Phua Desiree Y, Chen Helen, Chong Yap Seng, Gluckman Peter D, Broekman Birit F P, Meaney Michael J
Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (ASTAR), Singapore, Singapore.
Department of Psychological Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
Front Psychiatry. 2020 Aug 6;11:785. doi: 10.3389/fpsyt.2020.00785. eCollection 2020.
Maternal mental health problems often develop prenatally and predict post-partum mental health. However, the circumstances before and following childbirth differ considerably. We currently lack an understanding of dynamic variation in the profiles of depressive and anxiety symptoms over the perinatal period.
Depressive and anxiety symptoms were self-reported by 980 women at 26-week pregnancy and 3 months post-partum. We used network analysis of depressive and anxiety symptoms to investigate if the symptoms network changed during and after pregnancy. The pre- and post-partum depressive-anxiety symptom networks were assessed for changes in structure, unique symptom-symptom interactions, central and bridging symptoms. We also assessed if central symptoms had stronger predictive effect on offspring's developmental outcomes outcomes at birth and 24, 54, and 72 months old than non-central symptoms. Bridging symptoms between negative and positive mental health were also assessed.
Though the depressive-anxiety network structures were stable during and after pregnancy, the post-partum network was more strongly connected. The central depressive-anxiety symptoms were also different between prenatal and post-partum networks. During pregnancy, central symptoms were mostly related to feeling worthless or useless; after pregnancy, central symptoms were mostly related to feeling overwhelmed or being punished. Central symptoms during pregnancy were associated with poorer developmental outcomes for the child. Anxiety symptoms were strongest bridging symptoms during and after pregnancy. The interactions between negative and positive mental health symptoms were also different during and after pregnancy.
The differences between pre- and post-partum networks suggest that the presentation of maternal mental health problems varies over the peripartum period. This variation is not captured by traditional symptom scale scores. The bridging symptoms also suggest that anxiety symptoms may precede the development of maternal depression. Interventions and public health policies should thus be tailored to specific pre- and post-partum symptom profiles.
孕产妇心理健康问题通常在产前出现，并可预测产后心理健康状况。然而，分娩前后的情况差异很大。我们目前对围产期抑郁和焦虑症状特征的动态变化缺乏了解。
980名女性在怀孕26周和产后3个月时自我报告抑郁和焦虑症状。我们使用抑郁和焦虑症状的网络分析来调查症状网络在孕期和产后是否发生变化。评估产前和产后抑郁-焦虑症状网络在结构、独特的症状-症状相互作用、核心症状和桥梁症状方面的变化。我们还评估了核心症状对出生时以及24、54和72个月大的后代发育结局的预测作用是否比非核心症状更强。还评估了负面和正面心理健康之间的桥梁症状。
尽管抑郁-焦虑网络结构在孕期和产后是稳定的，但产后网络的连接更强。产前和产后网络的核心抑郁-焦虑症状也不同。孕期核心症状大多与感到无价值或无用有关；产后核心症状大多与感到不堪重负或受到惩罚有关。孕期的核心症状与孩子较差的发育结局相关。焦虑症状在孕期和产后都是最强的桥梁症状。孕期和产后负面和正面心理健康症状之间的相互作用也不同。
产前和产后网络之间的差异表明，孕产妇心理健康问题的表现形式在围产期会有所不同。这种差异无法通过传统症状量表得分体现。桥梁症状还表明，焦虑症状可能先于孕产妇抑郁症的发展。因此，干预措施和公共卫生政策应根据产前和产后的特定症状特征进行调整。
