Clinical phenotypes of perinatal depression and time of symptom onset: Analysis of data from an International Consortium

Karen T. Putnam, Marsha Wilcox, Emma Robertson-Blackmore, Katherine Sharkey, Veerle Bergink, Trine Munk-Olsen, Kristina M. Deligiannidis, Jennifer Payne, Margaret Altemus, Jeffrey Newport, Gisele Apter, Emmanuel Devouche, Alexander Viktorin, Patrik Magnusson, Brenda Penninx, Anne Buist, Justin Bilszta, Michael O'Hara, Scott Stuart, Rebecca Brock & 15 others Sabine Roza, Henning Tiemeier, Constance Guille, C. Neill Epperson, Deborah Kim, Peter Schmidt, Pedro Martinez, Arianna Di Florio, Katherine L. Wisner, Zachary Stowe, Ian Jones, Patrick F. Sullivan, David Rubinow, Kevin Wildenhaus, Samantha Meltzer-Brody

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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 10-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 (RDoC) 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. Funding: Janssen Research & Development.

Original languageEnglish
Article number4(6)
Pages (from-to)477-485
Number of pages13
JournalThe Lancet Psychiatry
DOIs
Publication statusPublished - Jun 2017

Cite this

Putnam, K. T., Wilcox, M., Robertson-Blackmore, E., Sharkey, K., Bergink, V., Munk-Olsen, T., ... Meltzer-Brody, S. (2017). Clinical phenotypes of perinatal depression and time of symptom onset: Analysis of data from an International Consortium. The Lancet Psychiatry, 477-485. [4(6)]. https://doi.org/10.1016/S2215-0366(17)30136-0
Putnam, Karen T. ; Wilcox, Marsha ; Robertson-Blackmore, Emma ; Sharkey, Katherine ; Bergink, Veerle ; Munk-Olsen, Trine ; Deligiannidis, Kristina M. ; Payne, Jennifer ; Altemus, Margaret ; Newport, Jeffrey ; Apter, Gisele ; Devouche, Emmanuel ; Viktorin, Alexander ; Magnusson, Patrik ; Penninx, Brenda ; Buist, Anne ; Bilszta, Justin ; O'Hara, Michael ; Stuart, Scott ; Brock, Rebecca ; Roza, Sabine ; Tiemeier, Henning ; Guille, Constance ; Epperson, C. Neill ; Kim, Deborah ; Schmidt, Peter ; Martinez, Pedro ; Di Florio, Arianna ; Wisner, Katherine L. ; Stowe, Zachary ; Jones, Ian ; Sullivan, Patrick F. ; Rubinow, David ; Wildenhaus, Kevin ; Meltzer-Brody, Samantha. / Clinical phenotypes of perinatal depression and time of symptom onset : Analysis of data from an International Consortium. In: The Lancet Psychiatry. 2017 ; pp. 477-485.
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abstract = "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 10-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 (RDoC) 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. Funding: Janssen Research & Development.",
author = "Putnam, {Karen T.} and Marsha Wilcox and Emma Robertson-Blackmore and Katherine Sharkey and Veerle Bergink and Trine Munk-Olsen and Deligiannidis, {Kristina M.} and Jennifer Payne and Margaret Altemus and Jeffrey Newport and Gisele Apter and Emmanuel Devouche and Alexander Viktorin and Patrik Magnusson and Brenda Penninx and Anne Buist and Justin Bilszta and Michael O'Hara and Scott Stuart and Rebecca Brock and Sabine Roza and Henning Tiemeier and Constance Guille and Epperson, {C. Neill} and Deborah Kim and Peter Schmidt and Pedro Martinez and {Di Florio}, Arianna and Wisner, {Katherine L.} and Zachary Stowe and Ian Jones and Sullivan, {Patrick F.} and David Rubinow and Kevin Wildenhaus and Samantha Meltzer-Brody",
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Putnam, KT, Wilcox, M, Robertson-Blackmore, E, Sharkey, K, Bergink, V, Munk-Olsen, T, Deligiannidis, KM, Payne, J, Altemus, M, Newport, J, Apter, G, Devouche, E, Viktorin, A, Magnusson, P, Penninx, B, Buist, A, Bilszta, J, O'Hara, M, Stuart, S, Brock, R, Roza, S, Tiemeier, H, Guille, C, Epperson, CN, Kim, D, Schmidt, P, Martinez, P, Di Florio, A, Wisner, KL, Stowe, Z, Jones, I, Sullivan, PF, Rubinow, D, Wildenhaus, K & Meltzer-Brody, S 2017, 'Clinical phenotypes of perinatal depression and time of symptom onset: Analysis of data from an International Consortium' The Lancet Psychiatry, pp. 477-485. https://doi.org/10.1016/S2215-0366(17)30136-0

Clinical phenotypes of perinatal depression and time of symptom onset : Analysis of data from an International Consortium. / Putnam, Karen T.; Wilcox, Marsha; Robertson-Blackmore, Emma; Sharkey, Katherine; Bergink, Veerle; Munk-Olsen, Trine; Deligiannidis, Kristina M.; Payne, Jennifer; Altemus, Margaret; Newport, Jeffrey; Apter, Gisele; Devouche, Emmanuel; Viktorin, Alexander; Magnusson, Patrik; Penninx, Brenda; Buist, Anne; Bilszta, Justin; O'Hara, Michael; Stuart, Scott; Brock, Rebecca; Roza, Sabine; Tiemeier, Henning; Guille, Constance; Epperson, C. Neill; Kim, Deborah; Schmidt, Peter; Martinez, Pedro; Di Florio, Arianna; Wisner, Katherine L.; Stowe, Zachary; Jones, Ian; Sullivan, Patrick F.; Rubinow, David; Wildenhaus, Kevin; Meltzer-Brody, Samantha.

In: The Lancet Psychiatry, 06.2017, p. 477-485.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Clinical phenotypes of perinatal depression and time of symptom onset

T2 - Analysis of data from an International Consortium

AU - Putnam, Karen T.

AU - Wilcox, Marsha

AU - Robertson-Blackmore, Emma

AU - Sharkey, Katherine

AU - Bergink, Veerle

AU - Munk-Olsen, Trine

AU - Deligiannidis, Kristina M.

AU - Payne, Jennifer

AU - Altemus, Margaret

AU - Newport, Jeffrey

AU - Apter, Gisele

AU - Devouche, Emmanuel

AU - Viktorin, Alexander

AU - Magnusson, Patrik

AU - Penninx, Brenda

AU - Buist, Anne

AU - Bilszta, Justin

AU - O'Hara, Michael

AU - Stuart, Scott

AU - Brock, Rebecca

AU - Roza, Sabine

AU - Tiemeier, Henning

AU - Guille, Constance

AU - Epperson, C. Neill

AU - Kim, Deborah

AU - Schmidt, Peter

AU - Martinez, Pedro

AU - Di Florio, Arianna

AU - Wisner, Katherine L.

AU - Stowe, Zachary

AU - Jones, Ian

AU - Sullivan, Patrick F.

AU - Rubinow, David

AU - Wildenhaus, Kevin

AU - Meltzer-Brody, Samantha

PY - 2017/6

Y1 - 2017/6

N2 - 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 10-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 (RDoC) 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. Funding: Janssen Research & Development.

AB - 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 10-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 (RDoC) 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. Funding: Janssen Research & Development.

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