A systematic review of growth curve mixture modelling literature investigating trajectories of perinatal depressive symptoms and associated risk factors

Abstract

Background The aim of this study was to review the growth curve mixture modelling (GCMM) literature investigating trajectories of perinatal maternal depressive symptoms and associated risk factors. Methods A systematic search of peer-reviewed articles published until November 2015 was conducted in seven databases. Articles using GCMM to identify trajectories of perinatal depressive symptoms were considered. Symptoms had to be assessed at least three times, anytime from pregnancy to two years postpartum (PROSPERO; 2016:CRD42016032600). Results Eleven studies met inclusion criteria. All reported a low risk trajectory, characterised by stable low depressive symptoms throughout the perinatal period. A stable moderate-high or high symptom trajectory was reported in eight of 11 studies, suggesting a high-risk group with persistent depressive symptoms. Six studies also reported transient trajectories, with either increasing, decreasing or episodic depressive symptoms. None of the demographic, personality or clinical characteristics investigated systematically differentiated groups of women with different symptom trajectories, within or across studies. Thus, it is difficult to differentiate women at high or low risk of specific perinatal depression trajectories. Limitations A meta-analysis was not possible. The studies' settings and inclusion criteria limit the generalisability of the findings to low-risk, middle- to high-income women. Conclusions Relatively similar trajectories of perinatal depressive symptoms were identified across studies. Evidence on factors differentiating women assigned to different trajectories was inconsistent. Research with larger samples and in more diverse settings is needed to inform services and policies on how and when to effectively identify subgroups of women at high risk of perinatal depression.

Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36 months

“…This study sought to identify latent trajectories of depressive symptoms from pregnancy to 18-month postpartum, and their predictors, among low-income perinatal women in South Africa. Altogether, the four trajectories identified support previous findings using similar modelling techniques [30,33]. First, the chronic low trajectory identified was reported in a previous study conducted in Africa [32], suggesting that, despite the high number and ongoing stressors experienced in LMICs, the majority of women remain at low risk of developing depressive symptoms during the perinatal period.…”

“…Studies which have used more complex longitudinal analyses, such as growth curve mixture modelling (GCMM), have enabled the identification of latent subgroups of women with both chronic and transient symptom trajectories during the perinatal period, in both HICs [30] and LMICs [31,32]. This allowed investigators to disentangle severity from chronicity and moving away from the dichotomisation of depressive symptoms.…”

Group‐based trajectory modelling for BMI trajectories in childhood: A systematic review

“…Any differences identified between trajectories in subsequent phases therefore have a level of uncertainty and do not capture the individual variability within each class. Findings should consequently be interpreted with caution …”

The effects of depressive symptom management interventions on low‐income mothers: A systematic review and meta‐analysis

“…However, the heterogeneity of levels of depressive symptoms in perinatal mothers and those with young children (under 5 years) has been mentioned in several studies and various social and psychological risk factors have been identified in the trajectory of depressive symptoms (Baron, Bass, Murray, Schneider, & Lund, ; Santos, Tan, & Salomon, ; van der Waerden et al., ). Although the effect of intervention was different for each group, the depressive symptoms of perinatal mothers and those with young children could be explained by complex factors, besides the type and effect of intervention.…”

“…Young children also affect the mothers if they adapt well to the effect of intervention. In addition, mother-child interaction facilitates interventions (Baron, Bass, Murray, Schneider, & Lund, 2017;Santos, Tan, & Salomon, 2017;van der Waerden et al, 2015). Although the effect of intervention was different for each group, the depressive symptoms of perinatal mothers and those with young children could be explained by complex factors, besides the type and effect of intervention.…”