Exploring Heterogeneity in perinatal depression: a systematic 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, not 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 aims to provide an updated and comprehensive account of research on heterogeneity in 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 heterogeneous trajectories and symptom profiles of PND, 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.

Optimizing cognitive and behavioral approaches for perinatal depression: A systematic review and meta-regression analysis

“…Meta-regression analyses revealed a weakly inverse association between the proportion of women with a history of mental health problems and intervention effect size. There is unequivocal evidence that complex presentations of PND (increased severity, relapsing, and recurrent) are associated with poorer treatment response (Ahmed Waqas and Rahman, 2023 ). A recent systematic review of observational studies demonstrates that perinatal women with complex and more severe forms of PND report more psychosocial adversities (Ahmed Waqas and Rahman, 2022 ).…”

“…There is unequivocal evidence that complex presentations of PND (increased severity, relapsing, and recurrent) are associated with poorer treatment response (Ahmed Waqas and Rahman, 2023 ). A recent systematic review of observational studies demonstrates that perinatal women with complex and more severe forms of PND report more psychosocial adversities (Ahmed Waqas and Rahman, 2022 ). Moreover, if left untreated, such PND symptoms contribute to intergenerational transfer of inequities; whereby children born to women with complex PND report poorer academic, mental, and physical health outcomes.…”

“…This systematic review and meta-analysis have been conducted per the PRISMA guidelines (Page et al, 2021). Before the conduct of this review, its protocol was registered on the PROSPERO database (Waqas and Rahman, 2022). The current systematic review does not report findings concerning secondary outcomes mentioned in the PROSPERO protocol.…”

“…These variables were selected apriori as described in the systematic review protocol (Waqas and Rahman, 2022). underpinned by a single theory-based approach, often called a therapy (e.g., CBT) or ii) a combination of elements drawn from different theories, forming a multicomponent intervention or eclectic therapy.…”