Heterogeneity of postpartum depression: a latent class analysis

Abstract

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.

Funding: Sources of funding are listed at the end of the article.

Copyright © 2015 Elsevier Ltd. All rights reserved.

Figures

Figure 1. Two-tiered approach to latent class analysis to identify phenotypic heterogeneity in postpartum depression

PACT=Postpartum Depression: Action Towards Causes and Treatment Consortium data. LCA=latent class analysis. EPDS=Edinburgh postnatal depression scale. PPD=postpartum depression.

Figure 2. Response probabilities for ten Edinburgh postnatal depression scale questions, by latent class

The questions “Blamed myself unnecessarily”, “Anxious or worried for no good reason”, and “Scared or panicky for no good reason” included scores from the Edinburgh postnatal depression scale anxiety subscale.