Emotion regulation is robustly associated with depressive symptoms across the peripartum – data from a prospective Swedish national cohort study
Authors: Weinmar Franziska , Fransson Emma , Derntl Birgit , Skalkidou Alkistis 
Published: November 2024

AbstractImportancePeripartum depression (PeriPD) is a prevalent condition with serious, long-term consequences for mother and child. Emotion regulation (ER) is increasingly recognized as key factor for maternal mental health and parenting. However, evidence remains limited regarding the relation of ER difficulties and depressive symptoms across the peripartum.ObjectiveTo determine whether self-reported ER difficulties in the antepartum are associated with depressive symptoms at multiple peripartum timepoints.Secondary: Whether PeriPD trajectories differ on antepartum ER difficulties.Design, Setting and ParticipantsData for this study were collected from January 2022 to April 2024 through the Mom2B cohort, a population-based, prospective Swedish national study using a smartphone app for data collection. The cohort includes Swedish-speaking, pregnant women over 18 years, residing in Sweden, who downloaded the Mom2B app. Eligibility for this sub-study required verification of pregnancy and delivery, along with complete background information (N = 1414). Participants were included if they completed the Difficulties in Emotion Regulation Scale-16 (DERS-16) during the second trimester (N = 623).ExposureDERS-16 total score at 16-25 weeks antepartum.Outcomes and MeasuresDepressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) at seven timepoints: 24-34, 36-42 weeks antepartum, and 1-4, 6-13, 14-23, 24-35, 36-42 weeks postpartum. Multiple linear regression models examined DERS-16 scores as exposure, with EPDS scores as outcomes, adjusting for potential confounders.Secondary: Comparison of DERS-16 scores between PeriPD trajectories using ANOVA.Results623 pregnant women, aged 19-44, were included. DERS-16 scores were strongly associated with EPDS scores up to 14-23 weeks postpartum, even after adjusting for potential confounders (all regression coefficients = .06 - .23, all 95% CIs = .00 - .26, allp-values < .05).Secondary: 134 participants were classified into a specific PeriPD trajectory. DERS-16 scores differed between trajectories (F(4,129) = 26.68,p< .001, ηp2= .45), with higher ER difficulties in early and late postpartum-onset trajectories compared to the healthy group (p= .017 andp= .018, respectively).Conclusion and RelevanceER difficulties in the second trimester present a robust vulnerability marker for PeriPD symptoms, particularly for progression to postpartum depression. The DERS-16 may aid in early detection of peripartum mental health risks, while enhancing ER offers a promising intervention approach. Further research is needed to evaluate DERS-16’s clinical utility and optimize ER-centered interventions for at-risk trajectories.KeypointsQuestion. Are self-reported difficulties in emotion regulation (ER) in the second trimester of pregnancy associated with depressive symptoms at multiple peripartum timepoints?Findings. In this population-based prospective Swedish national cohort study, difficulties in ER assessed in the second trimester were significantly associated with higher depressive symptoms during pregnancy and up to six months postpartum, even after adjusting for potential confounders.Meaning. The study’s findings suggest that ER difficulties during pregnancy present a robust vulnerability marker for depressive symptoms across the peripartum, especially postpartum, and may provide an opportunity for early detection and intervention approaches of peripartum depression.