Table 1.

Studies Assessing Heterogeneity in Perinatal Depression Symptom Profiles and Symptom Trajectories^*

PND SYMPTOM PROFILES
Study; N; Country	Methods	Main Findings Patterns	Outcomes**
Putnam et al. (2015); n=10801; International Consortium1	Timeframe: pooled cross- sectional, varying according to original study site: prior, during and after diagnosis of PND. Measures: EPDS, HAM-D Analysis: LCA	# of symptom profile classes: 3 1) No depressed class (53%): Mean score 3.27. 2) Symptomatic class (36%): Mean score 12.33. 3) Severe depression class (11%): Mean score 20.32.	Psychological risk factors: poor mood, increased anxiety, onset of depressive symptoms during pregnancy, suicidal ideation. Biological risk factors: pregnancy and obstetric complications.
PND SYMPTOM TRAJECTORIES
Study; N ; Country	Methods	Main Findings Patterns	Predictors/Outcomes***
Luoma et al. (2015); n=329; Finland	Timeframe: 3rd trimester pregnancy, 1st week, 2 and 6 months, 4–5, 8–9, 16–17 years postpartum. Measures: EPDS Analysis: LGCM	# of trajectory classes: 4 1) Very low symptoms trajectory (18%): Mean score range 0–1 across time. 2) Low-stable symptoms trajectory (53%): Mean score range 4–7 across time. 3) High-stable symptoms trajectory (27%): Mean score range 9–10 across time. 4) Intermittent symptoms trajectory (3%): Mean score range 11–19 across time.	Social risk factors: negative life events, poor relationship with own mother. Psychological risk factors: depressive and anxiety symptoms during pregnancy, loneliness. Parenting expectation: negative expectation towards the child.
Matijasevich et al. (2015); n=4231; Brazil	Timeframe: 3, 12, 24, 48 months and 6 years postpartum. Measures: EPDS Analysis: LGCM	# of trajectory classes: 5 1) Low symptoms trajectory (34.8%): Mean score range 3 across time. 2) Moderate-low symptoms trajectory (40.9%): Mean score range 6–7 across time. 3) Increasing symptoms trajectory (9%): Mean score range 8–15 across time. 4) Decreasing symptoms trajectory (9.9%): Mean score range 13–8 across time. 5) High-chronic symptoms trajectory (5.4%): Mean score range 15–19 across time.	Child outcome: more psychiatric disorders, and increased internalizing and externalizing problems.
van der Waerden et al. (2015a, 2015b);2 n=1807; France	Timeframe: 3rd trimester pregnancy, 4, 8, 12, 24 months postpartum, 3, 4, 5 years postpartum. Measures: CES-D Analysis: LGCM	# of trajectory classes: 5 1) No symptoms trajectory (60.2%): Mean score range 2.2–8.5 across time. 2) High pregnancy symptoms trajectory (4.7%): Mean score range 6.8–31.88 across time. 5) High preschool symptoms trajectory (4.9%): Mean score range 5.2–26.4 across time. 4) Persistent intermediate-level symptoms trajectory (25.2%): Mean score range 8.3–13.9 across time. 5) Persistent-high symptoms trajectory (5.0%): Mean score range 14.6–29.7 across time.	Child outcome: increased emotional and behavioral difficulties, conduct disorder, and peer problems. Social risk factors: negative life events, ethnic-minority status. Psychological risk factors: anxiety during pregnancy, history of psychopathology.
Parade et al. (2014); n=98; US	Timeframe: 8 and 2 weeks prior to due date, 4 and 24 weeks postpartum. Measures: CES-D Analysis: LGCM	# of trajectory classes: 2 1) Consistent-low symptoms trajectory (57.2%): Mean score range 5.0–6.8 across time. 2) Temporary decline symptoms trajectory (42.8%): Mean score range 9.4–12.3 across time.	Social risk factors: negative life events, conflict in partner-relationship.
Cents et al. (2013); n=4167; Netherlands	Timeframe: 20 weeks pregnancy, 2, 6 and 36 months postpartum. Measures: BSI Analysis: LCGM	# of trajectory classes: 4 1) No symptoms trajectory (34%): Mean score range 0.0 across time. 2) Low symptoms trajectory (54%): Mean score range 0.0–0.1 across time. 3) Moderate symptoms trajectory (11%): Mean score range 0.4–0.6 across time. 4) High symptoms trajectory (1.5%): Mean score range 1.2–2.5 across time.	Social risk factors: low education, ethnic-minority status, low-income. Child outcome: increased internalizing problems.
Glasheen et al. (2013); n=577; US	Timeframe: 4–5 and 7 months pregnancy, delivery, 8 and 18 months postpartum. Measures: CES-D Analysis: GMM	# of trajectory classes: 2 1) Low pre- and postpartum symptoms trajectory (16.5%): Mean score range 14–11 across time. 2) High pre- and postpartum symptoms trajectory (83.5%): Mean score range 24–23 across time.	Child outcome: no association between maternal pre- and postnatal depression trajectory exposure and major depression, anxiety, or conduct disorder in children.
Christensen et al. (2011); n=215; US	Timeframe: 18, 28 weeks pregnancy, and 6 weeks, 4 and 12 months postpartum. Measures: BDI Analysis: GMM	# of trajectory classes: 3 1) Low perinatal symptoms trajectory (80.0%): Mean score range 6–11 across time. 2) High postpartum symptoms trajectory (10.2%): Mean score range 14–25 across time. 3) High pregnancy symptoms trajectory (9.8%): Mean score range 6–35 across time.	Social risk factors: unintended pregnancy.
Ramos-Marcuse et al. (2010); n=181; US	Timeframe: 3 weeks, 6 and 24 months postpartum. Measures: BDI Analysis: LGCM	# of trajectory classes: 3 1) Low symptoms trajectory (41%): Mean score range 4– 6 across time. 2) Medium symptoms trajectory (45%): Mean score range 7–11 across time. 3) High symptoms trajectory (14%): Mean score range 20–22 across time.	Social risk factors: high negative life events. Psychological risk factors: low self- esteem. Parenting expectation: low parenting satisfaction.
Mora et al. (2009); n=1735; US	Timeframe: 2nd trimester gestation, 3, 11 and 25 months postpartum. Measures: CES-D Analysis: GMM	# of trajectory classes: 5 1) No symptoms trajectory (71%): Mean score range 8–9 across time. 2) Antepartum-only symptoms trajectory (6%): Mean score range 8–32 across time. 3) Postpartum symptoms trajectory (9%): Mean score range 16–30 across time. 4) Late, at 25 months postpartum, symptoms trajectory (7%): Mean score range 12–31 across time. 5) Chronic symptoms trajectory (7%): Mean score range 28–29 across time.	Social risk factors: ambivalence about the pregnancy. Biological risk factors: high parity.
Ashman et al. (2008); n=159; US	Timeframe: 14 months, 24 months, and 3.5, 4.5 and 6.5 years postpartum. Measures: LIFE Analysis: GMM	# of trajectory classes: 3 1) Decreasing depression (30%): mean score range 14.9– 7.5. 2) Stable mild depression (62%): mean score range 1– 1.5. 3) Chronic depression (8%): mean score range 12.2–9.8.	Child outcome: high levels of externalizing behavior problems, and behavior disorder diagnosis, and low social competence and decreased generalized brain activation, high respiratory sinus arrhythmia.
Avon Longitudinal Study of Children and Parents (ALSPAC)
Hammerton et al. (2015); n=10559; UK	Timeframe: 18, 32 weeks pregnancy, 8 weeks and 8 months postpartum, 1 year 9 months, 2 years 9 months, 5 years 1 month, 6 years 1 month, 8 years 1 month and 11 years 2 months. Measures: EPDS Analysis: LCGM	# of trajectory classes: 5 1) Minimal symptoms trajectory (39.6%): Mean score range 0–3.5 over time. 2) Mild symptoms trajectory (32.1%): Mean score range 5.5–7.5 over time. 3) Sub-threshold symptoms trajectory (17.6%): Mean score range 10–11 over time. 4) Increasing symptoms trajectory (5.5%): Mean score range 5–13 over time. 5) Chronic-severe symptoms trajectory (5.2%): Mean score range 14.5–16 over time.	Child outcome: increased suicidal ideation.
Barker (2013); n=12151; UK	Timeframe: 32 weeks pregnancy, 8 weeks, 8 months, 21 months and 33 months postpartum. Measures: EPDS Analysis: LLC	# of trajectory classes: 3 1) Low symptoms trajectory (54%): Mean score range 2– 4 over time. 2) Medium symptoms trajectory (36%): Mean score range 8–9 over time. 3) Chronic symptoms trajectory (10%): Mean score range 14–15 over time.	Child outcome: increased behavioral dysregulation.
The National Institute of Child Health and Human Development Study of Early Child Care and Youth Development
Campbell et al. (2009); n=1357; US	Timeframe: 1, 6, 15, 24, 36, 54 months, and 7, 9, 11 and 12 years postpartum. Measures: CES-D Analysis: GMM	# of trajectory classes: 5 1) Never depressed trajectory (48.7%): Mean score range 3.9–6.73 across time. 2) Early-decreasing symptoms trajectory (5.1%): Mean score range 9.8–24 across time. 3) Stable-subclinical symptoms trajectory (30.8%): Mean score range 9.1–12.5 across time. 4) Moderate-elevated symptoms trajectory (10.9%): Mean score range 12.9–20 across time. 5) Chronic symptoms trajectory (4.7%): Mean scores range 23.2–29.3 across time.	Social risk factors: low education, unmarried. Biological risk factors: more health problems. Child outcome: increased internalizing and externalizing problems, and more risky behavior.
Campbell et al. (2007); n=1261; US	Timeframe: 1, 6, 15, 24, 36 and 54 months, and 7 years postpartum. Measures: CES-D Analysis: LGCM	# of trajectory classes: 6 1) Low-stable symptoms trajectory (45.6%): Mean score range 4.2–6 across time. 2) Moderate-stable symptoms trajectory (36.4%): Mean score range 10.5–12.2 across time. 3) Intermittent symptoms trajectory (3.6%): Mean scores range 29–9 across time. 4) Moderate-increasing symptoms trajectory (6.2%): Mean score range 14.9–25.8 over time. 5) High-decreasing symptoms trajectory (5.6%): Mean score range 13.2–25.5 across time. 6) High-chronic symptoms trajectory (2.5%): Mean score range 27–32.8 across time.	Parenting expectation: low maternal sensitivity. Child outcome: more internalizing and externalizing symptoms.
Longitudinal Study of Australian Children (LSAC)
Giallo et al. (2015a); n=4164; Australia	Timeframe: 3–12 months, 2–3, 4–5, 6–7 years postpartum. Measures: Kessler-6 Analysis: LCGM	# of trajectory classes: 3 1) Minimal symptoms trajectory (74.6%): Mean score range 1.8–2.2 across time. 2) Subclinical symptoms trajectory (20.8%): Mean score range 5.3–6.3 across time. 3) Increasing and persistently-high symptoms trajectory (4.6%): Mean score range 9.5–12.4 across time.	Child outcome: increased odds of asthma.
Giallo et al. (2015b); n=1085; Australia	Timeframe: 10–24, 30–32 weeks gestation, 3, 6, 9, 12, and 18 months, and 4 years postpartum. Measures: EPDS Analysis: LCGM	# of trajectory classes: 3 1) Minimal symptoms trajectory (61.0%): Mean score range 2–3 across time. 2) Subclinical symptoms trajectory (30.2%): Mean score range 6–8 over time. 3) Increasing and persistently-high symptoms trajectory (8.8 %): Mean score range 10–14 over time.	Child outcome: increased emotional- behavioral difficulties.
Giallo et al. (2014); n=4879; Australia	Timeframe: 3–12 months, 2–3, 4–5, and 6–7 years postpartum. Measures: Kessler-6 Analysis: LGM	# of trajectory classes: 2 1) Minimal symptoms trajectory (84%): Mean score 2.1– 2.5 across time. 2) Persistently-high symptoms trajectory (16%): Mean score 7.9–8.5 across time.	Social risk factors: low education, negative life events, ethnic-minority status. Psychological risk factors: history of psychopathology, antidepressant use during pregnancy. Biological risk factor: younger maternal age. Parenting expectations: negative expectation towards the child, low self- efficacy, and early parenting difficulty.
Mater University of Queensland Study of Pregnancy (MUSP)
Najman et al. (2016); n=6753; Australia	Timeframe: 2nd trimester pregnancy, 6 months, 5, 14, 21 and 27 years postpartum. Measures: DSSI Analysis: LCGM	# of trajectory classes: 3 1) Low symptoms trajectory (48.4%): Mean score range 0–0.5 across time. 2) Mild symptoms trajectory (41.7%): Mean score range 0.5–1.1 across time. 3) High-escalating symptoms trajectory (9.9%): Mean score range 1.6–3.5 across time.	Biological risk factor: younger maternal age.
Kingsbury et al. (2015); n=2991; Australia	Timeframe: 6 months, 5, 14 and 21 years after the birth. Measures: DSSI Analysis: K-means	# of trajectory classes: 2 1) Low stable symptoms trajectory (78.9%): Mean score range 0.35–0.42 across time. 2) High-escalating symptoms trajectory (21.1%): Mean score range 1.34–3.45 across time.	Social risk factors: low education, ambivalence about pregnancy, poor social support, conflict in partner- relationship. Psychological risk factors: stress and anxiety symptoms during pregnancy. Biological risk factor: younger maternal age. Parenting expectations: negative expectation towards the child.
Taiwanese Women Cohort
Kuo et al. (2014); n=139; Taiwan	Timeframe: 3rd trimester pregnancy, 1, 3 days and 1 week, 1 and 6 months postpartum. Measures: EPDS Analysis: LGCM	# of trajectory classes: 3 1) Low symptoms trajectory (30.9%): Mean score range 3–6 across time. 2) Mild symptoms trajectory (41.7%): Mean score range 9–9.5 across time. 3) High-stable symptoms trajectory (27.3%): Mean score range 14–16 across time.	Biological risk factor: high pre- pregnancy body mass index and sleep difficulty.
Kuo et al. (2012); n=121; Taiwan	Timeframe: 3rd trimester pregnancy, 1, 3 days and 1 week postpartum. Measures: EPDS Analysis: LGCM	# of trajectory classes: 4 1) Low symptoms trajectory (23.1%): Mean score range 2–5 across time. 2) Mild symptoms trajectory (43%): Mean score range 7– 9.4 across time. 3) Moderate symptoms trajectory (25.6%): Mean score range 13.4 across time. 4) High symptoms trajectory (8.3%): Mean score range 17.6–20.3 across time.	Biological risk factor: sleep difficulty.

^*This table is organized by year of publication in decreasing order, and by study cohort with the most recent article of the cohort presented first.

^**Predictors significantly related to severity of depressive symptoms profile classes.

^***Predictors and outcomes related to high burden depressive symptom trajectories.

¹Represents 19 institutions in seven countries: Australia, France, Sweden, Netherlands, United Kingdom (UK), United States (US), and Denmark.

²EDEN mother-child cohort study. These two manuscripts were combined because they used the same measure, analytical method and identified similar trajectories. In the predictor/outcome column we describe the findings of both reports.

Note. Analysis: LCA, latent class analysis; LLC, longitudinal latent class; LGCM, latent growth curve model; GBTM, group-based trajectory model; GMM, growth mixture model; LGM, latent growth model; LCGM, latent class growth model.

Measures used to estimate the trajectory classes: EPDS, Edinburgh Postnatal Depression Scale; HAM-D, Hamilton Depression Rating Scale; CES-D, Center for Epidemiological Studies-Depression, BSI, Brief Symptom Inventory; BDI-II, Beck Depression Inventory-version II; DSSI, Delusions-Symptoms-States Inventory, 7-item depression sub-scale; LIFE, longitudinal interval follow-up evaluation.