Four Characteristics to Predict the 12-Month Course of Postpartum Depression

According to a study published in Depression & Anxiety, categorization in the chronic-severe vs partial improvement and gradual remission 12-month symptom trajectories for postpartum depression were predicted with 72.8% accuracy by 4 maternal characteristics: education, parity, baseline depression severity, and global functioning.

The purpose of this study was to determine 12-month symptom trajectories in postpartum depression, to identify characteristics capable of predicting a patient’s trajectory, and provide a computational algorithm to predict trajectory categorization. Data were taken from a prospective cohort of women with postpartum depressive disorder who gave birth at an academic medical center of an urban women’s hospital in Pittsburgh, Pennsylvania between 2006 and 2011, and who completed assessments of symptom severity at 4 to 8 weeks, and at 3, 6, and 12 months (n=507). Clinician interviews regarding infant status, obstetric experience, medical and psychiatric history, assessment of function, and depressive symptom severity were also conducted. Participants were predominately college educated (38.7%), married (53.3%), and Caucasian (71.8%).

Three distinct trajectories of postpartum depressive symptoms were identified:

·gradual remission (50.4%),

·partial improvement (41.8%), and

·chronic-severe (7.8%).

Compared with gradual remission, categorization in the trajectory for partial improvement and chronic-severe (2 vs 1 and 3 vs 1, respectively) was associated with global functioning (odds ratio [OR] for 1-point increase in global assessment of function score: 0.92 [0.88–0.96]; 0.92 [0.85–0.99]), anxiety comorbidity (OR: 1.80 [1.16–2.78]; 2.13 [0.84–5.42]), number of chronic illnesses (OR for each additional illness: 1.61 [1.05–1.29]; 1.15 [0.95–1.40]), physical abuse in adulthood (2.19 [1.39–3.45]; 1.82 [0.74–4.49]), and having multiple children (OR for each additional child: 1.17 [0.96– 1.42]; 1.86 [1.52–2.51]). Key characteristics that were predictive of chronic-severe vs partial improvement and gradual remission were education, parity, and baseline levels of depression severity and global functioning. Using these characteristics, the trajectory of postpartum depression could be predicted with 72.8% accuracy.  

Study investigators conclude, “Membership in the chronic severe trajectory versus the two better prognosis trajectories was predicted by four maternal characteristics with 72.8% accuracy. The trajectory groups comprise clinically relevant subgroups with the potential for tailored treatments to shorten the disease burden of postpartum depression.”

Reference

Fisher SD, Sit DK, Yang A, Ciolino JD, Gollan JK, Wisner KL.Four maternal characteristics determine the 12-month course of chronic severe postpartum depressive symptoms [published online January 15, 2019]. Depress Anxiety. doi: 10.1002/da.22879