Review articleA systematic review of growth curve mixture modelling literature investigating trajectories of perinatal depressive symptoms and associated risk factors

- Two to five different trajectories were identified in each study.
- Most studies report both chronic and transient symptom level trajectories.
- Most studies report one trajectory with chronic high levels of depressive symptoms.
- Chronic and transient trajectories could not be distinguished based on women's features.

BackgroundThe aim of this study was to review the growth curve mixture modelling (GCMM) literature investigating trajectories of perinatal maternal depressive symptoms and associated risk factors.MethodsA systematic search of peer-reviewed articles published until November 2015 was conducted in seven databases. Articles using GCMM to identify trajectories of perinatal depressive symptoms were considered. Symptoms had to be assessed at least three times, anytime from pregnancy to two years postpartum (PROSPERO; 2016:CRD42016032600).ResultsEleven studies met inclusion criteria. All reported a low risk trajectory, characterised by stable low depressive symptoms throughout the perinatal period. A stable moderate-high or high symptom trajectory was reported in eight of 11 studies, suggesting a high-risk group with persistent depressive symptoms. Six studies also reported transient trajectories, with either increasing, decreasing or episodic depressive symptoms. None of the demographic, personality or clinical characteristics investigated systematically differentiated groups of women with different symptom trajectories, within or across studies. Thus, it is difficult to differentiate women at high or low risk of specific perinatal depression trajectories.LimitationsA meta-analysis was not possible. The studies' settings and inclusion criteria limit the generalisability of the findings to low-risk, middle- to high-income women.ConclusionsRelatively similar trajectories of perinatal depressive symptoms were identified across studies. Evidence on factors differentiating women assigned to different trajectories was inconsistent. Research with larger samples and in more diverse settings is needed to inform services and policies on how and when to effectively identify subgroups of women at high risk of perinatal depression.