Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium
Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium
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DOI：
10.1016/s2215-0366(17)30136-0
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发表时间：
2017-06-01
影响因子：
64.3
通讯作者：
Meltzer-Brody, Samantha
中科院分区：
文献类型：
--
作者：
Putnam, Karen T.;Wilcox, Marsha;Meltzer-Brody, Samantha
背景围产期是抑郁症发病的高危期，与包括母亲自杀在内的大量发病率和死亡率相关。围产期抑郁症包括一组异质性的临床亚型，需要进一步完善，以改善治疗结果。我们试图经验性地确定和描述临床相关的表型亚型围产期抑郁症，并在怀孕期间和三个产后periods.Methods数据收集从一个子集的19个国际产后抑郁症的网站：对原因和治疗（PACT）财团的行动7症状发作的时间进一步的ESTA亚型。在这项分析中，队列仅限于19-40岁的妇女，在围产期抑郁症状的发病信息和完整的前瞻性数据的10项爱丁堡产后抑郁量表（EPDS）。采用主成分和公因子分析确定EPDS的症状维度。美国国家心理健康研究所的研究领域标准的功能结构的负效价和唤醒被应用到EPDS的尺寸，反映了抑郁情绪，快感缺乏和焦虑的状态。我们使用k-means聚类来识别共享症状模式的女性亚型。单变量和双变量统计被用来描述subtypes.Findings数据为663名妇女被列入这些分析。我们发现了EPDS测量的三个基本维度的证据：抑郁情绪，焦虑和快感缺乏。根据这些维度，我们确定了围产期抑郁症的五种不同亚型：重度焦虑性抑郁症，中度焦虑性抑郁症，焦虑性快感缺乏症，纯粹快感缺乏症，和解决抑郁症。这些亚型在症状质量和发病时间上有明显差异。焦虑和快感缺乏出现产后发病的突出症状维度，显着severe.Interpretation我们的研究结果表明，可能有不同类型和严重程度的围产期抑郁症发病时间不同，整个怀孕和产后。这些研究结果支持需要量身定制的治疗，改善围产期抑郁症的妇女的结果。
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.