Journal of affective disorders · 2026
Cyclothymic temperament and obstetric severity as independent correlates of antenatal depressive symptoms in high-risk pregnancy: A prospective cohort study.
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Jung Young Mi, Kim Hyeon Ji, Won Seunghyun, Myung Woojae, Park Jee Yoon
Аннотация
BACKGROUND: Antenatal depression affects 12.5%-44.2% of women with high-risk pregnancies, yet risk stratification relies predominantly on obstetric factors. We examined whether cyclothymic temperament is independently linked to antenatal depression beyond obstetric severity.
METHODS: This prospective cohort enrolled 161 women with high-risk pregnancies at a tertiary center (April 2020-May 2021). The primary outcome was antenatal depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] ≥10). Primary predictors were maternal-fetal intensive care unit (MFICU) admission and the cyclothymic subscale of the Korean-validated short Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). A pre-specified two-variable Firth's penalized logistic regression with bootstrap optimism correction was used; incremental value was assessed by the corrected area under the ROC curve (AUROC), calibration, and decision curve analysis.
RESULTS: Antenatal depression occurred in 52 of 161 participants (32.3%). Both MFICU admission (adjusted odds ratio [aOR], 3.27; 95% CI, 1.45-7.37) and cyclothymic score (aOR, 1.63 per unit; 95% CI, 1.37-1.95) were independently associated with antenatal depression. An exploratory cyclothymic threshold ≥4 yielded a negative predictive value of 87.5%; adding the cyclothymic score to the obstetric-only model improved the corrected AUROC from 0.629 to 0.821, with good calibration and higher net benefit. Symptoms persisted into the early postpartum period in 77.5% of affected women.
CONCLUSIONS: Cyclothymic temperament and MFICU admission were independently associated with antenatal depression in high-risk pregnancies. Because both were assessed concurrently the association is cross-sectional; pending validation, brief TEMPS-A cyclothymic assessment may help identify psychologically vulnerable women.
METHODS: This prospective cohort enrolled 161 women with high-risk pregnancies at a tertiary center (April 2020-May 2021). The primary outcome was antenatal depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] ≥10). Primary predictors were maternal-fetal intensive care unit (MFICU) admission and the cyclothymic subscale of the Korean-validated short Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). A pre-specified two-variable Firth's penalized logistic regression with bootstrap optimism correction was used; incremental value was assessed by the corrected area under the ROC curve (AUROC), calibration, and decision curve analysis.
RESULTS: Antenatal depression occurred in 52 of 161 participants (32.3%). Both MFICU admission (adjusted odds ratio [aOR], 3.27; 95% CI, 1.45-7.37) and cyclothymic score (aOR, 1.63 per unit; 95% CI, 1.37-1.95) were independently associated with antenatal depression. An exploratory cyclothymic threshold ≥4 yielded a negative predictive value of 87.5%; adding the cyclothymic score to the obstetric-only model improved the corrected AUROC from 0.629 to 0.821, with good calibration and higher net benefit. Symptoms persisted into the early postpartum period in 77.5% of affected women.
CONCLUSIONS: Cyclothymic temperament and MFICU admission were independently associated with antenatal depression in high-risk pregnancies. Because both were assessed concurrently the association is cross-sectional; pending validation, brief TEMPS-A cyclothymic assessment may help identify psychologically vulnerable women.