Department of Math, and Department of Population Health Sciences, University of Wisconsin-Madison.
Department of Psychology, Emory University.
J Abnorm Psychol. 2020 Oct;129(7):689-700. doi: 10.1037/abn0000612. Epub 2020 Aug 27.
Clinical guidelines recommend assessing depression during pregnancy and postpartum but often overlook potential changes in symptoms across this developmental period. Such changes contribute to difficulties in conceptualizing maternal depression. This study aimed to situate depressive symptoms and related concerns (anxiety, stress, sleep) across the perinatal period within a transdiagnostic framework and to use this framework to better understand how depressive symptoms change across the perinatal period. First, items from seven symptom scales were a priori categorized into six transdiagnostic factors: four based on Research Domain Criteria (loss, potential threat, frustrative nonreward, and sleep-wakefulness) and two based on the depression literature (somatic and coping symptoms). Second, using prospective data from women with a history of an affective disorder (n = 657) in an observational study of neuropsychiatric illness, factor analyses were performed in seven periods (three trimesters of pregnancy and four quarters of first year postpartum). For each period, a bifactor model with six transdiagnostic factors and a general factor fit data better than models that combined or dropped a factor (p < .003). Except around delivery, item loadings and intercepts could be fixed between consecutive periods and still adequately fit data from both periods. Means of sleep-wakefulness and somatic factors increased significantly from second to third trimester (p < .01), with trends reversing early postpartum. In conclusion, depressive symptoms and related concerns exhibit factor structures that are only partly congruent across the perinatal period. This conclusion suggests that greater attention to specific life phases is warranted in the conceptualization of depression during this time in women's lives. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
临床指南建议在怀孕期间和产后评估抑郁，但往往忽略了在此发育期间症状可能发生的变化。这些变化导致了对产妇抑郁概念化的困难。本研究旨在在跨诊断框架内定位围产期的抑郁症状和相关问题（焦虑、压力、睡眠），并使用该框架更好地理解围产期抑郁症状如何变化。首先，来自七个症状量表的项目被先验地分为六个跨诊断因素：四个基于研究领域标准（丧失、潜在威胁、挫败性非奖励和睡眠-觉醒），两个基于抑郁文献（躯体和应对症状）。其次，使用前瞻性数据，对神经精神疾病观察性研究中患有情感障碍病史的女性（n = 657）进行因子分析，分析在七个时期（妊娠三个三个月和产后四个季度）。对于每个时期，一个具有六个跨诊断因素和一个一般因素的双因素模型比结合或删除一个因素的模型更能拟合数据（p <.003）。除了分娩前后，连续两个时期的项目负荷和截距可以固定，仍能很好地拟合两个时期的数据。睡眠-觉醒和躯体因素的平均值从第二个三个月到第三个三个月显著增加（p <.01），产后早期趋势逆转。总之，抑郁症状和相关问题在围产期的表现出的因素结构仅部分一致。这一结论表明，在女性生命的这个时期，对特定生活阶段的关注更应受到重视。（PsycInfo 数据库记录（c）2020 APA，保留所有权利）。
