What Are The Core Symptoms of Antenatal Depression? A Study Using Patient Health Questionnaire-9 among Japanese Pregnant Women in the First Trimester

doi:10.3390/healthcare11101494

. 2023 May 20;11(10):1494.

doi: 10.3390/healthcare11101494.

What Are The Core Symptoms of Antenatal Depression? A Study Using Patient Health Questionnaire-9 among Japanese Pregnant Women in the First Trimester

Toshinori Kitamura^{1

2

3

4}, Yuriko Usui^{1

2

5}, Mikiyo Wakamatsu⁶, Mariko Minatani⁷, Ayako Hada^{1

2

8}

Affiliations

¹ Kitamura Institute of Mental Health Tokyo, Tokyo 104-0061, Japan.
² Kitamura KOKORO Clinic Mental Health, Tokyo 151-3306, Japan.
³ T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental Health, Tokyo 151-0063, Japan.
⁴ Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya 464-8601, Japan.
⁵ Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
⁶ Department of Reproductive Health Care Nursing, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan.
⁷ Life Value Creation Unit, NTT DATA Institute of Management Consulting, Inc., Tokyo 102-0093, Japan.
⁸ Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan.

PMID: 37239780
PMCID: PMC10218321
DOI: 10.3390/healthcare11101494

What Are The Core Symptoms of Antenatal Depression? A Study Using Patient Health Questionnaire-9 among Japanese Pregnant Women in the First Trimester

Toshinori Kitamura et al. Healthcare (Basel). 2023.

. 2023 May 20;11(10):1494.

doi: 10.3390/healthcare11101494.

Authors

Toshinori Kitamura^{1

2

3

4}, Yuriko Usui^{1

2

5}, Mikiyo Wakamatsu⁶, Mariko Minatani⁷, Ayako Hada^{1

2

8}

Affiliations

¹ Kitamura Institute of Mental Health Tokyo, Tokyo 104-0061, Japan.
² Kitamura KOKORO Clinic Mental Health, Tokyo 151-3306, Japan.
³ T. and F. Kitamura Foundation for Studies and Skill Advancement in Mental Health, Tokyo 151-0063, Japan.
⁴ Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya 464-8601, Japan.
⁵ Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
⁶ Department of Reproductive Health Care Nursing, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima 890-8544, Japan.
⁷ Life Value Creation Unit, NTT DATA Institute of Management Consulting, Inc., Tokyo 102-0093, Japan.
⁸ Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan.

PMID: 37239780
PMCID: PMC10218321
DOI: 10.3390/healthcare11101494

Abstract

Background: Depression is frequently seen among pregnant women. This is called antenatal depression (AND). Aim: Our aim was to identify clusters of AND and its core symptoms. Methods: The Patient Health Questionnaire-9 (PHQ-9), Pregnancy-Unique Quantification of Emesis and Nausea (PUQE-24), and Nausea and Vomiting of Pregnancy Quality of Life Questionnaire (NVP-QOL) were distributed to 382 pregnant women with a gestational age of 10 to 13 weeks who were attending antenatal clinics. The two PHQ-9 subscale scores were entered into a 2-step cluster analysis. The PHQ-9 items' capacity to identify AND were examined in terms of the area under curve (AUC) of a receiver operating characteristic (ROC) analysis. The selected symptom items were examined for their diagnostic capability in terms of the graded response model (GRM) in the item response theory (IRT) analysis. Results: Three clusters emerged. Cluster 3 scored highly in the scores of the two PHQ-9 subscales and the two emesis scales. In the ROC, five items showed an AUC > 0.80. The GRM identified four items with high information: 'loss of interest', 'depressed mood', 'self-esteem', and 'poor concentration'. Conclusions: The core symptoms of antenatal depression were four non-somatic symptoms; particularly, 'depressed mood' and 'loss of interest'. AND did not exist alone, but was accompanied by nausea and vomiting. Hence, we propose a new category: emesis-depression complex among pregnant women.

Keywords: antenatal depression; diagnostic entity; emesis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Somatic subscale and non-somatic subscale scores (z score) for each cluster.

**Figure 2**
Item information curves of GRM for *non-somatic* items. PHQ: Patient Health Questionnaire.

See this image and copyright information in PMC

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References

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1. Akechi T., Ietsugu T., Sukigara M., Okamura H., Nakano T., Akizuki N., Okamura M., Shimizu K., Okuyama T., Furukawa T.A., et al. Symptoms indicator of severity of depression in cancer patients: A comparison of the DSM-IV criteria with alternative diagnostic criteria. Gen. Hosp. Psychiatry. 2009;31:225–232. doi: 10.1016/j.genhosppsych.2008.12.004. - DOI - PubMed

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[1] Yin X., Sun N., Jiang N., Xu X., Gan Y., Zhang J., Qiu L., Yang C., Shi X., Chang J., et al. Prevalence and associated factors of antenatal depression: Symptomatic reviews and meta-analyses. Clin. Psychol. Rev. 2021;83:101932. doi: 10.1016/j.cpr.2020.101932. - DOI - PubMed

[2] Yin X., Sun N., Jiang N., Xu X., Gan Y., Zhang J., Qiu L., Yang C., Shi X., Chang J., et al. Prevalence and associated factors of antenatal depression: Symptomatic reviews and meta-analyses. Clin. Psychol. Rev. 2021;83:101932. doi: 10.1016/j.cpr.2020.101932. - DOI - PubMed

[3] Feighner J.P., Robins E., Guze S., Woodruff R.A., Winokur G., Minoz R. Diagnostic criteria for use in psychiatric research. Arch. Gen. Psychiatry. 1972;26:57–63. doi: 10.1001/archpsyc.1972.01750190059011. - DOI - PubMed

[4] Feighner J.P., Robins E., Guze S., Woodruff R.A., Winokur G., Minoz R. Diagnostic criteria for use in psychiatric research. Arch. Gen. Psychiatry. 1972;26:57–63. doi: 10.1001/archpsyc.1972.01750190059011. - DOI - PubMed

[5] Spitzer R.L., Endicott J., Robins E. Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders. 3rd ed. New York State Psychiatric Institute; New York, NY, USA: 1978.

[6] Spitzer R.L., Endicott J., Robins E. Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders. 3rd ed. New York State Psychiatric Institute; New York, NY, USA: 1978.

[7] Endicott J. Measurement of depression in patients with cancer. Cancer. 1984;53:2243–2248. doi: 10.1002/cncr.1984.53.s10.2243. - DOI - PubMed

[8] Endicott J. Measurement of depression in patients with cancer. Cancer. 1984;53:2243–2248. doi: 10.1002/cncr.1984.53.s10.2243. - DOI - PubMed

[9] Akechi T., Ietsugu T., Sukigara M., Okamura H., Nakano T., Akizuki N., Okamura M., Shimizu K., Okuyama T., Furukawa T.A., et al. Symptoms indicator of severity of depression in cancer patients: A comparison of the DSM-IV criteria with alternative diagnostic criteria. Gen. Hosp. Psychiatry. 2009;31:225–232. doi: 10.1016/j.genhosppsych.2008.12.004. - DOI - PubMed

[10] Akechi T., Ietsugu T., Sukigara M., Okamura H., Nakano T., Akizuki N., Okamura M., Shimizu K., Okuyama T., Furukawa T.A., et al. Symptoms indicator of severity of depression in cancer patients: A comparison of the DSM-IV criteria with alternative diagnostic criteria. Gen. Hosp. Psychiatry. 2009;31:225–232. doi: 10.1016/j.genhosppsych.2008.12.004. - DOI - PubMed

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What Are The Core Symptoms of Antenatal Depression? A Study Using Patient Health Questionnaire-9 among Japanese Pregnant Women in the First Trimester

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What Are The Core Symptoms of Antenatal Depression? A Study Using Patient Health Questionnaire-9 among Japanese Pregnant Women in the First Trimester

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Affiliations

Abstract

Conflict of interest statement

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Abstract

Conflict of interest statement

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