Individual and dyadic network analyses of depressive symptoms in Chinese postpartum couples: A cross-sectional study

Abstract

Background: The network approach to psychopathology is symptom oriented and may open new possibilities for intervention development and health care practices in postpartum depression.

Objective: To investigate the individual and dyadic symptom network of postpartum depression in Chinese mothers and fathers in the very early postpartum period.

Design: A cross-sectional study was conducted.

Settings and participants: A total of 457 couples in the 2∼3 days postpartum period was recruited consecutively from a hospital in Guangzhou, China from September 2020 to April 2021.

Methods: The Edinburgh Postnatal Depression Scale and socio-demographic and obstetric data sheet were used to collect data. We estimated the individual symptom networks of postpartum mothers and fathers separately and a dyadic symptom network that consisted of symptoms of both spouses. Network characteristics including global strength and node centralities were analyzed and systematically compared.

Results: Strength centralities in the individual networks showed acceptable stability [Correlation stability coefficient (CS) for mothers = 0.60; CS for fathers = 0.52]. The central depressive symptoms in mothers were Crying (Z_strength = 1.32), Overwhelmed (Z_strength = 1.01) and Sad mood (Z_strength = 0.93). The central depressive symptom in fathers was Sad Mood (Z_strength = 1.35). The symptom "Crying" had a distinctive link to thoughts of self-harm in fathers. The symptom network of mothers (global strength = 4.15) was more interconnected than that of fathers (global strength = 3.74). There was a statistically significant but unstable within-couple connection of thoughts of self-harm (CS = 0.21).

Conclusions: Postpartum mothers are more vulnerable to activation spreads of depressive symptoms than postpartum fathers. Symptoms including "Sad mood", "Overwhelmed" and "Crying" warrant the attention of health care providers. Investigations with larger sample sizes and gender-sensitive instruments are needed to further unfold the individual and dyadic symptom dynamics of postpartum depression.

Keywords: Dyadic study; Maternal depression; Paternal depression; Postpartum depression; Symptom network.