Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium

Abstract

Summary Background The perinatal period is a time of high risk for onset of depressive disorders and is associated with substantial morbidity and mortality, including maternal suicide. Perinatal depression comprises a heterogeneous group of clinical subtypes, and further refinement is needed to improve treatment outcomes. We sought to empirically identify and describe clinically relevant phenotypic subtypes of perinatal depression, and further characterise subtypes by time of symptom onset within pregnancy and three post-partum periods. Methods Data were assembled from a subset of seven of 19 international sites in the Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium. In this analysis, the cohort was restricted to women aged 19–40 years with information about onset of depressive symptoms in the perinatal period and complete prospective data for the ten-item Edinburgh postnatal depression scale (EPDS). Principal components and common factor analysis were used to identify symptom dimensions in the EPDS. The National Institute of Mental Health research domain criteria functional constructs of negative valence and arousal were applied to the EPDS dimensions that reflect states of depressed mood, anhedonia, and anxiety. We used k-means clustering to identify subtypes of women sharing symptom patterns. Univariate and bivariate statistics were used to describe the subtypes. Findings Data for 663 women were included in these analyses. We found evidence for three underlying dimensions measured by the EPDS: depressed mood, anxiety, and anhedonia. On the basis of these dimensions, we identified five distinct subtypes of perinatal depression: severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia, and resolved depression. These subtypes have clear differences in symptom quality and time of onset. Anxiety and anhedonia emerged as prominent symptom dimensions with post-partum onset and were notably severe. Interpretation Our findings show that there might be different types and severity of perinatal depression with varying time of onset throughout pregnancy and post partum. These findings support the need for tailored treatments that improve outcomes for women with perinatal depression. Funding Janssen Research & Development.

Maternal Depressive Symptoms During the Pre‐ and Postnatal Periods and Infant Attention to Emotional Faces

“…Maternal depressive symptoms of varying severity are common during the pre-and postnatal periods (Andersson, Sundstr€ om-Poromaa, Wulff, Str€ om, & Bixo, 2006;Leight, Fitelson, Weston, & Wisner, 2010), and have consistently been linked to adverse effects on both the mother and developing child (Field, 2010;Murray, Fearon, & Cooper, 2015). However, depression is a heterogeneous disorder with different subtypes (Rantala, Luoto, Krams, & Karlsson, 2018), and the time course of symptoms and the degree of chronicity also vary during the pre-and postnatal periods (Fredriksen, von Soest, Smith, & Moe, 2017;Putnam et al, 2017). Chronic depressive maternal symptoms seem to be more predictive of adverse child outcomes compared to transient symptoms (Murray, Halligan, & Cooper, 2010;van der Waerden et al, 2015).…”

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

“…Second, some women report elevated depressive symptoms between 18 and 32 weeks of gestation but later report remitted symptoms in the 8 months after delivery, and therefore may not require intervention (Heron et al 2004). For other women, elevated depressive symptoms in the antepartum (before parturition) period may be the beginning of a chronic state (McCall-Hosenfeld et al 2016) (see also Putnam et al (2017)). Documenting heterogeneous trajectories among childbearing women increases understanding of the varying course of depressive symptoms and may identify who to target for intervention during a period of heightened vulnerability.…”

Profiles and characteristics of clinical subtypes of perinatal depressive symptoms: A latent class analysis

“…Depression is a heterogeneous disorder; accordingly, increasingly many studies have explored the substantial heterogeneity of postnatal and perinatal depressive symptoms (Putnam et al, 2017). Researchers have attempted to classify subtypes of depression based on the symptoms, onset, neurophysiology, or severity (Rantala, Luoto, Krams, & Karlsson, 2018;Rush, 2007).…”

“…Some studies have recommended a person-centred approach rather than a variable-centred method to distinguish heterogeneous entities involving such co-occurring symptoms (Contractor, Roley-Roberts, Lagdon, & Armour, 2017;Kamperman et al, 2017;Putnam et al, 2015). For example Putnam et al (2017) used the Edinburgh Postnatal Depression Scale (EPDS, Cox, Holden, & Sagovsky, 1987) and time of depression onset to identify five distinct phenotypes of perinatal depression in 633 women, aged 19-40 years, with reported onset of perinatal depression in perinatal period. The phenotypes consisted of severe anxious depression, moderate anxious depression, anxious anhedonia, pure anhedonia and resolved depression.…”