Exploring Heterogeneity in perinatal depression: a comprehensive review

Abstract

Perinatal depression (PND) is a significant contributor to maternal morbidity globally. Recognized as a major cause of poor infant development, epidemiological and interventional research on it has increased over the last decade. Recently, studies have pointed out that PND is a heterogeneous condition, with variability in its phenotypes, rather than a homogenous latent entity and a concrete diagnosis, as previously conceptualized in psychometric literature and diagnostic systems. Therefore, it is pertinent that researchers recognize this to progress in elucidating its aetiology and developing efficacious interventions.This systematic review is conducted in accordance with the Meta-analysis of observational studies in epidemiology (MOOSE). It aims to provide an updated and comprehensive account of research on heterogeneity in phenotypes of PND and its implications in research, public health, and clinical practice. It provides a synthesis and quality assessment of studies reporting heterogeneity in PND using cutting-edge statistical techniques and machine learning algorithms. After reporting the phenotypes of PND, based on heterogeneous trajectories and symptom profiles, it also elucidates the risk factors associated with severe forms of PND, followed by robust evidence for adverse child outcomes. Furthermore, recommendations are made to improve public health and clinical practice in screening, diagnosis, and treatment of PND.

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

“…Confirmation of the findings described in our earlier work [30] was found in review papers published in the past 4 years ([9,34 ▪ ,72,73 ▪▪ ,74 ▪▪ ,75–80,81 ▪ ]. Alteration or disruption in the parent-infant relationship has been mentioned in several reviews, including a review on effects of perinatal interventions on parent anxiety, infant socio-emotional development and parent-infant relation outcomes [82].…”

“…Some studies examine differential offspring neurobehavioral developmental outcomes in groups of women showing different trajectories of onset, intensity and chronicity of depression symptoms, using cutting-edge statistical methods and machine learning algorithms [74 ▪▪ ]. These provide evidence that offspring of mothers with for example, a trajectory of chronic high depression (stable from pregnancy to postpartum) have more conduct, emotional, social (e.g., poor peer relations) problems, externalizing and/or internalizing problems, depression and emotional dysregulation.…”

Perinatal Depression and Risk of Suicidal Behavior

“… 6 , 7 In fact, suicidal ideation is part of the typical screening for PND. 8 Emerging evidence 9 suggests that those with PND are a heterogenous group. For instance, antenatal (during pregnancy) and postnatal (maximally within 1 year after delivery) depression may have different causes and symptom clusters.…”

“…For instance, antenatal (during pregnancy) and postnatal (maximally within 1 year after delivery) depression may have different causes and symptom clusters. 9 Existing literature 10 , 11 , 12 suggests that suicidal ideation is common among women with antenatal depression, while data on risk of suicidal behavior, including attempted and completed suicide, are lacking. Studies 13 , 14 have shown that 3% to 19% of women with postnatal depression endorsed suicidal ideation.…”

Long-Term Effects of Maternal Depression during Postpartum and Early Parenthood Period on Child Socioemotional Development

“…While depression is prevalent across the lifespan for both sexes globally [2], the World Health Organization (WHO), International Monetary Fund (IMF) and other international organizations emphasize the significance of maternal depressive disorders as an issue of global population health as they are well known to contribute to infant and child morbidity [3][4][5]. Poor outcomes for children may include lower birth weight, suboptimal infant growth, decreased breastfeeding rates, developmental delay, behavioral problems, compromised executive functions and other short-and long-term physical and mental health problems [3,[6][7][8].…”