Using the RDoC Framework to Investigate Potential Threat in Perinatal Affective Disorders

The perinatal period is a time of increased vulnerability to affective disorders in women, a risk in part associated with hormonal fluctuations. To account for heterogeneity among perinatal affective disorders (PNAD), the NIMH’s RDoC framework can be used to identify the relationships between specific domains of functioning and the subsequent development of PNAD. The present study examined how self-report measures of potential threat predict depressive and anxiety symptoms in a sample of 134 perinatal women. Participants completed the Behavioral Inhibition System (BIS), Intolerance of Uncertainty Scale (IUS), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7) at 267 visits across the perinatal period. Mixed effects models assessed the relationships of between- and within-person variation in self-reported potential threat (BIS, IUS) and symptoms of depression (PHQ-9) and anxiety (GAD-7). Measures of potential threat were strongly associated with both depression and anxiety symptoms across the perinatal period. Higher BIS (b=5.59, p<.001) and IUS (b=7.62, p<.001) scores between-persons were associated with higher depressive symptoms reported on the PHQ-9. Higher BIS scores within-persons were associated with higher depressive symptoms as well (b=2.84, p<.001). Higher BIS (b=6.66, p<.001) and IUS (b=9.55, p<.001) scores between-persons were also associated with higher anxiety symptoms reported on the GAD-7, and similarly higher BIS scores within-person were also associated with higher anxiety (b=2.51, p<.001). These findings suggest that potential threat is a significant and transdiagnostic feature of perinatal affective disorders, and elucidates potentially important “trait” versus “state”-like effects of behavioral inhibition and intolerance of uncertainty. Future research should expand investigation into biomarkers and treatment related to this construct.