST Action; (4) women preferences on screening for PPD.Presenting Author: Vera Mateus Background: Maternal peripartum depression (PPD) is a major depressive disorder with onset of symptoms during gestation or within four weeks postpartum.It is a common but serious mental health problem affecting women worldwide.PPD has a negative impact on women's interpersonal functioning, disrupting the quality and sensitivity of their responsiveness toward the infant.Indeed, PPD may profoundly disturb mother-infant interactions, which has been associated with long-term negative consequences on infant development.

Presentation 1: Tools and methods used to assess maternal interpersonal functioning in the context of peripartum depression
Objectives: This work presents the results of a scoping review aimed to identify and describe the methods and tools used to assess interpersonal functioning in the context of mother-infant dyads or mother-father-infant triads whose mother suffers from peripartum depression.Methods: A literature search was conducted in PubMed, PsychINFO, Web of Science and Scopus databases, from inception to June 2023, which resulted in 2969 records analyzed.Only studies published in English were included in the scoping review.Results: The screening process of the articles is ongoing and preliminary results will be presented.Discussion: Findings are discussed in light of the methods and tools that are typically used and what interpersonal functioning dimensions they measure.The combination of different methods and tools may contribute to further understand the impact of peripartum depression on maternal interpersonal functioning within mother-infant dyad and fathermother-infant triad.Presenting Author: Ana Conde Background: Approximately 10-20% of pregnant women worldwide experience perinatal depression (PND), emphasizing the need to comprehend its underlying mechanisms for early detection, prevention and treatment.Objectives: This systematic review identifies, summarizes and discusses observational studies that evaluate analytical levels of inflammatory molecules in biological fluids in relation to PND.Methods: Three electronic databases were used for search (Pubmed, Web of Science and PsychInfo) and quality assessment of selected studies were performed using the Newcastle-Ottawa Scale.Data extraction included study design; sample size; obstetric information; tools and timepoints of depression and inflammatory markers assessment.Fifty-six studies where the major aim was to analyze the association between depression and inflammatory biomarkers during pregnancy and the postpartum period were included in the review.Results: The associations between depression and markers were somewhat different looking at pregnancy compared to the delivery time-point and postpartum, and mainly referred to increased levels of IL-6, IL-8, CRP and TNF-a among depressed.Our results revealed high heterogeneity in the timing of biological sampling for markers, as well as the timing and instruments used to assess depression in the perinatal period across studies.Discussion: Overall, the findings support to the hypothesis that several inflammatory markers may be associated with peripartum depressive symptoms.Given the high burden of PND on women, children and families, it is crucial to try to harmonize methods used in related studies, in order to compile results that can provide insights into the pathophysiological mechanisms behind how the immune system and PND are connected.Objectives: To provide information about the processes used for screening for perinatal depression and other mental disorders in as many of the 29 countries participating to the Riseup-PPD Cost Action.Methods: In 2022, a web-based survey addressed to the perinatal mental health experts participating to the Riseup-PPD Cost Action collected information on screening instruments used in the clinical practice, type of health professionals responsible for perinatal mental health screening and respective clinical settings, timing of screening during and after pregnancy, as well as care pathways for women screening positive.

KEYWORDS: Peripartum depression; interpersonal functioning; motherinfant; assessment tools Presentation 2: A systematic review on the association between inflammatory biomarkers and perinatal depression
Results: An original form to collect information on the procedures adopted for perinatal depression/other mental disorders screening in different countries was made available.The information collected give an overview of how widespread screening for common perinatal mental disorders is in Europe, the methods used and the professionals involved.Discussion: Updated and reliable information on the current procedures to evaluate women mental health during pregnancy and in the first year after giving birth is the first step in promoting improved clinical practices where needed.Presenting Author: Colin Martin Background: Women's preferences in relation to clinical screening practice for the identification of perinatal depression may have major implications on the adherence to screening programmes, thus influencing their effectiveness.Objectives: To conduct a systematic review of women&#39;s preferences regarding provider, place, time and mode of screening for depression during the perinatal period.Methods: A systematic review was conducted.Studies were identified by structured searches of PubMed, PsycINFO, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE.Selection criteria were qualitative studies on pregnant and postpartum women, and primary outcomes were acceptability, satisfaction and preferences for depression screening.Results: We reviewed 2048 articles by title and abstract and 319 by full-text.Discussion: The findings from the reviewed papers are currently being discussed by the review team to determine a consensus summary of the salient points.However, even at this stage it is clear there are a number of important observations that may impact on contemporary clinical screening practice.The time around childbirth is frequently associated with mood swings in young parents.These changes, however, are not homogeneous and involve a range of clinical scenarios.In the first presentation, a recent longitudinal, prospective multi-method cohort study about the role of testosterone and other hormones as predictors and correlates of postpartum paternal depressive symptoms will be presented.Using the innovative method of analyzing steroid hormones in hair samples, the authors collected data from new fathers 8 weeks, 14 months and 2 years after childbirth.The aim of the study was to examine whether paternal testosterone levels act as a protective factor with respect to the development of postpartum depressive symptoms.

KEYWORDS
In the second presentation, we will discuss, in the context of new data, the specific risk factors and the gender aspects that play a role in the development of post-childbirth depression in mothers as well as fathers.
According to some preliminary evidence, men also experience hormonal changes during the pregnancy of their partner and after childbirth.In the third presentation a pilotstudy will be presented, where the authors found hints of decreased testosterone metabolites in the blood 3 and 6 months after childbirth, which correlated with depressive symptoms in fathers.Increased androstenedione was found to correlate with more anger toward and rejection of the child, as measured through the Postpartum Bonding Questionnaire.
Therefore, psychosocial and biological factors seem to interact in paternal perinatal depression and the fatherchild-bonding.Presenting Author: Sarah Kittel-Schneider Background: It is estimated that about 5-10% of fathers develop peripartum depression (PPD).Objectives: While there is evidence of psychosocial risk factors with respect to not only PPD but also impaired fatherchild bonding, the evidence of biological pathomechanisms in fathers is still scarce.It has been suggested that testosterone levels may correlate with depressive symptoms as well as with bonding and interaction with the child.Methods: We investigated fathers from their partners' pregnancy through 12 months postpartum (pp), assessing depressive symptoms, trait anxiety, history of childhood trauma, chronic social stress, sociodemographic and birth-related data as well as marital and bonding qualities.Blood samples were taken in pregnancy and after 3 and 6 months pp.We analyzed BDNF risk genotypes, gene methylation, protein expression and steroid hormones.Results: Several psychosocial factors, such as history of depressive episodes, unemployment and lower marriage quality as well as maternal depression, were found to be associated with paternal depression.Paternal psychopathology had an impact on the quality of bonding to the child.However, BDNF levels did not correlate with paternal depressive symptoms.After 3 and 6 months pp, increased depressive symptoms were significantly correlated with lower testosterone.After 3 months pp, infant-related anxiety factor was negatively correlated with DHEA and progesterone, and there was a significant negative correlation between PBQ total score and testosterone after 6 months pp.Discussion: This exploratory study found psychosocial factors as well as hormonal changes to correlate with depressive symptoms in fathers and their bonding to the child.The model had a good fit to the data.Positive beliefs about rumination predicted rumination that, in turn, predicted both dimensions of negative beliefs.Rumination predicted depression directly.However, none of the indirect effects, from rumination to depression through specific negative beliefs about ruminations, were significant.Additionally, when negative beliefs were combined into one factor, the model had a good fit to the data, but the indirect effect from ruminations to depression through negative beliefs remained nonsignificant.Discussion: Only positive beliefs about rumination and ruminations had a role in depression symptoms during pregnancy.This will be discussed in light of implications for the understanding peripartum depression and the metacognitive mechanisms involved.Evidence shows that national or regional perinatal depression screening programs can be effective in increasing referral rates and service use and are associated with more optimal emotional health among new mothers.Objectives: This study aimed to describe and evaluate the implementation process of a postpartum depression prevention project in Poland's primary healthcare setting.Method: The "Next Stop: Mum" project covers 37 primary healthcare centers and 7 state hospitals.26,621 mothers were screened with the Edinburgh Postnatal Depression Scale (including n ¼ 16,321 online and 11,365 midwife-led screening).Anxiety was assessed with ESDP −3 A. Women with EPDS >10 were eligible for psychological consultations.Results: The average EPDS score was 4.50 (SD ¼4.26) in midwife-led screening and 15.90 (SD ¼5.92) in the online screening.The "probable depression" rate (EPDS >12) was 7.2% in midwife-led screening, and 76,5% in the online platform.8.6% of midwife-screened mothers and 58.1% screened "online" presented with high levels of anxiety (ESDP −3 A score �5).8% of mothers with EPDS score >10 decided for the uptake of the referral, their average EPDS score in the midwife-led screening before the referral was 16.24 (SD ¼4.674).Discussion: Discrepancy between online and direct EPDS screening may show that stigma may be an important barrier to disclosing mental health difficulties.The possibility of performing an anonymous self-examination with clear guidance on further treatment steps is recommended.Additionally, adding an anxiety screening and extending the period of EPDS and anxiety screening is also recommended.Background: There is incontrovertible evidence from numerous studies using factor analysis approaches that the Edinburgh Postnatal Depression Scale (EPDS) is multidimensional.These findings have promoted the notion that an embedded sub-scale could be used for effective screening of generalized anxiety disorder.Contemporary papers indicate 3-4 items of the EPDS may be used for effective screening of postpartum generalized anxiety disorder.

Aim and objectives:
The assertion that embedded anxietyrelated sub-scales within the EPDS could be used for screening for generalized anxiety disorder postpartum was explored by replication and extension of previous studies.Method: Data was collected from postpartum women (up to two years) in the Czech Republic.EPDS data was evaluated using structural equation modeling approaches.Multidimensional models from previous research findings were reevaluated using factor analysis and alternative bifactor modeling.Results: 985 women provided complete and outlier-free data for analysis.Bifactor models were found to offer a better fit to data than multidimensional models.A consistent finding across all the bifactor models was that a general depression factor explained most of the variance in the data.The residual contribution of embedded anxiety sub-scales of all (bifactor) models tested was trivial.Discussion: Contrasting with the findings of traditional factor analysis studies of the EPDS, the current investigation revealed the EPDS to be comprised of depression domain with the hypothesized anxiety sub-scales offering little additional contribution to the variance within the model.These findings suggest the use of embedded anxiety sub-scales within the EPDS for screening for anxiety disorder should be reconsidered.Owing to the lack of methodological guidance specific to DHIs, there are inconsistencies in program costs reported in economic evaluations.Objectives: The aim of this paper is to build a framework that delineates the program costs of DHIs and then apply to framework to an app that prevents perinatal depression -"Mamma Mia".Method: A scoping review was performed to identify literature that offers guidance on program costs of DHIs, specifically methodology studies and reviews.Data extracted from the relevant studies were used to categorize program costs of DHIs and list their accompanying resource use and unit costs.The framework was then applied to Mamma Mia where the authors used information from publicly available sources, as well as from Mamma Mia's developer and data from an ongoing RCT, to estimate program costs of the app.Results: The cost categories identified via the scoping review are development, research, maintenance, implementation and health personnel involvement.Most of these costs are fixed and incurred throughout the DHI's lifecycle.The cost per mother were estimated as e37.47 for Mamma Mia Self-Guided and e87.61 for Mamma Mia Guided, excluding research costs.Development (37%), research (34%) and health personnel involvement (19%) represent the highest share of Mamma Mia's program costs.Discussion: A standardized framework for estimation of program costs can provide visibility to cost components and help make more informed decisions regarding the inclusion and exclusion of costs in economic evaluations of DHIs.Background: An adult's attachment style impacts the development of other significant relationships, including that between the mother and her infant.Self-compassion may also act as a predictor of postpartum attachment style and be key in fostering mothers' well-being.Objectives: This study explored differences in compassion (for self, for others and from others) in mothers grouped into a secure, avoidant or anxious attachment style.Methods: Participants were 298 pregnant women (22-30 weeks of gestation; M age ¼ 31.92;SD age ¼ 4.41), with a higher education degree (78,5%) for whom this was the first pregnancy (62,8%).Data were collected regarding selfreported scores from the Revised Adult Attachment Scale.Results: MANOVA revealed significant differences (V ¼ 0.253; F (6,578) ¼ 13.955, p < .001):those with secure attachment presented higher levels of compassion for self and for others, followed by avoidant attachment, and then anxious attachment.Women with secure attachment also scored higher on receiving compassion from others, in comparison with mothers with avoidant attachment.The discriminant function analysis revealed two discriminant functions that significantly differentiated attachment groups ( Ù ¼ :748; v2 6 ð Þ ¼ 83:870, p < :001).Function 1 significantly discriminated secure attachment from anxious and avoidant attachment styles based on self-compassion and compassion for others, whereas function 2 differentiated avoidant attachment from a secure and anxious attachment based on compassion from others.Discussion: Results highlight the importance of promoting self-compassion and compassion for others in women with insecure attachment styles.Specifically with avoidant attachment style, it seems key to also foster compassion from others.Background: Divorce or separation influences adults' economic security and well-being, and further impacts the health of the children.Postpartum depressive symptoms in mothers are associated with less close, warm, and confident relationships with both their child and partner over the first year after childbirth.However, research on the association between perinatal depression (PND) and parental separation is limited.Objectives: The aim of this study was to investigate the association between PND symptoms and parental separation.Methods: The study utilized data from the Biology, Affect, Stress, Imaging and Cognition (BASIC) study and the ongoing U-BIRTH study.Maternal depressive symptoms were evaluated during pregnancy, at 6 weeks, and 6 months postpartum using the Edinburgh Postnatal Depression Scale.Parental separation was assessed for 4344 women at 6 weeks postpartum and for 1119 women at 6 years postpartum.Logistic regression analyses were performed to determine the odds of separation among women with PND symptoms.Results: PND increased the likelihood of parental separation at both 6 weeks and 6 years postpartum.The risk of separation increased with the number of timepoints at which depression was experienced (unadjusted OR and 95% CIs: 1.9 [1.2, 3.0] for one depression rating, 2.2 [1.1, 4.6] for two depression ratings and 3.8 [1.5, 9.2] for three depression ratings).Discussion: In conclusion, women with PND, especially those with depression at multiple timepoints, are at a higher risk of parental separation.However, further research is needed to confirm these findings, and assessing paternal depression could provide additional insight into the results.Background: Postpartum depression is categorized by somatic, cognitive and biological symptoms and may have a detrimental impact on infants and children.We turn our attention to the effects of maternal depression on an embodied level in the caregiver-infant relationship.Objectives: Through a clinical case study, we present how postpartum depression unfolds on the embodied level in the parent-infant relationship.This will be done using the Parental Embodied Mentalizing Assessment (PEMA; Shai, 2018), which is a 13-point assessment and intervention tool that captures risk and protective factors of how mind is expressed through the body in dynamic parent-infant movement interactions (Shai [1]).We present the factor of Disembodiment, whereby there is a decoupling from, a disintegration between the soma and the psyche.Method: A 37-year-old Afghan refugee mother with a diagnosis of major depression fled to Iran with her family.She was video-recorded during a 10-min free-play session with her 18-month-old infant.The interaction was coded for PEMA.The kinesthetic qualities of the movements of the dyad are portrayed through a series of pencil illustrated drawings.Results: The use of PEMA resulted in identifying a series of risk factors in the dyad, and in particular Disembodiment in the mother.The mother's movements were vacant, disjointed, and mechanical.Discussion: Disembodiment was a useful lens to observe the relational embodied manifestations of maternal depression during a caregiver-infant interaction.Observation of the interaction of the bodies and movements of the motherinfant dyad portrays a rich nonverbal history that cannot always be captured in words.

KEYWORDS: Disembodiment; perinatal depression; parent-infant; parental mentalizing
Introduction: Postpartum depression is highly prevalent in Nepal.Dissatisfaction and poor experience of care are largely reported by the women giving birth in public health facilities of Nepal.We assessed the association of mistreatment during facility-based childbirth with postpartum depressive symptoms.Method: A prospective cohort study was conducted among postnatal women who gave birth in a public hospital of Nepal.Socio-demographics and obstetric information were collected from hospital registries.Based on mistreatment typology, a structured interview was used to assess mistreatment and Edinburg Postnatal Depression Scale (EPDS) was used to detect depressive symptoms.A telephone interview was completed between the 6th to 24th postpartum week.We used a binary generalized linear model to examine the relative risk of postpartum depressive symptoms in mistreated childbirth experience.Findings: Of 1629 eligible women, 1222 were enrolled, 29.5% (360) women reported one or more types of mistreatments and 4.4% had postpartum depressive symptoms.Mistreated women had two-fold higher odds of developing postnatal depressive symptoms (OR ¼2.31; 95% CI, 1.33, 3.99, p ¼ .003)which remained significant when adjusted with socio-demographic and obstetric characteristics (OR ¼2.240; 95% CI, 1.28-3.92,p ¼ .005).A strong association was observed with women aged �19 years (OR ¼4.298; 95% CI, 2.01-9.19,p � .001),previous births (OR ¼3.24, 95% CI, 1.59-6.58,p ¼ .001)and sex of newborn (OR ¼2.18, 95% CI, 1.21-3.95,p ¼ .010).Discussion: We found that health worker's behavior around the time of childbirth, social values, cultural practices and birth readiness affect mental health of woman after birth.Hence, enhancing provision of individualized respectful maternity care during facility-based childbirth and strengthening perinatal mental health care is a global health urgency.Results: Spearman's correlations indicate a positive association between perceived trauma during birth and postpartum depressive symptoms (r ¼ 0.20, p < .01),as well as a negative association between birth satisfaction (quality of care provision, women's personal attributes, and stress experienced during labor) and postpartum depressive symptoms (r ¼ −0.36, p < .01).The Kruskal-Wallis test does not reveal significant differences in postpartum depressive symptoms based on the mode of birth.Discussion: Both perceived trauma and low birth satisfaction are significantly associated with postpartum depressive symptomatology.Improvement of maternal care in Cyprus, as well as the provision of accessible perinatal mental healthcare, become undisputable priorities.

KEYWORDS:
Childbirth trauma; birth satisfaction; postpartum depression; perinatal mental healthcare

Co-designing a mental health literacy program for young mothers
V. Brakoulias a , A. Padhi a , K. Akter a , R. Bentley a , C. Cassettari a , A. Earl a , E. Edmunds a , C. Fleming a , P. Hesperi a , B. Hingston a , S. Joseph a , C. Kuplun a , H. Kojo a , J. Kwok a , D. Mainwaring a , J. Montgomery a , J. Mosley a , D. Ogunsiji a , S. Rafa a , R. Saheb a , V. Schmied a , F. Webber a and A. Reis b a Western Sydney Local Health District Mental Health, Australia; b Western Sydney University, Australia Background: Young mothers are reported to experience more significant mental health challenges than their peers without children, previous generations of young mothers, and older mothers.However, young mothers often do not engage in mental health services and may not receive appropriate assessment, diagnosis, or treatment for their mental health condition.The Young Well Beings project aims to codesign a self-help mental health literacy resource with and for young mothers to support their mental health needs in the perinatal period, with a focus on mental health selfawareness, providing choices and supporting decisionmaking.
Objectives: To describe the rationale and preliminary work to create a mental health literacy digital resource for young mothers.Methods: The Young Well Beings project utilized a Participatory Action Research approach to co-design with young mothers and community-based and other health professionals a learning resource aimed at improving the mental health literacy of young mothers.Results: Although perinatal and infant mental health clinicians are crucial facilitators of mental health literacy, young mothers often chose self-help independently due to a variety of political, organizational, structural, cultural and personal factors.Young mothers requested approachable and compassionate services with a "no wrong door" approach.A co-created digital learning platform is being developed and piloted and will offer accessible information for young mothers at no cost.Discussion: Consumer co-design of an online resource to improve mental health literacy in young mothers supports the identification of specific features to prioritize, thus improving accessibility to information and mental health services that fit their needs.KEYWORDS: Mental health literacy; co-design; consumers; maternal mental health; young mothers

C. Hancheva
Sofia University "St.Kliment Ohridski", Bulgaria Background: According to psychoanalytic theory, pregnancy involves complex internal dynamics -fantasies, representations, emotions, thoughts, and external behaviors.During pregnancy, a woman's unconscious thoughts and feelings, including desires, fears, and anxieties shape her experience and choices.Psychoanalytic theory suggests that pregnancy can evoke unresolved developmental conflicts and issues even in professionals undergone their personal therapy or analysis.Objectives: To explore two supervision cases of psychologist's pregnancy in Fertility clinic.Method: Case study.Results: A complicated situation of pregnancy of a person from the staff in a Fertility clinic brings various challenges.Women who are struggling with infertility or other reproductive problems may experience complex emotional states involving feelings of envy, resentment, jealousy, and rivalry toward those who possess something desirable that one lacks.Envy, as understood in psychoanalytic theory, is a complex and multifaceted emotion that can have both conscious and unconscious aspects.It may be influenced by a variety of individual, societal, and cultural factors, and can have different manifestations.The supervision process has to focus on: (1) the choice to work in a Fertility clinic; (2) the dilemma that a professional is facing: to leave (abandon) patients, to be able to carry and care for one's own baby; (3) exploration of defense mechanisms; (4) ambivalence in emotional experiences; (5) topics of personal and professional identity; and (6) resolve practical issues like referral or termination of therapy.
Discussion: A need for a protocol in regard with ethical standards, protection and best interests of both professionals and patients in the above-mentioned situations is discussed.

FC13
The impact of postnatal depression on mother-infant vocal interaction: a video-based analysis in the context of an mother-baby unit

V. Eirinaki
University of Roehampton, UK Background: Postnatal Depression (PND) affects maternal vocal behavior, reducing involvement and quality in vocal interactions with infants and potentially increasing infants' developmental risks in relation to their socioemotional wellbeing and cognitive skills.Sparse research exists on the impact of PND on maternal and infant vocal behaviors that relate to infant development.This study examines the effect of PND on infants' communication skills through the prism of maternal vocal behavior, focusing on hospitalized motherinfant pairs in a Mother-Baby Unit.Methods: The study used 52 videos of 104 participants (52 pairs of mother-infant aged 3-12 months).The clinical group comprised 22 inpatient mothers with PND and their infants, while 40 mothers without PND and their infants participated in the comparison group.Video-recordings were compared and analyzed using the CARE-Index, Global Rating Scale, and micro-analytic approach.Results: Mothers with PND were found to talk less to their infants and had poorer speech quality than those without, while their infants showed a significantly higher level of vocalisations.The effect of PND on spontaneous maternal singing was not statistically significant, but micro-analysis showed interesting group differences.Conclusions: The research findings contribute to the existing literature by revealing both strengths/challenges in vocal behavior of inpatient mothers with PND and their infants.
Results suggest future research opportunities on how to strengthen weaknesses and promote strengths, so as to improve the adverse impact of PND on mother-infant relationship and infant development, enhancing their quality of life.Background: Around 1.9 million babies were born with no signs of life worldwide in 2021, 3.9 per 1000 live births in Catalonia, Spain.There is limited evidence on how interventions recommended in the current clinical guidelines improve the mental health status of the mother and partners that experience pregnancy loss and how to implement them in healthcare settings.Objective: Determine the effectiveness and implementation of a multidisciplinary intervention on mothers and partners who experience pregnancy loss on their mental health status (grief, depression, anxiety, and post-traumatic stress disorders).Methods: This is a mixed-method study design, which will include a non-randomized semi-control trial and semi-structured interviews/focus groups.It will be carried out in SJD Hospital de Sant Boi and Hospital Comarcal de Alt Penedes, both in Barcelona, Spain.Participants will be mothers and partners who have suffered a miscarriage or stillbirth, and midwives and obstetricians.Clinical data will be collected regarding loss and intervention delivered, and mental health status will be evaluated on mothers and partners throughout the following questionnaires: PGS, EPDS, GAD-7 and PPQ.Interviews on mothers and focus groups on health professionals will be conducted to deepen into barriers toward developing the intervention.Results: We hypothesize that a multidisciplinary healthcare intervention could effectively prevent mental health problems in mothers and their partners and be implemented in healthcare settings.Discussion: Bereavement interventions are compassion-led and generally believed to be beneficial for parents.Although parents largely appreciate them, more evidence is needed to evaluate their effectiveness and implementation in healthcare settings.

Background:
The mental health of female prisoners having their babies within the criminal justice system is a neglected area of research.Despite this, there is compelling evidence that this group of women is at elevated risk of mental health problems.Screening for depression in this group is thus of paramount importance.Aim and objectives: The current investigation sought to examine the efficacy and veracity of the Edinburgh Postnatal Depression Scale (EPDS) for screening women within the criminal justice system in the Czech Republic who gave birth while serving a custodial sentence.Method: Data was collected at up to five years postpartum from women in a large women's prison in the Czech Republic.EPDS data will be compared to normative Czech data.Comparisons between normative data and study data and the relationships between key variables will be explored using Bayesian statistics and Bayesian structural equation modeling.

Results:
The study is currently underway and up to N ¼ 50 women prisoners will be enrolled into the study and data collected for analysis.Discussion: The findings will be presented and discussed at the conference.It is anticipated that the findings will have significant implications for screening practice for depression for women and their babies within the context of the Czech criminal justice system.KEYWORDS: Criminal justice system; depression; Edinburgh Postnatal Depression Scale; EPDS; prison; structural equation modeling

PO06
Exploring the motives why women drop out of a perinatal depression M-health study K. Pagoni a , H. Wierenga a,b , A. Skalkidou a , F. Papadopoulos a and F. Geusens a a Uppsala University, Sweden; b University of T€ ubingen, Germany Background: M-health tools can be powerful tools to support and monitor maternal mental health and collect research data.While literature focuses on the usability of these applications, there is little understanding of the reasons why women stop using m-health tools.Objectives: The aim of this study is twofold: (1) to explore why participants drop out of a perinatal depression m-health study and (2) to identify periods during pregnancy and postpartum when participants prefer to use the app more intensively.Methods: Previous users (n ¼ 134) of the Mom2B app who had dropped out of the study, completed an online questionnaire including multiple choice questions and optional free text fields.For the analysis of the quantitative data, descriptive statistics were used, and qualitative data was analyzed using content analysis.Results: Most participants dropped out of the study due to "Lack of time" (34%) and "Problem with pregnancy" (18.1%).The content analysis of the open-ended questions supported these findings.Also, the length and repetition of some surveys, need for more information on the study itself and technical issues of the app were repeatedly mentioned.Participants have no clear preference for when during the peripartum time-period they would prefer to use the app, but an inclination toward pregnancy in comparison to postpartum emerged.Discussion: These results provide insight in how to strengthen app design for studying and supporting maternal mental health.It shows the importance of using short surveys and streamlining the overall study design when including many questions.Extensive usability pre-testing is recommended.KEYWORDS: mHealth; peripartum depression; pregnancy apps; drop out analysis; users' perspectives

PO08
Perinatal severe depression with psychotic symptoms: multidisciplinary assessment, treatment and recovery R. Spencer and D. Sullivan CNWL Perinatal Mental Health Service, UK Background: Perinatal mental health (PMH) difficulties occur during pregnancy or in the first year following the birth of a child.In the UK, specialist PMH services provide care and treatment for women with complex mental health needs and increasingly support the developing relationship between parents and babies.
A small but significant proportion of these patients present with severe clinical depression, as well as psychotic features, including hallucinations and delusional thinking.The severity of the illness can have implications on the mother-infant relationship and caregiving interactions.Objectives: The purpose of this presentation is to provide an overview of severe depression with psychotic symptoms in the perinatal period and the psychosocial multidisciplinary assessment and treatment interventions provided at a mother and baby psychiatric unit (MBU).Method: Through a case presentation we demonstrate the red flags, symptoms and treatment pathway for a mother with a diagnosis of severe depression with psychotic symptoms admitted to the MBU.Practicing in a trauma-informed approach, we discuss how team case formulation and supervision helped to enhance understanding of the complex diagnosis.Results: Through a clinical case study, we share a specialist care plan for assessing and treating psychotic symptoms, depression and underlying complex trauma.Psychotropic medication, psychological interventions, nursing care, safeguarding and engaging the family network were all crucial for the patient's clinical management and recovery.Discussion: Perinatal severe depression with psychotic symptoms is a high-risk period.The clinical case study presented demonstrated how trauma-informed specialist multidisciplinary approach can lead to good treatment outcomes and recovery.Objectives: The study aimed to identify the correlation between socio-demographic and obstetric factors, which can potentially have an impact on the development of postpartum depression.Methods: Sixty patients (M age ¼ 27.9, SD ¼5.3, Range ¼19-41 years), each of whom delivered at the hospital, were evaluated using the Edinburgh Postnatal Depression Scale (EPDS) on the 8th day of the postpartum period.A cutoff value of ten or more points was set for diagnosing PD.We took into consideration socio-economic factors such as: region, patients' age, education, family income; obstetric factors included the cesarean section, vaginal birth and the number of deliveries.Results: PD was diagnosed in a total of 10 cases (16.7%).All PD cases were categorized as mild (MEPDS score ¼5.6, SD ¼3.4).The correlation analysis showed that EPDS score was inversely related to age (r ¼ − 0.395, 95% CI [−0.590, −0.157]; p ¼ .002),as well as the number of deliveries (r ¼ − 0.294, 95% CI [−0.510, −0.043]; p ¼ .023).The mean value of EPDS score in younger patients (< 30 years old, n ¼ 42) was 6.3 (SD ¼3.4).PD was diagnosed in 9 cases (21.4%).In a group of older patients (age �30 years old, n ¼ 42) was 6.3 (SD ¼3.4), we diagnosed one case of PD (5.6%).The difference between groups was significant (p ¼ .041).Other factors did not reveal any significant impact.Discussion: The age of the patient and first delivery may be considered as possible factors which have an impact on PD development.The results of our investigations need to be confirmed by further studies.Background: Perinatal depression prevalence has increased during the COVID-19 pandemic.It is important to explore changes in the profile of specific depressive symptoms that might underline this overall increase.Objectives: To analyze the impact of the COVID-19 pandemic on the prevalence and severity of specific symptoms and of clinically significant symptoms of depression during pregnancy and the postpartum period.Methods: Women recruited before (n ¼ 2395) or during the COVID-19 pandemic (n ¼ 1396) completed a sociodemographic and obstetric questionnaire and the Edinburgh Postnatal Depression Scale (EPDS).For each item, scores �1 and �2 were used to calculate the prevalence and the severity of symptoms of depression, respectively.Results: Significantly more severe symptoms of depression were reported during COVID-19 compared to before.Specific symptoms' prevalence increased more than 30%, namely "been able to laugh and see the funny side of things" (pregnancy 32.6%, postpartum 40.6%), "looking forward with enjoyment to things" (pregnancy 37.2%, postpartum 47.2%), as well as "feelings of sadness/miserable" or "unhappiness leading to crying" in the postpartum period (34.2% and 30.2%, respectively).Specific symptoms' severity was especially increased regarding feelings that "things have been getting on top of me" during pregnancy and the postpartum period (19.4% and 31.6%,respectively), "feeling sad or miserable" during pregnancy (10.8%), as well as "feeling scared/panicky" in the postpartum period (21.4%).Discussion: Clinical attention should be paid specifically to anhedonia-related symptoms of perinatal depression to provide adequate treatment in this and in future crisis contexts.KEYWORDS: Depression; pregnancy; postpartum; anhedonia; EPDS

PO14
Maternal self-esteem and negative affectivity in pregnant BULGARIAN women P. Bikovska and C. Hancheva Sofia University "st.Kliment Ohridski", Bulgaria Background: Growing body of longitudinal studies suggest that low self-esteem prospectively predicts depression in general populations.To date, there is little research on the connection between maternal self-esteem and negative affectivity (depression, anxiety) in populations of pregnant women.Objectives: In this study we present the results from an exploratory longitudinal study following pregnant women in their third trimester through the first year after giving birth.We test the hypothesis that self-esteem would serve as a protective factor for negative affect during pregnancy.Methods: Pregnant women (N ¼ 332) who were in the third trimester of their pregnancy were recruited via online advertising.Participants were assessed for negative affectivity (Edinburgh Postnatal Depression Scale Personality Inventory for DSM-5) and maternal self-esteem ((Maternal Self-Report Inventory -short form).Results: Several linear regression analyses were performed to ascertain factors predicting antenatal negative affectivity.Maternal self-esteem significantly predicted anxiousness (PID-5), b ¼ −0.51, t(330) ¼ −10.70, p < .001,R 2 ¼ 0:26, F(1, 330) ¼ 114.43, p < .001,negative affect (PID-5-BF), b ¼ −0.48, t(330) ¼ −9.90, p < .001,R 2 ¼ 0:23, F(1, 330) ¼ 98.09, p < .001,and levels of antenatal depression, X 2 ð2, N ¼ 332Þ ¼ 66:91, R 2 ¼ 0:21, p < .01.Education, living area and having other children were not significantly associated with levels of antenatal depression and anxiousness.Conclusions: Our study shows that maternal self-esteem could be considered a protective factor for negative affect during pregnancy.This gives specialists an alternative path for intervention during pregnancy and prevention of peripartum depression via interventions booting maternal self-esteem.KEYWORDS: Maternal self-esteem; peripartum depression; peripartum anxiety; pregnancy

PO15
The impact of the war in Ukraine on the perinatal period: perinatal mental health for refugee women M. Chrzan De Rtko� s a , M. Rodr� ıguez-Muñoz b , O. Morozova-Larina c , L. Krupelnytska c , Background: The consequences of war and migration can be particularly damaging for mothers and babies.United Nations Population Fund estimated that about 265,000 Ukrainian women were pregnant when the war broke out in February 2022.Eighty thousand women were expected to give birth in the subsequent 3 months in Ukraine or abroad.Objective: The aim of the Perinatal Mental Health for Refugee Women (PMH-RW) Project is to investigate the impact of the war on perinatal mental health: anxiety, posttraumatic stress, depression, and birth trauma symptoms.It will also evaluate the factors that serve as protective elements for the development of these potential diagnoses (such as personality traits, social support, sociodemographic characteristics, and access to medical/mental health services).Method: The study is an international observational cohort, based on an online survey with participants assessed in Ukraine (for internal refugees) and several European Countries (for external refugees).The participants are both pregnant women and those with babies up to 1 year old.By April 2023, 300 women took part in the survey.The assessment included measures on depression (EPDS), anxiety (GAD-7), experiences during birth (City Birth Questionnaire), posttraumatic stress symptoms [Impact of events scale-revised (PTSD-R)], Personality (10-Item Personality Inventory-TIPI), and a questionnaire for socio-demographic data such as social support.
Results: Given that we are still collecting data until the 30th of June, we will present the updated results during conference.Discussion: This study will provide needed information for determining the impact of the Ukrainian Crisis on perinatal mental health.

S. Pinar
Kahramanmaras Sutcu Imam University, Turkey Background: Perinatal depression affects not only women but also their partners and children.Early assessment, detection and treatment of perinatal depression are crucial to providing appropriate support and treatment timely.Although it is an important disorder to address, healthcare professionals experience challenges on screening perinatal women and identifying perinatal depression.Objectives: This literature review explores the challenges of screening for and identifying perinatal depression in the United Kingdom.Methods: CINAHL Plus, Medline and MIDIRS databases were searched to answer the questions "What are the challenges of screening women for perinatal depression in the United Kingdom" and "What are the challenges of identifying perinatal depression in the United Kingdom".Results: A total of five eligible studies were included.There appears to be potential confusion among healthcare professionals with regards to when and how they should screen perinatal women.Identifying women with perinatal depression also appears to be challenging because women tend to hide their real feelings and healthcare professionals do not feel adequate to deal with mental health problems.In addition, the perinatal mental healthcare pathways are unclear about cutoff scores and referrals.Discussion: The healthcare professionals may need to stress that women may be concerned about their feelings, but that they can count on them for support and assistance as they work to get through them.Asking women's mood at every visit may also be helpful.This is also crucial for establishing friendship and mutual trust with the woman as well as with their larger family.Objectives: This study aimed to assess the relationship between perceived social support and feelings of isolation with depression, and to assess whether there are differences before and after the pandemic.Methods: A cross-sectional study was conducted with a sample of 3356 women, 1402 in the prenatal period and 1954 in the postnatal period, living in Spain.The Edinburgh Postnatal Depression Scale (EPDS) and the Spanish version of the Coronavirus Perinatal Experiences -Impact Survey (COPE-IS) were used.Results: In the analysis of the differences between depressed and non-depressed women during the entire perinatal stage, the mean feeling of support before and during COVID-19 is lower among women with depression.This perception has attenuated during the pandemic, there is a significant difference between the perception of support before and during the pandemic.Discussion: Our data highlight the importance of working on cognitive aspects such as the perception of social support and the subjective experience of isolation.Therefore, healthcare institutions should take into account the relevance of social support as a strategy to buffer emotional distress and promote access to sources of social support both face-to-face and online.Introduction: Perinatal depression (PPD) is a public health problem, with high costs for the healthcare system.An increasing number of studies have concluded that the use of mobile health (m-Health) is useful.However, the literature has shown that there is a high drop-out rate in the use of these systems, estimated at around 43%.As far as the perinatal field is concerned, to our knowledge the "Healthy Moms and Babies" app is the only application in Spanish that is currently in use.Aim: This study aims to find out the dropout rate of the intervention, as well as to study the dropout patterns of participants enrolled in the mobile application "Healthy Moms and Babies".Methods: The sample includes 511 women, recruited between 2020 and 2022.Study data were collected from the Healthy Moms and Babies app.Results: A total of 511 users were obtained from the initial form, of whom 279 (54.6%) downloaded the mobile app and completed the assessment.When comparing the data from women who have allowed the app to alert them to the availability of modules and completion of the modules, (15.1%) there are significant differences in completion of the first 4 modules out of 11.

Conclusion:
The data obtained in this study show that reminder notifications influence subsequent use and habit formation, so offering personalized follow-up services could keep users committed to continuing.On the other hand, it also points to the need to improve accessibility, creating easily accessible health platforms, thus improving the consumer experience.Objective: This study aimed to explore the relationship and influence of EA and positive and negative affect on perinatal depression.
Discussion: PSS is a robust predictor of depression in the perinatal period, and dimensions of coping, are predictors of depressive symptoms only in the postpartum period.These results have implications for addressing depression in pregnancy and postpartum.Methods: Participants will be expectant women with and without depressive symptomatology, and never pregnant controls.Assessments will take place at five timepoints: the 1st, 2nd and 3rd trimester of pregnancy, 3 and 7 months postpartum.Self-report instruments will be used to assess depression/depression risk and anxiety symptoms, perceived stress, sleep quality, fatigue, emotion regulation, rumination, and relationship satisfaction.At each visit, participants will complete cognitive tasks, during which brain activity will be measured using functional near-infrared spectroscopy.In the postpartum, an emotion recognition task with infant faces will be added, and a mother-infant play interaction recorded and coded to assess maternal sensitivity.
Results: We hypothesize that mothers will show differences in cognitive performance and increased brain activity in the parental brain network as compared to non-mothers, and that these patterns will be decreased in expectant women/mothers with depressive symptoms.Discussion: The study aims to uncover risk factors and vulnerability periods for the development of PPD and assist in tailoring effective interventions.

Conclusions:
The importance of a perinatal-period tailored approach provided at all levels provided by the MRPOS will be highlighted.Objective: In this study we aim to describe three clinical cases of mothers with postpartum mental health disorders and the difficulties they experience when they are called to take care of their children and their feelings are too intense.The interest in these three cases is that women also experienced depression during adolescence.
Methods: Three clinical cases will be described.With the indepth interviews, the administration of a depression questionnaire (Beck II) and the administration of medication where needed.An environment of safety and protection was created for the new mother.The psychotherapy focused on internal feelings about maternity and on the understanding and support to young mothers to deal with new roles in their lifes.
Results: Two of the three mothers were diagnosed with moderate depression (23 and 25 score in BDI-II scale) and one with severe depression (33 score in BDI-II scale).Through the administration of the depression scale and the clinical interview, the cases where the administration of antidepressant treatment was deemed necessary were identified.Discussion: The postpartum period is a critical phase.The specialist needs to listen carefully to the initial request, to suggest the appropriate therapeutic treatment, bearing in mind that early intervention will mentally strengthen the new mother, especially when she mentions her personal history with depression in adolescence.Background: postpartum depression is a mental illness linked to a major fact in a woman's life: the birth of the child.
It is not rare that some woman experience feelings of disappointment, hopelessness, indisposition to take care of her child.The shift of the mother's interest from herself to the child, who is now perceived as something separate from herself, may convey feelings of anger, helplessness and guilt toward her newborn.
Objectives: In this study we aim to clarify psychodynamic factors that determine the behavior of mothers diagnosed with postpartum depression toward her child (e.g.guilt, aggressiveness, withdraw and depression).Methods: Through the psychodynamic thought and approach, we discuss the psychological impact of birth in a depressed woman during the postpartum period.The fact that the woman after childbirth has to "give up" her own childhood experiences in order to be able to love her child, is a process that can affect significantly a mother with a history of depression.
Results: The separation of the child from the mother leaves her empty and hopeless, in some cases, raising strong feelings, frequently bearable to handle.The psychodynamic approach by a specialist properly trained in the potentials that develop, in the support and installation of a "good enough mother" who identifies with and is supported by an adequate "external" reality, can provide psychic empowerment and functionality.Discussion: Mental health professionals should be trained to recognize the symptoms of depression in postpartum women, developing empathy and building an alliance with the mother as an effort to understand her and promote stronger psychological abilities that will result in more adequate behaviors and experiences toward her baby.The mothers using logistic regression.Models were adjusted for age, pre-pregnancy body mass index, parity, and history of depression (Model 1).
Results: Out of 4459 pregnancies, 949 (21.2%) had APD and 1123 (25%) had PPD.DMP had a prevalence of 1.2%.DMP accounted for two-fold higher odds for PPD but was not significantly associated with APD.None of the types of DMP were associated with APD nor PPD.Discussion: Our study showed that DMP enhances the risk for PPD and could thus be considered as a risk factor when screening for high-risk groups.

KEYWORDS:
Birth; childbirth plan; postpartum; posttraumatic stress disorder; mental health SYMPOSIUM 3 Understanding typical and atypical trajectories of motherhood: insights from the microbiota-gut-brain axis, cognitive functioning, self-reports, and digital phenotyping measures M. Sobral Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal from the microbiota-gut-brain axis M. Kimmel a , A. Edbom b , R. Bjorvang c , L. Hugerth b , E. Fransson b,d and A. Skalkidou d a Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, USA; b Department of Microbiology, Tumor and Cell Biology, Science for Life Laboratory, Centre for Translational Microbiome Research, Karolinska Institutet, Sweden; c Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Sweden; d Department of Women's and Children's Health, Uppsala University, SwedenPresenting Author: Mary Kimmel Background: Depression and anxiety during pregnancy are associated with immediate and long-term negative health outcomes for the pregnant person and their offspring.The microbiome holds the potential to assess the environment, health behaviors (e.g.diet), and host factors (e.g.immune system functioning) in relation to perinatal mental health.

KEYWORDS:
Peripartum depression; childbirth; screening; microbiome; a , M. Kimmel a , R. White b and F. Papadopoulos b a Department of Women's and Children's Health, Uppsala University, Sweden; b Department of Medical Sciences/Psychiatry, Uppsala University, Sweden KEYWORDS: peripartum depression, trajectories, heterogeneity, symptoms SYMPOSIUM 4 Taking care of data in PPD research -management, sharing and analysis B. Sousa Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal

:
Perinatal depression; brain imaging; MDD; TMS treatment Presentation 3: Sex-specific responsiveness to TMS M. Tik a,b a High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; b Department of Psyschiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA Presenting Author: Martin Tik Background:

KEYWORDS:
Perinatal depression; tDCS treatment; neurocognition Presentation 5: Perspectives on tDCS treatment in PPD A. Ganho-� Avila a , A. Cruz a , N. Szczygiel a,b , A. Tom� as a , P. Bastos a , C. Azevedo a and M. Moura-Ramos a,c a Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; b Department of Economics, Management and Industrial Engineering and Tourism, University of Aveiro, Aveiro, Portugal; c Centro Hospitalar Universit� ario de Coimbra, Coimbra, Portugal Corresponding Author: A. Ganho-� Avila

KEYWORDS:
Perinatal depression, immune system, biomarkers, cytokines, inflammation Presentation 3: State of the art on screening of perinatal depression and other perinatal mental disorders in the countries participating in the research network of peripartum depression disorders (Riseup-PPD) cost action I. Lega a , S. Mastroeni a , C. Martin-Gomez b , A. Skalkidou c , T. Stepi� snik d , C. Toscano e , E. Agius f and C. Zerafa f a Istituto Superiore di Sanit� a, Italy; b Andalusian Agency for Health Technology Assessment-Progress and Health Foundation, Spain; c Uppsala University Hospital, Sweden; d School of Advanced Social Studies, Slovenia; e University of Minho, Portugal; f Mater Dei Hospital, Malta Presenting Author: Ilaria Lega Background: Mental health screening in pregnancy and in the first months postpartum is recommended by international guidelines.

:
Screening; perinatal depression; women; preferences SYMPOSIUM 7 Don't forget the fathers: risk factors and impact of paternal perinatal depression N. Chechko Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany

KEYWORDS:FC01
Peripartum depression; BDNF; father; testosterone; bonding FREE COMMUNICATIONS The metacognitive model of rumination and depression during pregnancy S. Naki� c Rado� s a , M. Brekalo a , M. � Zuti� c a , M. Matija� s a , J. � Stefulj a,b , M. Bagari� c a and D. Zrinski Petrovi� c a a Catholic University of Croatia, Croatia; b Ruder Bo� skovi� c Institute, Croatia Background: The metacognitive model of rumination and depression (Papageorgiou & Wells [1]) was tested on the non-peripartum population and in the postpartum period but not during pregnancy.Objectives: This study aimed to examine the metacognitive model during pregnancy, where positive beliefs about rumination predict rumination that, in turn, predicts depression directly and indirectly through negative beliefs about rumination.Methods: Pregnant women participated in the longitudinal online study.Here are presented data on 850 women in T1 in mid-pregnancy.Participants completed questionnaires for depression (Edinburgh Postnatal Depression Scale, EPDS), rumination (Ruminative Responses Scale, RRS), and positive and negative beliefs about rumination (PBRS and NBRS).Negative beliefs about rumination consist of (1) beliefs about the uncontrollability and danger of rumination and (2) the interpersonal and social consequences of rumination.Results: The path analysis was conducted in Mplus software.

KEYWORDS:
Pregnancy; metacognition; depression; rumination; belief about rumination Funding This publication is based upon work from COST Action Research Innovation and Sustainable Pan-European Network in Peripartum Depression Disorder (Riseup-PPD), CA18138, supported by COST (European Cooperation in Science and Technology).

KEYWORDS:
Postpartum; prevention; screening; referral; postpartum depression FC04 Can embedded sub-scales within the Edinburgh Postnatal Depression Scale (EPDS) be used effectively for screening for postpartum anxiety disorder?K. Ratislavov� a a , E. Hendrych Lorenzov� a a , A. Lochmannov� a a and C. Martin b a University of West Bohemia, Czech Republic; b University of Suffolk, UK

KEYWORDS:
Anxiety disorder; Edinburgh Postnatal Depression Scale; EPDS; postpartum anxiety disorder; screening FC05 Cost calculation of digital health interventions: a scoping review and the case of mamma mia for prevention of perinatal depression Z. Khan, K. Kidholm, S. Pedersen, S. Haga, F. Drozd, T. Sundrehagen, E. Olavesen and V. Halsteinli Norwegian University of Science and Technology, Norway Background: The development of Digital Health Interventions (DHIs) has increased manifolds in recent years.

KEYWORDS:
Health economics; cost; perinatal mental health; digital health FC06 Can mother's compassion discriminate her attachment style?A study during pregnancy' B. Veloso a , S. Moreira b , M. Sousa b , A. Xavier a,c , J. Silva a , P. Vagos c,d and L. Palmeira a,c a Instituto Portucalense de Psicologia (I2P), Universidade Portucalense Infante D. Henrique, Porto, Portugal; b Departamento de Psicologia e Educac¸ão, Universidade Portucalense Infante D. Henrique, Porto, Portugal; c University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC),Coimbra, Portugal; d William James Research Center, Departamento de Educac ¸ão e Psicologia, Universidade de Aveiro, Aveiro, Portugal

KEYWORDS:
Pregnancy; attachment style; compassion; MANOVA; discriminant analysis FC07 The association between perinatal depressive symptoms and parental separation I. Liakea a,b , N. Kollia a,c , M. Nord a , E. Fransson a , M. Bodin d , J. Cox e , E. Br€ ann a,f and A. Skalkidou a a Department of Women's and Children's Health, Uppsala University, Sweden; b Behavioral Science Institute, Radboud University, The Netherlands; c Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Greece; d Centre for Medical Humanities, Uppsala University, Sweden; e Keele University, UK; f Institute of Environmental Medicine, Karolinska Institute, Sweden depression and relational risk in CAREGIVING interactions D. Sullivan a , R. Spencer a and D. Shai D b a Pemworks, Israel, UK; b The Academic College of Tel Aviv Yaffo, Israel

KEYWORDS:
Postpartum depression; perinatal mental health; mistreatment during facility-based childbirth; respectful maternity care FC10 Perceived trauma, birth satisfaction, and postpartum depression: women's experiences in the greekcypriot context A. Christoforou a , P. Vogazianos a and E. Hadjigeorgiou b a European University Cyprus, Cyprus; b Cyprus University of Technology, Cyprus Background: Several studies that have emerged in the last decade highlight the exceptionally high levels of childbirth medicalization in Cyprus.The literature suggests that unnecessary interventions or interventions without the mother's consent may result in traumatic experiences and low birth satisfaction, with negative outcomes for maternal mental health.Objectives: The primary objectives of this paper are to examine (a) the association between perceived trauma during childbirth and postpartum depressive symptoms, and (b) the association between birth satisfaction and postpartum depressive symptoms.The secondary objective is to examine whether postpartum depressive symptoms are associated with the mode of birth.Methods: This paper draws on data collected in Cyprus through the International Survey of Childbirth-Related Trauma (INTERSECT).The sample consists of 171 women, who were recruited between October 2022 and March 2023 through healthcare settings and had given birth in the previous 6-12 weeks.

KEYWORDS:
Postnatal depression; mother-baby unit; mother-infant interaction; vocal interaction; microanalysis POSTERS PO02 Health professional care impact on maternal mental health on miscarriage and stillbirth: a study protocol of a non-randomized trial C. Garcia-Terol a,b , E. Motrico c , J. Goberna-Tricas b and J. Asensi-Vicente a a Parc Sanitari Sant Joan De Deu, Spain; b Universitat de Barcelona, Spain; c Universidad Loyola Andalucia, Spain

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Stillbirth; miscarriage; grief; bereavement; maternal mental health PO05 Depression in female prisoners in the Czech Republic postpartum A. Lochmannov� a a and C. Martin b a University of West Bohemia, Czech Republic; b University of Suffolk, UK

KEYWORDS:
Perinatal severe depression; psychotic symptoms; multidisciplinary interventions; trauma-informed PO09 Prenatal mental health problems and fear of childbirth PO11 Socio-demographic and obstetric factors in correlation to postpartum depression assessed by Edinburgh Postnatal Depression Scale D. Gagua a , T. Gagua a , N. Okribelashvili b and A. Chonishvili b a David Tvildiani Medical University, Georgia; b Tbilisi State University, Georgia Background: Postpartum depression (PD) is a mental disorder and one of the most common and tabooed complications of childbirth.

KEYWORDS:
Postpartum depression; Edinburgh Postnatal Depression Scale; obstetrical risk factors; socio demographic risk factors PO13 Anhedonia-related symptoms have increased in women in the perinatal period during the COVID-19 pandemic R. Costa a,b,c , T. Costa c , A. Conde d , A. Mesquita e , E. Motrico f and B. Figueiredo e a EPIUnit, Instituto de Sa� ude P� ublica, Universidade do Porto, Porto, Portugal; b Laborat� orio para a Investigac ¸ão Integrativa e Translacional em Sa� ude Populacional (ITR), Portugal; c Hei-Lab: Digital Human-Environment Interaction Lab.Faculty of Psychology, Education and Sports, Lusofona University, Portugal; d INPP -Portucalense Institute for Human Development, Portucalense University, Portugal; e School of Psychology, University of Minho, Portugal; f Psychology Department, Universidad Loyola Andalucia, Seville, Spain

KEYWORDS:
Perinatal period; war; anxiety; post-traumatic stress; depression; birth trauma symptomsPO16Postpartum depression, anxiety and parental burnout in BULGARIAN mothersV.Aravena and C. HanchevaSofia University "St.Kliment Ohridski", Bulgaria Background: Postpartum depression, postpartum anxiety, and parental burnout are partly overlapping constructs.Both postpartum depression and anxiety are believed to be caused by hormonal changes, genetic predisposition, psychological factors, and social factors at the time of pregnancy and the first year postpartum.Parental burnout is largely related to chronic stress, overwhelming responsibilities, and lack of support in the parenting role.Objectives: The present study aims to reveal the impact of postpartum depression and postpartum anxiety on developing parental burnout at the early stages of parenting and to screen the levels of postpartum anxiety and depression one and two years after the pandemic lockdowns.Methods: A cross-sectional study was conducted with mothers of children under 2 years at three time points: (1) March 2021 (n ¼ 125); (2) March 2022 (n ¼ 95); (3) March 2023 (n ¼ 141).Respondents were screened for depressive symptoms (EPDS), anxiety (GAD-7), and parental burnout (PBI).Results: The results showed similarly elevated levels at three time points compared to the estimated pre-pandemic range.Postpartum depression appeared as a significant predictor of parental burnout (Adj.R 2 ¼ 0.37, F(1, 235) ¼ 139.92, p < .001)(b ¼ 0.38, p < .001),and anxiety adding 0.04 to the model (Adj.R 2 ¼ 0.41, F (2, 233) ¼ 82.33, p < .001),(b ¼ 0.30, p < .001).Demographic factors were not significantly associated with levels of depression, anxiety and parental burnout.Discussion: Developing individualized treatment plans for parents, independently assessing each condition is recommended.KEYWORDS: Postpartum depression; postpartum anxiety; parental burnout PO17 Challenges of screening and identifying perinatal depression in the United Kingdom: a narrative review

KEYWORDS:
Perinatal depression; social support; isolation; risk factors; COVID-19 PO20 The healthy moms and babies app to prevent postpartum depression: analysis of abandonment cases K. Kovacheva a , M. Rodr� ıguez-Muñoz a , H. Garc� ıa-Lopez b , L. Huynh-Nhu c , N. Ruiz a , M. Olivares d , N. Izquierdo d and P. Coronado d a Universidad Nacional de Educaci� on a Distancia, Spain; b University of Maryland Global Campus (Europe Site); c George Washington University, USA; d Universidad Complutense de Madrid, Spain

KEYWORDS:
Perinatal depression; m-health; mobile app; healthcare, dropout PO21 Positive and negative affect during pregnancy and postpartum: the role of experiential avoidance in the prediction of perinatal depression M. Provencio a , M. Lopez a and M. Rodr� ıguez b a Universidad Camilo Jos� e Cela, Spain; b Universidad Nacional de Educaci� on a Distancia, Spain Background: Postpartum depression (PPD) is the most prevalent disorder in the perinatal period.Despite research on PPD risk factors, exploring psychological processes involved is necessary.Evidence suggests experiential avoidance (EA) and emotions, play a significant role in depression.
000) and PANAS-P (b ¼ −0.195, p ¼ .014)are significant predictors of EPDS, while in the postpartum, all of them, PANAS-N (b ¼ 0.548, p ¼ .000),PANAS-P (b ¼ −0.208, p ¼ .002),and EA (b ¼ 0.186, p ¼ .017),are significant predictors of EPDS.Discussion: Our results help us understand the EA mechanism in the PPD.Previous beliefs about motherhood could be thwarted, increasing emotional distress and decreasing EA mechanisms.KEYWORDS: Postpartum depression; experiential avoidance; positive affect; negative affect; predictors PO22 The role of perceived stress and stress coping in women as predictors of perinatal depression M. L� opez a , M. Provencio a , C. G� ongora a and M. F. Rodr� ıguez-Muñoz b a Universidad Camilo Jos� e Cela, Spain; b Universidad Nacional de Educaci� on a Distancia, Spain Background: Postpartum depression (PPD) is widely studied due to its high prevalence and negative consequences.

KEYWORDS:
Psychopathology; perinatal period; prevention; clinical interventionsPO25Postpartum disorder characterizes the future relationship between mother and children E. Tsamadou and C. MallidouGeneral Hospital of Thessaloniki -Ippokratio, Greece Background: Postpartum disorder fluctuates between "baby blues" or severe depression and/or psychosis.Those children may appear with sleep problems, food problems, tantrums, less socialization and predisposition to depression.

KEYWORDS:
Postpartum disorder; depression; psychotherapy PO26 Psychodynamic background of postpartum depression E. Tsamadou and C. Mallidou General Hospital Of Thessaloniki -Ippokratio, Greece

childbirth plans during the COVID-19 pandemic and posttraumatic stress symptoms: a cross-national study
American College of Greece, Greece; m King's College London, UK; n University of Santiago de Compostela, Spain; o Cyprus University of Technology, Cyprus; p Universidad Nacional de Educaci� on a Distancia, Spain; q National University of Entre Rios, Argentina; r Universidad Aut� onoma de Entre R� ıos, Argentina; .Mesquita a,b � , R. Costa c,d,e � , P. Dikmen-Yildiz f , S. Faria g , G. Silvestrini a , V. Mateus h , E. Vousoura i , C. A. Wilson j , E. Felice k , E. Ajaz l , E. Hadjigeorgiou m , C. Hancheva n , Y. Contreras-Garc� ıa o , S. Dom� ınguez-Salas p , E. Motrico p , I. Soares a and S. Ayers q EPIUnit -Instituto de Sa� ude P� ublica, Universidade do Porto, Porto, Portugal; d Laborat� orio para a Investigac ¸ão Integrativa e Translacional em Sa� ude Populacional (ITR), Universidade do PortoPorto, Portugal; e Hei-Lab: Digital Human-Environment Interaction Lab, Lus� ofona University, Porto, Portugal; f Department of Psychology, Kirklareli University, Kirklareli, Turkey; g University of Minho, Center of Mathematics, Braga, Portugal; h Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal; -� Avila c and A. Mesquita s a Universidad Loyola Andalucia, Spain; b Instituto de Sa� ude P� ublica da Universidade do Porto, Portugal; c Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal; d Mackenzie Presbyterian University, São Paulo, Brasil; e Bar Ilan University, Israel; f Universidad de Concepci� on, Chile; g Beder College University, Tirana, Albania; h European University Cyprus, Cyprus; i Kirklareli University, Turkey; j University of Malta, Malta; k Sofia University, Bulgaria; l s Universidade do Minho, Braga, Portugal Presentation 4: Changes to women's Aa School of Psychology, University of Minho, Braga, Portugal; b Current affiliation: ProChild CoLAB, Guimarães, Portugal; c i Department of Psychology, School of Philosophy, National and Kapodistrian University of Athens, Greece; j Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, UK; k Department of Psychiatry, University of Malta, Msida, Malta; l Department of Education and English Language, Beder University College, Tirana, Albania; m Department of Nursing, School of Health Science, Cyprus University of Technology, Limassol, Cyprus; n Sofia University "St.Kliment Ohridski", Bulgaria; o Departamento de Obstetricia y Puericultura, Facultad de Medicina, Universidad de Concepci� on, Chile; p Department of Psychology, Universidad Loyola Andaluc� ıa, Dos Hermanas, Spain; q Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, University of London, London, UK � These authors equally contributed to the present work.
A. M. Neves a , F. G. Sampero b , R. Costa c , B. Sousa a,d , D. Faria e , T. Kneib f , R. Martins g , A. Mayr h and T. Munk-Olsen i Faculty of Psychology and Education Sciences, CINEICC, University of Coimbra, Coimbra, Portugal; b Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; c Public Health Institute -ISPUP, University of Porto, Porto, Portugal; d Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; e Instituto Superior T� ecnico, University of Lisbon, Lisbon, Portugal; f Faculty of Business and Economic Sciences, University of G€ ottingen, G€ ottingen, Germany; g Department of Statistics and Operational Research, University of Lisbon, Portugal; h Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany; i National Center for Register-based Research, Aarhus University, Aarhus, Denmark Artificial Intelligence (AI) is present in various areas of society such as medicine, education, or science. a

principles Presentation 2: Research data management and DMPs in the context of PPD
Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; d Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; e Faculty of Business and Economic Sciences, University of G€ ottingen, G€ ottingen, Germany; f Department of Statistics and Operational Research, University of Lisbon, Portugal; g Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), University of Bonn, Bonn, Germany; h National Center for Register-based Research, Aarhus University, Aarhus, Denmark.
KEYWORDS: Artificial intelligence; mental health; ethics in research; FAIR D. Faria a , R. Costa b , B. Sousa c , F. G. Sampero d , T. Kneib e,f , R. Martins e,f , A. Mayr g , T. Munk-Olsen h and A. M. Neves c a Instituto Superior T� ecnico, University of Lisbon, Lisbon, Portugal; b Public Health Institute -ISPUP, University of Porto, Porto, Portugal; c

Presentation 1: Unveiling perinatal depression: task-based approaches to brain imaging and cognitive assessment
Brain imaging studies have revealed structural and functional alterations in key brain regions implicated in emotional regulation, including the amygdala, prefrontal cortex, and anterior cingulate cortex in PPD.Cognitive assessment tasks have provided evidence of attentional bias toward negative stimuli, impaired executive functioning, and deficits in memory and learning processes.Discussion: The integration of multiple assessment modalities enables a comprehensive understanding of the underlying mechanisms of PPD.While these approaches have yielded important findings, their limitations must be acknowledged.Overcoming these limitations through longitudinal studies, objective measures, and larger sample sizes will contribute to a more comprehensive understanding of PPD, ultimately informing the development of targeted interventions.Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; b Lise Meitner Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany Objectives: This presentation aims to provide an overview of the different tasks used in brain imaging and cognitive assessment to better understand PPD-impacted domains, such as emotional processing, reward sensitivity and executive functioning.Methods: Review literature on tasks used in PPD research and critically synthesize results.Results: KEYWORDS: Perinatal depression; brain imaging; cognitive assessment; neural correlates Presentation 2: A comprehensive meta-analysis on neural correlates of PPD M. Sobral a , R. Guiomar a , A. Ganho-� Avila a and A. Schuler b a CONTACT A. Schuler Mateus a , A. Os� orio b , H. Moreira a , H. O. Miguel c , J. Baptista a , M. Sousa d and S. Cruz e Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; b Developmental Disorders Program and Mackenzie Center for Research in Childhood and Adolescence, Mackenzie Presbyterian University, São Paulo, Brazil; c Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, USA; d The Psychology for Positive Development Research Center, Lus� ıada University -Porto, Portugal; e Department of Psychology, School of Philosophy, Psychology &amp Language Sciences, University of Edinburgh, UK V.a e , E. Fransson f , A. R. Mesquita a , B. Figueiredo a and A. Skalkidou f Faculty of Health Sciences, Department of Nursing, University of Granada, Granada, Spain; e Instituto de Investigaci� on Biosanitaria ibs.GRANADA, Granada, Spain; f Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden � Both authors contributed equally to this work

systematic review on women preferences on screening for perinatal depression: preliminary results
. M. Gomez a , C. Martin b , R. V. Damme c , K. Uriko d , T. S. Perdih e , M. P. R. Lozano a , C. Toscano, H. Moreira f , G. Kalcev g , C. Zerafa h and I. Lega i a Andalusian Agency for Health Technology Assessment-Progress and Health Foundation, Spain; b University of Suffolk, UK; c Universitair Ziekenhuis Gent, Belgium; d Tallinn University, Tallinn, Estonia; e School of Advanced Social Studies, Slovenia; f Center for Research in Neuropsychology and Cognitive-Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; g University of Cagliari, Italy; h Mater Dei Hospital, Malta; i Istituto Superiore di Sanit� a, Rome, Italy KEYWORDS: Screening; perinatal depression; perinatal mental disorders Presentation 4: A C

Presentation 1: Associations between paternal postpartum depressive symptoms and hair testosterone and cortisol levels over 2 postpartum years: a random intercept cross-lagged panel model analysis
Hospital of W€ urzburg, W€ urzburg, Germany; e Department of Opthalmology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany; f Institute of Peripartal Interventions, Frankfurt, Germany; g Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, University of Frankfurt, Goethe-University, Frankfurt, Germany; h Department of Obstetrics and Gynecology, Buergerhospital Frankfurt, Frankfurt/Main; i Department of Psychiatry, University College of Cork, Cork, Ireland.
� Shared first authorship Universidad Nacional de Educaci� on a Distancia, Spain; b Universidad de Huelva, Spain; c Universidad Loyola Andaluc� ıa, Spain Background: Studies during the coronavirus pandemic (COVID-19) have reported an increase in the prevalence of perinatal depression (PPD) from 22% to 31%.Depressive symptoms are negatively associated with perceived social support, social isolation, frequency of video calls, and perceived loneliness.However, research is scarce and methodologically limited. a To better understand PPD and typical maternal functioning, this study proposes a multimodal longitudinal research plan assessing cognitive and psychological functioning, clinical status, brain activity in parental brain networks (social cognition, emotion regulation, and executive functions), and the caregiving behavioral system.
Perinatal mental health is a clinical and social need to be protected through an adequate response of care and promotion.Objectives: This study aims to present the approach of the Matteo Rota Perinatal Outpatient Service (MRPOS) of the ASST-Papa Giovanni XXIII Hospital located in Bergamo, Italy.Methods: Description of the MRPOS model of intervention as a service dedicated to prevention and treatment of psychopathology and psychological distress in the perinatal period.Results: The model of intervention has been developed in the field of care and prevention as follow.Future and new parents coming from the departmental territory can access the service directly or by referral, in short time and for free.Personalized, multidisciplinary treatment programs are offered.Interventions address mother, father and couples to enhance the triad development and quality of life.The assumption is that parental mental health is the prerequisite for the best neurodevelopment of the fetus-child-future adult.In addition to healing paths, preventive interventions are guaranteed as well: since 2016 a screening program for pregnant women accessing the hospital have been implemented to detect early signs of psychological distress, and to provide quick interventions if needed.The team is composed by two psychiatrists, three psychologists-psychotherapists, two psychologists and a psychiatric rehabilitation technician; the Service collaborates with obstetricians and with the Toxicology National Center held in the same hospital.
KEYWORDS:Peripartum depression; peripartum anxiety; neuroplasticity; caregiving Peripartum depression (PPD) is a common and complex condition associated with various unfavorable outcomes and an array of interrelated biological and psychosocial risk factors.The biopsychosocial model is considered to describe PPD best.Nevertheless, PPD has been investigated mostly unilaterally, focusing on biological or psychosocial aspects separately.Responding to such shortcomings, several biopsychosocial models of PPD emerged from the literature.Objectives: This narrative review aimed to provide an overview of the current state of the science on risk factors and biopsychosocial theoretical models of PPD and outline directions for future research and clinical practice.Methods:A literature search was conducted in databases to identify risk factors and biopsychosocial models of PPD.Results: There are several biopsychosocial models that account for depression during pregnancy, postpartum or the entire peripartum period.The chronological development in complexity of the biopsychosocial models is apparent, displaying the evolution of the biopsychosocial paradigm in PPD research.The conceptualization and suggested causal mechanisms for PPD vary between the existing models.Furthermore, some models neglected biological variables or more specific contextual and cultural factors that are robust in the literature.Risk factor dimensions are unequally represented, with variables constituting a biological dimension of PPD differing the most across the models.Conclusions:The biopsychosocial paradigm should be prioritized in research and clinical settings as a valuable framework for a comprehensive understanding of PPD.However, further evaluation and refinement of the biopsychosocial models in larger-scale integrative studies are needed.