期刊
LANCET PSYCHIATRY
卷 2, 期 1, 页码 59-67出版社
ELSEVIER SCI LTD
DOI: 10.1016/S2215-0366(14)00055-8
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资金
- National Institute of Mental Health [K23 MH085165-01A1, 1R01MH104468-01, K23MH080290, 5K23MH086689, K23 MH074799-01A2, 222963, MH50524 NIMH, 5R01MH60335, 5R01MH071825 NIMH, 5R01MH075921 NIMH, 5-2R01MH057102]
- Brain AMP
- Behavior Research Foundation
- ZonMW [10.000.1003]
- NIMH [K23 MH097794]
- NIH [UL1 TR000161]
- Worcester Foundation for Biomedical Research
- Pfizer Pharmaceuticals
- National Alliance for Research on Schizophrenia and Depression
- French Ministry of Health [PHRC 98/001]
- Mustela Foundation
- Geestkracht program of the Netherlands Organisation for Health Research and Development [10-000-1002]
- VU University Medical Centre
- GGZ Geest
- Arkin
- Leiden University Medical Centre
- GGZ Rivierduinen
- University Medical Centre in Groningen
- Lentis
- GGZ Fries land
- GGZ Drenthe
- IQ Healthcare
- Netherlands Institute for Health Services Research
- Netherlands Institute of Mental Health and Addiction
- South Carolina Clinical and Translational Research Institute [UL1 TR000062]
- Building Interdisciplinary Research Careers in Women's Health [K12 HD055885]
- National Institutes for Health [P50 MH-77928, P50 MH 68036]
- National Centre for Mental Health Wales
- [ZIA MH002865-09 BEB]
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT [K12HD055885] Funding Source: NIH RePORTER
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR000062, UL1TR000161] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF MENTAL HEALTH [R01MH057102, R01MH071825, ZIAMH002865, P50MH077928, R01MH075921, R01MH060335, R01MH050524, K23MH074799, P50MH068036, K23MH080290, K23MH097794, R01MH104468, K23MH085165, K23MH086689] Funding Source: NIH RePORTER
- Lundbeck Foundation [R155-2014-1724] Funding Source: researchfish
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.
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