TY - JOUR
T1 - Heterogeneity of postpartum depression
T2 - A latent class analysis
AU - Postpartum Depression: Action Towards Causes And Treatment (Pact) Consortium
AU - Putnam, Karen
AU - Robertson-Blackmore, Emma
AU - Sharkey, Katherine
AU - Payne, Jennifer
AU - Bergink, Veerle
AU - Munk-Olsen, Trine
AU - Deligiannidis, Kristina
AU - Altemus, Margaret
AU - Newport, Jeffrey
AU - Apter, Gisele
AU - Devouche, Emmanuel
AU - Vikorin, Alexander
AU - Magnusson, Patrik
AU - Lichtenstein, Paul
AU - Penninx, Brenda
AU - Buist, Anne
AU - Bilszta, Justin
AU - O'Hara, Michael
AU - Stuart, Scott
AU - Brock, Rebecca
AU - Roza, Sabine
AU - Tiemeier, Henning
AU - Guille, Constance
AU - Neill Epperson, C.
AU - Kim, Deborah
AU - Schmidt, Peter
AU - Martinez, Pedro
AU - Wisner, Katherine L.
AU - Stowe, Zachary
AU - Jones, Ian
AU - Rubinow, David
AU - Sullivan, Patrick
AU - Meltzer-Brody, Samantha
N1 - Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background: Maternal depression in the postpartum period confers substantial morbidity and mortality, but the definition of postpartum depression remains controversial. We investigated the heterogeneity of symptoms with the aim of identifying clinical subtypes of postpartum depression. Methods: Data were aggregated from the international perinatal psychiatry consortium Postpartum Depression: Action Towards Causes and Treatment, which represents 19 institutions in seven countries. 17 912 unique subject records with phenotypic data were submitted. We applied latent class analyses in a two-tiered approach to assess the validity of empirically defined subtypes of postpartum depression. Tier one assessed heterogeneity in women with complete data on the Edinburgh postnatal depression scale (EPDS) and tier two in those with postpartum depression case status. Findings: 6556 individuals were assessed in tier one and 4245 in tier two. A final model with three latent classes was optimum for both tiers. The most striking characteristics associated with postpartum depression were severity, timing of onset, comorbid anxiety, and suicidal ideation. Women in class 1 had the least severe symptoms (mean EPDS score 10·5), followed by those in class 2 (mean EPDS score 14·8) and those in class 3 (mean EPDS score 20·1). The most severe symptoms of postpartum depression were significantly associated with poor mood (mean EPDS score 20·1), increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptom onset within 4 weeks postpartum and had more pregnancy complications than in other two classes (69% vs 67% in class 1 and 29% in class 3). Interpretation: PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations. Funding: Sources of funding are listed at the end of the article.
AB - Background: Maternal depression in the postpartum period confers substantial morbidity and mortality, but the definition of postpartum depression remains controversial. We investigated the heterogeneity of symptoms with the aim of identifying clinical subtypes of postpartum depression. Methods: Data were aggregated from the international perinatal psychiatry consortium Postpartum Depression: Action Towards Causes and Treatment, which represents 19 institutions in seven countries. 17 912 unique subject records with phenotypic data were submitted. We applied latent class analyses in a two-tiered approach to assess the validity of empirically defined subtypes of postpartum depression. Tier one assessed heterogeneity in women with complete data on the Edinburgh postnatal depression scale (EPDS) and tier two in those with postpartum depression case status. Findings: 6556 individuals were assessed in tier one and 4245 in tier two. A final model with three latent classes was optimum for both tiers. The most striking characteristics associated with postpartum depression were severity, timing of onset, comorbid anxiety, and suicidal ideation. Women in class 1 had the least severe symptoms (mean EPDS score 10·5), followed by those in class 2 (mean EPDS score 14·8) and those in class 3 (mean EPDS score 20·1). The most severe symptoms of postpartum depression were significantly associated with poor mood (mean EPDS score 20·1), increased anxiety, onset of symptoms during pregnancy, obstetric complications, and suicidal ideation. In class 2, most women (62%) reported symptom onset within 4 weeks postpartum and had more pregnancy complications than in other two classes (69% vs 67% in class 1 and 29% in class 3). Interpretation: PPD seems to have several distinct phenotypes. Further assessment of PPD heterogeneity to identify more precise phenotypes will be important for future biological and genetic investigations. Funding: Sources of funding are listed at the end of the article.
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U2 - 10.1016/S2215-0366(14)00055-8
DO - 10.1016/S2215-0366(14)00055-8
M3 - Article
C2 - 26359613
AN - SCOPUS:84920848048
SN - 2215-0366
VL - 2
SP - 59
EP - 67
JO - The Lancet Psychiatry
JF - The Lancet Psychiatry
IS - 1
ER -