Determinants of vulnerability and onset of depression during pregnancy: Evidence from the PRESeNT cohort

Background Antenatal depression is a major public health concern, yet the factors distinguishing clinically manifest symptoms from underlying vulnerability remain poorly understood. This study examined a range of dimensions to identify determinants of antenatal depression and subclinical risk. Methods Two hundred thirty-one pregnant women participating in the PRESeNT cohort study have been stratified as controls (n=71), at risk of depression during pregnancy (n=107), or with antenatal depressive symptoms (n=53). Assessments included psychological measures (depressive symptoms, general and pregnancy-related anxiety, stress exposure and perception, and childhood trauma), along with sociodemographic, relational, health-related, lifestyle, and obstetric variables. Group differences were tested using Kruskal–Wallis and Fisher–Freeman–Halton tests, and correlations among psychological variables were examined using Spearman’s rank test. Elastic net penalized logistic regression with cross-validation was applied to identify predictors distinguishing depressed from at-risk women. Results At-risk and depressed women reported higher levels of depressive symptoms, anxiety, perceived stress, and childhood trauma when compared to controls. Depressed women were more likely to be single, report poorer self-rated health, endorse pre-pregnancy substance use, and have a history of spontaneous miscarriage. In elastic net models distinguishing depressed from at-risk women, higher trait anxiety (OR=1.11, p =0.024) and perceived stress (OR=1.15, p =0.025) independently predicted depressed status. Conclusions Antenatal depression appears to be embedded within broader psychological vulnerability during pregnancy. While several relational, obstetric, lifestyle, and trauma-related characteristics were associated with group differences, psychological factors showed the strongest contribution. These findings support the implementation of integrated psychosocial screening during pregnancy to enable earlier identification and preventive care.