Karen T Putnam1, Marsha Wilcox2, Emma Robertson-Blackmore3, Katherine Sharkey4, Veerle Bergink5, Trine Munk-Olsen6, Kristina M Deligiannidis7, Jennifer Payne8, Margaret Altemus9, Jeffrey Newport10, Gisele Apter11, Emmanuel Devouche12, Alexander Viktorin13, Patrik Magnusson13, Brenda Penninx14, Anne Buist15, Justin Bilszta15, Michael O'Hara16, Scott Stuart16, Rebecca Brock16, Sabine Roza5, Henning Tiemeier5, Constance Guille17, C Neill Epperson18, Deborah Kim18, Peter Schmidt19, Pedro Martinez19, Arianna Di Florio20, Katherine L Wisner21, Zachary Stowe22, Ian Jones20, Patrick F Sullivan23, David Rubinow1, Kevin Wildenhaus2, Samantha Meltzer-Brody24. 1. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 2. Janssen Research & Development, Titusville, NJ, USA. 3. Family Medicine Residency, Halifax Health, Daytona Beach, FL, USA. 4. Department of Internal Medicine and Psychiatry, Brown University, Providence, RI, USA. 5. Department of Psychiatry/Psychology, Erasmus MC, Rotterdam, Netherlands. 6. Department of Economics and Business-National Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark. 7. Departments of Psychiatry and Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Glen Oaks, NY, USA. 8. Department of Psychiatry, Johns Hopkins University, Baltimore, MD, USA. 9. Department of Psychiatry, Weill Cornell Medical College, New York City, NY, USA. 10. Department of Psychiatry, University of Miami, Miami, FL, USA. 11. Erasme Hospital, Paris Diderot University, Paris, France. 12. Erasme Hospital, Paris Descartes University, Paris, France. 13. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. 14. Department of Psychiatry, VU University Medical Center, Amsterdam, Netherlands. 15. University of Melbourne, Women's Mental Health, Melbourne, VIC, Australia. 16. Department of Psychology, University of Iowa, Iowa City, IA, USA. 17. Department of Psychiatry, Medical University of South Carolina, Charleston, SC, USA. 18. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA. 19. National Institutes of Mental Health, Bethesda, MD, USA. 20. Cardiff University School of Medicine, Institute of Psychological Medicine and Clinical Neuroscience, Cardiff, UK. 21. Northwestern University Feinberg School of Medicine, Asher Center for the Study and Treatment of Depressive Disorders, Chicago, IL, USA. 22. Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 23. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. 24. Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: meltzerb@med.unc.edu.
Abstract
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.
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.
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