Unraveling the onset and continuity of depressive symptoms from early pregnancy to six weeks postpartum: A longitudinal network analysis

Background: Perinatal depression is a major global public health problem, but the onset and progression of symptoms that give rise to perinatal depression are less clear in the scientific literature. Methods: This study followed 1210 Chinese pregnant women who completed the Edinburgh Postnatal Depression Scale at five time points: 13, 24, and 37 weeks of gestation (G13, G24, G37), and 1 and 6 weeks postpartum (W1, W6). Cross-lagged panel networks were used to analyze and compare networks from first to second trimester (G13 -* G24), second to third trimester (G24 -* G37), and one week to six weeks postpartum (W1 -* W6). Results: Results showed that network structure did not differ significantly between the three networks, demonstrating continuity of depressive symptoms over the course of pregnancy and postpartum. Across the three periods, self-reported panic was identified as the symptom that had the largest influence on other symptoms at a following assessment, and self-reported worry was the symptom that was most strongly influenced by depressive symptoms at previous timepoints. Moreover, thoughts of self-harm showed a distinct feature where it could only trigger other symptoms in the postnatal, but not prenatal period. Limitations: Self-reported questionnaires used in this study may be susceptible to bias. Items of perinatal depressive symptoms included in the network analysis are also not exhaustive. Conclusions: Findings from this symptom-oriented psychopathology network shed light upon the developmental course of perinatal depressive symptoms, providing insights for tailored preventative intervention programs.