The severity and role of somatic depressive symptoms in psychological networks in a longitudinal sample of peripartum women

The inclusion of somatic symptoms in assessing peripartum depression (PPD), which encompasses depression
during pregnancy and the postpartum period, has remained controversial, as there is substantial overlap between
somatic depression symptoms and normal features of pregnancy/postpartum. This study examined whether
trajectories differed by PPD symptom subscale and whether PPD symptom networks changed as a function of the
peripartum phase. 418 women with a history of neuropsychiatric illness participated in a longitudinal observational
study, completing symptom questionnaires assessing affective, cognitive, and somatic symptoms
throughout pregnancy and the first year postpartum. Assessments were grouped into five peripartum phases:
three trimesters of pregnancy and early/late postpartum. Two analyses were performed. First, a series of
multilevel spline regression models examined depression subscale trajectories over peripartum phase. Second,
symptom networks and related metrics were estimated for each peripartum phase and compared. Somatic
symptoms were most severe and had the most variable peripartum trajectory. The role of somatic symptoms
within the networks also changed as a function of peripartum phase. Our results suggest that somatic symptoms
can be severe and may play a crucial role in the maintenance of PPD. Thus, somatic symptoms should not be
disregarded when assessing for PPD in obstetrical, psychiatric, and pediatric clinics, and clinical research.