Network Structure of Perinatal Depressive Symptoms in Latinas: Relationship to Stress and Reproductive Biomarkers

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Perinatal depression (PND) is the most common mental health complication for women worldwide (Gavin et al., 2005). PND is characterized by symptoms such as depressed mood, low self‐esteem, feelings of guilt and loneliness, and appetite and sleep disturbances and is also associated with significant morbidity, mortality, and medical comorbidities for both mother and child (O'Hara & McCabe, 2013; Stein et al., 2014). The Diagnostic and Statistical Manual of Mental Health Disorders (DSM‐5) defined PND as a depressive episode with onset during pregnancy and lasting up to 4 weeks postpartum (American Psychiatric Association, 2013). Researchers often use a broader time window, up to 1 year postpartum (Wisner, Moses‐Kolko, & Sit, 2010).
Reported prevalence rates of PND vary widely, depending on the screening instrument and timing of assessment (Halbreich & Karkun, 2006). The most recent systematic review showed that up to 18.4% of women experience depression during pregnancy and as many as 19.2% suffer minor or major depression within the first 3 months after giving birth (Gavin et al., 2005; O'Hara & McCabe, 2013). Low‐income Latinas in the United States are at high risk to develop PND, with prevalence rates reported at three to four times higher than the general population (Kuo et al., 2004; Lucero, Beckstrand, Callister, & Sanchez Birkhead, 2012). The study of Latinas is an urgent research priority because they are the fastest‐growing minority group in the United States (48% increase from 2000 to 2011; Ennis, Rios‐Vargas, & Albert, 2011) and have the highest fertility rate among all ethnic groups. Yet, Latinas are under‐represented in PND research (Lara‐Cinisomo, Wisner, & Meltzer‐Brody, 2015).
The disproportionate exposure to stress and adversity experienced by low‐income Latinas may render them especially vulnerable to PND (Lara‐Cinisomo, Girdler, Grewen, & Meltzer‐Brody, 2016). Yet, studies linking stress‐related biological factors to PND symptoms in Latinas are rare (O'Hara & McCabe, 2013; Yim, Tanner Stapleton, Guardino, Hahn‐Holbrook, & Dunkel Schetter, 2015).
The etiology of PND remains elusive: Hormonal withdrawal (Bloch, Daly, & Rubinow, 2003), cognitive‐behavioral (O'Hara, Rehm, & Campbell, 1982), and interpersonal etiological models have been proposed by nurses and other health researchers trying to disentangle the causes of PND (Beck, 2002; O'Hara & McCabe, 2013; Yim et al., 2015). Despite considerable research on childbearing mental health problems, our understanding of PND mechanisms remains limited, hampering improvement in prevention and treatment (Yim et al., 2015). Clearer understanding of these mechanisms may lead to interventions that minimize PPD‐associated adverse effects and alleviate mental health vulnerability that crosses generations.
One important limitation in the current literature is the lack of analytical attention to specific PND symptoms. Most research on PND has been conducted at the disease level, focusing on the binary classification of PND (i.e., present or absent) or continuous summary scores (Santos, Tan, & Salomon, 2016). However, patients diagnosed with depressive disorders can differ dramatically in their symptoms (Fried & Nesse, 2015a; Olbert, Gala, & Tupler, 2014; Santos et al., 2016). Moreover, risk factors, the underlying biology, impairment of psychosocial function, and life events are differentially related to specific symptom profiles (for a review, see Fried & Nesse, 2015b). Focusing on individual symptoms and analyzing the relationships among them and among key risk factors is likely to extend our understanding of PND.
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