Disrupted Reinforcement Learning and Maladaptive Behavior in Women With a History of Childhood Sexual Abuse A High-Density Event-Related Potential Study Disrupted Reinforcement Learning

Pechtel P, Pizzagalli DA. — Wed, 01 May 2013 00:00:00 GMT

Importance

Childhood sexual abuse (CSA) has been associated with psychopathology, particularly major depressive disorder (MDD), and high-risk behaviors. Despite the epidemiological data available, the mechanisms underlying these maladaptive outcomes remain poorly understood.

Objective

We examined whether a history of CSA, particularly in conjunction with a past episode of MDD, is associated with behavioral and neural dysfunction in reinforcement learning, and whether such dysfunction is linked to maladaptive behavior.

Design

Participants completed a clinical evaluation and a probabilistic reinforcement task while 128-channel event-related potentials were recorded.

Setting

Academic setting; participants recruited from the community.

Participants

Fifteen women with a history of CSA and remitted MDD (CSA + rMDD), 16 women with remitted MDD with no history of CSA (rMDD), and 18 healthy women (controls).

Exposure

Three or more episodes of coerced sexual contact (mean [SD] duration, 3.00 [2.20] years) between the ages of 7 and 12 years by at least 1 male perpetrator.

Main Outcomes and Measures

Participants' preference for choosing the most rewarded stimulus and avoiding the most punished stimulus was evaluated. The feedback-related negativity and error-related negativity—hypothesized to reflect activation in the anterior cingulate cortex—were used as electrophysiological indices of reinforcement learning.

Results

No group differences emerged in the acquisition of reinforcement contingencies. In trials requiring participants to rely partially or exclusively on previously rewarded information, the CSA + rMDD group showed (1) lower accuracy (relative to both controls and the rMDD group), (2) blunted electrophysiological differentiation between correct and incorrect responses (relative to controls), and (3) increased activation in the subgenual anterior cingulate cortex (relative to the rMDD group). A history of CSA was not associated with impairments in avoiding the most punished stimulus. Self-harm and suicidal behaviors correlated with poorer performance of previously rewarded, but not previously punished, trials.

Conclusions and Relevance

Irrespective of past MDD episodes, women with a history of CSA showed neural and behavioral deficits in utilizing previous reinforcement to optimize decision making in the absence of feedback (blunted “Go learning”). Although our study provides initial evidence for reward-specific deficits associated with CSA, future research is warranted to determine if disrupted positive reinforcement learning predicts high-risk behavior following CSA.

Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings Depression Screening in Postpartum Women

Wisner KL, Sit DY, McShea MC, et al. — Wed, 01 May 2013 00:00:00 GMT

Importance

The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression.

Objectives

To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions.

Design

Sequential case series of women who recently gave birth.

Setting

Urban academic women's hospital.

Participants

During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes.

Main Outcomes and Measures

A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: “The thought of harming myself has occurred to me” (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses.

Results

Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders.

Conclusions and Relevance

The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed.

Trial Registration

clinicaltrials.gov Identifier: NCT00282776

JAMA Psychiatry: Depression and Dysthymia Topic Collection

Disrupted Reinforcement Learning and Maladaptive Behavior in Women With a History of Childhood Sexual Abuse A High-Density Event-Related Potential Study Disrupted Reinforcement Learning

Onset Timing, Thoughts of Self-harm, and Diagnoses in Postpartum Women With Screen-Positive Depression Findings Depression Screening in Postpartum Women