Evaluating a Hierarchical Structural Model of Psychopathology Symptoms Across Pregnancy and the Postpartum Period

Pregnancy and postpartum are times of increased risk for a variety of mental health problems. Historically, these symptoms have been conceptualized via ostensibly distinct, consensus-based diagnostic categories. However, applying an empirically-based, dimensional approach to psychiatric classification may significantly advance understanding of common and specific risk factors during this highly dynamic period. In the present study, we used exploratory psychometric methods to examine the structure of psychopathology symptoms from the “bottom-up” or using symptom-level co-occurrence to derive common factors in a sample of individuals (N = 347) across earlier pregnancy (M = 17.4 weeks gestation), later pregnancy (M = 34.6 weeks gestation), and postpartum (M = 25.3 weeks postpartum). We examined changes (or invariance) in symptom structure longitudinally and between distressed (N = 252) and euthymic (N = 96) pregnant individuals. Results demonstrated a hierarchical structure of symptoms including a robust Broad Distress factor at the highest level, followed by replicable Internalizing and Externalizing factors, all the way down to a nine-factor solution including Low Mood-Anhedonia, Pregnancy Anxiety, Fear-Worry-Tension, Social Anxiety-Dependence, Traumatic Stress, Somatic Problems, Detachment, Anger-Antagonism, and Inattention-Hyperactivity factors. Psychopathology structure was remarkably invariant from earlier to later pregnancy, but structure changed slightly into postpartum. Symptom structure also showed slight differences between distressed and euthymic individuals, indicating that while some factors (e.g., trauma and somatic symptoms) differ across time or clinical population, perinatal symptom factors are largely robust. Similarities and differences between the perinatal psychopathology structure recovered here and general population structure have important implications for empirically-based psychopathology classification.