Latent Trajectory Groups of Maternal Depressive and Anxiety Symptoms and the Associated Risk Factors

Abstract\nBackground: There is a growing evidence that depression and anxiety disorders have distinct groups of symptom trajectories, which are associated with factors that may vary among different groups. Studying these mental health trajectories is highly relevant during major life transitions, such as pregnancy and childbirth. The aim of this thesis is to identify subgroups of women who exhibit distinct longitudinal trajectory patterns of depressive and anxiety symptoms from early pregnancy to early postpartum and from pregnancy to five years postpartum and the risk factors associated with these trajectories. \nMethods: This study uses a longitudinal data collected from 615 women in Saskatchewan, Canada from pregnancy to five years postpartum between 2006 and 2013 (Feelings in Pregnancy and Motherhood (FIP) longitudinal study). The semiparametric group-based modeling strategy was used to identify the latent groups of maternal depressive and anxiety trajectories. Multinomial logit models were then used to explore the association between these latent trajectory groups and various maternal characteristics.\nResults: Across pregnancy to early postpartum, we identified four trajectory groups of depressive symptoms: low-stable (49.6%); moderate-stable (42.3%); postpartum (3.6%); and antepartum (4.6%), and three latent trajectory groups of anxiety symptoms: very low-stable (8.9%); low-stable (60.7%); and moderate-stable (30.4%). From pregnancy to five years postpartum, four latent trajectory groups of depressive symptoms were identified: low-stable (35.0%); moderate-stable (54.0%); low-rising (5.2%); and high-declining (5.9%), and three latent trajectory groups for anxiety symptoms were identified: very low-stable (13.0%); low-stable (58.1%); and high-stable (29.0%). Several maternal risk factors, most notably past depression and stress level, were associated with these trajectories. \nConclusion: Distinct latent trajectory patterns of maternal depressive and anxiety symptoms were identified, which were associated with different profiles of risk factors present prior to or during pregnancy. Our findings support the need for multiple assessments starting from early pregnancy to the postpartum, which may help to recognize women at high risk of major depression or anxiety. All significant risk factors can be identified during regular follow-up and thus, clinicians may be able to identify women at high risk, who may be potential candidates for early interventions that may alter the progress of their mental health symptoms.

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