围产期抑郁症的临床表型及症状发作时间：来自一个国际联盟的数据的分析。
Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium.
作者信息
Putnam Karen T, Wilcox Marsha, Robertson-Blackmore Emma, Sharkey Katherine, Bergink Veerle, Munk-Olsen Trine, Deligiannidis Kristina M, Payne Jennifer, Altemus Margaret, Newport Jeffrey, Apter Gisele, Devouche Emmanuel, Viktorin Alexander, Magnusson Patrik, Penninx Brenda, Buist Anne, Bilszta Justin, O'Hara Michael, Stuart Scott, Brock Rebecca, Roza Sabine, Tiemeier Henning, Guille Constance, Epperson C Neill, Kim Deborah, Schmidt Peter, Martinez Pedro, Di Florio Arianna, Wisner Katherine L, Stowe Zachary, Jones Ian, Sullivan Patrick F, Rubinow David, Wildenhaus Kevin, Meltzer-Brody Samantha
机构信息
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Janssen Research & Development, Titusville, NJ, USA.
出版信息
Lancet Psychiatry. 2017 Jun;4(6):477-485. doi: 10.1016/S2215-0366(17)30136-0. Epub 2017 May 3.
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 ten-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 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.
背景
围产期是抑郁障碍发病的高危时期，与包括孕产妇自杀在内的大量发病和死亡相关。围产期抑郁症包括一组异质性的临床亚型，需要进一步细化以改善治疗效果。我们试图通过实证确定并描述围产期抑郁症的临床相关表型亚型，并根据孕期和产后三个时期的症状发作时间进一步对亚型进行特征描述。
方法
数据来自产后抑郁症：病因与治疗行动（PACT）联盟19个国际站点中的7个站点的子集。在该分析中，队列仅限于年龄在19 - 40岁之间、有围产期抑郁症状发作信息且有完整的十项爱丁堡产后抑郁量表（EPDS）前瞻性数据的女性。主成分分析和共同因素分析用于确定EPDS中的症状维度。美国国立精神卫生研究所关于负性情绪和唤醒的研究领域标准功能结构被应用于反映抑郁情绪、快感缺失和焦虑状态的EPDS维度。我们使用k均值聚类来识别具有共同症状模式的女性亚型。单变量和双变量统计用于描述这些亚型。
结果
663名女性的数据纳入了这些分析。我们发现EPDS测量出三个潜在维度：抑郁情绪、焦虑和快感缺失。基于这些维度，我们确定了围产期抑郁症的五种不同亚型：重度焦虑抑郁、中度焦虑抑郁、焦虑性快感缺失、单纯性快感缺失和缓解性抑郁。这些亚型在症状性质和发作时间上有明显差异。焦虑和快感缺失是产后发作的突出症状维度，且尤为严重。
解读
我们的研究结果表明，整个孕期和产后不同时间发作的围产期抑郁症可能存在不同类型和严重程度。这些发现支持了需要针对性治疗以改善围产期抑郁症女性治疗效果的观点。
资助
杨森研发公司。
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