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

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.

Figure 1. Participant selection

EPDS=Edinburgh postnatal depression scale. PACT=Postpartum Depression: Action Towards Causes and Treatment Consortium. The perinatal depression period includes each trimester of pregnancy and three post-partum periods (0 to <4 weeks, ≥4 to <8 weeks, and ≥8 weeks).

Figure 2. Edinburgh postnatal depression scale score by time of onset of perinatal depressive symptoms

Column data are n (%).

Figure 3. Subtype distribution in the three trimesters of pregnancy and three post-partum periods

Column data are n (%). A bar representing the total sample is included on the right for comparison purposes. If there was no difference by onset period, each of the other bars would reflect the distribution of the total sample.