The COVID-19 pandemic has altered the normal course of life, with measures to reduce the virus spread impacting motherhood expectations and, in particular, breastfeeding practices. This study aimed to review evidence regarding the impact of COVID-19 on breastfeeding plans and how these relate to women’s psychological outcomes. Searches were conducted on PubMed and Web of Science for studies in English, Spanish, and Portuguese between January 2020 and January 2021. All study designs and pre-prints were considered. Twelve studies were included. Reports suggest that COVID-19 impacts differently on breastfeeding plans, which in turn leads to distinctive mental health outcomes. Positive breastfeeding experiences have been observed when mothers perceive that they have more time for motherhood, which may be associated with better mental health outcomes. Negative breastfeeding experiences have been observed when mothers are separated from their newborns, when mothers struggle with breastfeeding, or when mothers perceive decreased family and professional support, which seems to be associated with worse mental health outcomes. These preliminary results highlight the need for further research into the association between COVID-19, breastfeeding expectations, and maternal mental health. Filling this gap will foster the development of guidelines and interventions to better support mothers experiencing the obstacles of COVID-19 pandemic.

Background: Anxiety disorders are amongst the most common and interfering disorders. Research on the neural correlates of anxiety, such as cortical thickness, may provide a better understanding of the neural mechanisms underlying individual differences in what concerns distinctive profiles of anxiety symptoms and vulnerability to anxiety disorders. Objective: This scoping review aims to summarize the literature published since 2004 in the context of pre-clinical, clinical, and basic science studies, concerning the association between cortical thickness and anxiety measures in use, to determine the role of cortical thickness as a vulnerability factor for the development of anxiety disorders. Design: Our review followed the guidelines of the Arksey and O'Malley methodology.Searches were conducted in electronic databases (PubMed, PsycINFO and PsycARTICLES, and Web of Science) and reference lists of key studies. Two researchers independently screened the abstracts and full-text articles according to the eligibility criteria, as well as extracted and charted the data. Quantitative (i.e., numerical) and qualitative (i.e., narrative approach) syntheses were conducted to characterize the included studies and find gaps in knowledge. Results: A total of 17 articles were included in the final review. All publications reported cross-sectional studies, with the majority (n = 16) employing surface-based approaches to the measurement of cortical thickness.Overall, statistically significant associations between cortical thickness and measures/processes of anxiety were found, for self-report instruments (e.g., State-Trait Anxiety Inventory), psychophysiological measures (e.g., skin conductance reponses), and functional neuroimaging.Conclusions: Differences in cortical thickness across several brain regions were found to be associated with different measures and processes underlying anxiety. Regions of potential interest include the medial orbitofrontal cortex, the ventromedial prefrontal cortex, the insula, the temporoparietal areas, and the anterior cingulate cortex. Alterations in regional cortical thickness may be a vulnerability factor for the development of anxiety disorders, although more research into this association is needed, namely with healthy population or within longitudinal designs. Nonetheless, the possibility of a bidirectional relationship cannot be excluded.

Transcranial direct current stimulation (tDCS) is a potential treatment strategy across some psychiatric conditions. However, there is high heterogeneity in tDCS efficacy as a stand-alone treatment. To increase its therapeutic potential, researchers have begun to explore the efficacy of combining tDCS with psychological and pharmacological interventions. The current case series details the effect of 6–10 weeks of self-administered tDCS paired with a behavioral therapy smartphone app (Flow™), on depressive and anxiety symptoms, in seven patients (26–51 years old; four female) presenting distinctive psychiatric disorders (major depression, dysthymia, illness anxiety disorder, obsessive-compulsive disorder, and anxiety disorders). tDCS protocol consisted of an acute phase of daily 30 min sessions, across 10 workdays (2 weeks Monday-to-Friday; Protocol 1) or 15 workdays (3 weeks Monday-to-Friday; Protocol 2). A maintenance phase followed, with twice-weekly sessions for 4 or 3 weeks, corresponding to 18 or 21 sessions in total (Protocol 1 or 2, respectively). The Flow tDCS device uses a 2 mA current intensity, targeting the bilateral dorsolateral prefrontal cortex. The Flow app offers virtually guided behavioral therapy courses to be completed during stimulation. We assessed depressive symptoms using MADRS-S and BDI-II, anxious symptoms using STAI-Trait, acceptability using ACCEPT-tDCS, and side effects using the Adverse Effects Questionnaire, at baseline and week 6 of treatment. Six patients underwent simultaneous cognitive-behavioral psychotherapy and two were on antidepressants and benzodiazepines. According to the Reliable Change Index (RCI), for depressive symptoms, we found clinically reliable improvement in five patients using MADRS-S (out of seven; RCI: −1.45, 80% CI; RCI: −2.17 to −4.82, 95% CI; percentage change: 37.9–66.7%) and in four patients using BDI-II (out of five; RCI: −3.61 to −6.70, 95% CI; percentage change: 57.1–100%). For anxiety symptoms, clinically reliable improvement was observed in five patients (out of six; RCI: −1.79, 90% CI; RCI: −2.55 to −8.64, 95% CI; percentage change: 12.3–46.4%). Stimulation was well-tolerated and accepted, with mild tingling sensation and scalp discomfort being the most common side effects. This case series highlights the applicability, acceptability, and promising results when combining home-based tDCS with psychotherapy and pharmacotherapy to manage depression and anxiety symptoms in clinical practice.

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