Subtypes and associated factors of prenatal depressive symptoms and their association with health-related quality of life among pregnant women: a cross-sectional study

BACKGROUND: Pregnant women with prenatal depression could have distinctly heterogeneous constellations of symptoms. Classifying prenatal depressive symptoms into different subtypes using a person-centered approach and investigating their associated factors are beneficial for personalized assessment and management of the disorder. However, relevant evidence is still lacking. METHODS: A cross-sectional study was conducted in the obstetrics outpatient clinics of two university-affiliated, governmental, tertiary hospitals in Xi'an City, Northwestern China. A total of 1020 pregnant women were included in the study and administered with a researcher-designed sociodemographic, health-related and pregnancy-related information sheet, the 8-item Patient Health Questionnaire, the five-level EuroQol five-dimension questionnaire, the Generalized Anxiety Disorder-7 and the Pregnancy Stress Rating Scale. Latent profile analysis was used to classify prenatal depressive symptoms into different subtypes, while a multivariate binomial logistic regression model was employed to identify the associated factors of the different subtypes. Health-related quality of life, prenatal anxiety and stress were compared across subtypes of prenatal depressive symptoms. RESULTS: Prenatal depressive symptoms were classified into three subtypes, including 'minimal-to-mild symptoms' (58.6%), 'mild-to-moderate psychosomatic symptoms' (17.1%) and 'mild-to-moderate melancholic symptoms' (24.3%). Multiple sociodemographic, health-related and pregnancy-related factors were associated with the subtypes of prenatal depressive symptoms. Moreover, health-related quality of life, prenatal anxiety and stress differed significantly across subtypes of prenatal depressive symptoms. CONCLUSIONS: Pregnant women with depressive symptoms could be classified into distinct subgroups characterized by heterogeneous clinical manifestations. With further validation, investigating the relevant associated factors may become a useful addition to routine prenatal healthcare, facilitating the identification of women at risk of different subtypes and the implementation of early individualized management.