Identification of Core Antenatal Depressive Symptoms: A Network Analysis

BACKGROUND: The limited identification of core symptoms of antenatal depression is currently impeding the development of targeted interventions, with scant research utilizing network analysis to identify these core symptoms. OBJECTIVE: We aimed to construct a network of depressive symptoms using data from a sample of pregnant women in the United States, identifying the core symptoms using centrality indices within the network. METHODS: We conducted a secondary analysis of data from the National Health and Nutrition Examination Survey (2003-2020). Depressive symptoms were measured with the Patient Health Questionnaire-9. Pregnancy status was evaluated via self-report, urine, and serum testing. Centrality analysis was then used to examine the centralities in depressive symptoms and their relationships with each other. A case-dropping bootstrap procedure and a bootstrapped difference test were used to assess the accuracy and stability of the network. RESULTS: = 12) had the largest values in terms of strength, closeness, and betweenness. Sad mood-guilt had the highest edge weight. Although fatigue was the most severe depressive symptom among pregnant women, the centrality of fatigue was lower than the other depressive symptoms. CONCLUSIONS: Sadness, guilt, and anhedonia can be identified as core antenatal depressive symptoms. Targeting these core symptoms could improve the precision and effectiveness of interventions aimed at pregnant women with depression.