The dynamic course of peripartum depression across pregnancy and childbirth

Abstract

Objective. Peripartum depression (PPD) pertaining to depression in pregnancy and postpartum is one of the most common complications around childbirth with enduring adverse effects on mother and child health. Although psychiatric symptoms may improve or worsen over time, relatively little is known about the course of PPD symptoms and possible fluctuations. Methods. We applied a person-centered approach to examine PPD symptom patterns across pregnancy and childbirth. 824 women were assessed at three time points: first trimester (T1), third trimester (T2), and again at eight weeks (T3) postpartum. We assessed PPD symptoms, maternal mental health history, and childbirth variables. Results. Growth mixture modeling (GMM) analysis revealed four discrete PPD symptom trajectory classes including chronic PPD (1.1%), delayed (10.2%), recovered (7.2%), and resilient (81.5%). Delivery complications were associated with chronic PPD but also with the recovered PPD trajectory class. History of mental health disorders was associated with chronic PPD and the delayed PPD class. Conclusion. The findings underscore that significant changes in a woman's depression level can occur across pregnancy and childbirth. While a minority of women experience chronic PDD, for others depression symptoms appear to significantly alleviate over time, suggesting a form of recovery. Our findings support a personalized medicine approach based on the woman's symptom trajectory. Future research is warranted to identify the mechanisms underlying modifications in PPD symptoms severity and those implicated in recovery.

Distinct trajectories of perinatal depression in Chinese women: application of latent growth mixture modelling

“…Nonetheless, the severity of PND symptoms may significantly change over time in any population. In this study, 4.7% of women reported elevated PND symptoms over time, which is in contrast to previous studies [ 27 , 46 – 48 ]. For example, a study of 425 pregnant women in South Africa found two depression trajectories [ 48 ].…”

“…The fit indices of the models generated through LGMM are reported in Table 2 . The four- class solution was excluded given that the solution had one class comprising less than 10 women [ 27 ]. The AIC and BIC values suggested that the three-class solution yielded the best fit while the entropy value favoured the two-class solution.…”

“…The reason for this difference could be that the study in South Africa focused on low-income women, and a lack of food and living resources might affect the trajectory of perinatal depression. Moreover, some studies have reported the existence of a chronic and persistent high-level depression trajectory [ 27 ]. In this study, only 37% of the subjects lived with their partners and nearly 40% of the subjects were unmarried.…”

“…A meta-analysis of 23 studies related to PND symptom trajectories found that some research teams determined the trajectory of depression based on the characteristics and severity of the disease [ 26 ]. In contrast, others chose advanced statistical methods [ 27 – 30 ]. Thus, the variation in the number of final trajectories reported in different studies, ranging from two to six different PND trajectories, is likely related to the different grouping standards.…”

“…Other studies have reported that pregnancy complications increase the possibility of a persistent depression trajectory. The persistent depression trajectory is also associated with the maternal preterm delivery than other trajectories [ 27 ]. There is less published evidence for a dynamic trajectory of depression in the Asian population.…”