Department of Economics and Business Economics

Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an International Consortium

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • Karen T Putnam, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  • ,
  • Marsha Wilcox, Janssen Research & Development, Titusville, NJ, USA.
  • ,
  • Emma Robertson-Blackmore, Family Medicine Residency, Halifax Health, Daytona Beach, FL, USA.
  • ,
  • Katherine Sharkey, Department of Internal Medicine and Psychiatry, Brown University, Providence, RI, USA.
  • ,
  • Veerle Bergink, Department of Psychiatry/Psychology,Erasmus MC,Rotterdam,The Netherlands.
  • ,
  • Trine Munk-Olsen
  • Kristina M Deligiannidis, Departments of Psychiatry and Obstetrics and Gynecology, Hofstra Northwell School of Medicine, Glen Oaks, NY, USA.
  • ,
  • Jennifer Payne, Department of Psychiatry,The Johns Hopkins University,Baltimore,MD,USA.
  • ,
  • Margaret Altemus, Department of Psychiatry, Weill Cornell Medical College, New York City, NY, USA.
  • ,
  • D Jeffrey Newport, Department of Psychiatry,University of Miami,Miami,FL,USA.
  • ,
  • Gisele Apter, Erasme Hospital, Paris Diderot University,Paris,France.
  • ,
  • Emmanuel Devouche, Erasme Hospital, Paris Descartes University,Paris,France.
  • ,
  • Alexander Viktorin, Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
  • ,
  • Patrik Magnusson, Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
  • ,
  • Brenda P Penninx, Department of Psychiatry, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands.
  • ,
  • Anne Buist, Women's Mental Health, University of Melbourne,Melbourne,VIC,Australia.
  • ,
  • Justin Bilszta, Women's Mental Health, University of Melbourne,Melbourne,VIC,Australia.
  • ,
  • Michael O'Hara, Department of Psychology, University of Iowa, Iowa City, IA, USA.
  • ,
  • Scott Stuart, Department of Psychology, University of Iowa, Iowa City, IA, USA.
  • ,
  • Rebecca Brock, Department of Psychology, University of Iowa, Iowa City, IA, USA.
  • ,
  • Sabine Roza, Department of Psychiatry/Psychology,Erasmus MC,Rotterdam,The Netherlands.
  • ,
  • Henning Tiemeier, Department of Psychiatry/Psychology,Erasmus MC,Rotterdam,The Netherlands.
  • ,
  • Constance Guille, Department of Psychiatry,Medical University of South Carolina,Charleston,SC,USA.
  • ,
  • C Neill Epperson, Department of Psychiatry,University of Pennsylvania,Philadelphia,PA,USA.
  • ,
  • Deborah Kim, Department of Psychiatry,University of Pennsylvania,Philadelphia,PA,USA.
  • ,
  • Peter Schmidt, Childhood Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
  • ,
  • Juan-Pedro Martinez-Barbera, Childhood Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA.
  • ,
  • Arianna Di Florio, Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, United Kingdom; Neuroscience and Mental Health Research Institute, Cardiff University, United Kingdom.
  • ,
  • Katherine L Wisner, Asher Center for the Study and Treatment of Depressive Disorders, Northwestern University Feinberg School of Medicine,Chicago,IL,USA.
  • ,
  • Zachary N Stowe, Department of Psychiatry,University of Arkansas for Medical Sciences,Little Rock,AR,USA.
  • ,
  • Ian Jones, Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, United Kingdom; Neuroscience and Mental Health Research Institute, Cardiff University, United Kingdom.
  • ,
  • Patrick F Sullivan, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
  • ,
  • David Rubinow, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
  • ,
  • Kevin Wildenhaus, Janssen Research & Development, Titusville, NJ, USA.
  • ,
  • Samantha Meltzer-Brody, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: meltzerb@med.unc.edu.
  • ,
  • Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium

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 10-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 (RDoC) 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.

Original languageEnglish
JournalThe Lancet Psychiatry
Volume4
Issue6
Pages (from-to)477-485
ISSN2215-0366
DOIs
Publication statusPublished - 2 May 2017

    Research areas

  • Journal Article

See relations at Aarhus University Citationformats

ID: 112716602