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J Psychiatr Res. 2019 Mar 15;113:72-78. doi: 10.1016/j.jpsychires.2019.03.016. [Epub ahead of print]

The dynamic course of peripartum depression across pregnancy and childbirth.

Author information

1
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: sdekel@mgh.harvard.edu.
2
School of Psychology, Interdisciplinary Center (IDC) Herzliya, Israel.
3
Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland.
4
Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland; Social and Health, City of Kuopio, Kuopio, Finland.
5
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
6
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland; Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland.
7
Institute of Clinical Medicine, Child Psychiatry, University of Eastern Finland, Kuopio, Finland.
8
Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland.
9
Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland; Department of Health Sciences, Clinical Medicine University of Eastern Finland, Kuopio, Finland.
10
Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
11
Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland; Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Psychiatry, University of Helsinki, Helsinki, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.

Abstract

OBJECTIVE:

Peripartum depression (PPD) pertaining to depression in pregnancy and postpartum is one of the most common complications around childbirth with enduring adverse effects on mother and child health. Although psychiatric symptoms may improve or worsen over time, relatively little is known about the course of PPD symptoms and possible fluctuations.

METHODS:

We applied a person-centered approach to examine PPD symptom patterns across pregnancy and childbirth. 824 women were assessed at three time points: first trimester (T1), third trimester (T2), and again at eight weeks (T3) postpartum. We assessed PPD symptoms, maternal mental health history, and childbirth variables.

RESULTS:

Growth mixture modeling (GMM) analysis revealed four discrete PPD symptom trajectory classes including chronic PPD (1.1%), delayed (10.2%), recovered (7.2%), and resilient (81.5%). Delivery complications were associated with chronic PPD but also with the recovered PPD trajectory class. History of mental health disorders was associated with chronic PPD and the delayed PPD class.

CONCLUSION:

The findings underscore that significant changes in a woman's depression level can occur across pregnancy and childbirth. While a minority of women experience chronic PDD, for others depression symptoms appear to significantly alleviate over time, suggesting a form of recovery. Our findings support a personalized medicine approach based on the woman's symptom trajectory. Future research is warranted to identify the mechanisms underlying modifications in PPD symptoms severity and those implicated in recovery.

KEYWORDS:

Childbirth; Growth modeling; Peripartum depression; Prospective sample; Symptom trajectory

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