Xiong Jintao, Yu Yan, Qin Xuemei, Peng Yilin, Peng Zhuo, Cheng Junzhe, Mao Weiguo, Wang Yan, Guo Yin, Li Huiqin, Wang Mi, Zhang Li, Ju Yumeng, Liu Jin, Shen Minxue, Liu Bangshan, Zhang Yan
Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, Changsha, Hunan, 410011, China.
Mental Health Institute of Central South University, China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Hunan Key Laboratory of Psychiatry and Mental Health, Hunan Medical Center for Mental Health, Changsha, Hunan, 410011, China.
BMC Med. 2025 Jul 31;23(1):451. doi: 10.1186/s12916-025-04290-w.
Antenatal depression, especially moderate-to-severe depression, is associated with adverse maternal and infant health outcomes and is affected by multiple psychosocial factors. However, the cumulative effects of psychosocial determinants and trajectories of antenatal depression are underappreciated. This study aimed to investigate the cumulative effects of various psychosocial determinants on antenatal moderate-to-severe depressive symptoms (MSD) based on the polysocial risk score (PsRS), to identify trajectories of MSD based on group-based trajectory modeling (GBTM), and to explore the association between the PsRS and diverse trajectories.
A retrospective cohort study was conducted among 21,336 pregnant women in Shenzhen, China, from 2020 to 2023. Antenatal depressive symptoms were assessed by the Patient Health Questionnaire-9 (PHQ-9) across three pregnancy trimesters. The PsRS was selected and calculated by counting established social determinants from four social risk domains, including socioeconomic status, lifestyle behaviors, psychosocial factors, and living conditions. GBTM was employed to identify distinct trajectories of depressive symptoms. Multinomial logistic regression investigated the relationship between PsRS and diverse trajectories.
Of women, 9.1% experienced at least one episode of MSD across three pregnancy trimesters. An intermediate PsRS and a high PsRS were associated with higher risks of MSD during pregnancy, with the adjusted hazard ratios being 1.99 (95% CI, 1.71-2.31) and 4.44 (95% CI, 3.81-5.17), respectively, compared with those with a low PsRS. GBTM identified five distinct trajectories of antenatal depressive symptoms: persistent MSD, resolving MSD, chronic mild, resolving mild, and no depressive symptoms. Above all trajectories, persistent MSD demonstrated the highest PSRS scores and risk gradients.
This study provides a practical basis for integrating early polysocial risk screening into routine prenatal care, enabling the timely identification and targeted support of high-risk pregnant women. These findings underscore the need for incorporating comprehensive social risk assessment into maternal health policies and intervention programs to improve mental health outcomes across pregnancy.
产前抑郁，尤其是中重度抑郁，与母婴不良健康结局相关，且受多种社会心理因素影响。然而，社会心理决定因素和产前抑郁轨迹的累积效应尚未得到充分认识。本研究旨在基于多社会风险评分（PsRS）探讨各种社会心理决定因素对产前中重度抑郁症状（MSD）的累积影响，基于群体轨迹模型（GBTM）确定MSD的轨迹，并探讨PsRS与不同轨迹之间的关联。
对2020年至2023年在中国深圳的21336名孕妇进行了一项回顾性队列研究。在三个孕期通过患者健康问卷-9（PHQ-9）评估产前抑郁症状。通过计算来自四个社会风险领域（包括社会经济地位、生活方式行为、社会心理因素和生活条件）的既定社会决定因素来选择和计算PsRS。采用GBTM确定抑郁症状的不同轨迹。多项逻辑回归研究了PsRS与不同轨迹之间的关系。
在这些女性中，9.1%在三个孕期经历了至少一次MSD发作。与低PsRS的女性相比，中等PsRS和高PsRS与孕期MSD风险较高相关，调整后的风险比分别为1.99（95%CI，1.71-2.31）和4.44（95%CI，3.81-5.17）。GBTM确定了产前抑郁症状的五种不同轨迹：持续性MSD、缓解性MSD、慢性轻度、缓解性轻度和无抑郁症状。在所有轨迹中，持续性MSD的PSRS得分和风险梯度最高。
本研究为将早期多社会风险筛查纳入常规产前护理提供了实践依据，能够及时识别高危孕妇并给予针对性支持。这些发现强调了将全面社会风险评估纳入孕产妇健康政策和干预项目以改善整个孕期心理健康结局的必要性。
