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Despite recommendations from the World Health Organization and the American Academy of Pediatrics to exclusively breastfeed infants for their first 6 months of life, 75% of women do not meet exclusive breastfeeding guidelines, and 60% do not meet their own breastfeeding goals. Numerous observational studies have linked maternal psychological distress (eg, perceived stress, anxiety, and depression) with nonoptimal breastfeeding outcomes, such as decreased proportion and duration of exclusive breastfeeding. The physiological mechanisms underlying these associations, however, remain unclear. For this narrative review, we evaluated the evidence of relationships between maternal psychological distress and lactation and breastfeeding outcomes in pregnancy and post partum and the possible physiological mechanisms that facilitate these relationships. We searched PubMed using the following terms: stress, anxiety, depression, breastfeeding, and lactation. Additional search by hand was conducted to ensure a thorough review of the literature. Among the studies examined, methods used to assess maternal psychological distress were not uniform, with some studies examining perceived distress via a variety of validated tools and others measuring biological measures of distress, such as cortisol. Evidence supports a role for psychological distress in multiple breastfeeding outcomes, including delayed secretory activation and decreased duration of exclusive breastfeeding. One physiological mechanism proposed to explain these relationships is that psychological distress may impair the release of oxytocin, a hormone that plays a critical role in milk ejection during lactation. Continued impairment of milk ejection may lead to decreased milk production because of incomplete emptying of the breast during each feed. Maternal distress may also yield elevated levels of serum cortisol and decreased insulin sensitivity, which are associated with decreased milk production. The relationship between psychological distress and breastfeeding is likely to be bidirectional, however, in that breastfeeding appears to reduce maternal distress, again possibly via effects on the pleasure or reward pathway and calming effects of oxytocin on the mother. This finding suggests that interventions to support lactation and breastfeeding goals in women who score high on measures of psychological distress would be beneficial for both maternal and infant well-being. Evidence to date suggests that maternal psychological distress may impair lactation and breastfeeding outcomes, but stronger study designs and rigorous assessment methods are needed. A better understanding of the physiological mechanisms leading to impaired lactation may assist in the development of early interventions for mothers experiencing distress. In addition, stress-reducing programs and policies should be investigated for their potential to improve breastfeeding outcomes.

Background Baicalin, which is isolated from Radix Scutellariae , possesses strong biological activities including an anti-inflammation property. Recent studies have shown that the anti-inflammatory effect of baicalin is linked to toll-like receptor 4 (TLR4), which participates in pathological changes of central nervous system diseases such as depression. In this study, we explored whether baicalin could produce antidepressant effects via regulation of TLR4 signaling in mice and attempted to elucidate the underlying mechanisms. Methods A chronic unpredictable mild stress (CUMS) mice model was performed to explore whether baicalin could produce antidepressant effects via the inhibition of neuroinflammation. To clarify the role of TLR4 in the anti-neuroinflammatory efficacy of baicalin, a lipopolysaccharide (LPS) was employed in mice to specially activate TLR4 and the behavioral changes were determined. Furthermore, we used LY294002 to examine the molecular mechanisms of baicalin in regulating the expression of TLR4 in vivo and in vitro using western blot, ELISA kits, and immunostaining. In the in vitro tests, the BV2 microglia cell lines and primary microglia cultures were pretreated with baicalin and LY292002 for 1 h and then stimulated 24 h with LPS. The primary microglial cells were transfected with the forkhead transcription factor forkhead box protein O 1 (FoxO1)-specific siRNA for 5 h and then co-stimulated with baicalin and LPS to investigate whether FoxO1 participated in the effect of baicalin on TLR4 expression. Results The administration of baicalin (especially 60 mg/kg) dramatically ameliorated CUMS-induced depressive-like symptoms; substantially decreased the levels of interleukin-1 beta (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) in the hippocampus; and significantly decreased the expression of TLR4. The activation of TLR4 by the LPS triggered neuroinflammation and evoked depressive-like behaviors in mice, which were also alleviated by the treatment with baicalin (60 mg/kg). Furthermore, the application of baicalin significantly increased the phosphorylation of phosphatidylinositol 3-kinase (PI3K), protein kinase B (AKT), and FoxO1. The application of baicalin also promoted FoxO1 nuclear exclusion and contributed to the inhibition of the FoxO1 transactivation potential, which led to the downregulation of the expression of TLR4 in CUMS mice or LPS-treated BV2 cells and primary microglia cells. However, prophylactic treatment of LY294002 abolished the above effects of baicalin. In addition, we found that FoxO1 played a vital role in baicalin by regulating the TLR4 and TLR4-mediating neuroinflammation triggered by the LPS via knocking down the expression of FoxO1 in the primary microglia. Conclusion Collectively, these results demonstrate that baicalin ameliorated neuroinflammation-induced depressive-like behaviors through the inhibition of TLR4 expression via the PI3K/AKT/FoxO1 pathway.

Many patients experience psychological distress in the preoperative phase, whilst screening based on cut-off points of assessment scales showed limited value in predicting clinical postoperative adverse outcomes. To identify preoperative psychological distress and investigate their associations with adverse surgery-related outcomes, we included 16,662 patients from the China Surgery and Anesthesia Cohort (CSAC). We applied dimensionality reduction and unsupervised machine learning algorithms to classify participants into distinct psychological patterns. We then assessed the associations of machine learning-identified psychological patterns and traditional cut-off based psychological symptoms, with various adverse surgery-related outcomes, using logistic and linear regression models while adjusting for other relevant covariates. We successfully established clustering algorithms for 16,298 participants, demonstrating strong consistency in pattern features. Six distinct psychological patterns among participants were identified, including one group with normal psychological functioning and five groups with varying levels of psychological distress. All identified psychological distress patterns were significantly associated with most surgery-related adverse outcomes, both in short-term (e.g., any within-hospital postoperative complication, odds ratios [ORs] = 1.24-1.30) and long-term (e.g., cognitive impairment at 12 months postsurgery, 1.29-2.35). In contrast, traditional cut-off-based methods identified only 266 patients with significant psychological symptoms, which showed no association with some key short-term outcomes (e.g., length of hospital stay and postoperative complication), though they remained linked to most long-term outcomes. Our findings demonstrate the effectiveness of machine learning in accurately identifying patients with preoperative psychological distress who may require clinical attention, highlighting the potential of these techniques to guide targeted preoperative interventions and ultimately improve surgical outcomes.

Background Psychological distress is common in patients with cancer; interfering with physical and psychological wellbeing, and hindering management of physical symptoms. Our aim was to systematically review published evidence on non-pharmacological interventions for cancer-related psychological distress, at all stages of the disease. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered on PROSPERO (CRD42022311729). Searches were made using eight online databases to identify studies meeting our inclusion criteria. Data were collected on outcome measures, modes of delivery, resources and evidence of efficacy. A meta-analysis was planned if data allowed. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results Fifty-nine studies with 17,628 participants were included. One third of studies included mindfulness, talking or group therapies. Half of all studies reported statistically significant improvements in distress. Statistically significant intervention effects on distress were most prevalent for mindfulness techniques. Four of these mindfulness studies had moderate effect sizes ( d  = -0.71[95% CI: -1.04, -0.37] p  <  0.001 ) ( d  = -0.60 [95% CI: -3.44, -0.89] p  <  0.001 ) ( d  = -0.77 [CI: -0.146, -1.954] p  <  0.01 ) ( d  = -0.69 [CI: -0.18, -1.19] p  =  0.008 ) and one had a large effect size ( d  = -1.03 [95% CI: -1.51, -0.54] p  <  0.001 ). Heterogeneity of studies precluded meta-analysis. Study quality was variable and some had a high risk of bias. Conclusions The majority of studies using a mindfulness intervention in this review are efficacious at alleviating distress. Mindfulness—including brief, self-administered interventions—merits further investigation, using adequately powered, high-quality studies. Systematic review registration This systematic review is registered on PROSPERO, number CRD42022311729.

The prevalence of serious psychological distress (SPD) was elevated during the COVID-19 pandemic in the USA, but the relationships of SPD during the pandemic with pre-pandemic SPD, pre-pandemic socioeconomic status, and pandemic-related social stressors remain unexamined. A probability-based sample ( = 1751) of the US population age 20 and over was followed prospectively from February 2019 (T1), with subsequent interviews in May 2020 (T2) and August 2020 (T3). Multinomial logistic regression was used to assess prospective relationships between T1 SPD with experiences of disruption of employment, health care, and childcare at T2. Binary logistic regression was then used to assess relationships of T1 SPD, and socioeconomic status and T2 pandemic-related stressors with T3 SPD. At T1, SPD was associated with age, race/ethnicity, and household income. SPD at T1 predicted disruption of employment (OR 4.5, 95% CI 1.4-3.8) and health care (OR 3.2, 95% CI 1.4-7.1) at T2. SPD at T1 (OR 10.2, 95% CI 4.5-23.3), low household income at T1 (OR 2.6, 95% CI 1.1-6.4), disruption of employment at T2 (OR 3.2, 95% CI 1.4-7.6), and disruption of healthcare at T2 (OR 3.3, 95% CI 1.5-7.2) were all significantly associated with elevated risk for SPD at T3. Elevated risk for SPD during the COVID-19 pandemic is related to multiple psychological and social pathways that are likely to interact over the life course. Policies and interventions that target individuals with pre-existing mental health conditions as well as those experiencing persistent unemployment should be high priorities in the mental health response to the pandemic.

Infant development plays a foundational role in optimal child development and health. Some studies have demonstrated an association between maternal psychological distress and infant outcomes, although the main emphasis has been on postpartum depression and infant-maternal attachment. Prevention and early intervention strategies would benefit from an understanding of the influence of both prenatal and postpartum maternal distress on a broader spectrum of infant developmental outcomes. We conducted a systematic review of studies assessing the effect of prenatal and postpartum maternal psychological distress on five aspects of infant development: global; cognitive; behavioral; socio-emotional; and psychomotor. These findings suggest that prenatal distress can have an adverse effect on cognitive, behavioral, and psychomotor development, and that postpartum distress contributes to cognitive and socio-emotional development.

Epidemics are associated with increased burden of psychological distress. However, the role of boredom on mental health during epidemic periods has seldom been explored. This study attempted to examine the effect of state boredom on psychological outcomes, and the role of media use and meaning in life among the indirectly exposed Chinese adults in the initial phase of the COVID-19 outbreak. An online survey was administered to 917 Chinese adults on 28 January 2020 (1 week after the official declaration of person-to-person transmission of the coronavirus). Self-report questionnaires were used to assess state boredom, anxiety, depression, stress, media use and meaning in life. Moderated mediation analysis was conducted. Our results indicated that the effect of state boredom on anxiety and stress, but not depression, were mediated by media use and that sense of meaning in life modified this association. Meaning in life served as a risk factor, rather than a protective factor for the negative psychological outcomes when people experienced boredom. The association between boredom and media use was significant for high but not low meaning in life individuals. These findings demonstrated that boredom and media use were associated with an increased burden or psychological distress in the sample. It is important to pay attention to the possible negative impact of boredom and media use during COVID-19, and find more ways to cope with boredom, especially those with high presence of meaning in life.

Decision-making is important for adolescent wellbeing, and predictive of several other outcomes. While past research demonstrates the role of maternal psychological distress in adolescent decision-making, the role of paternal psychological distress remains relatively unexplored. This study examined the association between trajectories of paternal and maternal psychological distress, jointly modelled, in childhood and child decision-making in early adolescence. Using data from 9846 families of the Millennium Cohort Study, we identified paternal and maternal psychological distress trajectories across child ages 3–11 using joint group-based trajectory modelling and explored their associations with offspring decision-making at age 11 with multiple linear regression models. Paternal and maternal psychological distress was measured with the Kessler-6 scale, while adolescent decision-making was assessed using the Cambridge Gambling Task. We identified 2 trajectories for fathers (‘low distress’ and ‘moderate-increasing distress’) and 4 for mothers (‘minimal distress’, ‘low distress’, ‘moderate-increasing distress’ and ‘severe distress’). When jointly modelled, paternal and maternal trajectories predicted decision-making in fully adjusted models. Compared to the ‘low distress’ paternal trajectory, the ‘moderate-increasing distress’ paternal trajectory was associated with less delay aversion, although this effect disappeared when examining only two-parent biological families. Compared to the ‘minimal distress’ maternal trajectory, the ‘moderate-increasing distress’ trajectory predicted slower deliberation time, whereas the ‘severe distress’ trajectory predicted greater risk-taking. There were no gender differences in these paths. Consistently moderate and high levels of maternal distress during childhood are associated with increased decision latency and greater risk-taking, respectively, in early adolescence. Highlights Across child ages 3–11 years, we identified 2 trajectories for paternal and 4 for maternal psychological distress. Adolescents (11-year-olds) of fathers with ‘moderate-increasing distress’ displayed less delay aversion in a computerised, decision-making task. In the same task, adolescents of mothers with ‘moderate-increasing distress’ had slower deliberation time. Adolescents of mothers with ‘severe distress’ showed greater risk-taking.

Purpose This study aimed to investigate changes over time in quality of life, perceived stress, and serious psychological distress for individuals diagnosed with COVID-19 in an urban academic health system. Methods Phone-based surveys were completed with adult patients tested for COVID-19 during emergency department visits, hospitalizations, or outpatient visits at the Froedtert and Medical College of Wisconsin Health Network. Data were then matched to medical record data. Unadjusted and adjusted mixed effects linear models using random intercept were run for each outcome (physical health-related quality of life, mental health-related quality of life, perceived stress, and serious psychological distress) with time (baseline vs 3-month follow-up) as the primary independent variable. Individuals were treated as a random effect, with all covariates (age, sex, race/ethnicity, payor, comorbidity count, hospitalization, and intensive care unit (ICU) stay) treated as fixed effects. Results 264 adults tested positive for COVID-19 and completed baseline and 3-month follow-up assessments. Of that number, 31.8% were hospitalized due to COVID-19, and 10.2% were admitted for any reason to the ICU. After adjustment, patients reported higher physical health-related quality of life at 3 months compared to baseline (0.63, 95% CI 0.15, 1.11) and decreased stress at 3 months compared to baseline (− 0.85, 95% CI − 1.33, − 0.37). There were no associations between survey time and mental health-related quality of life or serious psychological distress. Conclusions Results suggest the influence of COVID-19 on physical health-related quality of life and stress may resolve over time, however, the influence of mental health on daily activities, work, and social activities may not.

AbstractThe present study aimed to test a model of relations to ascertain the determinants of distress caused by lockdown for COVID-19. It was hypothesized that the exposure to the COVID-19 increased distress directly and through the mediation of worry, health-related information seeking, and perception of the utility of the lockdown. It was also expected that higher levels of ambiguity intolerance corresponded to higher distress directly and through the mediation of worry, health information seeking behaviors, and perceived utility of the lockdown. Finally, it was expected that risk aversion positively influenced distress directly and through the increasing of worry, health-related information seeking behavior, and more positive perception of the utility of the lockdown The study was conducted in Italy during the mandatory lockdown for COVID-19 pandemic on 240 individuals (age range 18–76). Data recruitment was conducted via snowball sampling. COVID-19 exposure was positively associated with worry and health-related information seeking. Risk-aversion was positively associated with health-related information seeking and perceived utility of the lockdown to contain the spread of the virus. Worry and health-related information seeking were positively associated with distress, whereas the perceived utility of the lockdown was negatively associated with distress. Intolerance for the ambiguity was directly linked to distress with a positive sign. Findings suggest that risk aversion represents both a risk factor and a protective factor, based on what kind of variable mediates the relationship with distress, and that the intolerance to the ambiguity is a risk factor that busters distress.