Heterogeneity in perinatal depression: how far have we come? A systematic review

Abstract

Despite perinatal depression (PND) being a common mental disorder affecting pregnant women and new mothers, limited attention has been paid to the heterogeneous nature of this disorder. We examined heterogeneity in PND symptom profiles and symptom trajectories. Literature searches revealed 247 relevant studies, 23 of which were included in the final review. The most common statistical approaches used to explore symptom and trajectory heterogeneity were latent class model and growth mixture model. All but one study examined PND symptom trajectories, and provide collective evidence of at least three heterogeneous patterns: low, medium or chronic-high symptom levels. Social and psychological risk factors were the most common group of predictors related to a higher burden (high sum of score) of depressive symptoms. These studies were consistent in reporting poorer health outcomes for children of mothers assigned to high burden symptom trajectories. Only one study explored heterogeneity in symptom profile, and was the only one to describe the specific constellations of depressive symptoms related to the PND heterogeneous patterns identified. Therefore, there is limited evidence on the specific symptoms and symptom configurations that make up PND heterogeneity. We suggest directions for future research to further clarify the PND heterogeneity and its related mechanisms.

Network Structure of Perinatal Depressive Symptoms in Latinas: Relationship to Stress and Reproductive Biomarkers

“…One important limitation in the current literature is the lack of analytical attention to specific PND symptoms. Most research on PND has been conducted at the disease level, focusing on the binary classification of PND (i.e., present or absent) or continuous summary scores (Santos, Tan, & Salomon, ). However, patients diagnosed with depressive disorders can differ dramatically in their symptoms (Fried & Nesse, ; Olbert, Gala, & Tupler, ; Santos et al, ).…”

“…Most research on PND has been conducted at the disease level, focusing on the binary classification of PND (i.e., present or absent) or continuous summary scores (Santos, Tan, & Salomon, ). However, patients diagnosed with depressive disorders can differ dramatically in their symptoms (Fried & Nesse, ; Olbert, Gala, & Tupler, ; Santos et al, ). Moreover, risk factors, the underlying biology, impairment of psychosocial function, and life events are differentially related to specific symptom profiles (for a review, see Fried & Nesse, ).…”

Characteristics of women with different perinatal depression trajectories

“…Different trajectories, e.g., depression exclusively during pregnancy, exclusively in the postpartum period, or throughout the pregnancy and postpartum, may have different pathogenesis and consequences for the mother as well as for her family. A recent systematic review of 22 longitudinal studies including more than 38,000 women found between two and six different symptom trajectories (Santos, Tan, & Salomon, ). In studies adopting elaborate statistical modeling when determining PND trajectories, a three‐trajectory classes solution is most commonly reported, though many studies also support a five‐trajectory classes solution.…”

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.…”