Abstract
Objective: The primary purpose of this article is to identify factors that are associated with worsening mood and anxiety trajectories across the perinatal period among pregnant individuals receiving treatment with a selective-serotonin reupdate inhibitor. Methods: This secondary analysis of primary data from the original article, Trajectories of Depressive and Anxiety Symptoms Across Pregnancy and Postpartum in Selective Serotonin Reuptake Inhibitor-Treated Women, explores if number of lifetime episodes of depression as characterized in the Mini-International Neuropsychiatric Interview, elevated maternal adverse childhood experiences (ACE) score, or specific obstetric or neonatal factors from the Peripartum Events Scale (PES) were associated with membership in trajectory groups with the highest symptom burden. Results: No difference in ACE scores or obstetric or neonatal factors were associated with membership in the trajectory groups using Wilcoxon rank sum tests and bi-variable logistic regression. The trajectory group with the highest anxiety symptom burden experienced more lifetime episodes of depression compared to other groups (odds ratio = 1.17, 95% confidence intervals, 1.02–1.34, p = 0.03). Conclusions: Congruent with other studies, we found a high prevalence of co-occurring mood and anxiety symptoms and that past episodes of depression remain an important historical risk factor for perinatal symptom burden. This reinforces that past experiences of depression increase not only the risk of future symptoms but also higher symptom burden during antidepressant treatment.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 144-147 |
| Number of pages | 4 |
| Journal | Psychiatric Research and Clinical Practice |
| Volume | 5 |
| Issue number | 4 |
| DOIs | |
| State | Published - Dec 1 2023 |
Funding
The study population included 84 pregnant individuals enrolled in the NICHD-funded Obstetric-Fetal Pharmacology Research Center study. As described further in the initial publication, inclusion criteria were 18–45 years of age, singleton pregnancy less than 18 weeks gestation at enrollment, diagnosis of depression, treatment with SSRI and intent to continue through pregnancy and post-partum. Exclusion criteria included missing data, lifetime diagnosis of bipolar disorder or any psychotic episode, substance dependence, baseline EPDS >15 or score of 3 for self-harm thoughts, and individuals treated with other drugs or herbal supplements. Although the first study included 88 individuals, this secondary analysis included 84 individuals after excluding those with missing data (specifically a missing or incomplete ACE questionnaire). We used the Mini-International Neuropsychiatric Interview (MINI) (11) data to identify the number of lifetime depressive episodes with Wilcoxon rank sum tests. We compared the symptomatic anxiety (Breakthrough and Mild) and depressive (Subthreshold) trajectories to the GAD-7 (Minimal and Asymptomatic) and EPDS (Minimal and Mild) trajectory groups with symptoms in remission, to determine specific characteristics that differentiated patients with high symptom burden from the healthy groups maintained on SSRI treatment through pregnancy. We hypothesized that the groups with EPDS scores <5 (Minimal and Mild) and GAD-7 scores <5 (Asymptomatic and Minimal) were in remission, therefore we did not compare groups with minimal symptoms against each other. We investigated the relationship between ACE scores of ≥3 and trajectory groups using both Wilcoxon rank sum test and bi-variable logistic regression analysis. Odds ratio (OR) with 95% confidence intervals (CI) and p-values were reported from the model. A p-value of <0.05 was considered statistically significant. We explored whether symptom increases isolated to the postpartum period may have been associated with birth trauma or specific obstetric or neonatal factors for the postpartum portions of the trajectories using the PES (Table 1). Given the small sample size of most variables, we constructed categories based on obstetric and neonatal complications, and included a prior pregnancy loss or neonatal intensive care unit (NICU) admission as separate variables.
ASJC Scopus subject areas
- Psychiatry and Mental health