Pregnancy and the postpartum period are generally considered happy periods in life, but very often, women experience symptoms of depression during these times.
- The somatic symptoms of depression manifest at the physical level, for example, through fatigue, changes in appetite, difficulty sleeping, concentration or fluctuations in psychomotor pace.
- Emotional and cognitive symptoms of depression include changes in emotions and thinking. Examples include feelings of sadness, feelings of guilt or bad feelings about oneself, inability to experience joy or suicidal thoughts.
Diagnosing depression in pregnancy and the postpartum period is difficult. Many depressive symptoms overlap with normal physiological and life changes associated with pregnancy and the postpartum period. For example, an increased appetite, or conversely a lack thereof, can be a perfectly normative experience during pregnancy due to natural hormonal fluctuations. At the same time, however, appetite disturbances are a common depressive symptom. This ambiguity makes it difficult to recognize the disease and subsequent treatment in pregnancy and postpartum. Some researchers have recommended that somatic symptoms of depression should not be monitored at all during these periods, in fear of false-positive results. Others are inclined to believe that these symptoms are still significant with regard to depressive symptomatology and should be taken into account.
Petra Pátková Daňsová, Edita Chvojka, Hynek Cígler and Lenka Lacinová investigated the role of somatic symptoms of depression in women during (pregnancy and shortly after delivery) and outside the perinatal period. Using network analysis, they compared the structure of relationships among depressive symptoms across these periods. The study included 894 pregnant women, 586 postpartum women, and 1029 women outside the perinatal period.
Somatic vs. emotional and cognitive symptoms
Through the lens of network analysis, the interrelationship of somatic symptoms and their relationship to emotional and cognitive symptoms can be examined. While three of the five somatic symptoms measured by the PHQ-9 scale were more prevalent in pregnant women than in women outside the perinatal period, network analyses showed only negligible differences in the networks of relationships of depressive symptoms across the three periods.
Petra's team further observed that most symptoms of depression in pregnant women were predicted by other symptoms of depression to a lesser extent than in postpartum and non-perinatal women. Therefore, additional external variables are needed to explain these symptoms in pregnancy. This may be because women in this period may attribute individual symptoms to the specifics of pregnancy. An example would be fatigue, which, although a symptom of depression, may be attributed by women in pregnancy to the pregnancy itself and, therefore, may not be as closely related to other depressive symptoms as outside the perinatal period.
Changes in appetite after childbirth
The researchers also exploratively discuss the minor network differences across the three periods. Of interest, for example, is the role of symptom appetite changes. Fluctuations in appetite were one of the most central symptoms in the postpartum period and were related not only to other somatic symptoms of depression but also quite closely to feelings of guilt and bad feelings about the self. Loss of appetite or overeating (for example, to compensate for fatigue or increased need for calorie intake during breastfeeding) can lead to feelings of guilt or impaired self-esteem, as many women in the postpartum period may feel pressured to achieve their pre-pregnancy weight.
The study adds to previous research supporting the notion that somatic symptoms should not be overlooked when researching depression in pregnancy and postpartum and the importance of the meaning the women attach to their symptoms. Somatic changes during pregnancy and after childbirth are not necessarily indicative of depression. However, although these symptoms may be related to the normal physiological changes that pregnancy and the postnatal period entail, it is important to monitor them when assessing depression, as they appear to be related to other symptoms of depression in a similar way to the non-perinatal period.
Recommended citation
Pátková Daňsová, P., Chvojka, E., Cígler, H., & Lacinová, L. (2024). Mild differences in the role of somatic symptoms in depression networks in pregnancy and postpartum: A comparison with women outside peripartum. Journal of Psychiatric Research, 174, 165-171. https://doi.org/10.1016/j.jpsychires.2024.04.014
