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Peripartum depression (PPD) affects similar to 12-25% of pregnant and postpartum women worldwide, yet routine screening often fails to capture real-time symptom changes. Digital phenotyping (DP), using data from digital devices such as text entries, sleep tracking, physical activity, social media behavior, and ecological momentary assessments, has been proposed as a complementary approach to support the prediction and early identification for PPD. This systematic review (PROSPERO: CRD42023461325) examined 14 studies published between 2014 and March 2025 that explored passive and active DP data across the antenatal and postnatal periods. Most studies employed observational designs and used the Edinburgh Postnatal Depression Scale as the primary outcome. Passive DP data related to sleep and circadian rhythms were frequently associated with depressive symptoms, whereas findings for physical activity were inconsistent. Active DP data, including language features from text entries, mood logs, semi-random ecological momentary assessments, and social media behavior, were often reported as informative, particularly when combined with personal history or self-reported measures. However, considerable variation across study designs, data sources, analytical approaches, and validation strategies limits direct comparison of findings and prevents causal interpretation. Overall, the evidence remains largely exploratory, and findings should be interpreted cautiously pending more rigorous validation.

Objective: To investigate if academic achievement among children with nonsyndromic orofacial clefts (OFC) differs compared to nonaffected children and whether this association is modified by sex and psychiatric comorbidity.

Methods: A register-based cohort of children born with cleft lip (CL), cleft lip and palate (CLP), and cleft palate only (CPO) in Sweden between 1973 and 2004 (n = 6286) was compared to a matched community cohort (n = 61,352). Outcomes were academic achievements in mathematics and Swedish in school years 3, 5, 6, 9, and upper secondary school; all subjects’ grades in school year 9; and university degree. Binomial-, ordinal logistic-, linear-, and binary logistic regression were used.

Results: For the majority of outcomes, no statistically significant group differences were observed, and generally children with CL were less affected than those with CLP and CPO. Children with CPO demonstrated lower achievement in the third school year (Swedish; aOR 0.54, 95% CI 0.40–0.72, mathematics; aOR 0.54, 95% CI 0.42–0.70), in Swedish in the ninth school year (aOR 0.89, 95% CI 0.80–0.99), and in mathematics in upper secondary school (aOR 0.87, 95% CI 0.76–1.00). Individuals with CPO had reduced odds of graduating from university (aOR 0.81, 95% CI 0.67–0.98). Children with CLP demonstrated lower achievement in mathematics in the third school year (aOR 0.72, 95% CI 0.54–0.95) and in both Swedish and mathematics in the ninth school year (Swedish; aOR 0.89, 95% CI 0.80–0.99, mathematics; aOR 0.87, 95% CI 0.78–0.97). The majority of outcomes were less favorable in females but not for those with psychiatric comorbidity.

Conclusions: Our findings emphasize the need to screen children with clefts for learning difficulties to provide additional support in school. Girls with OFC appeared to be particularly vulnerable in this regard.

Background: Orofacial clefts are associated with neurodevelopmental conditions. However, whether or not this risk is different among children with unilateral compared with bilateral clefts is not known. The aim of this study was to compare children with bilateral clefts to those with unilateral clefts regarding psychiatric disorders, suicide, and self-harm.

Methods: We utilized data on all children born in Sweden between 1973 and 2012 with unilateral cleft lip (UCL), bilateral cleft lip (BCL), unilateral cleft lip and palate (UCLP), and bilateral cleft lip and palate (BCLP). We performed Cox regression analyses with direct comparisons between bilateral and unilateral clefts and comparisons to matched community cohorts, adjusting for confounders.

Results: Children with BCL compared with UCL showed risk increases for any psychiatric disorder (adjusted Cox-derived hazard ratios [aHRs], 2.13; 95% confidence interval [CI], 1.04–4.36), including intellectual disability (aHR, 5.31; 95% CI, 1.29–21.78). Children with BCLP compared with UCLP demonstrated risk increases for any psychiatric disorder (aHR, 1.55; 95% CI, 1.20–2.01), including speech and language disorders (aHR, 1.99; 95% CI, 1.00–3.97), neurodevelopmental disorders (aHR, 1.66; 95% CI, 1.11–2.47), and other psychiatric disorders (aHR, 1.54; 95% CI, 1.11–2.15), including personality disorders (aHR, 5.76; 95% CI, 2.13–15.55). No significant associations were observed for suicide or self-harm.

Conclusions: This large nationwide register study showed, for the first time, that individuals with bilateral clefts demonstrated elevated risks of psychiatric disorders compared with unilateral clefts. This is of clinical relevance to professionals as well as information that needs to be conveyed to families of children with orofacial clefts.

Background

Peripartum depression (PPD) is one of the most common pregnancy complications; nevertheless, it often goes underdiagnosed. Pinpointing important correlates is crucial for early risk identification and pathophysiology understanding. We aimed to investigate the association between self-reported mood swings during oral contraceptive (OC) use and peripartum depressive symptoms (PPDS).

Methods

We used data from the Swedish longitudinal cohort study Mom2B. 3829 women who had reported previous usage of OCs were included. Self-reported mood swings during OC use were assessed through a single question, and PPDS were evaluated using established cut-offs of the Edinburgh Postnatal Depression Scale (EPDS).

Results

Self-reported mood swings during OC use were associated with PPDS at gestational weeks 12-22 (OR = 1.30, 95% CI, 1.01-1.66), 24-34 (OR = 1.37, 95% CI, 1.10-1.71) and 36-42 (OR = 1.39, 95% CI, 1.05-1.82) as well as at postpartum weeks 6-13 (OR = 1.46, 95% CI, 1.12-1.92) and 24-35 (OR = 2.07, 95% CI, 1.43-2.99). Interestingly, self-reported mood swings during OC use were associated with higher odds for newly developed PPDS in early postpartum (OR for weeks 6-13 = 1.92, 95% CI: 1.19-3.08).

Conclusions

Women with self-reported mood swings during OC use have higher risk of experiencing depressive symptoms across the peripartum period and twice the risk of newly developed PPDS during the early postpartum, adding to current evidence of a hormonal sensitive subgroup of women and the opportunity to use this simple question in future predictive efforts.

IMPORTANCE: Paternal psychiatric disorders during the perinatal period can affect the health of the entire family; however, these conditions have often been underrecognized, and little is known about their incidence and timing of onset.

OBJECTIVE: To investigate incidence patterns of new-onset diagnosed psychiatric disorders among men in Sweden before, during, and after a partner's pregnancy.

DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used linked national register data for all fathers of children born in Sweden between January 1, 2003, and December 31, 2021, with follow-up from 1 year before to 1 year after pregnancy. Data were analyzed from October 1, 2024, to March 31, 2025.

EXPOSURES: The time during pregnancy and 1 year after childbirth (post partum) were considered the risk periods, while 1 year before pregnancy (before conception) was used as the reference period.

MAIN OUTCOMES AND MEASURES: Annual and weekly incidence rates (IRs) of clinical diagnoses of any psychiatric disorder and 9 type-specific disorders were calculated and standardized by age and calendar year. Adjusted Poisson regression analysis was used to further estimate incidence rate ratios (IRRs) of psychiatric disorders during and after pregnancy compared with before conception.

RESULTS: This study included 1 915 722 births from 1 096 198 fathers (mean [SD] age at childbirth, 33.8 [6.2] years) in Sweden. IRs of any diagnosed psychiatric disorder were lower during pregnancy (eg, pregnancy week 1: IR, 5.50 [95% CI, 4.69-6.31] per 1000 person-years) and the early postpartum period (eg, postpartum week 1: IR, 5.19 [95% CI, 4.41-5.97] per 1000 person-years) than in the corresponding preconception weeks (eg, preconception week 1: IR, 7.00 [95% CI, 5.97-8.04] per 1000 person-years); they returned to comparable rates later post partum. This pattern was also observed for IRRs of anxiety, alcohol use, and drug use (ie, the use of nonalcohol, nontobacco psychoactive drugs) disorders. IRRs of depression (eg, postpartum weeks 45-49: IRR, 1.30 [95% CI, 1.12-1.52]) and stress-related disorders (eg, postpartum weeks 45-49: IRR, 1.36 [95% CI, 1.15-1.61]), however, showed a notable 30% increase toward the end of the first postpartum year. In contrast, IRRs of diagnosis of tobacco use disorder, attention-deficit/hyperactivity disorder, bipolar disorder, or psychosis remained relatively stable before, during, and after pregnancy.

CONCLUSIONS AND RELEVANCE: In this nationwide cohort study, fathers in Sweden were less likely to be diagnosed with a psychiatric disorder during a partner's pregnancy and early post partum than before conception, but IRs returned to comparable levels thereafter. These incidence patterns may reflect transient protection and delayed detection during the transition to fatherhood and support the need for paternal mental health surveillance, particularly for increased depression and stress-related disorders in the late postpartum period.

Introduction: Despite an increasing amount of research related to gender-affirming treatment (GAT) outcomes among transgender and gender-diverse (TGD) people (ie, people who experience discomfort or distress in the misalignment between their gender and sex assigned at birth) in recent years, the evidence base for current recommendations is suboptimal. One contributing factor is the heterogeneity in the outcomes and outcome measures used. This study seeks to address this challenge by developing a foundational core outcome set (COS) to be used for TGD adults receiving GAT in Sweden.

Methods: Recommendations from the Core Outcome Measures in Effectiveness Trials initiative will be used to address this aim in four phases. Phase 1, an umbrella review of peer-reviewed literature and international guidelines in GAT will be conducted to identify relevant outcomes. In phase 2, we will solicit input from TGD individuals through the review of patient and interest organisations' reports and an anonymous survey to identify outcomes of personal significance. In phase 3, using the Delphi method, 2-3 rounds of assessment will be conducted where researchers, healthcare professionals, policy-makers and TGD adults rate the identified outcomes by perceived importance. In phase 4, a consensus meeting will convene representatives from all stakeholder groups to finalise the COS.

Analysis: The results of this study will consist of a COS for GAT regarding TGD adults in Sweden. Participant survey responses will be evaluated using interpretive analysis to identify core outcomes. During each of the Delphi rounds, Likert-type scale ratings will be aggregated for outcomes to advance or be eliminated in each round.

Ethics and dissemination: The study has received ethical approval by the Swedish Ethical Review Authority (Ume & aring; medicine department, Registration number: 2024-04672-01). The results of this study will be published open-access and disseminated through TGD interest organisations and a Swedish research network for gender dysphoria. Trial registration number COMET registration number 3223.

Background

Peripartum depression is a common but potentially debilitating pregnancy complication. Mobile applications can be used to collect data throughout the pregnancy and postpartum period to improve understanding of early risk indicators.

Aim

This study aimed to improve understanding of why women drop out of a peripartum depression mHealth study, and how we can improve the app design.

Method

Participants who dropped out of the Mom2B study (n = 134) answered closed and open questions on their motives for dropping out of the study, suggestions for improvement, and preferred timeframe of the study. A mix of quantitative and qualitative strategies was used to analyze the responses.

Results

The most common reasons for discontinuation were lack of time, problems with or loss of the pregnancy, the use of other pregnancy applications, surveys being too lengthy, the app draining too much battery, and participants incorrectly believing that their answers were irrelevant for the study. Participants suggested fewer survey moments, more reminders, and a need for more unique content compared to commercially available apps.

Conclusions

Researcher who want to use mHealth designs in peripartum studies need to ensure that their study designs are as time-efficient as possible, remind participants about the study, manage expectations about the study and what is expected of participants throughout the study, design their apps to be attractive in a competitive market, and follow-up with participants who are excluded from the study due to pregnancy complications.

Aim

Examine the psychometric properties of the Swedish Child Behaviour Check List (CBCL) 1.5–5.

Methods

CBCL 1.5–5 responses were collected from 1156 mothers about their 18-month-old children in a population-based study. Representation was analysed by comparing the study sample with two Swedish national samples; scores were reweighted to adjust for selection bias. Confirmatory factor analysis was done using Robust Maximum Likelihood (MLR) estimation on CBCL 1.5–5 syndrome scales and Diagonally Weighted Least Squares (DWLS) estimation for item level. Test–retest reliability was examined with the Pearson (r) coefficient in a subsample (n = 80). Convergent validity was tested between CBCL 1.5–5 and the Early Childhood Behaviour Questionnaire (ECBQ) Very Short Form (n = 826).

Results

Internal consistency of the CBCL scales varied, McDonald's Omega (ω) 0.5–0.9. Confirmatory factor analysis showed good factor fit for seven factors. Test–retest reliability for the Total Problem Score (TPS), Internalising Problems Score (IPS) and Externalising Problems Score (EPS) scales after 4–12 months was r = 0.53, 0.43 and 0.53. Convergence validity was tested between the CBCL 1.5–5 EPS scale and the Early Childhood Behaviour Questionnaire (ECBQ) Effortful control scale (r = −0.51), and the CBCL 1.5–5 IPS scale and ECBQ Negative Affectivity scale (r = 0.45).

Conclusion

The Swedish translation of CBCL 1.5–5 showed good psychometric properties.