Page 35 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Core depressive symptoms of peripartum women

postpartum (postpartum depression [PPD]). According circumvents the limitations of conventional methods
1
to epidemiological studies, the prevalence of PND among by identifying the most salient symptoms of psychiatric
women ranges from 13.3% to 19.7%. However, according conditions. 16-18 For example, network analysis has revealed
2,3
to a meta-analysis, the incidence of AND is higher at that the most central symptoms in individuals diagnosed
20.7%, and patients in their second and third trimesters with obsessive-compulsive disorder are compulsive
4
1
are particularly vulnerable to AND. Globally, PPD is behaviors and obsessive thoughts. Wang et al. applied
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projected to impact approximately 17.22% of women, and network analysis to discern shifts in the central symptoms
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it usually manifests within 6 weeks of childbirth. Women of depression and anxiety from the onset to the post-
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with PND face an elevated risk of self-harm and suicide as peak period of the COVID-19 pandemic; their findings
well as challenges in parenting and marital relationships. highlighted the evolving central characteristics over
The risk is particularly pronounced among women time. Consistent with network theory, these symptoms
who have utilized donor sperm for conception, possess exhibit intricate causal interconnections, which are best
restricted educational and financial means, lack sufficient understood from a causal systems perspective. Thus,
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social support, and have experienced previous episodes of the identification of network characteristics through this
depression disorders. 1,7,8 Furthermore, PND can impact innovative analytical instrument may yield significant
the early brain development of infants, with effects on clinical benefits for the diagnosis, treatment, and
cognition becoming apparent in primary schooling. PND prevention of mental disorders. However, studies on PND
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also increases the risk of depression in the spouse, thus have only analyzed the relationships between specific risk
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placing a significant burden on families and society. factors and depressive symptoms during pregnancy and
PND represents a diverse clinical entity, encompassing the postpartum period. 21,22 or have only exhibited the
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various subtypes that exhibit distinct symptom profiles network structure of depression in the second trimester.
and onset patterns at different stages of pregnancy and The changes in network characteristics in the different
the postpartum phase. 11,12 Investigating the onset timing trimesters and postpartum period remain to be explored.
is crucial for delineating more accurate phenotypic The current study aimed to assess the variations in
classifications as well as for biological and genetic studies the depressive severity among women in their second
of PND. For example, although PND typically emerges trimester, third trimester, and postpartum period to better
either in the final trimester of pregnancy or within understand how the core symptoms of PND change over
1
the first 6 weeks following childbirth, the underlying time, especially during high-risk periods for depression.
contributing factors differ. PND onset in the postpartum Furthermore, we aimed to estimate the networks of
period is a subtype sensitive to sex hormone fluctuations, depressive symptoms of PND at different time periods to
as sex hormone levels decline rapidly from high peaks after collect evidence for the precise diagnosis and treatment
childbirth. Conversely, PND onset in the third trimester is of PND subtypes. In addition, we aimed to propose
not hormone-sensitive. 13 recommendations for enhancing the psychological well-

The biological mechanisms underlying the variance being of women throughout pregnancy and the postpartum
in the central symptoms and severity of PND in different period. This study is the first to employ network analysis
periods of pregnancy remain to be elucidated. Previous on a cohort of women across various pregnancy stages
studies have only addressed the differences in depression and the postpartum period, aiming to explore symptom
severity between AND and PPD. 11,14 In these studies, interactions of depression and examine symptom
individuals from different trimesters were grouped together evolution over time. We hypothesized that the network
in the AND group, and the core symptoms of PND at each characteristics of depression symptoms would change over
stage were not clarified. Identifying the core symptoms the three time periods and that depression severity would
associated with PND subtypes is essential because it can significantly differ between the three groups.
enhance the development of more efficacious intervention 2. Methods
strategies.
Employing a novel network analysis approach can 2.1. Participants and procedure
provide deeper insights into the pivotal symptoms of PND The Wenjuanxing platform (Zhongyan Network Technology
and their interplay with other symptoms across various Co., Shanghai, China) was utilized to facilitate an online
time frames. Network theory posits that central symptoms, survey. The QR code for the online survey was disseminated
due to their extensive connections with other symptoms, across platforms such as Intent, WeChat, and Tencent QQ.
are instrumental in the etiology, perpetuation, and Women aged 19–49 years who could read and operate a
resolution of mental health disorders. This methodology computer or smartphone were recruited from two centers
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Volume 2 Issue 4 (2024) 2 doi: 10.36922/jcbp.4089