Category: Postpartum Depression

The Historical Context of Postpartum Depression Treatment

Throughout the late 1800s, isolation was seen as a normal treatment to “cure” women suffering from postpartum depression. This treatment was known as the “rest cure,” which consisted of isolating the patient completely to avoid any mental activity and provide rest. At the time, a well-known feminist writer, Charlotte Perkins Gilman, was prescribed this isolation treatment after the birth of her daughter that left her with a crippling depression (“Charlotte Perkins Gilman”379). “The Yellow Wallpaper” was then written by Gilman to share her experience with the “treatment” that was being prescribed not only to her, but also to several other women, driving them near the borderline of utter mental ruin. In the short story “The Yellow Wallpaper,” Gilman’s prescribed “rest cure” after giving birth took a big part in her descent into madness. While in today’s world, with so many medical advancements, Gilman’s treatment can be seen as a punishment more than anything else.

Depression, also referred to as melancholy, has been a common illness that has been dealt with for several of decades, although there had never been a stable cure until today. Throughout the early parts of American history, physicians back in the late 1800’s could not distinguish between the different types of mental disorder their patients were experiencing, therefore, they treated all of their mentally ill patients with the same rest cure. This then led to people suffering from mental illnesses to be diagnosed equally, and their treatment consisted of being held captive in buildings that were very similar to the types of structures a prison would have and being chained to their beds with conditions that were terrifying (“History of Mental Health Treatment”). These so called, health facilities were structured as if the mentally ill patients were murderous inmates, and equipped with barred windows, each door was latched separately, and had the entire building secured in case if any incident were to occur. Even though the confined patients were not threatening at all, these facilities treated them like savages, beating them in ways that were “unspeakably cruel” (“History of Mental Health Treatment”).

The Grim Reality of Mental Health Facilities in the 1800s

The method that people used back then to treat these mental illnesses was the total opposite of what a health facility would perform nowadays and seemed a lot more like a prison environment. In addition, this treatment that was applied and recommended only worsened the patient’s condition even more, resulting to what Gilman had described herself that her treatment “drove her so near the borderline of utter mental ruin” (“Charlotte Perkins Gilman”379). When Gilman was diagnosed with postpartum depression, her physician had advised her a “rest cure” that consisted of complete bed rest and mental inactivity (“Charlotte Perkins Gilman”379). Luckily, and thanks to Gilman’s story, a handful of critics were able to realize how this gruesome situation was and highlighted how the prescribed “treatment” had negatively affected the narrator’s overall psychological health. In an article by John Bak, the author reveals that the narrator’s prescribed treatment in this case scenario was the act of imprisonment that led the narrator to go insane. The author points out that Gilman’s environment in “The Yellow Wallpaper” is awfully similar to the environment in a panopticon system. The panopticon system was seen as a room that is “morally reformed and health preserved,” which would be the description of Gilman’s prescribed treatment or the “rest cure” for her illness which isolated her in a nursery three miles away from town (Bak41).

However, the actual use of this panopticon system was more as a “laboratory than a corrective institute” which was the exact reason why the narrator started to distinguish certain vivid objects that were not there as a “perfunctory dismissal of the paper’s “optic horror” (Bak41). Bak also showed how the narrator’s personality slowly unraveled “through the stages from concern to paranoia and, finally, to madness” throughout the time she had been forbidden to do any activities throughout her “rest cure” (Bak42), which had then gradually developed into a paranoia that Foucault says is inevitable with unabated surveillance” (Bak41). In addition to the rooms’ intriguing terror, the method physicians used to treat their mentally ill patients was as unbelievable as their environment, noting that highly qualified physicians should be devoting their full potential to help their helpless patients. Instead, these so-called “physicians” back then would torment their patients making the cure worse than the disease.

Furthermore, already considering that medical treatments and therapy were as bad as they were, it was especially worse with female patients. During this time in history, women were seen as inferior to men, thus giving men the superiority in society to treat women as they wished. Elaine Hedges had precisely pointed out in her article that Gilman’s role was to be “a rest and comfort” to her husband while she was obviously the one in need of that companionship throughout her illness (Hedges106). Within this article, the author also shows how Gilman was being treated in a less superior range; the physician also being her husband would dismiss every word the patient had to say and treated her as an inferior, distinguishing the narrator as if she were an infant speaking to her with sayings like, “blessed little goose” and his “little girl” (Hedges106). Just as the physician refers to the narrator as a “little girl,” he also places her in a room that is specifically child proof as the room was intended to “prevent small children from falling out”.

The Role of Gender in Mental Health Treatment

As the narrator had examined the wallpaper within the room, she viewed what seemed to be a pattern, but before she could even distinguish it the author mentions that “it slaps you in the face, knocks you down, and tramples upon you” (Hedges 106). The author used this personification to compare the wallpaper to the narrator’s relationship with her physician. This phrase boldly emphasizes how it is that the physician reacts when the narrator expresses her mixed emotions while he also laughs at her because she does not know any better, for she is just a “little girl”. As a result, patients during this time would go insane because their prescribed physicians would not fully assist them and their disorder.

Although this type of treatment seemed ordinary back then, it is very different in today’s modern lifestyle. This type of treatment was later seen more as a bitter way for physicians to treat their patients, which is why today’s standing medical field has risen to improve the treatment for postpartum depression. In contrast to the past, physicians can now identify what class of disorder a patient is dealing with, prescribing all their ill patients with the correct treatment that will rehabilitate them back to their usual state of mind. Postpartum depression may now be taken care of with several types of treatments, all depending on the mother’s severity of the condition. Patients with mild symptoms are most commonly to be treated with medications such as anti-depressants and therapy altogether (Johnson). The psychotherapy consists of a one to one conversation with a specialized therapist that assists the patient with emotional support, while also advising realistic goals for the patient to achieve throughout this difficult time they are experiencing (“Postpartum Depression Therapy”). The patient is also allowed to select which type of therapy they would like to attend out of the five available to that specific condition. The therapies consist of the following: cognitive behavioral, interpersonal, eye movement desensitization, reprocessing, group, and couples’ therapy. These postpartum therapies will all help the patient cope with their disorder and above all, the patient recognizes that this disorder is not their fault and realize that many people are battling throughout the same condition they are experiencing (“Postpartum Depression Therapy”). Doctors also suggest that patients should make a few adjustments to their current lifestyle, such as giving some time for themselves, where they can enter a happy and positive environment that friends and family can support them each step of the way. There are various ways that patients can accomplish this goal – eating nourishing meals, getting good rest, and especially getting a good workout that can help brighten up the patients’ day as they relieve their stress and get their mind off things while also lifting up their psyches (Johnson).

Modern Approaches to Postpartum Depression Treatment

In different circumstances, if the severity of the mother’s condition were to get out of hand, possibly experiencing symptoms of suicidal thoughts or psychosis, she will then need to be admitted into a mental hospital. There she would be prescribed a treatment plan by a psychiatrist that could involve a variety of other mental health professionals that would assist the patient with both psychiatric therapies and medications (Schimelpfening). Unlike the environment patients were placed in during Gilman’s time, today’s hospital staff gives their ill patients a healthy environment with respect. While hospitalized, patients now have the right to know what medications are being prescribed to them as well have the authority to deny any treatments they presume are unnecessary. Nevertheless, they could be placed in a room, although they would typically be roomed with a roommate and are allowed to freely interact with one another. They would also have an arranged schedule to follow throughout their stay, being able to attend on going activities and therapies, which would avoid the patients from being in an isolated environment, and instead, it allows them to surround themselves in a profound environment (Schimelpfening).

Although isolation was considered as a treatment for postpartum depression back then, in today’s modern world, it is seen and used as a form of punishment to discipline those who rebelliously disobey rules. As a matter of fact, isolation is most commonly used in federal prisons as a solitary confinement to discipline rebellious inmates. Prison itself is not the inmates’ sole punishment, but rather the confinement that defeats them all such as the hot box, hole, and lock down confinements where the prisoners are isolated in a small structured room for days until their time is up just as Breslow had stated “it is a prison within a prison”(Bennett). Several prisons determine how long the prisoner will go from being both socially and physically cut off ranging from “low, moderate, high, and greatest” using how critical of a crime the inmate had committed (Breslow). Prisoners who are charged with serious crimes ranging from both high and greatest would endure an isolation that would last for about thirty to sixty days being in a confined room that is smaller than a closet. In today’s society, it is seen more as a normality for prisoners to be dreadfully punished by being locked up in an isolated room for numerous days, and contrastingly abnormal for them to be outdoors getting any form of exercise (Breslow). Prisoners are isolated in atrocious confinements for the “sake” of their health and others; however, this “disciplinary” confinement has done the opposite. Research has shown that isolation has greatly impacted a person’s psychological health. It has been proven that a third of prisoners that have been isolated have ended up critically insane with suicidal urges that engages them towards self – mutilation (Breslow). The federal prison system showed that the prisoners that were being isolated in a special housing status or psychiatrist seclusion cells had approximately sixty-three percent suicidal death rate. However, suicide is not the only effect prisoners are left with; they can also end up with a psychiatric syndrome which leads them to having hallucinations, panic attacks, overt paranoia, impulse control; hypersensitivity to external stimuli; trouble processing, concentration and memory loss (Breslow). One example of isolation affecting a person’s psychological health was an inmate that had stated himself “the hole and segregation cells are depressing enough to drive many men to take their lives in order to escape” (Breslow). The psychological effects that inmates are left with due to isolation only makes them even more dangerous than they already were previously.

Isolation as a Disciplinary Measure in Today’s Society

It has been proven that isolation is not a treatment, but rather a disciplinary punishment that is used upon rebellious individuals. Throughout history, isolation had been used as a treatment for women. As it was used upon Gilman, she wrote “The Yellow Wallpaper” to inform the world of what it is that isolation actually does to a person. Society has slowly evolved making significant changes in order to be able to provide the correct treatment for women with postpartum depression and now uses isolation as a disciplinary punishment in the prison system.

Depression is a mental illness effecting behavior as well as thinking and function. It can happen at any time during life and to any one regardless of age, upbringing, sex, race, or spirituality. Postpartum depression is depression that occurs after a baby is born and differs from the baby blues most women experience after birth. Baby blues occur in most women following the birth of her baby, the difference between postpartum depression and baby blues is the severity and length of time.

The increase in hormones before and during pregnancy are a factor in postpartum depression. Hormones from the thyroid, which grows to 135% of its pre-pregnancy size, as well as both estrogen and progesterone are increased during pregnancy. After birthing these hormones drop back to what they were before pregnancy, this change is a lot like to what happens before the menstrual cycle, but more severe (Office on women’s Health, 2018). Prognosis is dependent on if the woman seeks help. The earlier help is looked for, the sooner treatment and assistance can be given to a suffering mother and prevent other complications after baby is born.

Treatment is often determined based off signs and symptoms that are presented. For example, there are medications that can be utilized to treat hormone imbalances as well as thyroid issues related to the decrease in hormones of a woman suffering from postpartum depression. Medications are not the only treatment. There is also therapy and preventative methods such as offering assistance so the mother can take a break or rest is beneficial to the mother’s mental health. The office on women’s health also lists talk therapy which is beneficial for expressing feeling of inadequacy, stress, anger, guilt, and trouble connecting with baby.

Expected lab pertaining to the diagnosis is looking at hormone levels in comparison with normal levels. If there is a huge gap in hormone levels, supplementation can be done. This is generally completed by a blood test that checks for these levels as well as a depression screen (Mayo Clinic, 2019). Based off of these results, the doctor or physician can decide what steps to take next to better treat they symptoms presented.

The patient should be sure to set regular follow ups to be sure that the treatment is working as intended. In certain cases, visits will be more frequent due to the severity and ongoing assessments. Every mom is different, every coping mechanism and reaction to birth is different. Any signs of a depressive disorder should be monitored closely, especially throughout pregnancy. The number one priority for health care professionals is to be sure that both mom and baby are safe.

When we teach our postpartum mom, her spouse and family the signs and differences between the baby blues in comparison to postpartum depression, we need to be sure that we state one of the major differences is time. It is natural to feel a bit of sadness after birth; however, the longer the sadness lasts the more likely it is developing into postpartum depression. Mental health has a stigma that comes a long with it that can and in some cases will prevent the new mother from seeking treatment. As a nurse we, it is of the upmost importance that we provide reassurance that these feelings are real, they can develop into something dangerous if left untreated, and we are here for the new mother. We need to be nonjudgmental and encourage expression of grief or whatever feelings the new mom may be feeling. Feelings such as being overwhelmed, and hopelessness can really take a toll on mom and baby in relation to proper bonding. As nurses we need to let her know that it is normal to be a little sad after birth, but if it lasts longer than two weeks, she needs to seek medical attention to protect her and her child.

In relation to my patients currently, I do not have a postpartum mother; however, this will apply to the patients I will see in the future. There is bound to be a postpartum mom, who is at risk or of is going through this. No matter where it is, knowing the signs and symptoms as well as watching behaviors and the interaction between mom and baby will help me give proper education to the new mother, her spouse as well as family. No matter where I work, patient safety is number one, and being able to properly identify these certain behaviors will enable me to help my patient faster.

Gene-environment interactions measure how genes can lead to different responses to the environment or how the environment leads to different effects of genes (Schnittker et al. 2015). The study of these interactions is essential to develop our understanding of whether genes or the environment have a stronger influence on personal health. Through research, it has been found that instead of one gene causing a given condition, it is usually multiple genes that lead to that given condition. This discovery led studies to focus more on how genes matter rather than how much they matter in the development of a certain condition (Schnittker et al., 2015). Also, studies focus on the environmental risks that could lead to the development of a specific condition. For example, the role of stress in the development of a mental health disorder (Schnittker et al., 2015). Each individual has a different stress response, and the reason for this most likely lies in an individual’s genes. Presently, gene-environment interactions show a promising discovery to explain the question of how much genes or environment impact each individual’s health.

The environmental element of this interaction refers to outside influences on a person’s health. Some examples of environmental factors include chemical exposure, living in a high-poverty neighborhood, and stress (Schnittker et al., 2015). One of the main environmental factors that leads to inadequate health care is poverty (Burke et al., 2014). Poverty leads to a lack of healthcare access for many across the country which oftentimes leads to the development of conditions that could have been prevented with adequate care. There is a gap of over 35 years in life expectancy between different populations in the United States (Burke et al., 2014). This gap largely stems from environmental elements. The problem with environmental factors is that it is very hard to determine their effect on the development of certain conditions. There is no clear-cut technique for figuring out their role. However, this trend is changing. A new technique called the PhenX Toolkit helps to standardize assessment for the environmental factors that help lead to the development of a certain condition (Vrieze et al., 2012).

The genetic component in this interaction is the influence of genes on an individual’s health. This component is generally defined in terms of specific genes, but can also be generic genetic influences (Schnittker et al., 2015). Recent scientific discoveries have led researchers to understand that multiple genes lead to the development of diseases, rather than just one gene. Therefore, research has shifted away from tests for individual genes to tests for multiple genes, referred to as genomics (Burke et al., 2014). It is easy for researchers to determine how genes affect the development of certain conditions because of the many advancements we have made in technology.

Genomics, also known as genetic testing, is a test that assesses multiple genes in a person and determines risks for certain conditions in that person. Genetic testing can help to inform individuals about the risk or response to therapeutics and can determine the clinical problem (Burke et al., 2014). A new study called pharmacogenomics uses genetic testing to see how a drug will affect patients. This illustrates the rising use of genomics in our society. However, one downfall to this technique is that it only focuses on the genetic side of conditions, it does not look at environmental issues. Therefore, these drugs could be ineffective due to environmental factors such as poverty, meaning that the drug is too expensive for the patient to purchase. Despite this, genomic information can help to guide difficult clinical decisions. An example would be those involved in breast cancer screening and management.

Human DNA is composed of many pieces and each individual has a unique structure. The DNA is contained in 23 chromosomes. These chromosomes are made up of 22 autosomes and 1 sex chromosome. Each autosome has two copies of DNA, one coming from the mother and the other from the father. These copies are made up of base pairs of nucleotides. The nucleotides are adenine, thymine, cytosine, and guanine. Nucleotides are found in pairs, and base pairs, and the nucleotides always pair with the same one. Genetic variation stems majorly from single nucleotide polymorphisms. Humans have over 15 million single nucleotide polymorphisms (Vrieze et al., 2012).

A gene-environment correlation is when an individual’s genes are related to their exposure to certain environments. For example, someone who is prone to stress due to their genes may end up putting themselves in more stressful situations. This implies that genes affect environments but not the opposite as in a gene-environment interaction. The three different correlations are passive correlation, active correlation, and reactive correlation. If people are in environments that are related to their genes and not their behavior, this is a passive correlation (Schnittker et al., 2015). If people put themselves into an environment based on their genes, this is an active correlation (Schnittker et al., 2015). Reactive correlation is when people trigger behaviors in others related to their genes (Schnittker et al., 2015). Many environments are affected by gene-environment correlations.

Numerous challenges occur in determining whether the genes or the environment influence a specific condition to develop. Part of this problem stems from inconsistent measures of the environment. Different researchers use different methods to determine environmental influences. There is no set standard on how to measure the environment. An example of this is analyzing the environmental effect on stress because a stressful event can be analyzed differently by each person. However, studies produce stronger results when they use objective techniques to measure a stressful event rather than self-reports (Schnittker et al., 2015). Also, this problem stems from our lack of understanding of how genes work. The effects of genes are largely not well understood, which hinders researchers’ abilities to determine their true role in the development of certain conditions (Schnittker et al., 2015).

Researchers often use twins to differentiate the influence of genes and environment on behavior and disease. These studies provide an important foundation for the study of gene-environment interaction. Cumulated over the past 50 years, this research has revealed much about what causes differences in behavior between twins (Vrieze et al., 2012). It is found that genetic factors lead to differences in environmental factors such as parent-child relationships, stress, peer-group characteristics, and divorce (Vrieze et al., 2012). Genetic factors lead to these differences because they contribute to the stability of behavior and behavioral change in individuals (Vrieze et al., 2012). Despite all that twin studies have discovered, researchers are beginning to turn to molecular studies for more reliable and clear results (Schnittker et al., 2015). These studies are aimed at finding out the contribution of specific genes (Vrieze et al., 2012).

The history of gene-environment research is controversial due to the interpretation of results and the difficulty of replicating previous experiments. Early research concluded that certain genes led to the inferiority of some populations (Schnittker et al., 2015). Although these results have now been discredited, there is still distrust in genetic research (Schnittker et al., 2015). However, modern gene-environment research helps to resolve this distrust because it considers genes and the environment equally. Yet there is a tendency to regard this research as revealing more about genes than the environment, despite that the definition of an interaction means that two components play a role. Furthermore, the experiments done in the past are notoriously difficult to replicate. This decreases the validity of all the research done. Therefore, the interaction between genetic factors and environmental factors has recently been questioned.

Personalized Medicine is a new practice that is based on a partnership between doctor and patient, utilizing the patient’s personal preferences and clinical findings to make important health decisions. It is a new idea that shows the possibilities of a completely new healthcare system. This practice has multiple dimensions and should be seen as an effort to tailor health care to the individual. It focuses on a wide range of therapeutic options and helps to find the one best suited to each patient. To determine which is best suited, physicians look at the patient’s medical needs and personal preferences. This approach is especially important for difficult clinical decisions that have trade-offs and uncertainty. To use this practice, basic health needs must be met. This means that the patient must have adequate food, water, shelter, and healthcare. Without these, physicians will focus on getting these basic needs met rather than personalized medicine.

In this work, I review evidence that addresses to what extent are genetic variation and personal health linked. Using surveys to measure what caused postpartum depression in women, Kimmel et al. (2014) showed that medication intake did not affect whether or not these women developed postpartum depression. In addition, Tuvblad et al. (2016) used surveys measuring the levels of psychopathic personality in twins to show that changes in scores on the scale had to do with genetic and environmental factors. Taken together these studies show that a mix of genes and environmental factors influence the development of these specific conditions and suggest that the same results would occur within other health conditions.

Postpartum Depression

Kimmel et al. (2014) sought to find out if medication intake affects the development of postpartum depression in high-risk women. Before this study, there were conflicting results from previous studies on whether or not antidepressant intake during pregnancy decreases the risk for postpartum depression. However, other studies showed that a family history of postpartum depression increased the risk of the development of postpartum depression. However, the results were unclear what the risk of postpartum depression in women who were clinically well during pregnancy and taking antidepressants. These uncertain results motivated Kimmel et al. (2014) to lead this study and see what affects the development of postpartum depression in women with a family history of it.

Postpartum depression is a mood disorder that some mothers suffer after childbirth. Symptoms include mood swings, insomnia, loss of appetite, and difficulty bonding with the baby. Postpartum depression affects approximately 10-15% of mothers (Kimmel et al., 2014). It can also affect up to 10% of fathers. If an individual develops postpartum depression, they have a 50% chance of developing it again with the next child. Postpartum depression affects parenting behavior, parents have a disregard for infant safety and healthy child development practices (Kimmel et al., 2014). Exposure to postpartum depression leads to slower language development, behavioral problems, and lower IQ in the child (Kimmel et al., 2014). Therefore, the treatment of postpartum depression not only helps the mother but also helps the child as well.

To determine the clinical predictors of postpartum depression, Kimmel et al. (2014) examined the effects of medication and family medical history. They tracked women during pregnancy and postpartum period. Participants either took antidepressants or did not take any medications; all participants had a family history of mood disorder. Participants were interviewed with the Structured Clinical Interview for DSM-IV Axis 1 Disorders throughout the study. The psychiatrist analyzed these interviews and decided if the participant met DSM-IV criteria for a major depressive episode (Kimmel et al., 2014). If the participant met the criteria for a major depressive disorder within four weeks of delivery and did not begin during pregnancy, then Kimmel et al. (2014) considered them to have postpartum depression. Women who were depressed before delivery and remained depressed post-delivery did not meet this definition of postpartum depression.

Kimmel et al. (2014) interviewed women, aged 18 or older, to determine if they developed postpartum depression and if so, what caused this depression to develop. The participants needed to have a family history of any mood disorder and could be in any trimester of pregnancy (Kimmel et al., 2014). They tracked premenstrual symptoms, hospitalizations, education, employment, age, and personal and family history of postpartum depression (Kimmel et al., 2014). In the interview, data was collected on medication use, stress, sleep quality, and personality traits (Kimmel et al., 2014). Participants were studied during each trimester of pregnancy after study entry and then one week, one month, and three months postpartum (Kimmel et al., 2014). The participants were interviewed at each of these stages to determine depression levels.

The data showed that there was a high rate of a family history of postpartum depression in those who developed postpartum depression. 80% of women who developed postpartum depression were taking medications during pregnancy (Kimmel et al., 2014). Also, women who had no signs of depression before delivery were found to have a 39.4% rate of developing postpartum depression within the first four weeks after delivery (Kimmel et al., 2014). Those who did not take medication were 2.8 times more susceptible to being depressed (Kimmel et al., 2014). 38 participants were psychiatrically well during the third semester, and 39.5% of them developed postpartum depression within four weeks of delivery (Kimmel et al., 2014).

Since the data shows that medication use does not prevent the development of postpartum depression, this supports the thought that there is a link between postpartum depression and family history. Of the women who developed postpartum depression, 53.3% had a family history of postpartum depression (Kimmel et al., 2014). This shows a strong link between family history and the development of postpartum depression. The use of psychiatric medications during pregnancy reduced the rate of depression overall. However, the use of these medications may not protect those who have a family history of postpartum depression.

Psychopathic Personality

Tuvblad et al. (2016) worked to find out the genetic and environmental factors that lead to the development of psychopathic personality in children. There are limited studies done on what stems from the development of a psychopathic personality. Tuvblad et al. (2016) aimed to fill this gap. Previous studies done regarding this topic reported that genetic factors lead to the development of psychopathic personality (Tuvblad et al., 2016). Furthermore, previous twin studies showed that genetic and nonshared environmental factors lead to the development of psychopathic personality (Tuvblad et al., 2016). None of these studies found that any shared environmental factors contributed to the development (Tuvblad et al., 2016). In addition, none of these studies examined the development of psychopathic personality from childhood into adolescence (Tuvblad et al., 2016). Tuvblad et al. (2016) studied these previous experiments and designed one that includes all the factors not considered.

Psychopathy is a personality disorder that is characterized by antisocial behavior, impulsive behavior, low levels of empathy and remorse, and egotistical traits. Specifically in children, common signs of psychopathy include: lying, lack of guilt after misbehaving, and sneaky. Research has not shown exactly what causes the development of psychopathic personality, but it is likely a combination of genetic and environmental factors. While there is little success in treating adult psychopathy, there has been some success in treating psychopathy in children. Psychopathy is estimated to affect about 1% of the population, but these individuals are believed to make up to 50% of all serious crimes. Statistics like this one show why it is important to work to treat children who show psychopathic personality traits.

To further understand what causes the development of psychopathic personality, twins were examined by filling out surveys at different ages (Tuvblad et al., 2016). Tuvblad et al. (2016) looked to find what caused children to develop psychopathic personalities through shared environmental, nonshared environmental, and genetic factors. They studied 780 twin pairs from childhood into adolescence. To collect data, they used a survey that used the Child Psychopathy Scale to measure psychopathic personality.

Tuvblad et al. (2016) surveyed children, ages 9-18, to determine what causes them to develop psychopathic personalities. The survey used help researchers, using the Child Psychopathy Scale, to determine when and what caused these children to develop psychopathic personalities. The Child Psychopathy Scale measures many factors including glibness, impulsivity, manipulativeness, callousness, and lack of guilt. The twins were measured in four different waves. Wave one was at ages 9-10, wave two at ages 11-13, wave three at ages 14-15, and wave four at ages 16-18 (Tuvblad et al., 2016). At each wave, reports were taken from the child and caregivers (Tuvblad et al., 2016).

The data showed that variations in levels and scores were mainly due to genetic and nonshared environmental influences. Psychopathic personality development appeared consistent between males and females (Tuvblad et al., 2016). The data best fit a piecewise growth curve model, in which the first change score influenced all ages and the second change score only influenced ages 14–15 and 16–18 (Tuvblad et al., 2016). Also, based on caregiver ratings 81%, 89%, and 94% of variance were explained by genetic factors, whereas for self-reports there was a 94%, 71%, and 66% variance explained by genetic factors (Tuvblad et al., 2016). 

Gene-environment interactions measure how genes can lead to different responses to the environment or how the environment leads to different effects of genes (Schnittker et al. 2015). The study of these interactions is essential to develop our understanding of whether genes or the environment have a stronger influence on personal health. Through research, it has been found that instead of one gene causing a given condition, it is usually multiple genes that lead to that given condition. This discovery led studies to focus more on how genes matter rather than how much they matter in the development of a certain condition (Schnittker et al., 2015). Also, studies focus on the environmental risks that could lead to the development of a specific condition. For example, the role of stress in the development of a mental health disorder (Schnittker et al., 2015). Each individual has a different stress response, and the reason for this most likely lies in an individual’s genes. Presently, gene-environment interactions show a promising discovery to explain the question of how much genes or environment impact each individual’s health.

The environmental element of this interaction refers to outside influences on a person’s health. Some examples of environmental factors include chemical exposure, living in a high-poverty neighborhood, and stress (Schnittker et al., 2015). One of the main environmental factors that leads to inadequate health care is poverty (Burke et al., 2014). Poverty leads to a lack of healthcare access for many across the country which oftentimes leads to the development of conditions that could have been prevented with adequate care. There is a gap of over 35 years in life expectancy between different populations in the United States (Burke et al., 2014). This gap largely stems from environmental elements. The problem with environmental factors is that it is very hard to determine their effect on the development of certain conditions. There is no clear-cut technique for figuring out their role. However, this trend is changing. A new technique called the PhenX Toolkit helps to standardize assessment for the environmental factors that help lead to the development of a certain condition (Vrieze et al., 2012).

The genetic component in this interaction is the influence of genes on an individual’s health. This component is generally defined in terms of specific genes, but can also be generic genetic influences (Schnittker et al., 2015). Recent scientific discoveries have led researchers to understand that multiple genes lead to the development of diseases, rather than just one gene. Therefore, research has shifted away from tests for individual genes to tests for multiple genes, referred to as genomics (Burke et al., 2014). It is easy for researchers to determine how genes affect the development of certain conditions because of the many advancements we have made in technology.

Genomics, also known as genetic testing, is a test that assesses multiple genes in a person and determines risks for certain conditions in that person. Genetic testing can help to inform individuals about the risk or response to therapeutics and can determine the clinical problem (Burke et al., 2014). A new study called pharmacogenomics uses genetic testing to see how a drug will affect patients. This illustrates the rising use of genomics in our society. However, one downfall to this technique is that it only focuses on the genetic side of conditions, it does not look at environmental issues. Therefore, these drugs could be ineffective due to environmental factors such as poverty, meaning that the drug is too expensive for the patient to purchase. Despite this, genomic information can help to guide difficult clinical decisions. An example would be those involved in breast cancer screening and management.

Human DNA is composed of many pieces and each individual has a unique structure. The DNA is contained in 23 chromosomes. These chromosomes are made up of 22 autosomes and 1 sex chromosome. Each autosome has two copies of DNA, one coming from the mother and the other from the father. These copies are made up of base pairs of nucleotides. The nucleotides are adenine, thymine, cytosine, and guanine. Nucleotides are found in pairs, and base pairs, and the nucleotides always pair with the same one. Genetic variation stems majorly from single nucleotide polymorphisms. Humans have over 15 million single nucleotide polymorphisms (Vrieze et al., 2012).

A gene-environment correlation is when an individual’s genes are related to their exposure to certain environments. For example, someone who is prone to stress due to their genes may end up putting themselves in more stressful situations. This implies that genes affect environments but not the opposite as in a gene-environment interaction. The three different correlations are passive correlation, active correlation, and reactive correlation. If people are in environments that are related to their genes and not their behavior, this is a passive correlation (Schnittker et al., 2015). If people put themselves into an environment based on their genes, this is an active correlation (Schnittker et al., 2015). Reactive correlation is when people trigger behaviors in others related to their genes (Schnittker et al., 2015). Many environments are affected by gene-environment correlations.

Numerous challenges occur in determining whether the genes or the environment influence a specific condition to develop. Part of this problem stems from inconsistent measures of the environment. Different researchers use different methods to determine environmental influences. There is no set standard on how to measure the environment. An example of this is analyzing the environmental effect on stress because a stressful event can be analyzed differently by each person. However, studies produce stronger results when they use objective techniques to measure a stressful event rather than self-reports (Schnittker et al., 2015). Also, this problem stems from our lack of understanding of how genes work. The effects of genes are largely not well understood, which hinders researchers’ abilities to determine their true role in the development of certain conditions (Schnittker et al., 2015).

Researchers often use twins to differentiate the influence of genes and environment on behavior and disease. These studies provide an important foundation for the study of gene-environment interaction. Cumulated over the past 50 years, this research has revealed much about what causes differences in behavior between twins (Vrieze et al., 2012). It is found that genetic factors lead to differences in environmental factors such as parent-child relationships, stress, peer-group characteristics, and divorce (Vrieze et al., 2012). Genetic factors lead to these differences because they contribute to the stability of behavior and behavioral change in individuals (Vrieze et al., 2012). Despite all that twin studies have discovered, researchers are beginning to turn to molecular studies for more reliable and clear results (Schnittker et al., 2015). These studies are aimed at finding out the contribution of specific genes (Vrieze et al., 2012).

The history of gene-environment research is controversial due to the interpretation of results and the difficulty of replicating previous experiments. Early research concluded that certain genes led to the inferiority of some populations (Schnittker et al., 2015). Although these results have now been discredited, there is still distrust in genetic research (Schnittker et al., 2015). However, modern gene-environment research helps to resolve this distrust because it considers genes and the environment equally. Yet there is a tendency to regard this research as revealing more about genes than the environment, despite that the definition of an interaction means that two components play a role. Furthermore, the experiments done in the past are notoriously difficult to replicate. This decreases the validity of all the research done. Therefore, the interaction between genetic factors and environmental factors has recently been questioned.

Personalized Medicine is a new practice that is based on a partnership between doctor and patient, utilizing the patient’s personal preferences and clinical findings to make important health decisions. It is a new idea that shows the possibilities of a completely new healthcare system. This practice has multiple dimensions and should be seen as an effort to tailor health care to the individual. It focuses on a wide range of therapeutic options and helps to find the one best suited to each patient. To determine which is best suited, physicians look at the patient’s medical needs and personal preferences. This approach is especially important for difficult clinical decisions that have trade-offs and uncertainty. To use this practice, basic health needs must be met. This means that the patient must have adequate food, water, shelter, and healthcare. Without these, physicians will focus on getting these basic needs met rather than personalized medicine.

In this work, I review evidence that addresses to what extent are genetic variation and personal health linked. Using surveys to measure what caused postpartum depression in women, Kimmel et al. (2014) showed that medication intake did not affect whether or not these women developed postpartum depression. In addition, Tuvblad et al. (2016) used surveys measuring the levels of psychopathic personality in twins to show that changes in scores on the scale had to do with genetic and environmental factors. Taken together these studies show that a mix of genes and environmental factors influence the development of these specific conditions and suggest that the same results would occur within other health conditions.

Postpartum Depression

Kimmel et al. (2014) sought to find out if medication intake affects the development of postpartum depression in high-risk women. Before this study, there were conflicting results from previous studies on whether or not antidepressant intake during pregnancy decreases the risk for postpartum depression. However, other studies showed that a family history of postpartum depression increased the risk of the development of postpartum depression. However, the results were unclear what the risk of postpartum depression in women who were clinically well during pregnancy and taking antidepressants. These uncertain results motivated Kimmel et al. (2014) to lead this study and see what affects the development of postpartum depression in women with a family history of it.

Postpartum depression is a mood disorder that some mothers suffer after childbirth. Symptoms include mood swings, insomnia, loss of appetite, and difficulty bonding with the baby. Postpartum depression affects approximately 10-15% of mothers (Kimmel et al., 2014). It can also affect up to 10% of fathers. If an individual develops postpartum depression, they have a 50% chance of developing it again with the next child. Postpartum depression affects parenting behavior, parents have a disregard for infant safety and healthy child development practices (Kimmel et al., 2014). Exposure to postpartum depression leads to slower language development, behavioral problems, and lower IQ in the child (Kimmel et al., 2014). Therefore, the treatment of postpartum depression not only helps the mother but also helps the child as well.

To determine the clinical predictors of postpartum depression, Kimmel et al. (2014) examined the effects of medication and family medical history. They tracked women during pregnancy and postpartum period. Participants either took antidepressants or did not take any medications; all participants had a family history of mood disorder. Participants were interviewed with the Structured Clinical Interview for DSM-IV Axis 1 Disorders throughout the study. The psychiatrist analyzed these interviews and decided if the participant met DSM-IV criteria for a major depressive episode (Kimmel et al., 2014). If the participant met the criteria for a major depressive disorder within four weeks of delivery and did not begin during pregnancy, then Kimmel et al. (2014) considered them to have postpartum depression. Women who were depressed before delivery and remained depressed post-delivery did not meet this definition of postpartum depression.

Kimmel et al. (2014) interviewed women, aged 18 or older, to determine if they developed postpartum depression and if so, what caused this depression to develop. The participants needed to have a family history of any mood disorder and could be in any trimester of pregnancy (Kimmel et al., 2014). They tracked premenstrual symptoms, hospitalizations, education, employment, age, and personal and family history of postpartum depression (Kimmel et al., 2014). In the interview, data was collected on medication use, stress, sleep quality, and personality traits (Kimmel et al., 2014). Participants were studied during each trimester of pregnancy after study entry and then one week, one month, and three months postpartum (Kimmel et al., 2014). The participants were interviewed at each of these stages to determine depression levels.

The data showed that there was a high rate of a family history of postpartum depression in those who developed postpartum depression. 80% of women who developed postpartum depression were taking medications during pregnancy (Kimmel et al., 2014). Also, women who had no signs of depression before delivery were found to have a 39.4% rate of developing postpartum depression within the first four weeks after delivery (Kimmel et al., 2014). Those who did not take medication were 2.8 times more susceptible to being depressed (Kimmel et al., 2014). 38 participants were psychiatrically well during the third semester, and 39.5% of them developed postpartum depression within four weeks of delivery (Kimmel et al., 2014).

Since the data shows that medication use does not prevent the development of postpartum depression, this supports the thought that there is a link between postpartum depression and family history. Of the women who developed postpartum depression, 53.3% had a family history of postpartum depression (Kimmel et al., 2014). This shows a strong link between family history and the development of postpartum depression. The use of psychiatric medications during pregnancy reduced the rate of depression overall. However, the use of these medications may not protect those who have a family history of postpartum depression.

Psychopathic Personality

Tuvblad et al. (2016) worked to find out the genetic and environmental factors that lead to the development of psychopathic personality in children. There are limited studies done on what stems from the development of a psychopathic personality. Tuvblad et al. (2016) aimed to fill this gap. Previous studies done regarding this topic reported that genetic factors lead to the development of psychopathic personality (Tuvblad et al., 2016). Furthermore, previous twin studies showed that genetic and nonshared environmental factors lead to the development of psychopathic personality (Tuvblad et al., 2016). None of these studies found that any shared environmental factors contributed to the development (Tuvblad et al., 2016). In addition, none of these studies examined the development of psychopathic personality from childhood into adolescence (Tuvblad et al., 2016). Tuvblad et al. (2016) studied these previous experiments and designed one that includes all the factors not considered.

Psychopathy is a personality disorder that is characterized by antisocial behavior, impulsive behavior, low levels of empathy and remorse, and egotistical traits. Specifically in children, common signs of psychopathy include: lying, lack of guilt after misbehaving, and sneaky. Research has not shown exactly what causes the development of psychopathic personality, but it is likely a combination of genetic and environmental factors. While there is little success in treating adult psychopathy, there has been some success in treating psychopathy in children. Psychopathy is estimated to affect about 1% of the population, but these individuals are believed to make up to 50% of all serious crimes. Statistics like this one show why it is important to work to treat children who show psychopathic personality traits.

To further understand what causes the development of psychopathic personality, twins were examined by filling out surveys at different ages (Tuvblad et al., 2016). Tuvblad et al. (2016) looked to find what caused children to develop psychopathic personalities through shared environmental, nonshared environmental, and genetic factors. They studied 780 twin pairs from childhood into adolescence. To collect data, they used a survey that used the Child Psychopathy Scale to measure psychopathic personality.

Tuvblad et al. (2016) surveyed children, ages 9-18, to determine what causes them to develop psychopathic personalities. The survey used help researchers, using the Child Psychopathy Scale, to determine when and what caused these children to develop psychopathic personalities. The Child Psychopathy Scale measures many factors including glibness, impulsivity, manipulativeness, callousness, and lack of guilt. The twins were measured in four different waves. Wave one was at ages 9-10, wave two at ages 11-13, wave three at ages 14-15, and wave four at ages 16-18 (Tuvblad et al., 2016). At each wave, reports were taken from the child and caregivers (Tuvblad et al., 2016).

The data showed that variations in levels and scores were mainly due to genetic and nonshared environmental influences. Psychopathic personality development appeared consistent between males and females (Tuvblad et al., 2016). The data best fit a piecewise growth curve model, in which the first change score influenced all ages and the second change score only influenced ages 14–15 and 16–18 (Tuvblad et al., 2016). Also, based on caregiver ratings 81%, 89%, and 94% of variance were explained by genetic factors, whereas for self-reports there was a 94%, 71%, and 66% variance explained by genetic factors (Tuvblad et al., 2016).