Community Research and Development Information Service - CORDIS

Periodic Report Summary 1 - POSTPARTUM BID (Improving prediction of the triggering of bipolar disorder episodes by childbirth)

The aim of this fellowship is the development of valid, clinically relevant predictive models for episodes of bipolar disorder following childbirth. This involves bringing together, harmonizing and analysing large, well-characterized clinical and genetic datasets from Europe and USA.
List of activities and achievements of the “outgoing phase”:
1) Understanding the cultural differences in perinatal mood disorders between Europe and USA.
• Di Florio et al. The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale. Psychological Medicine in press. doi:10.1017/S0033291716002087
For this study the Fellow was awarded a Seleni travel grant to present the results at the 2nd Biennial Perinatal Mental Health Conference, November 4-6, 2015 - Chicago, Illinois, USA
• Kimmel, MC; Lara-Cinisomo, S; Melvin, K; Di Florio, A; Brandon, AR; Meltzer-Brody, S.
Treatment of Severe Perinatal Mood Disorders on a Specialized Perinatal Psychiatry Inpatient Unit. Archives of Women’s Mental Health. In press.
• The Fellow has been invited to give a seminar on cross-cultural issues in perinatal psychiatry at the University of Illinois at Urbana-Champaign, USA (September 25th 2015).
The fellow is also collaborating with Dr Sandraluz Lara-Cinisomo (University of Illinois at Urbana and Champaign) in a series of studies on the neuroendocrinology of postpartum depression in Latinas.
2) Understanding the mood switch associated with reproductive events
• Di Florio et al. Effects of progesterone on plasma metabolites in women with and in those without premenstrual dysphoric disorder. Ready for submission.
• Ferguson, Di Florio, et al. HPA Axis Reactivity to Stress in Euthymic Women with Histories of Major Depression and Postpartum Depression. Submitted to
3) Exploring the nosology of perinatal mood disorders.
• Di Florio A, Meltzer-Brody S. Is postpartum depression a distinct disorder? Curr Psychiatry Rep 2015 Oct;17(10):617
4) Getting additional training in biostatistics and genetics. The Fellow has been awarded a scholarship to attend the Interdisciplinary
Approaches to Biomedical Data Science Challenges: Statistical and Applied Mathematical Sciences Institute Ideas Lab, at the Statistical and Applied Mathematical Sciences Institute, July 2015 (35 scientists selected from over 350 applicants across the United States) and two collaborative seed grants by the National Science Foundation- division of applied mathematics.
The Fellow also attended the lectures of the PhD program in biostatistics at the University of North Carolina at Chapel Hill and the lab meetings of Prof Patrick Sullivan (Human Genetics)
5) Developing international independent collaborations.
At the University of North Carolina at Chapel Hill the fellow works closely with Michael
Kosorok, world-leading expert in Empirical Processes, Semiparametric Inference and Machine Learning. The collaboration has already resulted in a book chapter proposing a master pipeline for biomarker discovery and validation and submitted a research manuscript on risk predictions. The fellow has also served as mentor for the Big Data to Knowledge (BD2K) Training Program led by Dr Kosorok. The fellow is currently the clinical leader of two collaborative research grants funded by the USA National Science Foundation - Division of applied mathematics and statistics. The project entitled “Interactive ensemble clustering for mixed data with application to mood disorders" uses the genetic and clinical data of the UK
Biobank cohort to develop new mathematical, statistical and data visualization methods.
With Trine Munk-Olsen (University of Aarhus, Denmark) and Veerle Bergink (Erasmus University, The Netherlands), the fellow has recently obtained the inclusion of postpartum affective psychosis in the Orphanet list of rare disorders. This is the firrst psychiatric disorder to appear on the list. This achievement and its consequences in a letter published in Lancet Psychiatry.

Expected final results and their potential impact and use:
The prospect of developing risk prediction models for the triggering of bipolar episodes by childbirth opens many new avenues for research, into both the identification of women at high risk and the development of novel treatment options for women who develop this devastating disorder. The results of the proposed study are potentially of huge importance, and may lead to clinical tests to predict and help diagnose postpartum bipolar disorder as well as to novel therapeutic targets for amelioration of the clinical disease. In addition, the work will develop resources for a wide variety of future work including mechanistic/etiological studies. It will also potentially open the venue to a wider use of rigorous risk prediction tools in psychiatry.

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