Women's Brain Health: Young Investigator Symposium

Bonnie Lee, PhD, University of British Columbia

Authors: Bonnie lee, Paula Duarte-Guterman, Muna Ibrahim, Rand S. Eid, Stephanie E. Lieblich, Nicole C. Minielly,
Daria Tai, Yanhua Wen, Liisa A.M. Galea

Pregnancy and motherhood (parity) are female-specific experiences associated with dramatic changes in physiology that can lead to repercussions in short-term as well as long-term health, including increased likelihood of developing certain mental health disorders. Females with Alzheimer’s disease (AD) show greater neuropathology and cognitive decline compared to males and interestingly, parity is further associated with a greater risk of AD, greater neuropathology, and an earlier age of AD onset. Previous parity also influences cognition and hippocampal neurogenesis in middle-aged rats. On the molecular level, increased parity is associated with increased neuroinflammation and reduced neurogenesis in the hippocampus – both of which are also observed in AD. This study investigates whether APOE4, a major genetic risk factor for sporadic AD, interacts with parity to influence spatial working memory,
neuroinflammation, and neurogenesis in middle-aged rats. We used an AD rat model that expresses the human form of APOE4. Age-matched wildtype and APOE4 female rats were either nulliparous (never mothered) or primiparous (first-time mothers). At middle-age (13-14 months of age, equivalent to 9 months postpartum in primiparous rats), rats were trained and tested on the delayed win-shift radial arm maze, in which spatial working memory performance depends on the integrity of the hippocampus and frontal cortex. APOE4 rats made more total errors than wildtype rats, but parity did not influence errors. However, primiparous rats made more omission errors than nulliparous rats. Analyses are ongoing to examine neuroinflammation and neurogenesis outcomes. This research has implications for the importance of tailored treatments based on the reproductive history and genotype of women with AD.

Brooke Belanger, PhD Candidate, University of Calgary

Authors: Brooke Belanger, Michael Avery, Arindom Sen & Alim Mitha

Background: Intracranial aneurysms (IAs) are small pockets caused by broken down blood vessels in the brain.  They affect up to 5% of the population, and women are more likely to be affected compared to men at a ratio of 3:2. Women over the age of 55 are 1.5 times more likely to have an IA rupture, which results in fatality 50% of the time. Treatments fail 30% of the time. Before new treatment can be discovered, a sufficient model to mirror human IAs is needed. The goal of this research was to improve current models and produce IAs with an IA size considered treatable in humans, which is greater than 5mm in any dimension. Methods: Thirty two female New Zealand rabbits were allocated into four groups. The right carotid artery was exposed in surgery. An aneurysm clip was placed at the brachiocephalic bifurcation and a ligature was placed 2 or 3cm distal to the clip. The solution, either elastase or elastase with calcium chloride, was placed in the stagnant vessel stump for 20 minutes. The clip was then removed for reperfusion. Animals were recovered; 28 days later an angiogram was performed to visualize the aneurysm. Results: Using Student’s T-test and ANOVA tests, we determined that the experimental model provided significantly larger aneurysms (p<0.05) compared to controls. Originally, successful aneurysms (>5mm) were only created 50% of the time. The experimental model produced aneurysms successfully 100% of the time. Conclusions: This experiment has produced a better aneurysm model, which will lead to better treatments for human aneurysms.

Figure 1. A visual representation of the aneurysms based on average width, height and opening. The red group is the standard accepted model. The green group is the experimental group which provided significantly larger height, width and volume.

Colin Wallace, PDF, University of British Columbia

Authors: Wallace C, Smirl JD, Jones KE, Val Crocker C, Maldonado-Rodriguez N, Boyle Q, van Donkelaar P

Background: Intimate partner violence (IPV) affects one third of females globally and up to 92% of these individuals will concurrently suffer a traumatic brain injury (TBI). Response inhibition, an executive control process responsible for suppressing inappropriate actions, is commonly impaired following many forms of TBI; however, it has yet to be investigated in IPV survivors. Impairment can lead to impulsive behavior and a reduced capacity to successfully complete everyday tasks. The purpose of this study was to assess response inhibition impairment in IPV-related TBI. Hypothesis: Response inhibition will be impaired following IPV-related TBI and correlates with brain injury severity. Methods: Seventeen female IPV survivors (37±7.5 yrs) and eight male university-age athletes (23±4.1 yrs) completed the Kinarm End-Point Lab Object Hit & Avoid task. Impaired response inhibition was defined as an increased number of distractor targets hit. Between group comparisons were assessed by an independent samples Mann-Whitney Utest. The Brain Injury Severity Assessment (BISA) scale indexed IPV survivor TBI severity and correlated with the number of aborted distractors (i.e., irrelevant shapes targeted but movement cancelled) through multiple linear regression while accounting for comorbidities (i.e., depression, anxiety, etc. Results: IPV-related TBI led to an increase in total distractor hits compared to the athlete cohort (p=0.03). Further, the BISA score, along with selected comorbidities, predicted the number of aborted distractors (R2=0.64, p<0.001). Conclusions: Response inhibition is impaired following IPV-related TBI. This highlights the need for TBI-informed support for this population to help guide recovery and navigate day-to-day life.

Dannia Islas, PDF, University of British Columbia

Authors: Islas-Preciado Dannia, Flores-Celis Karla, González-Olvera Jorge, Estrada-Camarena Erika

Abuse in early life stages may induce long-lasting outcomes that impair women’s mental health. Notably, a high prevalence of abuse has been observed in women with menstrually-related mood disorders (MRMDs). Here we explored whether physical and/or sexual violence in childhood and/or adolescence increases the risk of developing MRMDs in adulthood. A systematic search was conducted in PubMed, Web of Science and ScienceDirect, (["Premenstrual Syndrome"[MeSH]] OR ["Premenstrual Dysphoric Disorder"[MeSH]] AND ["Violence"[MeSH]] / "menstrually-related mood disorders" AND "abuse"). Fifty-four articles were initially reviewed and 32 were excluded based on the criteria. Twenty-two articles were thoroughly analyzed by two reviewers. Finally, five case-control articles (publication years 2014, 2013, 2012, 2007, and 2003) were included and submitted to a meta-analysis. Results showed that physical and/or sexual abuse in childhood and/or adolescence two-folded the probability to develop MRMDs in adulthood in comparison to women who did not suffer this type of violence (odds ratio [OR] = 1.99; 95% confidence interval, 1.58–2.51, p<0.0001). Our findings suggest that women who experienced violence through physical and/or sexual abuse during childhood and/or adolescence might have a greater risk of developing MRMDs in adulthood.

Kendra Zadravec, MSc, University of British Columbia

Authors: K. Zadravec, K.A. Bland, E. Chesley, F. Wolf, M. Janelsins, K. Campbell

Cancer-related cognitive impairment (CRCI) is a common side-effect of cancer and its treatment, notably chemotherapy, that may persist long-term after treatment completion. Exercise’s capacity to improve cognitive function in healthy older adults and adults with cognitive impairments is well-established, suggesting that exercise may be a viable strategy to mitigate CRCI. We performed a systematic review of randomized controlled trials (RCTs) to examine the effect of exercise on CRCI. Relevant literature was retrieved from CINAHL, Medline (Ovid), and EMBASE. Eligible articles were RCTs prescribing aerobic, resistance, combined aerobic/resistance, or mind-body (e.g., yoga, Qigong) exercise during or following cancer treatment that included self-reported and/or objective outcome measures of cognitive function. Twenty-nine trials were included in the final analysis, with 15 (52%) during treatment and 14 (48%) after treatment. A statistically significant effect of exercise on self-reported cognitive function was noted in 12 trials (41%) (Cohen’s d range: 0.24-1.14), most commonly using the EORTC QLQ-C30 cognitive function subscale. Ten trials (34%) evaluated cognitive function using neuropsychological testing. Of these, three trials (10%), all in women with breast cancer, reported a significant effect of exercise on cognitive function (Cohen’s d range: 0.41-1.47). Given that the majority of trials in this review evaluated cognitive function as a secondary outcome, there is limited evidence to-date supporting exercise’s potential to manage CRCI. In order to understand the potential of exercise to mitigate CRCI in adults with cancer, future exercise trials should be designed with cognitive function as a primary outcome, especially using objective outcome measures.

Andrea Araujo, Ph.D., RCC, BCN, Researcher at Numinus Wellness

Author: Araujo, A.

This case study employed the use of Z-score neurofeedback training with a 19 channel ElectroCap and BrainMaster Avatar software to reduce cravings, anxiety, and trauma symptoms in a 35-year-old female in recovery from over 15 years of daily opiate use. Both eyes-open and eyes-closed trainings were conducted, with auditory and visual feedback, using protocols derived from QEEGs and brain maps of surface and source density (sLORETA) brain activity in the resting state. A reassessment was conducted after seven weekly 30 min training sessions, and the comparison between the first and second assessments showed significant improvements, with a reduction of both the surface and source density deviant activity. Data from the QEEG Pro questionnaire and as well as the Beck Depression Inventory and Beck Anxiety Index were collected in the first and second assessment times. Statistical analysis showed that the client achieved a complete reduction in craving and that her anxiety was markedly reduced. The study supports the effectiveness of neurofeedback training as an adjunct therapy to traditional recovery group work with addicts. Keywords: neurofeedback, addiction, anxiety, cravings, depression, QEEG Funding: There was no funding provided for this study. The financial costs of this study were assumed by the lead researcher and author, Dr. Araujo. 

Annie Hayward, Unclassified Student, University of British Columbia

Author: Annie C. Hayward, Dr. Christine Anderl, Dr. Frances S. Chen

Background: Recent studies have suggested that hormonal contraceptive (HC) use, especially during adolescence, may be associated with both concurrent and prospective depression risk. However, the direction of these effects remains unclear and may partially depend on women’s reasons for first using HCs. Objective: We set out to examine the risk of major depressive disorder (MDD) associated with different reasons for first using HCs and to see if treating mood symptoms is a common reason why women begin using HCs. Methods: An online sample of 1077 women living in the US were asked about their history of HC use, reasons for first using HCs, and history of MDD diagnoses. Results: Ever use of HCs was associated with elevated MDD risk across reasons for first use (24.6-44.7%) compared to never use of HC (17.8%), with the exception of treatment of endometriosis (13.0%). The relationship between HC use and MDD was strongest for people who began using HC to treat mood symptoms (44.7%), especially those who began using HC during adolescence (57.7%). However, only a small fraction of participants who had ever used HCs reported treatment of mood symptoms to be a primary or secondary reason for first using HCs (1.3 and 4.2%, respectively). Conclusions: Our findings suggest that using HCs to treat mood symptoms is associated with strongly elevated risk for MDD. However, treating mood symptoms with HCs does not appear to be common enough to fully explain the previously observed association between HC use and depression risk. Future studies on HC use and depression should consider the reasons women begin using HC.

Catriona Hippman, PhD, University of British Columbia

Author: Catriona Hippman, MSc1, Lynda G. Balneaves, PhD, RN2, Deirdre Ryan, MD1, and Jehannine Austin, PhD, CGC, CCGC1, (1)University of British Columbia, Vancouver, BC, Canada, (2)University of Manitoba, Winnipeg, MB, Canada

Introduction: Depression during pregnancy affects upwards of 10-15% of women. Practice guidelines recommend that clinicians support women to make informed treatment decisions in light of risks of untreated depression and antidepressant use during pregnancy. However, there is minimal evidence regarding how women make these decisions or how clinicians can best support their decision making. This study aimed to develop a constructivist grounded theory, within a feminist theoretical framework, of women’s decision making regarding depression treatment during pregnancy. Methods: Semi-structured interviews were conducted with purposively-sampled, pregnant or preconception women from the community or specialty clinics in Vancouver, Canada. (N=31). Iterative data collection and analysis, along with theoretical sampling and member checking, were used to determine saturation in the theory. Results: Participants were highly conscious of societal stigma towards mental illness and medication use during pregnancy. As a result, they faced fear, anxiety, and guilt while decision making. Participants navigated, in a non-linear manner, between three clusters of decision-making activities: seeking information, making sense of information, and self-soothing. ‘Seeking information’ included internal processes (e.g., reviewing past experiences), and external processes (e.g., seeking healthcare providers’ expertise). In ‘making sense of information’, participants appraised available evidence (e.g., based on their beliefs and values). In ‘self-soothing’, participants engaged in coping strategies, such as developing mantras or normalizing, to try to alleviate the painful emotions they encountered. Conclusion: This grounded theory can be used by clinicians and patients to support patient-oriented decision making regarding how best to care for maternal mental health during pregnancy.

Christine Ou, PhD Candidate, University of British Columbia

Author: Christine Ou RN, PhD Candidate, Dr. Wendy Hall RN, PhD, Dr. Patricia Rodney RN, PhD, Dr. Robyn Stremler RN, PhD

Background: Despite recognizing postpartum mothers’ risk for depressive symptoms, researchers have overlooked anger as a mood disturbance. The factors associated with postpartum anger are unclear. We hypothesized that poor maternal-infant sleep quality, depressive symptoms, and limited social support are associated with maternal anger. Methods: For this mixed methods study design, an online survey assessed maternal-infant sleep quality, maternal fatigue, thoughts about infant sleep, social support, anger and depressive symptoms while interviews explored how and why mothers become angry. A convenience sample of biological mothers of singleton-infants in Canada with no depression history were recruited through social media. Mothers from the online survey with high anger and depression scores were invited to participate in qualitative interviews. Results: 286 women completed the survey. Mean maternal age was 32.5 (SD = 3.8, range 23-44) years. Mothers self-reported a mean of 6.2 hours of sleep (SD = 1.28 hours, range 4-9 hours). Preliminary regression analysis revealed that number of children, depression scores, and negative thoughts about infant sleep significantly predicted higher anger scores. Qualitative data analysis (n=20), using a grounded theory approach, demonstrated that maternal-infant sleep problems contributed to maternal heightened sensitivity and unmet needs, resulting in anger. Conclusions: Maternal perceptions of infant sleep problems are associated with higher levels of anger and symptoms of depression. They contribute to mothers’ sensitivities to anger triggers in the postpartum period. The findings suggest that attention to maternal-infant sleep may help to mitigate postpartum mood disturbances.

Erika Estrada, Researcher at Instituto Nacional de Psiquiatría "Ramón de la Fuente"

Author: Estrada-Camarena E, Islas-Preciado D,Ugalde G, Sollozo-Dupont I, López-Rubalcava C, González-Trujano E

The etiology of Premenstrual Dysphoric Disorder (PMDD) involves an abrupt drop of progesterone and abnormalities in the hypothalamus-pituitary-adrenal (HPA) axis that may lead to impairments in GABAA/benzodiazepine receptors. However, preclinical studies have not considered experimental subjects exhibiting HPA axis alterations when studying the physiological bases of premenstrual symptoms through the progesterone withdrawal (PW) model. To fill this gap in the literature, we used the Wistar-Kyoto rats (WKY) rat strain, which exhibits HPA axis alterations and is prone to develop anxiety. Thus, female WKY and Wistar rats (control strain) were ovariectomized and administered with 1.5 mg/kg of progesterone for five consecutive days; 24hr after the last administration were tested in the anxiety-like burying behaviour test (BBT). Subsequently, [3H]-Flunitrazepam binding autoradiography was performed in response to PW and/or BBT in the amygdala nuclei and dentate gyrus (DG). Finally, we assessed the GABA/benzodiazepine receptor pharmacology under PW. Results showed that PW induced higher anxiety-like behaviors in WKY along with corticosterone concentrations, confirming the abnormalities in the HPA axis response. Differential strain-dependent [3H]-Flunitrazepam binding pattern was observed, as Wistar rats showed increased binding in response to BBT, whereas in WKY the PW increased [3H]-Flunitrazepam binding in the DG and central amygdala, suggesting greater sensitivity to the hormonal challenge. WKY showed a higher behavioral response to diazepam, and an anxiogenic-like response was observed only in PW animals. Collectively, the WKY strain could be useful to further explore the neurobiology of PMDD.

Eunice Bawafaa, PhD, University of British Columbia

Author: Bawfaa, E. & Campbell, S

Like other institutions of the social structure, health care developed as a colonial infrastructure which was built on and around European epistemologies and values. While segregation for purposes of medically containing contagious diseases or for optimizing care is necessary and well-meaning, it is a gateway to discriminatory behavior. The purpose of this paper is to examine how the construction and manifestation of marginalization impacts women’s health care. Specifically, the paper underscores the historical roots of oppression that have resulted in the normalization of oppressive and marginalizing behavior in healthcare and nursing practice for indigenous women. The paper aims to contribute to knowledge on this topic by arguing that while marginalization in healthcare has been recognized as a problem, efforts made to resolve it often miss its colonial roots for transformative knowledge in women’s healthcare practice. A scoping review of the literature will be done to see the discusses and connection between marginalization and its implications for women’s health.  A survey will be conducted examining nursing practice in relation to social injustice for women. Selection of sources of evidence will be done using PRISMA flow diagrams, presenting the characteristics of evidence and summarizing in relation to social justice activism, respectful nursing care and nursing education. Findings from this study will provide theoretical basis for socio-cultural factors, the effect of colonialism, nursing educational structures and their impact on women’s healthcare. This will be an entity for navigating a complex matrix of historical power dynamics resulting from colonialism and the international political economy.

Holly Dempster, Medical Student, Memorial University of Newfoundland

Author: Dempster, HA1, Gustafson DL2

Polycystic ovary syndrome (PCOS) is an endocrine disorder experienced by 5-10% of women within reproductive age. Symptoms of PCOS are heterogeneous and can include: irregular menses, hirsutism and infertility. Approximately, 70-80% of women with PCOS experience infertility. PCOS and infertility can have an immense impact on mental health as many women feel less feminine compared to socially valued feminine traits. PCOS patients are at high risk for psychological illness. There are a lack of studies examining how PCOS patients feel about their disorder. Our research objective was to explore the experiences of a woman with PCOS induced infertility and gain insight about potential psychological distress. Our hypothesis was that women with PCOS lack health care support and suffer from depression. Specific inclusion criteria were used for recruitment. A narrative case study was used to obtain results by an in-depth interview with a woman living with PCOS in Canada. Narrative re-storying was used to analyze the interview and data was coded for major life events and themes. Three categories and six themes emerged: PCOS related (body image issues/medical invalidation of PCOS), Fertility related (importance of supportive partner/infertility and isolation), and Physician related (physician’s gender and sexual health/importance of family physician). Also, four main events were observed in the data and 75% of them were related to being in a serious relationship. Our findings conclude that physicians need to treat PCOS with a whole-body perspective and provide early resources like mental health counselling, dieticians and physical therapy for patients. 

Madusin Lackie, Researcher, Women's Health Research Institute

Author: Madison Lackie, MSc1,2; Julia Santana-Parrilla, MSc3; Brynn Lavery, BA1; Andrea Kennedy, MD, FRCPC4,5, Deirdre Ryan, MD, FRCPC4,5, Barbara Shulman, MD, FRCPC4,5, & Lori A. Brotto, PhD, RPsych1,2

Background: Despite up to 18% of mothers in Canada developing postpartum depression (PPD) symptoms, they face many barriers when accessing care. Digital health offers a unique opportunity to provide psychosocial skills and support to new mothers; however, this field has historically created tools that do not cater to the diversity of women in Canada and their distinct needs. Aims: This study engaged non-Indigenous, non-migrant women across British Columbia (BC) who have a history of PPD, for the purposes of informing the content and design of a web-enabled resource providing education and psychosocial skills. Methods: Focus groups were conducted in seven communities, discussing participants’ needs, preferences, and opinions as they relate to the use of technology in treatment. Transcripts were analyzed using the approaches of qualitative description and emergent thematic analysis. Results: Five themes emerged: bridging gaps to meet needs; providing validation to combat stigma; nurturing capacity to cope, manage, and/or reach wellness; empowering people to take ownership over their mental health; and offering customization to ensure relevance. At the intersection of these themes was the overarching value of promoting agency for women experiencing PPD. Conclusions: New mothers require accessible mental health resources that ensures their agency in mental health care decision-making. Our participants believe a web-enabled platform could help meet this need. This data will be used to guide web development, with the eventual implementation of this resource as a first-line support for postpartum depression.

Maggie Coval, Undergraduate Student, University of British Columbia

Author: Maggie Coval, Alison Tracy, Ellen Jopling, and Joelle LeMoult.

Rates of depression increase substantially during the transition from childhood to adolescence. During this time, gender differences in rates of depression emerge: in girls, symptoms of depression tend to increase significantly between the ages of 11 and 13, whereas in boys, symptoms remain stable. This gender gap in depression persists into adolescence and adulthood. Thus, identifying protective factors for depression in pre-adolescence is important for women’s health across the lifespan. Both social support and self-compassion have been found to promote well-being, particularly for women; however, their ability to synergistically protect youth against psychopathology has not yet been evaluated. The current study utilized a moderated mediation model in order to examine whether the association among social support, self-compassion, and symptoms of depression differed by gender. The results revealed that low social support was associated with depressive symptoms for girls, but not boys. Interestingly, we also observed a significant indirect effect of social support on symptoms of depression through self-compassion, particularly for boys. Thus, for girls, there was a direct association between social support and depressive symptoms; in contrast, for boys, social support was associated with depressive symptoms only when social support promoted more self-compassion. Follow-up analyses indicated that social support from parents was a particularly crucial source of support for pre-adolescents. These findings identify gender differences in the association of social support and depression that have important treatment implications.

Sadaf Sediqi​, Undergraduate Student, University of British Columbia

Author: Sadaf Sediqi1, Awais Quadre1,2 

Post-partum depression (PPD) is a psychological mood disorder characterized by physical, emotional and behavioral changes that occur after giving birth. Previous studies have shown correlations between the severity of postnatal symptoms and socio-cultural approaches as a contributing factor to their burdens but lack a detailed description of what those factors entail. In this study we conducted a qualitative analysis that studied the social and cultural factors that contribute towards the emotional wellbeing of new immigrant mothers between the ages of 20-48 through via nine in-depth interviews. We found that participants consistently expressed their emotional challenges were attributed to the lack of family and disconnect of culture leading to feelings of isolation, loneliness and stress. About 90% of the women described ‘shame’ as a major emotion when describing their mental health. The lack of professional and spousal help was linked to the cultural stigma associated with mental health. Religion and spirituality were identified as having positive effects on their distress. These findings confirm the need for cultural-based support for immigrant women, and rational for the lack of professional outreach. Further research and investment is required in this area.

Shawna Narayan, University of British Columbia

Author: Shawna Narayan, Sharan Sandhu, Hiram Mok, Kendall Ho, David Kealy

Ethnic minorities experience difficulties such as language barriers, difficulty navigating the healthcare system, and lack of culturally tailored resources, compared to the general population when accessing mental health services. Technology can improve quality to underserved populations through e-mental health which involves services and information delivered through the Internet and related technologies. However, this approach is currently limited and should be culturally tailored for optimal effectiveness. The CREDA study aims to investigate the use of emental health among ethnic minorities for anxiety and depressive disorders in the Metro Vancouver Regional District. In this presentation, we will focus on the experiences of ethnic women that participated in the CREDA Study. Ethnic women (N=89) submitted a multi-item online questionnaire involving questions around e-mental health use, the severity of their depression and anxiety symptoms, and sociodemographic characteristics. 54% of ethnic women (N=77) were satisfied with their overall experience with e-mental health. However, women reported that the resources and services that they have used are not culturally relevant. Qualitative data from open-ended questions provide recommendations and suggestions for future services. The findings from this on-going study have the potential to benefit culturally diverse communities by improving access to effective treatments for anxiety and depressive disorders using technology and support the creation of culturally responsive e-mental health resources and services.

Sonia Hasani, Researcher at Tabriz University of Medical Sciences

Author: Sonia Hasani, Mojgan Mirghafourvand, Khalil Esmaeilpour and Fahimeh Sehhati-Shafaie

Objectives: In all types of pregnancies women experienced changes in their mental health and self-esteem condition. The aim of the present study was to determine the effect of counseling on mental health and self-esteem following an ectopic pregnancy. Study design: This was a randomized controlled clinical trial on 68 pregnant women with ectopic pregnancy referring to Al-Zahra hospital in Tabriz, Iran in 2018. The participants randomly allocated to counseling and control groups. Intervention group received 4 sessions of counseling including 1) providing medical information about ectopic pregnancy and its physical and psychological complications; 2) explaining the syndrome of sadness after losing a pregnancy; 3) mental health and ways to improve it after pregnancy loss, 4) self-esteem and how to increase it after losing a pregnancy and control group received only routine care. Before and two weeks after the end of the intervention, data were collected by the General Health Questionnaire-28 and Rosenberg self-esteem questionnaires. Data were analyzed using SPSS software. The registration number was IRCT20100109003027N41. Results: There was no significant difference between the two groups in terms of socio-demographic characteristics and the scores of mental health and self-esteem before the intervention. Two weeks after the end of the intervention, the mean (SD) total score of mental health of women in counseling and control groups were 20.1 (5.0) and 32.9 (9.8), respectively.  When compared with the control group, a significant reduction in the total score of mental health (adjusted difference= -11.27; 95% Confidence Interval: -15.19 to -7.34; P<0.001) was observed in the counseling group. In counseling group compared with the control group, a significant increase in the total score of self-esteem (adjusted difference= 4.79; 95% Confidence Interval: 3.07 to 6.51; P<0.001) was observed.Conclusion: Providing counseling based on health promotion awareness by the midwife can help reduce mental health problems and increase self-esteem. For this reason, counseling should be considered as part of care after losing a pregnancy

Taylyn Jameson, Researcher at University of British Columbia

Author: Taylyn Jameson, Ellen Jopling, & Joelle LeMoult

Adverse childhood experiences (ACEs) are associated with significant changes to neural structure and function. These changes increase the risk of future psychopathology, and there is evidence to suggest that the relation between ACEs and the development of later psychopathology may be stronger for women than men. As a result, it is imperative to identify mechanisms through which women with a history of ACEs are protected from the development or worsening of psychopathology. While there is evidence to substantiate the buffering effect of resilience on the relationship between ACEs and depression, these effects have yet to be investigated directly in the context of anxiety symptoms. In particular, they have not been explored amongst women during emerging adulthood, wherein approximately 1 in 5 will meet criteria for an anxiety disorder. Therefore, to address this gap in the literature, the present study examined whether resilience mediates the association between ACEs and symptoms of anxiety among a sample of 148 women during emerging adulthood (18-25 years of age). Analyses revealed that resilience significantly mediated the association between ACEs and anxiety symptoms, accounting for nearly 20% of the total effect between ACEs and symptoms of anxiety (β=0.09, 95% CI [0.03, 0.15], PM=.198). These results indicate that efforts to promote resilience during the crucial developmental period of early adulthood may allow women to circumvent possible deleterious consequences of ACEs, and ultimately serve to fortify their psychological well-being. 

​Candace Oghide, Graduate Student, McMaster University

Author: Candace Oghide

Background: In Canada, 61 % of women have experienced an unintended pregnancy. Young adulthood (18-26 years old), for women, can present the highest risk of experiencing an unintended pregnancy with the least amount of access to healthcare. Adequate contraception methods may mitigate this experience. However, the meaning and perception of ‘adequacy’ may vary racially and culturally. In the United States (US), research studies have focused on understanding contraception disparities across races. African American women in the US have a higher number of unwanted pregnancies, unintended pregnancies, and negative maternal health outcomes than other races. Understanding these disparities can help contextualize and individualize contraception care for this group. To date, Canadian contraception research has yet to stratify for the African, Caribbean, and Black Canadian population when developing research for care management. Therefore, there is currently no evidence to understand potential contraceptive health disparities being faced by African, Caribbean, and Black Canadian women. Purpose: To identify how second-generation African, Caribbean, and Black Canadian women in Ontario explain the contexts and factors involved in their contraceptive decision-making process. Design: An interpretive description qualitative study Data Collection Methods: Focus groups and mind maps. To further supplement the data, focused follow up interviews may occur. Objectives: 1. Describe the process for contraceptive decision-making for African, Caribbean, and Black Canadian women. 2. Compare the decision making processes between African American women and African, Caribbean, and Black Canadian women. 3. Develop strategies to engage nurses in culturally-competent contraception care management for African, Caribbean, and Black Canadian women. 

Laura Pritschet, PhD, University of California Santa Barbara

Author: Laura Pritschet, Tyler Santander, Caitlin M. Taylor, Scott T. Grafton, Emily G. Jacobs

Neuroscience has largely overlooked how fluctuations in sex hormones—a central facet of reproductive life—might shape the functional architecture of the human brain. A handful of studies have explored this topic by sparsely sampling discrete stages of the menstrual cycle, but this approach obscures the rhythmic nature of endogenous hormone production. In a series of densesampling, deep phenotyping studies, we examined the extent to which endogenous fluctuations in sex hormones alter intrinsic brain networks at rest in a woman. In Study 1, a naturally cycling woman underwent 30 consecutive days of brain imaging and venipuncture across a menstrual cycle. Time-synchronous analyses revealed widespread increases in whole-brain connectivity as a function of increasing estradiol, while progesterone demonstrated opposite, negative associations with connectivity. Time-lagged analyses examined the temporal directionality of these relationships and revealed estrogen’s ability to drive connectivity across major functional brain networks, including the Default Mode, Dorsal Attention and Frontal Control Networks, whose hubs are densely populated with estrogen receptors. In Study 2, to isolate the impact of estradiol on brain network connectivity, the same woman was sampled (30 days) under selective progesterone suppression. The results were replicated in Study 2, as estradiol, unopposed by progesterone, remained positively associated with increased whole-brain connectivity. Taken together, these results suggest that endogenous hormone fluctuations have a robust impact on the intrinsic network properties of the human brain. Understanding how changes in sex hormones influence the large-scale functional organization of the human brain is imperative for our basic understanding of the brain and for women’s health. Funding. This study was supported by the Rutherford Fett Fund (STG) and the Brain and Behavior Research Foundation (EGJ).

Maria Shock, Undergraduate Student, University of British Columbia

Author: Maria A Shock, Cecilia Jalabert, Chunqi Ma & Kiran K Soma

Estrogens are steroids that affect many aspects of brain function in both females and males, including cognition, social behaviour, and neuroprotection. It is well-known that estrogens are synthesized in the ovaries, but estrogens are also locally synthesized in the brain. Aromatase is the enzyme that catalyzes the conversion of testosterone to 17β-estradiol, and aromatase is expressed in the ovaries and brain. Importantly, estrogens are active in the brain at extremely low levels. Current methods to measure estrogens however suffer from low specificity and/or low sensitivity. Furthermore, current methods focus on only 17β-estradiol and disregard other estrogens. Here, we aimed to develop a method to measure several estrogens simultaneously, with high specificity and high sensitivity. We used liquid chromatography tandem mass spectrometry, and to improve sensitivity, we chemically modified estrogens using 1,2-dimethylimidazole-5-sulfonyl-chloride (DMIS). We examined a panel of six estrogens: 17β-estradiol, 17α-estradiol, estriol, estrone, 2-methoxyestradiol, and 4-methoxyestradiol. Our pilot data suggest that the method is extremely specific and sensitive. Moreover, we were able to simultaneously quantify multiple estrogens in small biological samples (1-2 mg of tissue or 1-2 µl of plasma). The high sensitivity of this assay will be useful in studies of small animal models. The high sensitivity will also be useful in human studies that analyze saliva samples or include subjects with very low estrogen levels (e.g., post-menopausal women, women receiving aromatase inhibitor treatment for breast cancer, men, and children).

Neelam Punjani, PhD Candidate, University of Alberta

Author: Neelam Saleem Punjani, Elizabeth Papathanassoglou & Kathleen Hegadoren

Background: Adolescence is a critical period in the transition from childhood into adulthood, during the course of which young children aged 11-19 years’ experience substantial physical, psychological, social, and emotional changes. Sexual health incorporates a wide range of interlinked mental, physical, and emotional factors. In Alberta, immigrant youth and children account for 31% of the total immigrant population. The experience of developing sexuality and any relationships with their well-being has not been studied among Pakistani-descent adolescents in Canada. Moreover, based on evidence from LMICs revealing specific challenges faced by adolescent girls, it will be interesting to explore the experience of developing sexuality among Pakistani-descent girls. Aims: The purpose of the proposed study is to explore the experience of developing sexuality and their relationship to psychological well-being in middle- to late- adolescence girls of Pakistani-descent, living in Edmonton, Alberta. Methods: An Interpretive Descriptive approach will be used to study the experiences of female Pakistani-descent adolescents in relation to developing sexuality and psychological well-being.  A purposive and theoretical sampling strategy will be used to recruit adolescent girls (age: 14-19 years) with the collaboration of the Indo-Canadian Women’s Association.  Participants will be interviewed using a semi-structured interview guide with open-ended questions. Participants will also be asked to create timelines about their life experiences on a sheet of paper. Qualitative data analysis software (NVIVO 12.0) will be used to manage the data and themes and patterns emerging will be identified. As the findings will generate new angles or discoveries, additional literature will be searched from other disciplines to see what other new similar or opposing ideas or perspectives exist within the themes arising in current study. Anticipated outcomes: It is anticipated that the study will provide preliminary insight into the complex phenomenon of developing sexuality and its relationship to psychological well-being among adolescent girls of Pakistani descent. The study will draw attention to the hidden voices of adolescent girls and will increase awareness about the psychological aspect of sexuality.  Recommendations from the study can potentially inform healthcare professionals to address adolescents’ sexuality and their psychological well-being and integrate those while providing sexual and reproductive health care services. 

Tanvi Puri, PhD, University of British Columbia

Author: Tanvi Puri, Paul A. S. Sheppard, Stephanie E. Lieblich, Liisa A. M. Galea

17β-Estradiol (E2) can modulate memory consolidation through rapid (5-30 min) cell signaling cascades in the dorsal hippocampus (HPC) and has neuroprotective effects that are mediated through mitogen-activated protein kinase (MAPK) pathways in both sexes. However, E2 has dose-dependent effects on HPC-dependent learning, with low E2 enhancing and high E2 impairing performance of females. Repeated administration (72h) of E2 increases Akt signaling cascade activity in the HPC, but rapid effects remain unknown. This experiment determined whether changes in cell signaling cascades occur in a dose-dependent manner following E2 treatment in females. We treated adult ovariectomized rats subcutaneously with high E2 (10µg), low E2 (0.3µg), or vehicle, extracted the HPC either 15min, 30 min, or 24 hours later. Brains were either microdissected to collect dorsal and ventral hippocampal tissue, or flash frozen and punched to collect the CA1 and dentate gyrus regions. Hippocampal tissue was homogenized and analyzed for cell signaling markers using electrochemiluminescence. We found low but not high E2 administration increased pp38, P70S6K, and pGSK3 concentration in both the dorsal and ventral HPC at 30 minutes compared to 24h. High but not low doses of E2 lowered concentration of pATK 24 hours after administration in the dorsal HPC. These data show that Akt and MAPK cell signaling phosphoproteins are affected in a dose-dependent, non-linear manner after E2 administration. Given the ability of E2 to rapidly improve memory consolidation and cell proliferation, it is important to establish which cell signaling proteins are activated in the short- and long-term after E2 and estrone exposure. Current experiments examine changes in these cell-signaling cascades in the CA1 region and dentate gyrus 15 minutes after E2 administration to investigate the changes in these phosphoproteins. 

Taylor Foreman​, Undergraduate Student, University of Northern British Columbia

Author: Taylor A. Foreman, Zachary T. Vaughan, Annie Duchesne

Xenoestrogens are a class of estrogen-like endocrine disrupting molecules. They can interact with estrogen receptors, interfering with the functions of endogenous estrogens which are important in multiple affective and cognitive processes. For example, the regulation of females’ hippocampal functions by endogenous estrogens is disrupted by environmental xenoestrogen exposure. Given that humans are ubiquitously exposed to varying amounts of environmental xenoestrogens and estrogen systems are important for women’s brain health and function, the aims of the current project are to 1) identify a subset of the most relevant xenoestrogens, 2) characterize their sources of exposure, routes of exposure, and metabolism rates, and 3) develop a survey to approximate exposure levels to these chemicals. Based on a review of the literature, we identified nine of the most common xenoestrogens. Bisphenol A, bisphenol AF, bisphenol S, methylparaben, monoethyl phthalate, genistein, coumestan, daidzein, & triclosan were selected as the most representative species based on prevalence and potency as indicated in the literature. For each compound, we identified their environmental sources, routes of entry, and rates of metabolism. This information was combined to generate survey questions for exposure assessment, which will be presented at the conference. Through the development and validation of an environmental xenoestrogen exposure questionnaire, we hope to make an easily accessible tool to account for environmental sources of exogenous estrogens. This tool will be relevant to research across a variety of disciplines including women’s brain health.

Tristan Philippe​, PhD, University of British Columbia

Author: Authors: Philippe TJ, Dordevic M, Pavlidis P, Underhill M, Viau V.

Experience with a controllable challenge can protect an organism from the negative consequences of stress. Thus, determining the molecular mechanisms of adaptive responses has important implications for understanding stress resistance and vulnerability. Here we used a model of stress hypothalamic-pituitary-adrenal (HPA) axis habituation and compared transcriptional responses in male and female Sprague Dawley rats exposed to a single bout of 2h restraint or to multiple bouts repeated daily for 5 consecutive days. Males and females showed completely different transcriptional profiles between the sexes depending on the brain region surveyed. RNA sequencing revealed 3 types of responses in the raphe nucleus, reflected by 1) transient changes in differentially expressed genes (DEGs) that returned to baseline after repeated restraint; 2) sustained increments/decrements in DEGs unique to the repeat restraint condition; and 3) sustained changes in DEGs regardless of restraint experience. Distinct and sexually dimorphic transcriptional patterns also occurred within forebrain regions known to be targeted by the raphe-serotonin system and/or mediating adaptive neuroendocrine and behavioral responses. Many of these DEGs in the paraventricular nucleus, zona incerta and septum belong to key neurotransmitter (serotonergic, GABAergic) and neuroendocrine systems, in addition to those mediating synaptic remodeling and signaling pathways. The extent to which these transcriptional alterations contribute to the state of habituation, or otherwise respond to stress, remains to be seen. Nonetheless, the current findings provide several testable frameworks for determining factors controlling sex differences in adaptive responses.

Zachary Vaughan, Undergraduate Student, University of Northern British Columbia

Author: Zachary T. Vaughan, Taylor A. Foreman, and Annie Duchesne

Background: According to the Endocrine Society, “[a]n endocrine-disrupting chemical (EDC) is an exogenous chemical, or a mixture of chemicals, that can interfere with any aspect of hormone action.” Environmental xenoestrogens (EXEs) are a specific group of environmental EDCs characterized by their effects on the estrogenic system. 17β-estradiol (E2), a major form of endogenous estrogen, is known to regulate several neurocognitive functions in females. For example, in rodents, E2 has been found to enhance female’s hippocampal plasticity and memory performance; however, in the presence of bisphenol A (BPA), a well-established EXE, these effects are no longer observed. While research increasingly demonstrates the neurocognitive consequences of BPA, humans and laboratory animals are ubiquitously exposed to various EXEs. To date, there is no unified review of the effects of EXEs on neurocognitive processes. Aims: The current project aims at reviewing the animal and human neurocognitive literature that have assessed and/or controlled for EXEs. Methods: We are currently conducting a systematic review of the neurocognitive literature published after 2009, which corresponds to the publication of the first Scientific Statement of The Endocrine Society regarding EDCs. Further, the search is restricted to nine chemical compounds previously identified as the most relevant EXEs. The final number of articles to be reviewed will be coded independently by three raters. Results: The results of the systematic review will be presented at the conference. Conclusion: This review will provide insight and awareness of the estrogenic effects of EXEs on neurocognition and their possible implications on women’s brain health.