Perinatal Trajectories of Depressive and Anxiety Symptoms

Perspectives differ on whether the course of depressive and anxiety symptoms during the perinatal period is constant or variable. Recent evidence on the trajectories of perinatal depression is mostly based on studies of participants at high-risk for poor perinatal mental health. Research on perinatal anxiety trajectories is particularly scarce.

We conducted a study to determine the trajectories of depressive and anxiety symptoms from the second trimester of pregnancy to 1 year postpartum among a community sample of women in Alberta, Canada.

Our results identified the following 5 distinct trajectory groups, which reflect both constant and variable patterns for depressive and anxiety symptoms: minimal, mild, antepartum, postpartum, and chronic. We found that a large proportion of the women had consistently minimal or mild symptoms of depression (77.7%) and anxiety (87.2%). A small proportion of the women experienced chronic symptoms of depression (2.4%) and anxiety (1.5%) throughout the perinatal period. Women with chronic depression were more likely to be younger (< 25 years) than women in other trajectory groups. Twenty percent of women experienced variable depressive symptoms that appeared in either the antepartum or postpartum periods. Women in the chronic and antepartum depression groups were more likely to have unplanned pregnancy or low household income.

Seven percent of women experienced constant elevated anxiety throughout pregnancy, which decreased after delivery. Women in the antepartum anxiety and depression trajectory groups were more likely to be a recent immigrant or have a history of infertility. Interestingly, we found that, throughout the perinatal period, approximately 1 in 4 women had average anxiety scores that fell just below the Spielberger State-Trait Anxiety Inventory cutoff of 40.

In conclusion, about 1 in 5 women experienced variable symptoms from pregnancy to one year postpartum, with shifts occurring around the birth. This heterogeneity of anxiety and depressive symptoms among a perinatal population highlights the importance of conducting multiple mental health assessments. Based on these findings, antepartum screening for anxiety and depression is sensible for the identification of women with chronic symptoms and poor antepartum mental health. A second screening during the early postpartum period will be helpful to identify new symptoms that emerged after delivery.

Financial disclosure:Drs Bayrampour, Tomfohr-Madsen, and Tough have no relevant personal financial relationships to report.