Maternal Psychological Symptom Trajectories from 2 to 24 Months Postpartum: A Latent Class Growth Analysis

Abstract

Background Postpartum women experience an array of psychological symptoms that are associated with adverse health behaviors and outcomes including postpartum suicidal ideation and long-term depression. To provide early management of postpartum psychological symptoms, it is important to understand how the symptom experiences change over time. Objective To examine maternal psychological symptom trajectories over 2, 6, 15, and 24 months postpartum using latent class growth analysis (LCGA) and to examine how each trajectory is associated with maternal depression outcome at 24 months. Methods We used secondary data from the Family Life Project (N = 1,122) and performed multi-trajectory LCGA based on four observed symptom variables (depression, anxiety, somatization, and hostility). After the final model was identified, bivariate analyses were conducted to examine the association between each trajectory and (a) individual characteristics and (b) outcome (Center for Epidemiologic Studies Depression Scale [CES-D]) variables. Results A 4-class model was selected for the final model because it had better fit indices, entropy, and interpretability. The four symptom trajectories were: (1) No symptoms over 24 months, (2) low symptoms over 24 months, (3) moderate symptoms increasing over 15 months, and (4) high symptoms increasing over 24 months. More postpartum women with the trajectory of high symptoms increasing over 24 months (Trajectory 4) were in low economic status (92.16%), unemployed (68.63%), or did not complete 4-year college education (98.04%). Most postpartum women (95.56%) in trajectory 4 also had higher CES-D cut-off scores, indicating a possible clinical depression at 24 months postpartum. Discussion Postpartum women who experience increasing symptom trajectories over 15 to 24 months (Trajectories 3 and 4) could benefit from tailored symptom management interventions provided earlier in the postpartum period to prevent persistent and worsening symptom experiences.