Abstract
The study of women's health and reproductive medicine involves not only physiology and pathology, but also the many psychological and social factors that interface with human biology to influence the onset and outcome of diseases in women. The North American Society for Psychosocial Obstetrics and Gynecology is a group dedicated to the study of these factors. At its recent meeting in Columbus, Ohio (USA), the society presented the latest research on behavioral and mental health aspects of caring for women. Two of the themes that were featured at this meeting were the psychosocial aspects of treating cancer in women, and the interplay between stress and pregnancy.
The North American Society for Psychosocial Obstetrics and Gynecology (NASPOG) is an interdisciplinary group that recognizes the importance of psychological, social and cultural issues impacting the diseases of women and their treatment. The society brings together obstetrician–gynecologists, psychiatrists, psychologists, nurses and social workers in an effort to promote research into these issues and to encourage collaboration between various disciplines in caring for women.
The society hosts a biennial meeting to showcase the current research and schools of thought involving aspects of women's mental health. At each meeting, a variety of symposia are organized to highlight particular fields of women's health that involve psychological and social concerns. The program planners traditionally try to balance topics that involve pregnancy and the postpartum period with gynecological topics and issues of general interest to the care of women. At this year's conference, which was held from 6–9 April in Columbus, Ohio (USA), the symposia that were featured were:
Stress and social stressors in pregnancy;
Psychosocial aspects of cancer treatment;
Psychosocial education in women's health;
Fear and anxiety surrounding labor;
Impact of psychotropic drug exposures in pregnancy;
Psychological issues related to abortion.
An impressive array of research and background talks were presented in all of these areas, but two topic areas offered a particularly rich collection of findings and ideas. The symposium on treating cancer in women highlighted important scientific work to demonstrate that attention to psychosocial aspects improves not only quality of life issues for cancer victims but outcomes of treatment as well. Another overarching theme arising from the meeting was how stress can impact all aspects of pregnancy, from conception to delivery.
Psychosocial aspects of cancer treatment
Presenters who focused on cancer treatment in women emphasized that both the diagnosis and treatment of cancer profoundly impact mental health and that the presence of co-existing mood and anxiety disorders can influence the response to treatment. Although addressing mental health needs cannot be overemphasized, it is often rarely addressed during routine oncology care due to lack of expertise, time and/or resources. The speakers highlighted efforts to address these issues in the clinical setting.
Barbara Andersen, Professor in Psychology and Obstetrics and Gynecology at the Ohio State University Wexner Medical Center (OSUWMC), presented an overview of depression and mental health after breast cancer. She highlighted that although frequently unrecognized, roughly 20–25% of cancer patients have comorbid mood or anxiety disorders. Efficacious psychological therapies, such as cognitive behavior therapy, need to be utilized.
Along these same lines, Kristen Carpenter, Clinical Health Psychologist at the OSUWMC, presented her R21 sponsored data regarding sexuality and cancer survivorship. She highlighted that sexual morbidity is common in cancer survivors and these issues contribute to poor quality of life outcomes. Developing and incorporating resources are available and simple behavioral strategies can be introduced to improve outcomes.
Ritu Salani, Assistant Professor in Gynecologic Oncology at the OSUWMC, addressed the impact of cancer on the mental health of both survivors and their caregivers. Focusing on fear of cancer recurrence and psychosocial stressors experienced by their caregivers, the importance of continuing to monitor mental health after active treatment is critical to promote improved quality of life.
Susan Lutgendorf, Professor in Psychology, Obstetrics and Gynecology, and Urology at the University of Iowa (USA), discussed biobehavioral pathways by which psychosocial stress can enhance tumor growth in ovarian cancer. She presented preclinical experimental evidence and clinical correlates of stress promoting invasion and survival of tumor cells. She highlighted that reducing stress may positively affect cancer outcomes.
Pregnancy & stress
Another main theme of this conference was the interplay of stress and maternal–fetal health. The clinicians and researchers who spoke about these issues demonstrated that not only can stress impact the outcome of pregnancy from conception to birth, but that a stressful experience of pregnancy and birth may negatively impact women's mental health. In addition, underlying psychiatric disorders can become more pronounced in the process of childbearing and represent an important risk factor that should be considered in the care of all women.
Courtney Lynch, Director of Reproductive Epidemiology and Assistant Professor of Obstetrics and Gynecology, Epidemiology and Pediatrics at the OSUWMC presented her research on the role of stress in the time-to-pregnancy interval and infertility. While many anecdotes exist of infertility patients who became pregnant after a sudden decrease in stress (after a vacation or adoption), scant data have been previously available looking at this phenomenon more quantitatively. She reported that women with higher objective levels of stress were 30% less likely to become pregnant each month, and she suggested techniques such as yoga to help reduce pre-pregnancy stress.
Catherine Monk, Associate Professor in Psychiatry and Obstetrics and Gynecology and the Director of Research at the Women's Program at Columbia University, described the effect of stress on fetal heart rate patterns during nonstress testing. By measuring maternal cortisol she was able to divide women into categories of stress; fetuses exposed to higher rates of maternal cortisol were more likely to have higher baseline fetal heart rates and increased variability patterns on nonstress testing compared with those fetuses with lower cortisol exposure. As these changes in heart rate could impact the effect of stress on infants even after pregnancy, interventions to improve stress management during pregnancy are critical.
Arthur James, Associate Professor in Obstetrics and Gynecology at the OSUWMC and on the Pediatric faculty with Nationwide Children's Adolescent Medicine Fellowship, discussed the epidemiologic consequences of racial discrepancies in pregnancy outcomes. He highlighted neonatal mortality data from individual states and demonstrated the detrimental association between African–American race and maternal and infant well-being; these differences cross socio economic lines, suggesting that racism plays an important role.
Also looking at risks for poor pregnancy outcome, Jay Iams, Emeritus Frederick P Zuspan Professor and Endowed Chair at the OSUWMC in MFM, gave the Paul C Weinberg Memorial Lecture on Stress and Preterm Birth. He reported that African-American women are at the highest risk for preterm birth. He noted that this risk is not attributed to a lack of access to prenatal care, but rather the cumulative effect of racism on stress levels in these patients is possibly the contributing factor in the incidence of preterm birth.
Following childbirth, some women go on to develop postpartum depression or post-traumatic stress disorder (PTSD). Marieke Paarlberg, an Obstetrics and Gynecology at the Gelre Teaching Hospital Apeldoorn and Claire Stramrood, Obstetrics and Gynecology resident at Meander Medical Center in Amersfoort, The Netherlands, gave a combined lecture on PTSD following childbirth. With the assessment of risk factors, pregnancy-related complications, and the consequences of PTSD, they highlighted management strategies, such as cognitive-behavioral therapy, and the need for increased attention to this topic in order to provide truly comprehensive pregnancy care.
Conclusion & future perspective
The presentations made at this meeting provide further evidence of the important interactions between the mental and social aspect of healthcare and the biology of women's health. Hopefully, additional research will examine how attention to women's mental health and reducing stress can improve a broad spectrum of health outcomes, from cancer survival to pregnancy success and infant health. Additional prospective trials are needed to determine if psychotherapeutic modalities including medications, interpersonal therapy and stress reduction programs will lead to measurable improvements in outcomes in susceptible women. NASPOG invites researchers with an interest in these topics to share their work in future forums, or by visiting the society's website at www.naspog.org. There will hopefully be an opportunity to hear about additional developments in this field when NASPOG holds its next conference in New York City (USA) in 2016.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.