Distinguishing postpartum and antepartum depressive trajectories in a large population-based cohort: the impact of exposure to adversity and offspring gender

Abstract

Background Distinguishing temporal patterns of depressive symptoms during pregnancy and after childbirth has important clinical implications for diagnosis, treatment, and maternal and child outcomes. The primary aim of the present study was to distinguish patterns of chronically elevated levels of depressive symptoms v. trajectories that are either elevated during pregnancy but then remit after childbirth, v. patterns that increase after childbirth. Methods The report uses latent growth mixture modeling in a large, population-based cohort (N = 12 121) to investigate temporal patterns of depressive symptoms. We examined theoretically relevant sociodemographic factors, exposure to adversity, and offspring gender as predictors. Results Four distinct trajectories emerged, including resilient (74.3%), improving (9.2%), emergent (4.0%), and chronic (11.5%). Lower maternal and paternal education distinguished chronic from resilient depressive trajectories, whereas higher maternal and partner education, and female offspring gender, distinguished the emergent trajectory from the chronic trajectory. Younger maternal age distinguished the improving group from the resilient group. Exposure to medical, interpersonal, financial, and housing adversity predicted membership in the chronic, emergent, and improving trajectories compared with the resilient trajectory. Finally, exposure to medical, interpersonal, and financial adversity was associated with the chronic v. improving group, and inversely related to the emergent class relative to the improving group. Conclusions There are distinct temporal patterns of depressive symptoms during pregnancy, after childbirth, and beyond. Most women show stable low levels of depressive symptoms, while emergent and chronic depression patterns are separable with distinct correlates, most notably maternal age, education levels, adversity exposure, and child gender.

Characteristics of women with different perinatal depression trajectories

“…Depression with onset during pregnancy has previously been pointed out to more often be associated with psychosocial stressors compared with postpartum onset depression (Altemus et al, ). The present findings are in line with previous studies suggesting that more psychosocially vulnerable women, i.e., those with previous mental health morbidity or low SES, more often have depression during pregnancy or even chronic symptoms during the perinatal period (Biaggi, Conroy, Pawlby, & Pariante, ; Denckla et al, ; Howard et al, ).…”

“…Addressing such limitations, the present study defined PND trajectories that more easily could be applicable in a clinical setting by using an established screening instrument (EPDS; Cox et al, ) and cut‐offs available for use among clinicians (Wickberg & Hwang, ). Nevertheless, the present findings correspond well with previous studies defining trajectories with statistical methods (Bayrampour et al, ; Denckla et al, ; McCall‐Hosenfeld, Phiri, Schaefer, Zhu, & Kjerulff, ; Mora et al, ; Vänskä et al, ). In line with previous studies, the healthy trajectory in the present study was most common, suggesting this trajectory may be normative (Baron et al, ; Santos et al, ).…”

“…In addition, some studies lack detailed background information, particularly regarding previous history of mental illness (e.g., Vliegen, Casalin, & Luyten, ) and history of stressful life events, such as abuse and trauma (Putnam et al, ). Furthermore, at present, there are no studies examining PND trajectories in a Swedish setting, which may be of importance considering the majority of the larger PND trajectory studies has been conducted in the United States, Canada, or Australia (Bayrampour, Tomfohr, & Tough, ; Santos et al, ) while others in the United Kingdom, (Denckla et al, ). Only a few studies have been carried out in the Nordic countries (Drozd, Haga, Valla, & Slinning, ; Luoma, Korhonen, Salmelin, Helminen, & Tamminen, ; Vänskä et al, ) that have different health care and welfare systems to, e.g., the United States.…”

The dynamic course of peripartum depression across pregnancy and childbirth

“…The findings of more mental illness in family of origin among women with chronic symptoms accord with previous work on the strong contribution of history of mood disorder in the family to PPD etiology (Jones and Craddock, 2007). Mental illness in the family may suggest a biological predisposition for developing chronic PPD although there are also adversity and environmental contributing factors (Denckla et al, 2017).…”

Dietary intake of fish and n-3 polyunsaturated fatty acids and risk of postpartum depression: a nationwide longitudinal study – the Japan Environment and Children's Study (JECS)

“…The prevalence of postpartum depression peaks at about 1 month (Ishikawa et al ., 2011; Shimizu et al ., 2015; Iwata et al ., 2016), but its symptoms become fixed and intractable at about 6 months (Denckla et al ., 2018). Despite conventional thinking that 6 months is outside the standard postpartum depression period (American Psychiatric Association, 2013), many experts believe that the postpartum depression period should be extended to as long as 12 months (Gaynes et al ., 2005).…”