Network Structure of Perinatal Depressive Symptoms Among Women in Rural Bihar

Background: Perinatal depression (PND) is a common mental disorder affecting women worldwide. Despite receiving considerable attention as a unitary construct, PND’s inter-symptom interactions have received limited attention. The present study examined the network structure of perinatal depressive symptoms, their relative importance, and interconnectedness among women experiencing PND from rural Bihar. Methods: A community-based cross-sectional study screened women for PND using the Edinburgh Postnatal Depression Scale (EPDS) through door-to-door surveys by trained workers. Women scoring above the cutoff were recruited. Using R 4.0.3 and the qgraph package, the network structure was estimated to visualize symptom relationships. Centrality indices highlighted the connectivity of each symptom within the network. Accuracy and stability analyses assessed the robustness of the results. Results: Data from 132 participants with elevated depressive symptom scores on the EPDS were analyzed. The most central item was “I have been so unhappy that I have been crying”. The strongest association was between “laughing/seeing the funny side of things” and “looking forward with interest and pleasure.” Results suggest that mood and interest/pleasure symptoms, such as crying, anticipating enjoyable activities, and feeling sad showed relatively higher strength centrality in this exploratory analysis. Conclusion: The present study advances efforts to uncover symptom–symptom interactions within PND networks in India, particularly in rural Bihar. Future research to establish the clinical and prognostic utility of these symptoms can pave the way for evidence-based interventions in rural Indian settings.