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Background and Purpose: Maternal depression is an important public health problem that can compromise child development. However, continuities and discontinuities in perinatal depression are poorly understood because most research has been cross-sectional, focusing primarily on postpartum depression. The current study aims to advance the literature by investigating prenatal and postpartum depression trajectories in a sample of low-income women.
Methods: The study sample consisted of 899 women in Wisconsin who received services within a network of evidence-based home visiting programs. Eligible participants were screened by home visitors using the Edinburgh Postnatal Depression Scale (EPDS; range 0-30) at least three times across four time periods: (1) first or second trimester of pregnancy, (2) third trimester of pregnancy, (3) month 1 postpartum, (4) months 2-6 postpartum. Descriptive analyses and paired t-tests were performed for the full sample, rendering mean depression scores, sample proportions above the clinical cutoff (> 12) for likely clinical depression, and mean differences by time. Growth Mixture Modeling (GMM) was applied to identify distinct trajectory subgroups, and multinomial logit models were then applied to examine associations between latent class memberships and marital status, gravidity (number of pregnancies), and prior miscarriage.
Results: Results showed a significant decrease over time in mean depression scores (M(t1) = 8.08, M(t2) = 8.05, M(t3) = 7.09, M(t4) = 6.82) and sample proportions above the clinical cutoff (t1 = 24.5%, t2 = 23.3%, t3 = 20.7%, t4 = 21.0%). Paired t-tests revealed significant mean differences between times 1 and 2 (p < .001) and between times 2 and 3 (p < .001). GMM selection statistics such as Akaike’s Information Criterion, the Bayesian Information Criterion, Entropy, and Vuong–Lo–Mendell–Rubin Likelihood Ratio supported a four-class model. Class 1 (76.2% of sample) had depression scores that were consistently below the depression cutoff (intercept = 6.16, p < .001; slope = -.35, p < .001). Class 2 (4.5% of sample) had a low baseline depression score (intercept = 7.36, p < .001) that increased precipitously over time (slope = 3.49, p < .001). Class 3 (7.8% of sample) presented with a subclinical EPDS score at baseline and decreasing scores thereafter (intercept = 17.32, p < .001; slope = -4.33, p < .001). Class 4 (11.5% of sample) maintained consistently high scores (intercept = 16.67, p < .001; slope = -.40, p = .122). Multinomial logit models showed that primigravid mothers were more likely classified in Class 1 than Class 3.
Conclusions and Implications: Results showed that a large majority of women reported consistently low levels of depression throughout the perinatal period. The estimated prevalence of prenatal depression was higher than the prevalence of postpartum depression. Among women whose EPDS scores indicated likely postpartum depression, most showed signs of prenatal depression. In sum, the proportion of cases that exhibited continuity in perinatal mental health far exceeded the proportion that exhibited discontinuity. Implications for prenatal and postpartum home visiting services aimed at promoting maternal mental health and positive child development outcomes will be discussed.